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Sample records for identify barriers limiting

  1. A qualitative case study to identify possible barriers that limit effective elementary science education

    Science.gov (United States)

    Foster, Donald Carey

    The purpose of this case study was to identify barriers that limit the effectiveness of elementary teachers in the teaching of science. It is of the utmost urgency that barriers be first identified, so that possible solutions can be explored to bring about the improvement of elementary science education. This urgency has been imposed by the scheduled national testing of students in science by 2007, as mandated by the No Child Left Behind Act of 2001. Using qualitative case study methods, the researcher conducted interviews with 8 elementary teachers from two schools within one school district who taught 3rd, 4th, and 5th grade. These interviews were designed to gain insight into barriers these elementary teachers perceived as factors limiting their effectiveness in teaching science and preparing students for high-stakes testing. Barriers in the areas of teacher background, typical teaching day, curriculum, inservices, and legislative influences were explored. This study concluded that the barriers explored do have a substantial negative affect on the teaching and learning of science in the elementary grades. Specifically, the barriers revealed in this study include the limited science background of elementary teachers, inadequate class time devoted to science, non-comprehensive curriculum, ineffective or lack of inservice training, and pressures from legislated mandates. But it is also clear that these barriers are so intertwined that one cannot remove these barriers one at a time. It will take a collective effort from all involved, including legislators, administrators, teachers, parents, and students, to alleviate these barriers and discover effective solutions to improve elementary science education.

  2. Identifying Barriers, Perceptions and Motivations Related to Healthy Eating and Physical Activity among 6th to 8th Grade, Rural, Limited-Resource Adolescents

    Science.gov (United States)

    Kumar, Janavi; Adhikari, Koushik; Li, Yijing; Lindshield, Erika; Muturi, Nancy; Kidd, Tandalayo

    2016-01-01

    Purpose: The purpose of this paper is to enable community members to discuss their perceptions of eating habits and physical activity in relation to sixth, seventh, and eighth graders, and reveal facilitators and barriers to healthy eating behavior and physical activity engagement. Design/methodology/approach: Nine focus groups, which included six…

  3. Identifying and overcoming barriers to technology implementation

    International Nuclear Information System (INIS)

    Bailey, M.; Warren, S.; McCune, M.

    1996-01-01

    In a recent General Accounting Office report, the Department of Energy's (DOE) Office of Environmental Management was found to be ineffective in integrating their environmental technology development efforts with the cleanup actions. As a result of these findings, a study of remediation documents was performed by the Technology Applications Team within DOE's Office of Environmental Restoration (EM-40) to validate this finding and to understand why it was occurring. A second initiative built on the foundation of the remediation document study and evaluated solutions to the ineffective implementation of improved technologies. The Technology Applications Team examined over 50 remediation documents (17 projects) which included nearly 600 proposed remediation technologies. It was determined that very few technologies are reaching the Records of Decision documents. In fact, most are eliminated in the early stages of consideration. These observations stem from regulators' and stakeholders' uncertainties in cost and performance of the technology and the inability of the technology to meet site specific conditions. The Technology Applications Team also set out to identify and evaluate solutions to barriers to implementing innovative technology into the DOE's environmental management activities. Through the combined efforts of DOE and the Hazardous Waste Action Coalition (HWAC), a full day workshop was conducted at the annual HWAC meeting in June 1995 to solve barriers to innovative technology implementation. Three barriers were identified as widespread throughout the DOE complex and industry. Identified barriers included a lack of verified or certified cost and performance data for innovative technologies; risk of failure to reach cleanup goals using innovative technologies; and communication barriers that are present at virtually every stage of the characterization/remediation process from development through implementation

  4. Identifying barriers to emergency care services.

    Science.gov (United States)

    Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

    2012-01-01

    This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

  5. Identifying Food Safety Concerns when Communication Barriers Exist

    Science.gov (United States)

    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…

  6. Identifying barriers in the diffusion of renewable energy sources

    International Nuclear Information System (INIS)

    Eleftheriadis, Iordanis M.; Anagnostopoulou, Evgenia G.

    2015-01-01

    Rapid diffusion of renewable energy sources (RES) in the electricity power sector is crucial if the EU wants to fulfill its 2050 CO 2 reduction commitments. For this reason, identifying and alleviating all barriers that hinder the development of RES is necessary to the successful deployment of these technologies. This paper discusses the main barriers in the diffusion of wind and photovoltaic (PV) solar power in the Greek electricity sector by drawing on the literature of technological innovation systems and system functions. Furthermore, we provide an explanation of the different diffusion rates between the two technologies. Inadequate financial resources, low grid capacity, delays in the issuance of building permits, opposition from local communities to the construction of wind farms and the lack of a stable institutional framework are among the most important barriers that inhibit the diffusion of the wind and PV solar power. The nature of the barriers identified in this study calls for policy intervention. - Highlights: • Firms in the Greek wind and solar power sectors assess RES barriers. • Lack of financial resources is the most important RES barrier. • Lack of a stable institutional framework negatively affects RES deployment. • The support of the public sector is crucial to the diffusion of RES. •Wind power faces strong legitimization barriers

  7. Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

    Science.gov (United States)

    Rowe, Laura A; Vossenaar, Marieke; Garrett, Greg S

    2015-01-01

    While fortification of staple foods and condiments has gained enormous global traction, poor performance persists throughout many aspects of implementation, most notably around the critical element of regulatory monitoring, which is essential for ensuring foods meet national fortification standards. Where coverage of fortified foods is high, limited nutritional impact of fortification programs largely exists due to regulatory monitoring that insufficiently identifies and holds producers accountable for underfortified products. Based on quality assurance data from 20 national fortification programs in 12 countries, we estimate that less than half of the samples are adequately fortified against relevant national standards. In this paper, we outline key findings from a literature review, key informant interviews with 11 fortification experts, and semi-quantitative surveys with 39 individuals from regulatory agencies and the food fortification industry in 17 countries on the perceived effectiveness of regulatory monitoring systems and barriers to compliance against national fortification standards. Findings highlight that regulatory agencies and industry disagree on the value that enforcement mechanisms have in ensuring compliance against standards. Perceived political risk of enforcement and poorly resourced inspectorate capacity appear to adversely reinforce each other within an environment of unclear legislation to create a major hurdle for improving overall compliance of fortification programs against national standards. Budget constraints affect the ability of regulatory agencies to create a well-trained inspector cadre and improve the detection and enforcement of non-compliant and underfortified products. Recommendations to improve fortification compliance include improving technical capacity; ensuring sustained leadership, accountability, and funding in both the private and the public sectors; and removing political barriers to ensure consistent detection of

  8. Identifying and responding to barriers impacting women educators ...

    African Journals Online (AJOL)

    Drawing on these reflections, this article explores the notion of academic citizenship as it relates to the status and practice of these five educators who teach at various institutions of higher education in Southern Africa. The article is divided into two parts. a) Part 1 identifies the barriers impacting the participants. It draws on ...

  9. A survey to identify barriers of implementing an antibiotic checklist.

    Science.gov (United States)

    van Daalen, F V; Geerlings, S E; Prins, J M; Hulscher, M E J L

    2016-04-01

    A checklist is an effective implementation tool, but addressing barriers that might impact on the effectiveness of its use is crucial. In this paper, we explore barriers to the uptake of an antibiotic checklist that aims to improve antibiotic use in daily hospital care. We performed an online questionnaire survey among medical specialists and residents with various professional backgrounds from nine Dutch hospitals. The questionnaire consisted of 23 statements on anticipated barriers hindering the uptake of the checklist. Furthermore, it gave the possibility to add comments. We included 219 completed questionnaires (122 medical specialists and 97 residents) in our descriptive analysis. The top six anticipated barriers included: (1) lack of expectation of improvement of antibiotic use, (2) lack of expected patients' satisfaction by checklist use, (3) lack of feasibility of the checklist, (4) negative previous experiences with other checklists, (5) the complexity of the antibiotic checklist and (6) lack of nurses' expectation of checklist use. Remarkably, 553 comments were made, mostly (436) about the content of the checklist. These insights can be used to improve the specific content of the checklist and to develop an implementation strategy that addresses the identified barriers.

  10. Identifying barriers to aboriginal renewable energy deployment in Canada

    International Nuclear Information System (INIS)

    Krupa, Joel

    2012-01-01

    As one of the largest and wealthiest countries in the world, Canada stands well-positioned to take advantage of ongoing growth in North American demand for primary energy supply by expanding domestic delivery of renewable energy generation to internationally interconnected electric grids across the country. There are myriad benefits of adopting the renewable energy approach to development—as the province of Ontario has acknowledged through the implementation of their 2009 Green Energy Act—including drastic reductions in carbon emissions, the decommissioning of existing fossil fuel power generation that cause serious public health problems, and opportunities for sustainable development at the community level. One group in particular stands poised to shape these debates. In Canada, historically marginalized Aboriginal peoples remain one of the groups with the greatest potential for meeting these enormous renewable energy deployment needs. Aboriginal involvement in renewable energy generation in Canada has been as diverse as Canada's Aboriginal peoples and groups have already adopted a range of different solutions to meet energy supply needs. However, many significant barriers exist that prevent this diverse cultural group from reaching its full potential. The article identifies some of these shortcomings and analyzes their roots. - Highlights: ► Renewable energy is one of the most important sustainable development opportunities today. ► Aboriginal-led renewable development could dramatically increase Canadian supply. ► Surmountable barriers are identified.

  11. Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education.

    Science.gov (United States)

    Albert, David A; Bruzelius, Emilie; Ward, Angela; Gordon, Judith S

    2016-04-01

    The aims of this mixed-methods study were to assess tobacco treatment behaviors among residents and faculty in dental specialty postdoctoral programs and to explore factors in training and practice related to tobacco treatment education. Surveys and focus groups were conducted with a convenience sample of participants at three postdoctoral residency programs in New York City. Surveys assessed tobacco cessation training and behaviors. Focus groups explored barriers to implementing tobacco cessation treatment in educational settings. Data were collected between May and December 2013. Among the 160 faculty and residents identified as potentially eligible for the study, 60 were invited by program directors to participate, and 50 subsequently completed the survey and participated in a focus group (response rate of 31.3%). Survey results indicated high levels of asking patients about tobacco use and advising patients to quit. In contrast, specific tobacco cessation assistance and follow-up care occurred less frequently. There were statistically significant differences in tobacco cessation intervention across the specialties surveyed, but not between residents and faculty. Focus group comments were grouped into three broad areas: clinician factors, organizational support, and structural and contextual factors. Focus group results indicated that participants experienced significant organizational and structural barriers to learning about and providing tobacco treatment. Participants from each specialty indicated that multi-level barriers impeded their provision of evidence-based tobacco cessation interventions in postdoctoral educational settings. They suggested that didactic education should be reinforced by organizational- and systems-level changes to facilitate comprehensive tobacco education and effective cessation treatment in future dental practice.

  12. A survey to identify barriers of implementing an antibiotic checklist

    NARCIS (Netherlands)

    van Daalen, F. V.; Geerlings, S. E.; Prins, J. M.; Hulscher, M. E. J. L.

    2016-01-01

    A checklist is an effective implementation tool, but addressing barriers that might impact on the effectiveness of its use is crucial. In this paper, we explore barriers to the uptake of an antibiotic checklist that aims to improve antibiotic use in daily hospital care. We performed an online

  13. Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach.

    Science.gov (United States)

    Ayakaka, Irene; Ackerman, Sara; Ggita, Joseph M; Kajubi, Phoebe; Dowdy, David; Haberer, Jessica E; Fair, Elizabeth; Hopewell, Philip; Handley, Margaret A; Cattamanchi, Adithya; Katamba, Achilles; Davis, J Lucian

    2017-03-09

    The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact

  14. Na+/K+-ATPase α1 identified as an abundant protein in the blood-labyrinth barrier that plays an essential role in the barrier integrity.

    Directory of Open Access Journals (Sweden)

    Yue Yang

    2011-01-01

    Full Text Available The endothelial-blood/tissue barrier is critical for maintaining tissue homeostasis. The ear harbors a unique endothelial-blood/tissue barrier which we term "blood-labyrinth-barrier". This barrier is critical for maintaining inner ear homeostasis. Disruption of the blood-labyrinth-barrier is closely associated with a number of hearing disorders. Many proteins of the blood-brain-barrier and blood-retinal-barrier have been identified, leading to significant advances in understanding their tissue specific functions. In contrast, capillaries in the ear are small in volume and anatomically complex. This presents a challenge for protein analysis studies, which has resulted in limited knowledge of the molecular and functional components of the blood-labyrinth-barrier. In this study, we developed a novel method for isolation of the stria vascularis capillary from CBA/CaJ mouse cochlea and provided the first database of protein components in the blood-labyrinth barrier as well as evidence that the interaction of Na(+/K(+-ATPase α1 (ATP1A1 with protein kinase C eta (PKCη and occludin is one of the mechanisms of loud sound-induced vascular permeability increase.Using a mass-spectrometry, shotgun-proteomics approach combined with a novel "sandwich-dissociation" method, more than 600 proteins from isolated stria vascularis capillaries were identified from adult CBA/CaJ mouse cochlea. The ion transporter ATP1A1 was the most abundant protein in the blood-labyrinth barrier. Pharmacological inhibition of ATP1A1 activity resulted in hyperphosphorylation of tight junction proteins such as occludin which increased the blood-labyrinth-barrier permeability. PKCη directly interacted with ATP1A1 and was an essential mediator of ATP1A1-initiated occludin phosphorylation. Moreover, this identified signaling pathway was involved in the breakdown of the blood-labyrinth-barrier resulting from loud sound trauma.The results presented here provide a novel method for

  15. Barrier inhomogeneities limited current and 1/f noise transport in GaN based nanoscale Schottky barrier diodes

    Science.gov (United States)

    Kumar, Ashutosh; Heilmann, M.; Latzel, Michael; Kapoor, Raman; Sharma, Intu; Göbelt, M.; Christiansen, Silke H.; Kumar, Vikram; Singh, Rajendra

    2016-01-01

    The electrical behaviour of Schottky barrier diodes realized on vertically standing individual GaN nanorods and array of nanorods is investigated. The Schottky diodes on individual nanorod show highest barrier height in comparison with large area diodes on nanorods array and epitaxial film which is in contrast with previously published work. The discrepancy between the electrical behaviour of nanoscale Schottky diodes and large area diodes is explained using cathodoluminescence measurements, surface potential analysis using Kelvin probe force microscopy and 1ow frequency noise measurements. The noise measurements on large area diodes on nanorods array and epitaxial film suggest the presence of barrier inhomogeneities at the metal/semiconductor interface which deviate the noise spectra from Lorentzian to 1/f type. These barrier inhomogeneities in large area diodes resulted in reduced barrier height whereas due to the limited role of barrier inhomogeneities in individual nanorod based Schottky diode, a higher barrier height is obtained. PMID:27282258

  16. Identifiability of location and magnitude of flow barriers in slightly compressible flow

    NARCIS (Netherlands)

    Kahrobaei, S.; Mansoori Habib Abadi, M.; Joosten, G.J.P.; Hof, Van den P.M.J.; Jansen, J.D.

    2015-01-01

    Classic identifiability analysis of flow barriers in incompressible single-phase flow reveals that it is not possible to identify the location and permeability of low-permeability barriers from production data (wellbore pressures and rates), and that only averaged reservoir properties in between

  17. Identifiability of location and magnitude of flow barriers in slightly compressible flow

    NARCIS (Netherlands)

    Kahrobaei, S.; Mansoori Habib Abadi, M.; Joosten, G.J.P.; Van den Hof, P.; Jansen, J.D.

    2016-01-01

    Classic identifiability analysis of flow barriers in incompressible single-phase flow reveals that it is not possible to identify the location and permeability of low-permeability barriers from production data (wellbore pressures and rates), and that only averaged reservoir properties in between

  18. Barriers and Limitations of Mentoring in Polish Organizations

    Directory of Open Access Journals (Sweden)

    Joanna Mesjasz

    2013-09-01

    Full Text Available In Polish organizations one can recognize a lot of barriers in the mentoring implementation. According to the author, at the root of these barriers are hierarchies of values: social, national, organizational, and hierarchies of values represented by individual employees. The purpose of this article is to trace the sources of constraints in the mentoring implementation process. The analysis is carried out on several levels: from the broadest social perspective, through the national to the perspective of the organization. In the article, there are also presented actions that should be taken by Polish organizations to overcome barriers and constraints in the mentoring implementation process.

  19. Interaction of tide and salinity barrier: Limitation of numerical model

    Directory of Open Access Journals (Sweden)

    Suphat Vongvisessomjai1

    2008-07-01

    Full Text Available Nowadays, the study of interaction of the tide and the salinity barrier in an estuarine area is usually accomplished vianumerical modeling, due to the speed and convenience of modern computers. However, numerical models provide littleinsight with respect to the fundamental physical mechanisms involved. In this study, it is found that all existing numericalmodels work satisfactorily when the barrier is located at some distance far from upstream and downstream boundary conditions.Results are considerably underestimate reality when the barrier is located near the downstream boundary, usually theriver mouth. Meanwhile, this analytical model provides satisfactory output for all scenarios. The main problem of thenumerical model is that the effects of barrier construction in creation of reflected tide are neglected when specifying thedownstream boundary conditions; the use of the boundary condition before construction of the barrier which are significantlydifferent from those after the barrier construction would result in an error outputs. Future numerical models shouldattempt to account for this deficiency; otherwise, using this analytical model is another choice.

  20. Structural and Psycho-Social Limits to Climate Change Adaptation in the Great Barrier Reef Region.

    Science.gov (United States)

    Evans, Louisa S; Hicks, Christina C; Adger, W Neil; Barnett, Jon; Perry, Allison L; Fidelman, Pedro; Tobin, Renae

    2016-01-01

    Adaptation, as a strategy to respond to climate change, has limits: there are conditions under which adaptation strategies fail to alleviate impacts from climate change. Research has primarily focused on identifying absolute bio-physical limits. This paper contributes empirical insight to an emerging literature on the social limits to adaptation. Such limits arise from the ways in which societies perceive, experience and respond to climate change. Using qualitative data from multi-stakeholder workshops and key-informant interviews with representatives of the fisheries and tourism sectors of the Great Barrier Reef region, we identify psycho-social and structural limits associated with key adaptation strategies, and examine how these are perceived as more or less absolute across levels of organisation. We find that actors experience social limits to adaptation when: i) the effort of pursuing a strategy exceeds the benefits of desired adaptation outcomes; ii) the particular strategy does not address the actual source of vulnerability, and; iii) the benefits derived from adaptation are undermined by external factors. We also find that social limits are not necessarily more absolute at higher levels of organisation: respondents perceived considerable opportunities to address some psycho-social limits at the national-international interface, while they considered some social limits at the local and regional levels to be effectively absolute.

  1. Structural and Psycho-Social Limits to Climate Change Adaptation in the Great Barrier Reef Region.

    Directory of Open Access Journals (Sweden)

    Louisa S Evans

    Full Text Available Adaptation, as a strategy to respond to climate change, has limits: there are conditions under which adaptation strategies fail to alleviate impacts from climate change. Research has primarily focused on identifying absolute bio-physical limits. This paper contributes empirical insight to an emerging literature on the social limits to adaptation. Such limits arise from the ways in which societies perceive, experience and respond to climate change. Using qualitative data from multi-stakeholder workshops and key-informant interviews with representatives of the fisheries and tourism sectors of the Great Barrier Reef region, we identify psycho-social and structural limits associated with key adaptation strategies, and examine how these are perceived as more or less absolute across levels of organisation. We find that actors experience social limits to adaptation when: i the effort of pursuing a strategy exceeds the benefits of desired adaptation outcomes; ii the particular strategy does not address the actual source of vulnerability, and; iii the benefits derived from adaptation are undermined by external factors. We also find that social limits are not necessarily more absolute at higher levels of organisation: respondents perceived considerable opportunities to address some psycho-social limits at the national-international interface, while they considered some social limits at the local and regional levels to be effectively absolute.

  2. Identifying barriers to chronic disease reporting in Chicago Public Schools: a mixed-methods approach.

    Science.gov (United States)

    Rivkina, Victoria; Tapke, David E; Cardenas, Lilliana D; Harvey-Gintoft, Blair; Whyte, Stephanie A; Gupta, Ruchi S

    2014-12-06

    Chronic disease among school-aged children is a public health concern, particularly for asthma and food allergy. In Chicago Public Schools (CPS), rates of asthma and food allergy among students are underreported. The aim of this study was to determine the barriers to chronic disease reporting as experienced by CPS parents and school nurses. A mixed-methods approach included focus groups and key informant interviews with parents and school nurses, and a cross-sectional survey was completed by parents. Qualitative data analysis was performed and survey data were analyzed to determine the significant demographic and knowledge variables associated with successfully completing the reporting process. The three main barriers identified were 1) a lack of parental process knowledge; 2) limited communication from schools; and 3) insufficient availability of school nurses. Parents were significantly more likely to successfully complete the reporting process if they knew about special accommodations for chronic diseases, understood the need for physician verification, and/or knew the school nurse. These findings suggest that increasing parental knowledge of the reporting process will allow schools to better identify and manage their students' chronic conditions. A parent-focused intervention informed by these results has been completed.

  3. Women with physical disability and the mammogram: An observational study to identify barriers and facilitators

    International Nuclear Information System (INIS)

    Poulos, Ann; Balandin, Susan; Llewellyn, Gwynnyth; McCarthy, Louella; Dark, Leigha

    2011-01-01

    Purpose: To identify barriers and facilitators experienced by women with physical disability having a mammogram. Method: Direct observation of the mammography procedure for women with a range of physical disability at screening facilities of BreastScreen NSW Australia. Results: A volunteer sample of 13 women with varying degrees of physical disability participated in the study. The outcomes suggested that many barriers for women with physical disability can be ameliorated by environmental adaptations and guidelines for both radiographers and women. Some women however cannot be screened successfully, or can be screened only with a level of trauma and/or pain which militates against their continuation within the screening program. This study has identified physical limitations which preclude a successful outcome, those which increase the discomfort/pain of the procedure and aspects of the procedure which can be improved to minimise the experience of discomfort/pain. Conclusion: From the outcomes of the study the development of a decision tool is indicated as a method of providing information for women with physical disability and their doctors as to the likelihood of a successful outcome to participation in mammography screening.

  4. Women with physical disability and the mammogram: An observational study to identify barriers and facilitators

    Energy Technology Data Exchange (ETDEWEB)

    Poulos, Ann, E-mail: ann.poulos@sydney.edu.a [University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Sciences, PO Box 170, Lidcombe, NSW 1825 (Australia); Balandin, Susan [University of Sydney, Faculty of Health Sciences, Discipline of Speech Pathology, PO Box 170, Lidcombe, NSW 1825 (Australia); Avdeling for helse- og sosialfag, Hogskolen i Molde, Postboks 2110, 6402 Molde (Norway); Llewellyn, Gwynnyth; McCarthy, Louella [University of Sydney, Faculty of Health Sciences, Discipline of Occupational Therapy, PO Box 170, Lidcombe, NSW 1825 (Australia); Dark, Leigha [University of Sydney, Faculty of Health Sciences, Discipline of Speech Pathology, PO Box 170, Lidcombe, NSW 1825 (Australia)

    2011-02-15

    Purpose: To identify barriers and facilitators experienced by women with physical disability having a mammogram. Method: Direct observation of the mammography procedure for women with a range of physical disability at screening facilities of BreastScreen NSW Australia. Results: A volunteer sample of 13 women with varying degrees of physical disability participated in the study. The outcomes suggested that many barriers for women with physical disability can be ameliorated by environmental adaptations and guidelines for both radiographers and women. Some women however cannot be screened successfully, or can be screened only with a level of trauma and/or pain which militates against their continuation within the screening program. This study has identified physical limitations which preclude a successful outcome, those which increase the discomfort/pain of the procedure and aspects of the procedure which can be improved to minimise the experience of discomfort/pain. Conclusion: From the outcomes of the study the development of a decision tool is indicated as a method of providing information for women with physical disability and their doctors as to the likelihood of a successful outcome to participation in mammography screening.

  5. Space charge effects and coherent stability limits in barrier buckets

    Directory of Open Access Journals (Sweden)

    Oliver Boine-Frankenheim

    2003-03-01

    Full Text Available A large-scale Vlasov simulation study of the microwave instability below transition energy in a beam confined between two barrier pulses is performed. Starting from a matched distribution function for the confined ion beam including the space charge impedance the stability threshold in the longitudinal impedance plane is obtained. A simple stability criterium is found to be in good agreement with the simulation results.

  6. Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

    Science.gov (United States)

    Jankowski, Irene M; Nadzam, Deborah Morris

    2011-06-01

    Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

  7. Identifying barriers to recovery from work related upper extremity disorders: use of a collaborative problem solving technique.

    Science.gov (United States)

    Shaw, William S; Feuerstein, Michael; Miller, Virginia I; Wood, Patricia M

    2003-08-01

    Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers' compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers' reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.

  8. Identifying barriers to the implementation of nutrition education in South Korea.

    Science.gov (United States)

    Lee, Jounghee; Hong, Youngsun

    2015-01-01

    To improve the nutritional status of children and adolescents, it is critical to identify the barriers to the implementation of nutrition education in schools. We carried out a cross-sectional study by analyzing data from 121 subjects (45 nutrition teachers and 76 school dietitians). Among the personal, environmental and systematic barriers, the top four barriers to the implementation of nutrition education were heavy workload (4.28 points), lack of a systematic curriculum (4.12 points), lack of perception of nutrition education by school administrators and teachers (4.07 points), and lack of continuing education for nutrition teachers and school dietitians (4.05 points). Additionally, poor working conditions, such as low pay, were identified as significant barriers to nutrition education for school dietitians compared with nutrition teachers (4.33 vs 3.47 points, peducation in schools in South Korea.

  9. Securing the Future of Cultural Heritage by Identifying Barriers to and Strategizing Solutions for Preservation under Changing Climate Conditions

    Directory of Open Access Journals (Sweden)

    Sandra Fatorić

    2017-11-01

    Full Text Available Climate change challenges cultural heritage management and preservation. Understanding the barriers that can impede preservation is of paramount importance, as is developing solutions that facilitate the planning and management of vulnerable cultural resources. Using online survey research, we elicited the opinions of diverse experts across southeastern United States, a region with cultural resources that are particularly vulnerable to flooding and erosion from storms and sea level rise. We asked experts to identify the greatest challenges facing cultural heritage policy and practice from coastal climate change threats, and to identify strategies and information needs to overcome those challenges. Using content analysis, we identified institutional, technical and financial barriers and needs. Findings revealed that the most salient barriers included the lack of processes and preservation guidelines for planning and implementing climate adaptation actions, as well as inadequate funding and limited knowledge about the intersection of climate change and cultural heritage. Experts perceived that principal needs to overcome identified barriers included increased research on climate adaptation strategies and impacts to cultural heritage characteristics from adaptation, as well as collaboration among diverse multi-level actors. This study can be used to set cultural heritage policy and research agendas at local, state, regional and national scales.

  10. Identifying real and perceived barriers to therapeutic education programs for individuals with inflammatory arthritis.

    Science.gov (United States)

    Bain, Lorna; Sangrar, Ruheena; Bornstein, Carolyn; Lukmanji, Sara; Hapuhennedige, Sandani; Thorne, Carter; Beattie, Karen A

    2016-09-01

    Therapeutic Education Programs (TEPs) grounded in self-management principles have been shown to improve quality of life of patients with chronic conditions and reduce patient-related healthcare costs. Though these programs are becoming more readily available, patients often experience barriers in participating. This study sought to identify barriers faced by inflammatory arthritis (IA) patients in attending a TEP and understand how patients overcame perceived barriers. A mixed-method study design was used. Questionnaires were distributed to individuals with IA who were invited to attend a TEP between 2010 and 2013. Respondents were those that chose not to attend (group A), individuals who attended ≤4 of 10 sessions (group B), individuals who attended ≥5 of 10 sessions prior to May 2013 (group C), and individuals who attended ≥5 of 10 sessions from June 2013 to November 2013 (group D). Individuals in group D were also invited to participate in focus groups to discuss how they had overcome perceived barriers. Real barriers identified by individuals in groups A and B included time, distance, and cost associated with attendance. Individuals who overcame perceived barriers (groups C and D) discussed strategies they used to do so. Aspects of the overall program experience and access to clinic and program also contributed to patients being able to overcome barriers. Time, distance, and cost are external barriers that prevented individuals from utilizing self-management education opportunities. These barriers were overcome if and when individuals had resources available to them. Readiness for behavior change also influenced commitment to participate in the program.

  11. Identifying and prioritizing barriers to implementation of smart energy city projects in Europe: An empirical approach

    International Nuclear Information System (INIS)

    Mosannenzadeh, Farnaz; Di Nucci, Maria Rosaria; Vettorato, Daniele

    2017-01-01

    Successful implementation of smart energy city projects in Europe is crucial for a sustainable transition of urban energy systems and the improvement of quality of life for citizens. We aim to develop a systematic classification and analysis of the barriers hindering successful implementation of smart energy city projects. Through an empirical approach, we investigated 43 communities implementing smart and sustainable energy city projects under the Sixth and Seventh Framework Programmes of the European Union. Validated through literature review, we identified 35 barriers categorized in policy, administrative, legal, financial, market, environmental, technical, social, and information-and-awareness dimensions. We prioritized these barriers, using a novel multi-dimensional methodology that simultaneously analyses barriers based on frequency, level of impact, causal relationship among barriers, origin, and scale. The results indicate that the key barriers are lacking or fragmented political support on the long term at the policy level, and lack of good cooperation and acceptance among project partners, insufficient external financial support, lack of skilled and trained personnel, and fragmented ownership at the project level. The outcome of the research should aid policy-makers to better understand and prioritize implementation barriers to develop effective action and policy interventions towards more successful implementation of smart energy city projects. - Highlights: • A solid empirical study on the implementation of European smart energy city projects. • We found 35 barriers in nine dimensions; e.g. policy, legal, financial, and social. • We suggested a new multi-dimensional methodology to prioritize barriers. • Lacking or fragmented political support on the long term is a key barrier. • We provided insights for action for project coordinators and policy makers.

  12. Technical barriers, import licenses and tariffs as means of limiting market access

    DEFF Research Database (Denmark)

    Jørgensen, Jan G.; Schröder, Philipp

    2003-01-01

    Technical barriers (standards), import licenses and tariffs may be deployed as means of limiting the market entry of foreign firms. The present paper examines these measures in a setting of monopolistic competition. It is established that -- contrary to what one would expect -- a technical barrier...

  13. Local food in Iceland: identifying behavioral barriers to increased production and consumption

    Science.gov (United States)

    Ósk Halldórsdóttir, Þórhildur; Nicholas, Kimberly A.

    2016-11-01

    Increased production and consumption of local food may reduce the negative environmental, social, and economic impacts of industrialized and globalized food production. Here we examined potential barriers to increasing production and consumption of food produced in Iceland. First, we developed a new framework to address the behaviors of production and consumption simultaneously, to comprehensively analyze their potential barriers. We examined structural barriers by estimating the food production capacity of Iceland, and cultural and personal barriers through survey data on cultural norms and purchasing behavior from Matís, a research and development company. We found no structural barriers preventing Iceland from increasing production of local cereals, which would compliment current local production of meat and dairy and reduce reliance on imports, currently at 50% of the daily caloric intake. However, if food production became entirely local without changing the current mix of crops grown, there would be a 50% reduction in diversity (from 50 to 25 items in eight out of ten food categories). We did not identify any cultural barriers, as survey results demonstrated that consumers hold generally positive worldviews towards local food, with 88% satisfied with local food they had purchased. More than two-thirds of consumers regarded supporting the local farmer and considerations such as environmentally friendly production, fewer food miles, lower carbon footprint as important. However, they rated the local food they have access to as lower in meeting sustainability criteria, showing that they make justifications for not choosing local food in practice. This is a personal barrier to increased consumption of local food, and implies that marketing strategies and general knowledge connected to local food in Iceland might be improved. Although the results apply to the case of Iceland, the method of identifying behavioral barriers to change is applicable to other countries

  14. Barriers and limitations during implementation of the surgical safety checklist of the World Health Organization

    OpenAIRE

    Rosa Amalia Arboleda; Andrés Felipe Ausenón; Jairo Alberto Ayala; Diana Carolina Cabezas; Lina Gissella Calvache; Juan Pablo Caicedo; Jose Andres Calvache

    2014-01-01

    Introduction: The surgical safety checklist of the World Health Organization (WHO) is a tool that checks and evaluates each procedure in the operating room. Despite its demonstrated effectiveness, it has many limitations and barriers to its implementation. The aim of this article was to present the current evidence regarding limitations and barriers to achieve a successful implementation of the surgical safety WHO checklist. Methods: A narrative review was designed. We performed a systematic ...

  15. Moving Towards Sustainable Food Consumption : Identifying Barriers to Sustainable Student Diets

    OpenAIRE

    Ede, James; Graine, Sophia; Rhodes, Chris

    2011-01-01

    Adopting more sustainable consumption habits has been identified as a necessary step in the progression towards a sustainable society. In the area of sustainable consumption, personal food behaviour represents a strong leverage point. University students have been identified as a strategic audience; habits established during this transformative period can track forward into later life. This study seeks to identify the barriers inhibiting students from eating more sustainably. Perceived benefi...

  16. Technical Barriers, Licenses and Tariffs as Means of Limiting Market Access

    DEFF Research Database (Denmark)

    Schröder, Philipp J.H.; Jørgensen, Jan Guldager

    2006-01-01

    Technical barriers (standards), import licenses and tariffs may be deployed as means of limiting the market access of foreign firms. The present paper examines these measures in a setting of monopolistic competition. We find that, if protection focuses predominantly on the number of foreign firms...... accessing the domestic market, a technical barrier (an import license) may dominate a tariff (tariff and a tech- nical barrier) in terms of consumer welfare, even when tariff revenues are fully redistributed. However, if protection pays su±cient focus on limiting the total import volume, then tariffs...

  17. Building America Guidance for Identifying and Overcoming Code, Standard, and Rating Method Barriers

    Energy Technology Data Exchange (ETDEWEB)

    Cole, P. C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Halverson, M. A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2013-09-01

    This guidance document was prepared using the input from the meeting summarized in the draft CSI Roadmap to provide Building America research teams and partners with specific information and approaches to identifying and overcoming potential barriers to Building America innovations arising in and/or stemming from codes, standards, and rating methods.

  18. Identifying Barriers in Implementing Outcomes-Based Assessment Program Review: A Grounded Theory Analysis

    Science.gov (United States)

    Bresciani, Marilee J.

    2011-01-01

    The purpose of this grounded theory study was to identify the typical barriers encountered by faculty and administrators when implementing outcomes-based assessment program review. An analysis of interviews with faculty and administrators at nine institutions revealed a theory that faculty and administrators' promotion, tenure (if applicable),…

  19. Moderated mediation to identify the knowledge stocks, learning flows and barriers at a Dutch telecom operator

    NARCIS (Netherlands)

    de Schryver, Tom; Rosendaal, Bas

    2013-01-01

    Drawing on the 4I-model of Crossan et al. (1999), we have identified the knowledge stocks, learning flows and barriers at a Dutch telecom operator by means of moderated mediation. In this company, the strategic relevant knowledge stocks move in the same direction and many processes support their

  20. Identifying Facilitators and Barriers to Physical Activity for Adults with Down Syndrome

    Science.gov (United States)

    Mahy, J.; Shields, N.; Taylor, N. F.; Dodd, K. J.

    2010-01-01

    Background: Adults with Down syndrome are typically sedentary, and many do not participate in the recommended levels of physical activity per week. The aim of this study was to identify the facilitators and barriers to physical activity for this group. Method: Semi-structured interviews were conducted to elicit the views of adults with Down…

  1. Barriers to installing innovative energy systems in existing housing stock identified

    NARCIS (Netherlands)

    Hoppe, Thomas

    2013-01-01

    Several barriers to upgrading existing social housing with innovative energy systems (IES) have been identified by a study of eight large-scale renovation projects in the Netherlands. These include a lack of trust between stakeholders, opposition from tenants on grounds of increased costs or delays,

  2. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

    Science.gov (United States)

    Cotner, Bridget A; Ottomanelli, Lisa; O'Connor, Danielle R; Trainor, John K

    2018-06-01

    In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified. Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes. Some barriers to implementation occurred throughout the study, such as Veterans' lack of motivation and providers' difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team. Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

  3. Attempting to be active: Self-efficacy and barrier limitation differentiate activity levels of working mothers.

    Science.gov (United States)

    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.

  4. Quantifying family dissemination and identifying barriers to communication of risk information in Australian BRCA families.

    Science.gov (United States)

    Healey, Emma; Taylor, Natalie; Greening, Sian; Wakefield, Claire E; Warwick, Linda; Williams, Rachel; Tucker, Kathy

    2017-12-01

    PurposeRecommendations for BRCA1 and BRCA2 mutation carriers to disseminate information to at-risk relatives pose significant challenges. This study aimed to quantify family dissemination, to explain the differences between fully informed families (all relatives informed verbally or in writing) and partially informed families (at least one relative uninformed), and to identify dissemination barriers.MethodsBRCA1 and BRCA2 mutation carriers identified from four Australian hospitals (n=671) were invited to participate in the study. Distress was measured at consent using the Kessler psychological distress scale (K10). A structured telephone interview was used to assess the informed status of relatives, geographical location of relatives, and dissemination barriers. Family dissemination was quantified, and fully versus partially informed family differences were examined. Dissemination barriers were thematically coded and counted.ResultsA total of 165 families participated. Information had been disseminated to 81.1% of relatives. At least one relative had not been informed in 52.7% of families, 4.3% were first-degree relatives, 27.0% were second-degree relatives, and 62.0% were cousins. Partially informed families were significantly larger than fully informed families, had fewer relatives living in close proximity, and exhibited higher levels of distress. The most commonly recorded barrier to dissemination was loss of contact.ConclusionLarger, geographically diverse families have greater difficulty disseminating BRCA mutation risk information to all relatives. Understanding these challenges can inform future initiatives for communication, follow-up and support.

  5. Parent-identified barriers to pediatric health care: a process-oriented model.

    Science.gov (United States)

    Sobo, Elisa J; Seid, Michael; Reyes Gelhard, Leticia

    2006-02-01

    To further understand barriers to care as experienced by health care consumers, and to demonstrate the importance of conjoining qualitative and quantitative health services research. Transcripts from focus groups conducted in San Diego with English- and Spanish-speaking parents of children with special health care needs. Participants were asked about the barriers to care they had experienced or perceived, and their strategies for overcoming these barriers. Using elementary anthropological discourse analysis techniques, a process-based conceptual model of the parent experience was devised. The analysis revealed a parent-motivated model of barriers to care that enriched our understanding of quantitative findings regarding the population from which the focus group sample was drawn. Parent-identified barriers were grouped into the following six temporally and spatially sequenced categories: necessary skills and prerequisites for gaining access to the system; realizing access once it is gained; front office experiences; interactions with physicians; system arbitrariness and fragmentation; outcomes that affect future interaction with the system. Key to the successful navigation of the system was parents' functional biomedical acculturation; this construct likens the biomedical health services system to a cultural system within which all parents/patients must learn to function competently. Qualitative analysis of focus group data enabled a deeper understanding of barriers to care--one that went beyond the traditional association of marker variables with poor outcomes ("what") to reveal an understanding of the processes by which parents experience the health care system ("how,"why") and by which disparities may arise. Development of such process-oriented models furthers the provision of patient-centered care and the creation of interventions, programs, and curricula to enhance such care. Qualitative discourse analysis, for example using this project's widely applicable

  6. IEA Wind Task 32: Wind lidar identifying and mitigating barriers to the adoption of wind lidar

    DEFF Research Database (Denmark)

    Clifton, Andrew; Clive, Peter; Gottschall, Julia

    2018-01-01

    IEA Wind Task 32 exists to identify and mitigate barriers to the adoption of lidar for wind energy applications. It leverages ongoing international research and development activities in academia and industry to investigate site assessment, power performance testing, controls and loads, and complex...... flows. Since its initiation in 2011, Task 32 has been responsible for several recommended practices and expert reports that have contributed to the adoption of ground-based, nacelle-based, and floating lidar by the wind industry. Future challenges include the development of lidar uncertainty models......, best practices for data management, and developing community-based tools for data analysis, planning of lidar measurements and lidar configuration. This paper describes the barriers that Task 32 identified to the deployment of wind lidar in each of these application areas, and the steps that have been...

  7. Knowledge sharing in Chinese hospitals identifying sharing barriers in traditional Chinese and Western medicine collaboration

    CERN Document Server

    Zhou, Lihong

    2015-01-01

    This book aims to identify, understand and qualify barriers to the patient-centred knowledge sharing (KS) in interprofessional practice of Traditional Chinese Medicine (TCM) and Western Medicine (WM) healthcare professionals in Chinese hospitals.  This collaboration is particularly crucial and unique to China since, contrary to Western practice, these two types of professionals actually work together complimentary in the same hospital. This study adopted a Grounded Theory approach as the overarching methodology to guide the analysis of the data collected in a single case-study design.  A public hospital in central China was selected as the case-study site, at which 49 informants were interviewed by using semi-structured and evolving interview scripts.  The research findings point to five categories of KS barriers: contextual influences, hospital management, philosophical divergence, Chinese healthcare education and interprofessional training.  Further conceptualising the research findings, it is identifie...

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

    Science.gov (United States)

    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 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.

  9. IDENTIFYING AND ANALYZING THE TRANSIENT AND PERMANENT BARRIERS FOR BIG DATA

    Directory of Open Access Journals (Sweden)

    SARFRAZ NAWAZ BROHI

    2016-12-01

    Full Text Available Auspiciously, big data analytics had made it possible to generate value from immense amounts of raw data. Organizations are able to seek incredible insights which assist them in effective decision making and providing quality of service by establishing innovative strategies to recognize, examine and address the customers’ preferences. However, organizations are reluctant to adopt big data solutions due to several barriers such as data storage and transfer, scalability, data quality, data complexity, timeliness, security, privacy, trust, data ownership, and transparency. Despite the discussion on big data opportunities, in this paper, we present the findings of our in-depth review process that was focused on identifying as well as analyzing the transient and permanent barriers for adopting big data. Although, the transient barriers for big data can be eliminated in the near future with the advent of innovative technical contributions, however, it is challenging to eliminate the permanent barriers enduringly, though their impact could be recurrently reduced with the efficient and effective use of technology, standards, policies, and procedures.

  10. IEA Wind Task 32: Wind Lidar Identifying and Mitigating Barriers to the Adoption of Wind Lidar

    Directory of Open Access Journals (Sweden)

    Andrew Clifton

    2018-03-01

    Full Text Available IEA Wind Task 32 exists to identify and mitigate barriers to the adoption of lidar for wind energy applications. It leverages ongoing international research and development activities in academia and industry to investigate site assessment, power performance testing, controls and loads, and complex flows. Since its initiation in 2011, Task 32 has been responsible for several recommended practices and expert reports that have contributed to the adoption of ground-based, nacelle-based, and floating lidar by the wind industry. Future challenges include the development of lidar uncertainty models, best practices for data management, and developing community-based tools for data analysis, planning of lidar measurements and lidar configuration. This paper describes the barriers that Task 32 identified to the deployment of wind lidar in each of these application areas, and the steps that have been taken to confirm or mitigate the barriers. Task 32 will continue to be a meeting point for the international wind lidar community until at least 2020 and welcomes old and new participants.

  11. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

    DEFF Research Database (Denmark)

    Andersen, P.O.; Jensen, Michael Kammer; Lippert, A.

    2010-01-01

    Background: The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable...... for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. Methods: Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April...... 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews...

  12. Barriers and limitations during implementation of the surgical safety checklist of the World Health Organization

    Directory of Open Access Journals (Sweden)

    Rosa Amalia Arboleda

    2014-04-01

    Full Text Available Introduction: The surgical safety checklist of the World Health Organization (WHO is a tool that checks and evaluates each procedure in the operating room. Despite its demonstrated effectiveness, it has many limitations and barriers to its implementation. The aim of this article was to present the current evidence regarding limitations and barriers to achieve a successful implementation of the surgical safety WHO checklist. Methods: A narrative review was designed. We performed a systematic literature search in PubMed/MEDLINE. Articles that describe or present as primary or secondary endpoints barriers or limitations during the implementation of the checklist WHO were selected. Observational or experimental articles were included from the date of the official launch of the WHO list. To describe the data a summary table was designed. Detailed results were organized qualitatively extracting the most prevalent limitations. Results: 17 studies were included in the final review process. The main findings were: 1 a large number of constraints reported in the literature that hinder the implementation process, 2 limitations were grouped into 9 categories according to their similarities and 3 the most frequently reported category was “knowledge”. Discussion: There are several factors that limit the proper implementation of the surgical safety checklist WHO. Among these, cultural factors, knowledge, indifference and / or relevance, communication, filling completeness, among others. Effective implementation strategies would reach its successful implementation.

  13. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Matthew O. [Program in Applied and Computational Mathematics, Princeton University, New Jersey 08544 (United States); Rypina, Irina I. [Department of Physical Oceanography, Woods Hole Oceanographic Institute, Massachusetts 02543 (United States); Rowley, Clarence W. [Department of Mechanical and Aerospace Engineering, Princeton University, New Jersey 08544 (United States)

    2015-08-15

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  14. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    International Nuclear Information System (INIS)

    Williams, Matthew O.; Rypina, Irina I.; Rowley, Clarence W.

    2015-01-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea

  15. Identifying finite-time coherent sets from limited quantities of Lagrangian data.

    Science.gov (United States)

    Williams, Matthew O; Rypina, Irina I; Rowley, Clarence W

    2015-08-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that "leak" from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, "data rich" test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or "mesh-free" methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  16. CITY TRANSPORT IN BARRIER-FREE ARCHITECTURAL PLANNING SPACE FOR PEOPLE WITH LIMITED MOBILITY

    Directory of Open Access Journals (Sweden)

    Pryadko Igor’ Petrovich

    2014-09-01

    Full Text Available This paper reviews the current state of transport organization for people with limited mobility. The article evaluates the results of the actions the executive authorities of Moscow and Moscow Region take. Barrier-free space organization for disabled people and parents with prams is given a special attention. The lack of strategy in the sphere leads to considerable difficulties for people with limited ability. This problem should be solved in cooperation with the survey of other peoples' needs. The article gives examples of comfortable urban space in Sochi, Moscow, Chita, Mytishchi and analyses the ways urbanism influences people with limited abilities.

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

    Energy Technology Data Exchange (ETDEWEB)

    Necefer, Len Edward [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Univ. of Arizona, Tucson, AZ (United States); Jones, Thomas Elisha [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Carnegie Mellon Univ., Pittsburgh, PA (United States)

    2016-11-01

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

  18. Identifying facilitators and barriers for implementation of interprofessional education: Perspectives from medical educators in the Netherlands.

    Science.gov (United States)

    de Vries-Erich, Joy; Reuchlin, Kirsten; de Maaijer, Paul; van de Ridder, J M Monica

    2017-03-01

    Patient care and patient safety can be compromised by the lack of interprofessional collaboration and communication between healthcare providers. Interprofessional education (IPE) should therefore start during medical training and not be postponed until after graduation. This case study explored the current situation in the Dutch context and interviewed experts within medical education and with pioneers of successful best practices to learn more about their experiences with IPE. Data analysis started while new data were still collected, resulting in an iterative, constant comparative process. Using a strengths, weaknesses, opportunities, and threats (SWOT) analysis framework, we identified barriers and facilitators such as lack of a collective professional language, insufficient time or budget, stakeholders' resistance, and hierarchy. Opportunities and strengths identified were developing a collective vision, more attention for patient safety, and commitment of teachers. The facilitators and barriers relate to the organisational level of IPE and the educational content and practice. In particular, communication, cohesiveness, and support are influenced by these facilitators. An adequate identification of the SWOT elements in the current situation could prove beneficial for a successful implementation of IPE within the healthcare educational system.

  19. Identifying Communication Barriers to Colorectal Cancer Screening Adherence among Appalachian Kentuckians.

    Science.gov (United States)

    Bachman, Audrey Smith; Cohen, Elisia L; Collins, Tom; Hatcher, Jennifer; Crosby, Richard; Vanderpool, Robin C

    2017-08-18

    Utilizing data from 40 in-depth interviews, this article identifies both barriers and facilitators to colorectal screening guideline adherence among Appalachian Kentucky adults recruited through a community-based research network. Key findings identify (a) varying levels of knowledge about screening guidelines, (b) reticence to engage in screening processes, and (c) nuanced communication with healthcare providers and family members regarding screening adherence. What participants knew about the screening process was often derived from personal stories or recalled stories from family members about their screening experiences. Reticence to engage in screening processes reflected reports of cumbersome preparation, privacy issues, embarrassment, medical mistrust, fear of receiving a cancer diagnosis, and lack of symptoms. Participants cited many ways to enhance patient-centered communication, and the findings from this study have implications for health communication message design and communication strategies for healthcare practices in Appalachian Kentucky clinics.

  20. Building America Guidance for Identifying and Overcoming Code, Standard, and Rating Method Barriers

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Pamala C.; Halverson, Mark A.

    2013-09-01

    The U.S. Department of Energy’s (DOE) Building America program implemented a new Codes and Standards Innovation (CSI) Team in 2013. The Team’s mission is to assist Building America (BA) research teams and partners in identifying and resolving conflicts between Building America innovations and the various codes and standards that govern the construction of residences. A CSI Roadmap was completed in September, 2013. This guidance document was prepared using the information in the CSI Roadmap to provide BA research teams and partners with specific information and approaches to identifying and overcoming potential barriers to Building America (BA) innovations arising in and/or stemming from codes, standards, and rating methods. For more information on the BA CSI team, please email: CSITeam@pnnl.gov

  1. Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya

    Directory of Open Access Journals (Sweden)

    Beth Rachlis

    2016-08-01

    Full Text Available Abstract Background Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB and Hypertension (HTN as part of the Academic Model Providing Access to Healthcare (AMPATH program in western Kenya. Methods In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization. Results A total of 235 participants including 110 individuals living with HIV (n = 50, TB (n = 39, or HTN (n = 21; 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support. Conclusions Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that

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

    Science.gov (United States)

    Hamamura, Faith D; Hughes, Kira

    2017-01-01

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

  3. Bayesian inference for partially identified models exploring the limits of limited data

    CERN Document Server

    Gustafson, Paul

    2015-01-01

    Introduction Identification What Is against Us? What Is for Us? Some Simple Examples of Partially Identified ModelsThe Road Ahead The Structure of Inference in Partially Identified Models Bayesian Inference The Structure of Posterior Distributions in PIMs Computational Strategies Strength of Bayesian Updating, Revisited Posterior MomentsCredible Intervals Evaluating the Worth of Inference Partial Identification versus Model Misspecification The Siren Call of Identification Comp

  4. Identifying climate risk perceptions, information needs, and barriers to information exchange among public land managers.

    Science.gov (United States)

    Peters, Casey B; Schwartz, Mark W; Lubell, Mark N

    2018-03-01

    Meeting ecosystem management challenges posed by climate change requires building effective communication channels among researchers, planners and practitioners to focus research on management issues requiring new knowledge. We surveyed resource managers within two regions of the western United States regions to better understand perceived risks and vulnerabilities associated with climate change and barriers to obtaining and using relevant climate science information in making ecosystem management decisions. We sought to understand what types of climate science information resource managers find most valuable, and the formats in which they prefer to receive climate science information. We found broad concern among natural resource managers in federal agencies that climate change will make it more difficult for them to achieve their management goals. Primary barriers to incorporating climate science into planning are distributed among challenges identifying, receiving, and interpreting appropriate science and a lack of direction provided by agency leadership needed to meaningfully use this emerging science in resource planning. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Novel Active Learning Experiences for Students to Identify Barriers to Independent Living for People with Disabilities.

    Science.gov (United States)

    McArthur, Polly; Burch, Lillian; Moore, Katherine; Hodges, Mary Sue

    2016-07-01

    This article describes interactive learning about independent living for people with disabilities and features the partnership of the College of Nursing and a Center for Independent Living (CIL). Using qualitative descriptive approach, students' written reflections were analyzed. Through "Xtreme Challenge," 82 undergraduate nursing students participated in aspects of independent living as well as identifying barriers. Students were engaged and learned to consider the person before the disability. Moreover, students valued the activity leaders' openness, which facilitated understanding the point of view of a person with disability. The value of partnership was evident as it allowed students to participate in active learning, which led to growth in the affective domain. Students became aware of potential education resources through the CIL. This article will guide educators in designing experiences that teach nursing care at the individual, family, and community level for people living with disabilities. © 2015 Association of Rehabilitation Nurses.

  6. Use of participant focus groups to identify barriers and facilitators to worksite exercise therapy adherence in randomized controlled trials involving firefighters

    Directory of Open Access Journals (Sweden)

    Mayer JM

    2013-03-01

    Full Text Available John M Mayer,1 James L Nuzzo,1 Simon Dagenais2 1School of Physical Therapy and Rehabilitation Sciences, College of Medicine, University of South Florida, Tampa, FL, 2Palladian Health, West Seneca, NY, USA Background: Firefighters are at increased risk for back injuries, which may be mitigated through exercise therapy to increase trunk muscle endurance. However, long-term adherence to exercise therapy is generally poor, limiting its potential benefits. Focus groups can be used to identify key barriers and facilitators to exercise adherence among study participants. Objective: To explore barriers and facilitators to worksite exercise therapy adherence among firefighters to inform future randomized controlled trials (RCTs. Methods: Participants enrolled in a previous RCT requiring twice-weekly worksite exercise therapy for 24 weeks were asked to take part in moderated focus group discussions centered on eight open-ended questions related to exercise adherence. Responses were analyzed qualitatively using a social ecological framework to identify key intrapersonal, interpersonal, and institutional barriers and potential facilitators to exercise adherence. Results: A total of 27 participants were included in the four focus group discussions, representing 50% of those assigned to a worksite exercise therapy group in the previous RCT, in which only 67% of scheduled exercise therapy sessions were completed. Lack of self-motivation was cited as the key intrapersonal barrier to adherence, while lack of peer support was the key interpersonal barrier reported, and lack of time to exercise during work shifts was the key institutional barrier identified. Conclusion: Focus group discussions identified both key barriers and potential facilitators to increase worksite exercise therapy adherence among firefighters. Future studies should consider educating and reminding participants about the benefits of exercise, providing individual and group incentives based on

  7. The Future of Basic Science in Academic Surgery: Identifying Barriers to Success for Surgeon-scientists.

    Science.gov (United States)

    Keswani, Sundeep G; Moles, Chad M; Morowitz, Michael; Zeh, Herbert; Kuo, John S; Levine, Matthew H; Cheng, Lily S; Hackam, David J; Ahuja, Nita; Goldstein, Allan M

    2017-06-01

    The aim of this study was to examine the challenges confronting surgeons performing basic science research in today's academic surgery environment. Multiple studies have identified challenges confronting surgeon-scientists and impacting their ability to be successful. Although these threats have been known for decades, the downward trend in the number of successful surgeon-scientists continues. Clinical demands, funding challenges, and other factors play important roles, but a rigorous analysis of academic surgeons and their experiences regarding these issues has not previously been performed. An online survey was distributed to 2504 members of the Association for Academic Surgery and Society of University Surgeons to determine factors impacting success. Survey results were subjected to statistical analyses. We also reviewed publicly available data regarding funding from the National Institutes of Health (NIH). NIH data revealed a 27% decline in the proportion of NIH funding to surgical departments relative to total NIH funding from 2007 to 2014. A total of 1033 (41%) members responded to our survey, making this the largest survey of academic surgeons to date. Surgeons most often cited the following factors as major impediments to pursuing basic investigation: pressure to be clinically productive, excessive administrative responsibilities, difficulty obtaining extramural funding, and desire for work-life balance. Surprisingly, a majority (68%) did not believe surgeons can be successful basic scientists in today's environment, including departmental leadership. We have identified important barriers that confront academic surgeons pursuing basic research and a perception that success in basic science may no longer be achievable. These barriers need to be addressed to ensure the continued development of future surgeon-scientists.

  8. Internal transport barrier and β limit in ohmically heated plasma in TUMAN-3M

    International Nuclear Information System (INIS)

    Andreiko, M.V.; Askinazi, L.G.; Golant, V.E.

    2001-01-01

    An Internal Transport Barrier (ITB) was found in ohmically heated plasma in TUMAN-3M (R 0 =53 cm, a l =22 cm - circular limiter configuration, B t ≤0.7T, I p ≤175 kA, ≤6.0·10 19 m -3 ). The barrier reveals itself as a formation of a steep gradient on electron temperature and density radial profiles. The regions with reduced diffusion and electron thermal diffusivity are in between r=0.5a and r=0.7a. The ITB appears more frequently in the shots with higher plasma current. At lower currents (I p N limit in the ohmically heated plasma are presented. Stored energy was measured using diamagnetic loops and compared with W calculated from kinetic data obtained by Thomson scattering and microwave interferometry. Measurements of the stored energy and of the β were performed in the ohmic H-mode before and after boronization and in the scenario with the fast Current Ramp-Down in the ohmic H-mode. Maximum value of β T of 2.0 % and β N of 2 were achieved. The β N limit achieved is 'soft' (nondisruptive) limit. The stored energy slowly decays after the Current Ramp-Down. No correlation was found between beta restriction and MHD phenomena. (author)

  9. Internal transport barrier and β limit in ohmically heated plasma in TUMAN-3M

    International Nuclear Information System (INIS)

    Andreiko, M.V.; Askinazi, L.G.; Golant, V.E.

    1999-01-01

    An Internal Transport Barrier (ITB) was found in ohmically heated plasma in TUMAN-3M (R 0 = 53 cm, a l = 22 cm - circular limiter configuration, B t ≤ 0.7 T, I p ≤ 175 kA, ≤ 6.0·10 19 m -3 ). The barrier reveals itself as a formation of a steep gradient on electron temperature and density radial profiles. The regions with reduced diffusion and electron thermal diffusivity are in between r = 0.5a and r = 0.7a. The ITB appears more frequently in the shots with higher plasma current. At lower currents (I p N limit in the ohmically heated plasma are presented. Stored energy was measured using diamagnetic loops and compared with W calculated from kinetic data obtained by Thomson scattering and microwave interferometry. Measurements of the stored energy and of the β were performed in the ohmic H-mode before and after boronization and in the scenario with the fast Current Ramp-Down in the ohmic H-mode. Maximum value of β T of 2.0% and β N of 2 were achieved. The β N limit achieved is 'soft' (non-disruptive) limit. The stored energy slowly decays after the Current Ramp-Down. No correlation was found between beta restriction and MHD phenomena. (author)

  10. Identifying motivators and barriers to student completion of instructor evaluations: A multi-faceted, collaborative approach from four colleges of pharmacy.

    Science.gov (United States)

    McAuley, James W; Backo, Jennifer Lynn; Sobota, Kristen Finley; Metzger, Anne H; Ulbrich, Timothy

    To identify motivators and barriers to pharmacy student completion of instructor evaluations, and to develop potential strategies to improve the evaluation process. Completed at four Ohio Colleges of Pharmacy, Phase I consisted of a student/faculty survey and Phase II consisted of joint student/faculty focus groups to discuss Phase I data and to problem solve. In Phase I, the top three student-identified and faculty-perceived motivators to completion of evaluations were to (1) make the course better, (2) earn bonus points, and (3) improve the instructor's teaching. The top three student-identified barriers to completion of evaluations were having to (1) evaluate multiple instructors, (2) complete several evaluations around the same time, and (3) complete lengthy evaluations. Phase II focus groups identified a number of potential ways to enhance the motivators and reduce barriers, including but not limited to making sure faculty convey to students that the feedback they provide is useful and to provide examples of how student feedback has been used to improve their teaching/the course. Students and faculty identified motivators and barriers to completing instructor evaluations and were willing to work together to improve the process. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cosmetic dermatologic surgical training in US dermatology residency programs: identifying and overcoming barriers.

    Science.gov (United States)

    Bauer, Bruce; Williams, Erin; Stratman, Erik J

    2014-02-01

    The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety. To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures. An online survey in academic dermatology practices among PDs of US dermatology residency programs. Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models. Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic

  12. Barriers and strategies for identifying and managing risk factors of cardiovascular diseases in levels of preventing, screening, and treating

    Directory of Open Access Journals (Sweden)

    Saber Azami Aghdash

    2015-11-01

    Full Text Available Introduction: Cardiovascular diseases (CVD are of the main causes of mortality in the world and impose a heavy economic, social, and health burden on society. Therefore, the objective of this study was to determine the barriers and strategies for identifying and managing risk factors of CVD in levels of preventing, screening, and treating. Methods: During present qualitative study with phenomenological approach, 60 subjects of cardiologists, nurses, patients, and their relatives were selected based on purposive sampling from educational-medical cardiothoracic subspecialty centers. Data were collected using an open-ended questionnaire and was extracted and analyzed with content analysis method. Results: Barriers were divided into three groups of individual barriers (low awareness, delay in referring for treatment and screening, incorrect beliefs, and not caring about health, socio-economic barriers (high costs, lack of resources, mental and psychological pressures, and health care barriers (non-alignment of doctors, being therapy-oriented, managerial and planning weaknesses, and lack of health care facilities. The most important presenting strategies are: providing public educations, improving family physician program, reduction of costs, cooperation of patients, and using functional indices to evaluate and improve the quality of services. Conclusion: Low awareness of people, high costs of services, lack of health care facilities, socio-cultural problems of people, and delay in referring of people, for treatment and screening are of the most important barriers of proper identifying and managing risk factors of CVD. Strategies provided in this study to overcome these barriers could be used.

  13. Investigating rate-limiting barriers to nanoscale nonviral gene transfer with nanobiophotonics

    Science.gov (United States)

    Chen, Hunter H.

    Nucleic acids are a novel class of therapeutics poised to address many unmet clinical needs. Safe and efficient delivery remains a significant challenge that has delayed the realization of the full therapeutic potential of nucleic acids. Nanoscale nonviral vectors offer an attractive alternative to viral vectors as natural and synthetic polymers or polypeptides may be rationally designed to meet the unique demands of individual applications. A mechanistic understanding of cellular barriers is necessary to develop guidelines for designing custom gene carriers which are expected to greatly impact this delivery challenge. The work herein focused on the relationships among nanocomplex stability, intracellular trafficking and unpacking kinetics, and DNA degradation. Ultrasensitive nanosensors based on QD-FRET were developed to characterize the biophysical properties of nanocomplexes and study these rate-limiting steps. Quantitative image analysis enabled the distributions of the subpopulation of condensed or released DNA to be determined within the major cellular compartments encountered during gene transfer. The steady state stability and unpacking kinetics within these compartments were found to impact transgene expression, elucidating multiple design strategies to achieve efficient gene transfer. To address enzymatic barriers, a novel two-step QD-FRET nanosensor was developed to analyze unpacking and DNA degradation simultaneously, which has not been accomplished previously. Bioresponsive strategies such as disulfide crosslinking and thermosensitivity were evaluated by QD-FRET and quantitative compartmental analysis as case studies to determine appropriate design specifications for thiolated polymers and thermoresponsive polypeptides. Relevant nanobiophotonic tools were developed as a platform to study major rate-limiting barriers to nanomedicine and demonstrated the feasibility of using mechanistic information gained from these tools to guide the rational design of

  14. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    Directory of Open Access Journals (Sweden)

    Findlay-Reece Barbara

    2010-01-01

    Full Text Available Abstract Background Integrative health care (IHC is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader

  15. Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

    Science.gov (United States)

    Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

    2017-09-08

    Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

  16. Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

    Directory of Open Access Journals (Sweden)

    Sun Lee

    2017-09-01

    Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

  17. Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction

    Directory of Open Access Journals (Sweden)

    Fariborz Khorvash

    2017-01-01

    Full Text Available Background: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients. Materials and Methods: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n = 180 who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications. Results: The mean age of males versus females was 60 versus 77.5 years (ranged 23–93 vs. 29–70 years, respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8–209.04 min for door to IV-tPA needle time. Conclusion: Despite the international guidelines for IV-tPA injection within 3–4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.

  18. Identifying barriers to glycemic control in patients with type 2 diabetes after completion of an accredited education program.

    Science.gov (United States)

    Gildea, Chris M; Lantaff, Wendy M; Olenik, Nicole L

    The objective of this study was to identify patient-perceived barriers to achieving A1C targets after receiving instruction in an accredited diabetes education program. Qualitative research using semistructured interviews and thematic analyses. One pharmacist-run diabetes center located within an independent community pharmacy in a suburban region of southern Indiana. A total of 17 participants between the ages of 41-78 were interviewed in March and April 2016. Not applicable. Patient-perceived barriers to attaining glycemic control after completion of a pharmacist-taught diabetes self-management education (DSME) program accredited by the American Association of Diabetes Educators. Participants reported a variety of perceived barriers to glycemic control subsequent to the receipt of structured education. Seven major themes emerged: 1) health care provider factors; 2) self-identified indiscretions; 3) psychological barriers and poor social support; 4) knowledge deficits; 5) personal injury or adverse drug events; 6) time constraints and competing life demands; and 7) financial constraints. Participants reported a variety of perceived barriers to achieving A1C targets after completing DSME. Incorporation of solutions and coping mechanisms to these barriers into diabetes education programs may help patients attain glycemic control. Other factors may require individualized attention outside of DSME in follow-up episodes of diabetes care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  19. Identifying and Overcoming Barriers to Diabetes Management in the Elderly: An Intervention Study

    National Research Council Canada - National Science Library

    Munshi, Medha

    2008-01-01

    .... The interventions are now being implemented with help of a geriatric life specialist (GLS). Intervention by GDT includes focused strategies to overcome barriers in the areas of clinical care, education, social environment, and finances...

  20. Identifying barriers to remaining physically active after rehabilitation: differences in perception between physical therapists and older adult patients.

    Science.gov (United States)

    Zalewski, Kathryn; Alt, Carlynn; Arvinen-Barrow, Monna

    2014-06-01

    Cross-sectional study. To describe readiness for change and barriers to physical activity in older adults and to contrast perceptions of physical therapists and patients using the Barriers to Being Active Quiz. Regular physical activity is vital to recovery after discharge from physical therapy. Physical therapists are positioned to support change in physical activity habits for those transitioning to home care. Understanding of readiness for change and barriers to physical activity could optimize recovery. Thirteen physical therapists enrolled in the study and invited patients who met the inclusion criteria to enroll (79 patients enrolled). The physical therapists provided the ICD-9 code, the physical therapist diagnosis, and completed the Barriers to Being Active Quiz as they perceived their patients would. The enrolled patients provided demographics and filled out the Satisfaction With Life Scale, the stages-of-change scale for physical activity, and the Barriers to Being Active Quiz. Patients were predominantly in the early stages of readiness for change. Both patients and physical therapists identified lack of willpower as the primary barrier to physical activity. Patients identified lack of willpower and social influence as critical barriers more often than physical therapists, whereas physical therapists identified fear of injury and lack of time more often than their patients did. Differences between physical therapists and their patients were noted for fear of injury (z = 2.66, P = .008) and lack of time (z = 3.46, P = .001). The stage of change for physical activity impacted perception of social influence (χ2 = 9.64, Pbarriers to physical activity may allow physical therapists to better tailor intervention strategies to impact physical activity behavior change.

  1. Identifying and Overcoming Critical Barriers to Widespread Second Use of PEV Batteries

    Energy Technology Data Exchange (ETDEWEB)

    Neubauer, J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Smith, K. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wood, E. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Pesaran, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-02-01

    Both the market penetration of plug-in electric vehicles (PEVs) and deployment of grid-connected energy storage systems are presently restricted by the high cost of batteries. Battery second use (B2U) strategies--in which a single battery first serves an automotive application, then is redeployed into a secondary market--could help address both issues by reducing battery costs to the primary (automotive) and secondary (electricity grid) users. This study investigates the feasibility of and major barriers to the second use of lithium-ion PEV batteries by posing and answering the following critical B2U questions: 1. When will used automotive batteries become available, and how healthy will they be? 2. What is required to repurpose used automotive batteries, and how much will it cost? 3. How will repurposed automotive batteries be used, how long will they last, and what is their value? Advanced analysis techniques are employed that consider the electrical, thermal, and degradation response of batteries in both the primary (automotive) and secondary service periods. Second use applications are treated in detail, addressing operational requirements, economic value, and market potential. The study concludes that B2U is viable and could provide considerable societal benefits due to the large possible supply of repurposed automotive batteries and substantial remaining battery life following automotive service. However, the only identified secondary market large enough to consume the supply of these batteries (utility peaker plant replacement) is expected to be a low margin market, and thus B2U is not expected to affect the upfront cost of PEVs.

  2. Identifying and Overcoming Barriers to Effective Consideration of Human and Organisational Factors in Event Analysis and Root Cause Analysis. Workshop Proceedings, September 21-22, 2009, Paris, France

    International Nuclear Information System (INIS)

    2011-01-01

    Nuclear licensees must have effective processes for learning from operating experience in order to manage safety, secure continuous improvement and defend against the potential for repeat events. These processes include root cause analysis (RCA) to identify the underlying causes of events and mechanisms to learn from these analyses and to implement improvements. Correctly identifying and correcting the causes of events will allow lessons to be learned and shared with others in the industry. The treatment of Human and Organisational Factors (HOF) in RCA is of special interest to WGHOF. It is estimated that approximately 60-80% of events in the nuclear industry can be attributed to human and organisational factors. Although the importance of correctly identifying the HOF causes is understood, there is still a tendency for the analysis to focus solely on the technical issues of the event. The history of prominent events across the major hazards sector shows that HOF lessons often fail to be learned. A NEA/CSNI special experts meeting entitled 'Identification of Barriers to Analyzing and Identifying Human and Organisational Factors in Root Cause Analysis' was held at the NEA Headquarters in Paris, France on September 21-22, 2009. A total of 17 participants from 10 countries representing licensee organisations, regulators, international organisations and an independent consultant attended the meeting. The meeting was structured to allow for small group discussions during which a number of themes were explored, followed by plenary discussion. There were also four papers presented which complemented the discussion themes. As set out in the objectives of this work, the participants identified barriers to the effective treatment of HOF in RCA and recommendations to mitigate the effects of these barriers. Many of the barriers and recommendations identified relate to the RCA process in general, not specifically to the treatment of HOF in the RCA process. This is logical, for

  3. Performance of intact and partially degraded concrete barriers in limiting mass transport

    International Nuclear Information System (INIS)

    Walton, J.C.

    1992-06-01

    Mass transport through concrete barriers and release rate from concrete vaults are quantitatively evaluated. The thorny issue of appropriate diffusion coefficients for use in performance assessment calculations is covered, with no ultimate solution found. Release from monolithic concrete vaults composed of concrete waste forms is estimated with a semi-analytical solution. A parametric study illustrates the importance of different parameters on release. A second situation of importance is the role of a concrete shell or vault placed around typical waste forms in limiting mass transport. In both situations, the primary factor controlling concrete performance is cracks. The implications of leaching behavior on likely groundwater concentrations is examined. Frequently, lower groundwater concentrations can be expected in the absence of engineered covers that reduce infiltration

  4. Identifying the Correlates and Barriers of Future Planning among Parents of Individuals with Intellectual and Developmental Disabilities

    Science.gov (United States)

    Burke, Meghan; Arnold, Catherine; Owen, Aleksa

    2018-01-01

    Although individuals with intellectual and developmental disabilities (IDD) are living longer lives, fewer than half of parents of individuals with IDD conduct future planning. The correlates and barriers to future planning must be identified to develop targeted interventions to facilitate future planning. In this study, 388 parents of individuals…

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

    Science.gov (United States)

    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…

  6. Understanding low levels of physical activity in people with intellectual disabilities : A systematic review to identify barriers and facilitators

    NARCIS (Netherlands)

    Bossink, Leontien; van der Putten, Annette; Vlaskamp, Carla

    2017-01-01

    Background: People with intellectual disabilities (ID) undertake extremely low levels of physical activity. Aims: To enhance understanding concerning low levels of physical activity in people with ID, this study has three aims: (1) to identify barriers to and facilitators of physical activity in

  7. Identifying the Barriers and Facilitators to Participation in Physical Activity for Children with Down Syndrome

    Science.gov (United States)

    Barr, M.; Shields, N.

    2011-01-01

    Background: Many children with Down syndrome do not undertake the recommended amount of daily physical activity. The aim of this study was to explore the barriers and facilitators to physical activity for this group. Methods: Eighteen in-depth interviews were conducted with 20 parents (16 mothers, 4 fathers) of children with Down syndrome aged…

  8. Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders

    Science.gov (United States)

    Craft, Lesley R.; Brandt, Heather M.; Prince, Mary

    2016-01-01

    Background: To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in…

  9. Evaluation of five strategies to limit the impact of fouling in permeable reactive barriers

    International Nuclear Information System (INIS)

    Li Lin; Benson, Craig H.

    2010-01-01

    Ground water flow and geochemical reactive transport models were used to assess the effectiveness of five strategies used to limit fouling and to enhance the long-term hydraulic behavior of continuous-wall permeable reactive barriers (PRBs) employing granular zero valent iron (ZVI). The flow model accounted for geological heterogeneity and the reactive transport model included a geochemical algorithm for simulating iron corrosion and mineral precipitation reactions that have been observed in ZVI PRBs. The five strategies that were evaluated are pea gravel equalization zones, a sacrificial pre-treatment zone, pH adjustment, large ZVI particles, and mechanical treatment. Results of simulations show that installation of pea gravel equalization zones results in flow equalization and a more uniform distribution of residence times within the PRB. Residence times within the PRB are less affected by mineral precipitation when a pre-treatment zone is employed. pH adjustment limits the total amount of hydroxide ions in ground water to reduce porosity reduction and to retain larger residence times. Larger ZVI particles reduce porosity reduction as a result of the smaller iron surface area for iron corrosion, and retain longer residence time. Mechanical treatment redistributes the porosity uniformly throughout the PRB over time, which is effective in maintaining residence time.

  10. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline.

    Science.gov (United States)

    van der Wees, Philip J; Zagers, Cor A M; de Die, Sara E; Hendriks, Erik J M; Nijhuis-van der Sanden, Maria W G; de Bie, Rob A

    2013-05-01

    Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation planning. This study aimed at developing a questionnaire to identify perceived barriers for implementing the Dutch COPD guideline for physical therapists and its recommended measurement instruments. An overall questionnaire, based on two existing questionnaires, was constructed to identify barriers and facilitators for implementing the COPD guideline. The construct of the questionnaire was assessed in a cross-sectional study among 246 chest physical therapists. Factor analysis was conducted to explore underlying dimensions. Psychometric properties were analyzed using Cronbach's alpha. Barriers and facilitators were assessed using descriptive statistics. Some 139 physical therapists (57%) responded. Factor analysis revealed 4-factor and 5-factor solutions with an explained variance of 36% and 39% respectively. Cronbach's alpha of the overall questionnaire was 0.90, and varied from 0.66 to 0.92 for the different factors. Underlying domains of the 5-factor solution were characterized as: attitude towards using measurement instruments, knowledge and skills of the physical therapist, applicability of the COPD guideline, required investment of time & money, and patient characteristics. Physical therapists showed a positive attitude toward using the COPD guideline. Main barriers for implementation were required time investment and financial constraints. The construct of the questionnaire revealed relevant underlying domains for the identification of barriers and facilitators for implementing the COPD guideline. The questionnaire allowed for tailoring to the target group and may be used across health care professionals as basis for in-depth analysis of barriers to specific recommendations in

  11. IDENTIFYING AND ANALYZING THE TRANSIENT AND PERMANENT BARRIERS FOR BIG DATA

    OpenAIRE

    SARFRAZ NAWAZ BROHI; MERVAT ADIB BAMIAH; MUHAMMAD NAWAZ BROHI

    2016-01-01

    Auspiciously, big data analytics had made it possible to generate value from immense amounts of raw data. Organizations are able to seek incredible insights which assist them in effective decision making and providing quality of service by establishing innovative strategies to recognize, examine and address the customers’ preferences. However, organizations are reluctant to adopt big data solutions due to several barriers such as data storage and transfer, scalability, data quality, data c...

  12. Communicating with disabled children when inpatients: barriers and facilitators identified by parents and professionals in a qualitative study.

    Science.gov (United States)

    Sharkey, Siobhan; Lloyd, Claire; Tomlinson, Richard; Thomas, Eleanor; Martin, Alice; Logan, Stuart; Morris, Christopher

    2016-06-01

    Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children. To explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients. This was an exploratory qualitative study. We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication. Barriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids. Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers. © 2014 John Wiley & Sons Ltd.

  13. Identifying the barriers and enablers to palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study.

    Science.gov (United States)

    Hosie, Annmarie; Lobb, Elizabeth; Agar, Meera; Davidson, Patricia M; Phillips, Jane

    2014-11-01

    Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes. The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings. A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data. Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes. Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. The Genomic Landscape of Renal Oncocytoma Identifies a Metabolic Barrier to Tumorigenesis

    Directory of Open Access Journals (Sweden)

    Shilpy Joshi

    2015-12-01

    Full Text Available Oncocytomas are predominantly benign neoplasms possessing pathogenic mitochondrial mutations and accumulation of respiration-defective mitochondria, characteristics of unknown significance. Using exome and transcriptome sequencing, we identified two main subtypes of renal oncocytoma. Type 1 is diploid with CCND1 rearrangements, whereas type 2 is aneuploid with recurrent loss of chromosome 1, X or Y, and/or 14 and 21, which may proceed to more aggressive eosinophilic chromophobe renal cell carcinoma (ChRCC. Oncocytomas activate 5′ adenosine monophosphate-activated protein kinase (AMPK and Tp53 (p53 and display disruption of Golgi and autophagy/lysosome trafficking, events attributed to defective mitochondrial function. This suggests that the genetic defects in mitochondria activate a metabolic checkpoint, producing autophagy impairment and mitochondrial accumulation that limit tumor progression, revealing a novel tumor-suppressive mechanism for mitochondrial inhibition with metformin. Alleviation of this metabolic checkpoint in type 2 by p53 mutations may allow progression to eosinophilic ChRCC, indicating that they represent higher risk.

  15. Physiologic upper limit of pore size in the blood-tumor barrier of malignant solid tumors

    Directory of Open Access Journals (Sweden)

    Griffiths Gary L

    2009-06-01

    Full Text Available Abstract Background The existence of large pores in the blood-tumor barrier (BTB of malignant solid tumor microvasculature makes the blood-tumor barrier more permeable to macromolecules than the endothelial barrier of most normal tissue microvasculature. The BTB of malignant solid tumors growing outside the brain, in peripheral tissues, is more permeable than that of similar tumors growing inside the brain. This has been previously attributed to the larger anatomic sizes of the pores within the BTB of peripheral tumors. Since in the physiological state in vivo a fibrous glycocalyx layer coats the pores of the BTB, it is possible that the effective physiologic pore size in the BTB of brain tumors and peripheral tumors is similar. If this were the case, then the higher permeability of the BTB of peripheral tumor would be attributable to the presence of a greater number of pores in the BTB of peripheral tumors. In this study, we probed in vivo the upper limit of pore size in the BTB of rodent malignant gliomas grown inside the brain, the orthotopic site, as well as outside the brain in temporalis skeletal muscle, the ectopic site. Methods Generation 5 (G5 through generation 8 (G8 polyamidoamine dendrimers were labeled with gadolinium (Gd-diethyltriaminepentaacetic acid, an anionic MRI contrast agent. The respective Gd-dendrimer generations were visualized in vitro by scanning transmission electron microscopy. Following intravenous infusion of the respective Gd-dendrimer generations (Gd-G5, N = 6; Gd-G6, N = 6; Gd-G7, N = 5; Gd-G8, N = 5 the blood and tumor tissue pharmacokinetics of the Gd-dendrimer generations were visualized in vivo over 600 to 700 minutes by dynamic contrast-enhanced MRI. One additional animal was imaged in each Gd-dendrimer generation group for 175 minutes under continuous anesthesia for the creation of voxel-by-voxel Gd concentration maps. Results The estimated diameters of Gd-G7 dendrimers were 11 ± 1 nm and those of Gd-G8

  16. Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews

    DEFF Research Database (Denmark)

    Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart

    2016-01-01

    Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative and explora......Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative...... of the system and some inconsistencies (different meaning of colors) posed challenges, when considered with the actual application context, in which there is little time to get familiar with the design features. Conclusions For optimizing medicine labels and obtaining the full benefit of label design features...

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

    Science.gov (United States)

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

    2014-09-01

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

  18. Breast Cancer Awareness and Prevention Behavior among Women of Delhi, India: Identifying Barriers to Early Detection

    Directory of Open Access Journals (Sweden)

    Subhojit Dey

    2016-01-01

    Full Text Available Background Globally, breast cancer (BC has become the leading cause of mortality in women. Awareness and early detection can curb the growing burden of BC and are the first step in the battle against BC. The aim of this qualitative study was to explore the awareness and perceived barriers concerning the early detection of BC. Methods A total of 20 focus group discussions (FGDs were conducted during May 2013–March 2014. Pre-existing themes were used to conduct FGDs; each FGD group consisted of an average of ~10 women (aged ≥18–70 years who came to participate in a BC awareness workshop. All FGDs were audio taped and transcribed verbatim. The transcripts were inductively analyzed using ATLAS.ti. Based on emerged codes and categories, thematic analysis was done, and theory was developed using the grounded theory approach. Results Data were analyzed in three major themes: i knowledge and perception about BC; ii barriers faced by women in the early presentation of BC; and iii healthcare-seeking behavior. The findings revealed that shyness, fear, and posteriority were the major behavioral barriers in the early presentation of BC. Erroneously, pain was considered as an initial symptom of BC by most women. Financial constraint was also mentioned as a cause for delay in accessing treatment. Social stigma that breast problems reflect bad character of women also contributed in hiding BC symptoms. Conclusions Lack of BC awareness was prevalent, especially in low socioeconomic class. Women's ambivalence in prioritizing their own health and social and behavioral hurdles should be addressed by BC awareness campaigns appropriately suited for various levels of social class.

  19. Breast Cancer Awareness and Prevention Behavior Among Women of Delhi, India: Identifying Barriers to Early Detection.

    Science.gov (United States)

    Dey, Subhojit; Sharma, Surabhi; Mishra, Arti; Krishnan, Suneeta; Govil, Jyotsna; Dhillon, Preet K

    2016-01-01

    Globally, breast cancer (BC) has become the leading cause of mortality in women. Awareness and early detection can curb the growing burden of BC and are the first step in the battle against BC. The aim of this qualitative study was to explore the awareness and perceived barriers concerning the early detection of BC. A total of 20 focus group discussions (FGDs) were conducted during May 2013-March 2014. Pre-existing themes were used to conduct FGDs; each FGD group consisted of an average of ~10 women (aged ≥18-70 years) who came to participate in a BC awareness workshop. All FGDs were audio taped and transcribed verbatim. The transcripts were inductively analyzed using ATLAS.ti. Based on emerged codes and categories, thematic analysis was done, and theory was developed using the grounded theory approach. Data were analyzed in three major themes: i) knowledge and perception about BC; ii) barriers faced by women in the early presentation of BC; and iii) healthcare-seeking behavior. The findings revealed that shyness, fear, and posteriority were the major behavioral barriers in the early presentation of BC. Erroneously, pain was considered as an initial symptom of BC by most women. Financial constraint was also mentioned as a cause for delay in accessing treatment. Social stigma that breast problems reflect bad character of women also contributed in hiding BC symptoms. Lack of BC awareness was prevalent, especially in low socioeconomic class. Women's ambivalence in prioritizing their own health and social and behavioral hurdles should be addressed by BC awareness campaigns appropriately suited for various levels of social class.

  20. Breast Cancer Awareness and Prevention Behavior Among Women of Delhi, India: Identifying Barriers to Early Detection

    OpenAIRE

    Dey, Subhojit; Sharma, Surabhi; Mishra, Arti; Krishnan, Suneeta; Govil, Jyotsna; Dhillon, Preet K.

    2016-01-01

    Background Globally, breast cancer (BC) has become the leading cause of mortality in women. Awareness and early detection can curb the growing burden of BC and are the first step in the battle against BC. The aim of this qualitative study was to explore the awareness and perceived barriers concerning the early detection of BC. Methods A total of 20 focus group discussions (FGDs) were conducted during May 2013–March 2014. Pre-existing themes were used to conduct FGDs; each FGD group consisted ...

  1. Identifying and intervening on barriers to healthcare access among members of a small Korean community in the southern USA.

    Science.gov (United States)

    Rhodes, Scott D; Song, Eunyoung; Nam, Sang; Choi, Sarah J; Choi, Seungyong

    2015-04-01

    We used community-based participatory research (CBPR) to explore barriers to healthcare access and utilization and identify potentially effective intervention strategies to increase access among members of the Korean community in North Carolina (NC). Our CBPR partnership conducted 8 focus groups with 63 adult Korean immigrants in northwest NC and 15 individual in-depth interviews and conducted an empowerment-based community forum. We identified 20 themes that we organized into four domains, including practical barriers to health care, negative perceptions about care, contingencies for care, and provider misconceptions about local needs. Forum attendees identified four strategies to improve Korean community health. Despite the implementation of the Patient Protection and Affordable Care Act (ACA), many Korean community members will continue to remain uninsured, and among those who obtain insurance, many barriers will remain. It is imperative to ensure the health of this highly neglected and vulnerable community. Potential strategies include the development of (1) low-literacy materials to educate members of the Korean community about how to access healthcare services, (2) lay health advisor programs to support navigation of service access and utilization, (3) church-based programming, and (4) provider education to reduce misconceptions about Korean community needs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Identifying the barriers to affirmative action training: Perceptions of affirmative action appointees in Mpumalanga public hospitals

    Directory of Open Access Journals (Sweden)

    Edward Rankhumise

    2010-11-01

    Research purpose: The aim of this study is to gauge the perceptions about existing barriers in the implementation of affirmative action (AA training interventions at public hospitals in the Mpumalanga Province. Motivations for the study: The research conducted in this study provides valuable information which would enable the Mpumalanga health department and public hospital management to develop improved interventions associated with AA training interventions. Research design, approach and method: The population of the study consists of two groups of participants which are AA appointees and AA mentors. The study mixed qualitative and quantitative research methodological processes. Main findings: Results of this study show that there are differences in perceptions between Black respondents who believe that mentors should be held liable for the failure of the mentees and White respondents who disagreed. The findings suggest that employees are of the opinion that internal policy guidelines on the implementation of AA are not communicated to all employees. Practical implications: Public hospital management should articulate the purpose of AA interventions and its targets to both mentors and mentees and continuously review the implementation thereof. Contribution: The study contributes towards explaining the importance of training interventions that are useful for the success of AA appointees in their respective duties and also give account of barriers that are experienced by these appointees.

  3. Identifying Barriers and Facilitators at Affect Community Pharmacists' Ability to Engage Children in Medication Counseling: A Pilot Study

    Science.gov (United States)

    Alexander, Dayna S.; Schleiden, Loren J.; Carpenter, Delesha M.

    2017-01-01

    OBJECTIVES This study aimed to describe the barriers and facilitators that influence community pharmacists' ability to provide medication counseling to pediatric patients. METHODS Semistructured interviews (n = 16) were conducted with pharmacy staff at 3 community pharmacies in 2 Eastern states. The interview guide elicited pharmacy staff experiences interacting with children and their perceived barriers and facilitators to providing medication counseling. Transcripts were reviewed for accuracy and a codebook was developed for data analysis. NVivo 10 was used for content analysis and identifying relevant themes. RESULTS Ten pharmacists and 6 pharmacy technicians were interviewed. Most participants were female (69%), aged 30 to 49 years (56%), with ≥5 years of pharmacy practice experience. Eight themes emerged as barriers to pharmacists' engaging children in medication counseling, the most prevalent being the child's absence during medication pickup, the child appearing to be distracted or uninterested, and having an unconducive pharmacy environment. Pharmacy staff noted 7 common facilitators to engaging children, most importantly, availability of demonstrative and interactive devices/technology, pharmacist demeanor and communication approach, and having child-friendly educational materials. CONCLUSIONS Findings suggest that pharmacy personnel are rarely able to engage children in medication counseling because of the patient's absence during medication pickup; however, having child-friendly materials could facilitate interactions when the child is present. These findings can inform programs and interventions aimed at addressing the barriers pharmacists encounter while educating children about safe and appropriate use of medicines. PMID:29290741

  4. Examining emergency department communication through a staff-based participatory research method: identifying barriers and solutions to meaningful change.

    Science.gov (United States)

    Cameron, Kenzie A; Engel, Kirsten G; McCarthy, Danielle M; Buckley, Barbara A; Mercer Kollar, Laura Min; Donlan, Sarah M; Pang, Peter S; Makoul, Gregory; Tanabe, Paula; Gisondi, Michael A; Adams, James G

    2010-12-01

    We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED). ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes. A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice. Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  5. Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    E. L. Mc Goldrick

    2016-10-01

    Full Text Available Abstract Background The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework. Methods Semi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored. Results Seventy-three health professionals completed either a semi-structured interview (n = 35 or on-line questionnaire (n = 38. Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities. Conclusion This study has identified some of the

  6. On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings.

    Science.gov (United States)

    Rutstein, S E; Golin, C E; Wheeler, S B; Kamwendo, D; Hosseinipour, M C; Weinberger, M; Miller, W C; Biddle, A K; Soko, A; Mkandawire, M; Mwenda, R; Sarr, A; Gupta, S; Mataya, R

    2016-01-01

    Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider

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

    Science.gov (United States)

    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.

  8. Use of electric and bubble barriers to limit the movement of Eurasian ruffe (Gymnocephalus cernuus)

    Science.gov (United States)

    Dawson, Heather A.; Reinhardt, Ulrich G.; Savino, Jacqueline F.

    2006-01-01

    Eurasian ruffe (Gymnocephalus cernuus) is an aquatic invasive species accidentally introduced via ballast water to the Great Lakes in the mid-1980s. Fish barrier technology is being studied to stop the spread of invasive fish species such as ruffe. Electrical barriers have been constructed, most notably in the Chicago Sanitary and Ship Canal, to prevent non-indigenous species such as ruffe from spreading into areas where they are currently absent. Information on the response of an invasive fish to barriers can help managers determine strategies to prevent the spread of these species via artificial waterways. In this laboratory study electrical barriers were set up to determine effectiveness of four electrical settings for repelling Eurasian ruffe measuring 10 cm or more in length. In separate tests, airbubble curtains with two bubble sizes and densities were created to test this type of barrier in blocking movement of ruffe less than 10 cm in length. The most effective electrical settings found (5 ms, 6 Hz) repelled only about half of the attempted passes. When ruffe were offered food or shelter on the opposite side of the electrical barrier, neither food-starved nor shelter-deprived ruffe made significantly more attempts to cross the barrier. Ruffe were significantly repelled by all air-bubble curtains, but a large proportion of passes (4.5 passes per fish on average in the treatments) were still observed. Electrical barrier settings and air-bubble curtains used in this study were found ineffective at completely blocking the movement, but somewhat effective at inhibiting the passage of ruffe.

  9. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability

    Directory of Open Access Journals (Sweden)

    Chew Lisa D

    2006-03-01

    Full Text Available Abstract Background Reading skills are important for accessing health information, using health care services, managing one's health and achieving desirable health outcomes. Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener (SILS to identify limited reading ability, one component of health literacy, as measured by the S-TOFHLA. Methods Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states. Participants were randomly recruited from Primary Care practices in the Vermont Diabetes Information System June 2003 – December 2004. The main outcome was limited reading ability. The primary predictor was the SILS. Results Of the 999 persons screened, 169 (17% had limited reading ability. The sensitivity of the SILS in detecting limited reading ability was 54% [95% CI: 47%, 61%] and the specificity was 83% [95% CI: 81%, 86%] with an area under the Receiver Operating Characteristics Curve (ROC of 0.73 [95% CI: 0.69, 0.78]. Seven hundred seventy (77% screened negative on the SILS and 692 of these subjects had adequate reading skills (negative predictive value = 0.90 [95% CI: 0.88, 0.92]. Of the 229 who scored positive on the SILS, 92 had limited reading ability (positive predictive value = 0.4 [95% CI: 0.34, 0.47]. Conclusion The SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. Further study of the use of the SILS in clinical settings and with more diverse populations is warranted.

  10. Identifying barriers to patient acceptance of active surveillance: content analysis of online patient communications.

    Science.gov (United States)

    Mishra, Mark V; Bennett, Michele; Vincent, Armon; Lee, Olivia T; Lallas, Costas D; Trabulsi, Edouard J; Gomella, Leonard G; Dicker, Adam P; Showalter, Timothy N

    2013-01-01

    Qualitative research aimed at identifying patient acceptance of active surveillance (AS) has been identified as a public health research priority. The primary objective of this study was to determine if analysis of a large-sample of anonymous internet conversations (ICs) could be utilized to identify unmet public needs regarding AS. English-language ICs regarding prostate cancer (PC) treatment with AS from 2002-12 were identified using a novel internet search methodology. Web spiders were developed to mine, aggregate, and analyze content from the world-wide-web for ICs centered on AS. Collection of ICs was not restricted to any specific geographic region of origin. NLP was used to evaluate content and perform a sentiment analysis. Conversations were scored as positive, negative, or neutral. A sentiment index (SI) was subsequently calculated according to the following formula to compare temporal trends in public sentiment towards AS: [(# Positive IC/#Total IC)-(#Negative IC/#Total IC) x 100]. A total of 464 ICs were identified. Sentiment increased from -13 to +2 over the study period. The increase sentiment has been driven by increased patient emphasis on quality-of-life factors and endorsement of AS by national medical organizations. Unmet needs identified in these ICs include: a gap between quantitative data regarding long-term outcomes with AS vs. conventional treatments, desire for treatment information from an unbiased specialist, and absence of public role models managed with AS. This study demonstrates the potential utility of online patient communications to provide insight into patient preferences and decision-making. Based on our findings, we recommend that multidisciplinary clinics consider including an unbiased specialist to present treatment options and that future decision tools for AS include quantitative data regarding outcomes after AS.

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

    Science.gov (United States)

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

    2014-03-01

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

  12. Performance of intact and partially degraded concrete barriers in limiting fluid flow

    International Nuclear Information System (INIS)

    Walton, J.C.; Seitz, R.R.

    1991-07-01

    Concrete barriers will play a critical role in the long-term isolation of low-level radioactive wastes. Over time the barriers will degrade, and in many cases, the fundamental processes controlling performance of the barriers will be different for intact and degraded conditions. This document examines factors controlling fluid flow through intact and degraded concrete disposal facilities. Simplified models are presented fro predicting build up of fluid above a vault; fluid flow through and around intact vaults, through flaws in coatings/liners applied to a vault, and through cracks in a concrete vault; and the influence of different backfill materials around the outside of the vault. Example calculations are presented to illustrate the parameters and processes that influence fluid flow. 46 refs., 49 figs., 2 tabs

  13. Stakeholders identify similar barriers but different strategies to facilitate return-to-work: A vignette of a worker with an upper extremity condition.

    Science.gov (United States)

    Peters, Susan E; Truong, Anthony P; Johnston, Venerina

    2018-01-01

    Stakeholders involved in the return-to-work (RTW) process have different roles and qualificationsOBJECTIVE:To explore the perspectives of Australian stakeholders of the RTW barriers and strategies for a worker with an upper extremity condition and a complex workers' compensation case. Using a case vignette, stakeholders were asked to identify barriers and recommend strategies to facilitate RTW. Content analysis was performed on the open-ended responses. The responses were categorised into RTW barriers and strategies using the biopsychosocial model. Pearson's Chi Square and ANOVA were performed to establish group differences. 621 participants (488 healthcare providers (HCPs), 62 employers, 55 insurers and 16 lawyers) identified 36 barriers (31 modifiable): 4 demographic; 8 biological; 15 psychological and 9 social barriers. 484 participants reported 16 RTW strategies: 4 biological; 6 psychological and 6 social strategies. 'Work relationship stressors' (83.4%) and 'Personal relationship stressors' (64.7%) were the most frequently nominated barriers. HCPs most frequently nominated 'Pain management' (49.6%), while employers, insurers and lawyers nominated 'RTW planning/Suitable duties programs' (40.5%; 42.9%; 80%). Stakeholders perceived similar barriers for RTW but recommended different strategies. Stakeholders appeared to be more proficient in identifying barriers than recommending strategies. Future research should focus on tools to both identify RTW barriers and direct intervention.

  14. Born to roam? Surveying cat owners in Tasmania, Australia, to identify the drivers and barriers to cat containment.

    Science.gov (United States)

    McLeod, Lynette J; Hine, Donald W; Bengsen, Andrew J

    2015-12-01

    Free-roaming domestic cats, Felis catus, are a major public nuisance in neighbourhoods across the world, and have been linked to biodiversity loss and a host of community health problems. Owners who let their cats roam, also place their cats at risk of serious injury. One management strategy that is gaining considerable support involves encouraging cat owners to contain their pets within their property. Contemporary behaviour change models highlight the importance of identifying drivers and barriers that encourage and discourage target behaviours such as cat containment. Results from a random dial phone survey of 356 cat owners in northern Tasmania identified four distinct cat containment profiles: owners who contained their cat all the time, owners who only contained their cat at night, owners who sporadically contained their cat with no set routine, and owners who made no attempt to contain their pet. Our results indicated that cat-owners' decisions to contain or not contain their cats were guided by a range of factors including owners' beliefs about their ability to implement an effective containment strategy and their views about the physical and psychological needs of their cats. The results are discussed in terms of improving the behavioural effectiveness of cat containment interventions by selecting appropriate behavioural change tools for the identified drivers and barriers, and developing targeted engagement strategies and messaging. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Identifying barriers to mental health system improvements: an examination of community participation in assertive community treatment programs

    Directory of Open Access Journals (Sweden)

    Wakefield Patricia A

    2011-11-01

    Full Text Available Abstract Background Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance. Methods Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations. Results An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues. Conclusions The reasons for low compliance of ACT programs with community

  16. An open simulation approach to identify chances and limitations for vulnerable road user (VRU) active safety.

    Science.gov (United States)

    Seiniger, Patrick; Bartels, Oliver; Pastor, Claus; Wisch, Marcus

    2013-01-01

    It is commonly agreed that active safety will have a significant impact on reducing accident figures for pedestrians and probably also bicyclists. However, chances and limitations for active safety systems have only been derived based on accident data and the current state of the art, based on proprietary simulation models. The objective of this article is to investigate these chances and limitations by developing an open simulation model. This article introduces a simulation model, incorporating accident kinematics, driving dynamics, driver reaction times, pedestrian dynamics, performance parameters of different autonomous emergency braking (AEB) generations, as well as legal and logical limitations. The level of detail for available pedestrian accident data is limited. Relevant variables, especially timing of the pedestrian appearance and the pedestrian's moving speed, are estimated using assumptions. The model in this article uses the fact that a pedestrian and a vehicle in an accident must have been in the same spot at the same time and defines the impact position as a relevant accident parameter, which is usually available from accident data. The calculations done within the model identify the possible timing available for braking by an AEB system as well as the possible speed reduction for different accident scenarios as well as for different system configurations. The simulation model identifies the lateral impact position of the pedestrian as a significant parameter for system performance, and the system layout is designed to brake when the accident becomes unavoidable by the vehicle driver. Scenarios with a pedestrian running from behind an obstruction are the most demanding scenarios and will very likely never be avoidable for all vehicle speeds due to physical limits. Scenarios with an unobstructed person walking will very likely be treatable for a wide speed range for next generation AEB systems.

  17. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6.

    Science.gov (United States)

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance.

  18. Breaking barriers to interoperability: assigning spatially and temporally unique identifiers to spaces and buildings.

    Science.gov (United States)

    Pyke, Christopher R; Madan, Isaac

    2013-08-01

    The real estate industry routinely uses specialized information systems for functions, including design, construction, facilities management, brokerage, tax assessment, and utilities. These systems are mature and effective within vertically integrated market segments. However, new questions are reaching across these traditional information silos. For example, buyers may be interested in evaluating the design, energy efficiency characteristics, and operational performance of a commercial building. This requires the integration of information across multiple databases held by different institutions. Today, this type of data integration is difficult to automate and propone to errors due, in part, to the lack of generally accepted building and spaces identifiers. Moving forward, the real estate industry needs a new mechanism to assign identifiers for whole buildings and interior spaces for the purpose of interoperability, data exchange, and integration. This paper describes a systematic process to identify activities occurring at building or within interior spaces to provide a foundation for exchange and interoperability. We demonstrate the application of the approach with a prototype Web application. This concept and demonstration illustrate the elements of a practical interoperability framework that can increase productivity, create new business opportunities, and reduce errors, waste, and redundancy. © 2013 New York Academy of Sciences.

  19. The Dragons of Inaction: Psychological Barriers That Limit Climate Change Mitigation and Adaptation

    Science.gov (United States)

    Gifford, Robert

    2011-01-01

    Most people think climate change and sustainability are important problems, but too few global citizens engaged in high-greenhouse-gas-emitting behavior are engaged in enough mitigating behavior to stem the increasing flow of greenhouse gases and other environmental problems. Why is that? Structural barriers such as a climate-averse infrastructure…

  20. Identifying barriers to the availability and use of Magnesium Sulphate Injection in resource poor countries: a case study in Zambia.

    Science.gov (United States)

    Ridge, Anna L; Bero, Lisa A; Hill, Suzanne R

    2010-12-16

    Pre-eclampsia and eclampsia are serious complications of pregnancy and major causes of maternal mortality and morbidity worldwide. According to systematic reviews and WHO guidelines magnesium sulphate injection (MgSO4) should be the first -line treatment for severe pre-eclampsia and eclampsia. Studies have shown that this safe and effective medicine is unavailable and underutilized in many resource poor countries. The objective of this study was to identify barriers to the availability and use of MgSO4 in the Zambian Public Health System. A 'fishbone' (Ishikawa) diagram listing probable facilitators to the availability and use of MgSO4 identified from the literature was used to develop an assessment tool. Barriers to availability and use of MgSO4 were assessed at the regulatory/government, supply, procurement, distribution, health facility and health professional levels. The assessment was completed during August 2008 using archival data, and observations at a pragmatic sample of health facilities providing obstetric services in Lusaka District, Zambia. The major barrier to the availability of MgSO4 within the public health system in Zambia was lack of procurement by the Ministry of Health. Other barriers identified included a lack of demand by health professionals at the health centre level and a lack of in-service training in the use of MgSO4. Where there was demand by obstetricians, magnesium sulphate injection was being procured from the private sector by the hospital pharmacy despite not being registered and licensed for use for the treatment of severe pre-eclampsia and eclampsia by the national Pharmaceutical Regulatory Authority. The case study in Zambia highlights the complexities that underlie making essential medicines available and used appropriately. The fishbone diagram is a useful theoretical framework for illustrating the complexity of translating research findings into clinical practice. A better understanding of the supply system and of the pattern

  1. Identifying barriers to the availability and use of Magnesium Sulphate Injection in resource poor countries: A case study in Zambia

    Directory of Open Access Journals (Sweden)

    Hill Suzanne R

    2010-12-01

    Full Text Available Abstract Background Pre-eclampsia and eclampsia are serious complications of pregnancy and major causes of maternal mortality and morbidity worldwide. According to systematic reviews and WHO guidelines magnesium sulphate injection (MgSO4 should be the first -line treatment for severe pre-eclampsia and eclampsia. Studies have shown that this safe and effective medicine is unavailable and underutilized in many resource poor countries. The objective of this study was to identify barriers to the availability and use of MgSO4 in the Zambian Public Health System. Methods A 'fishbone' (Ishikawa diagram listing probable facilitators to the availability and use of MgSO4 identified from the literature was used to develop an assessment tool. Barriers to availability and use of MgSO4 were assessed at the regulatory/government, supply, procurement, distribution, health facility and health professional levels. The assessment was completed during August 2008 using archival data, and observations at a pragmatic sample of health facilities providing obstetric services in Lusaka District, Zambia. Results The major barrier to the availability of MgSO4 within the public health system in Zambia was lack of procurement by the Ministry of Health. Other barriers identified included a lack of demand by health professionals at the health centre level and a lack of in-service training in the use of MgSO4. Where there was demand by obstetricians, magnesium sulphate injection was being procured from the private sector by the hospital pharmacy despite not being registered and licensed for use for the treatment of severe pre-eclampsia and eclampsia by the national Pharmaceutical Regulatory Authority. Conclusions The case study in Zambia highlights the complexities that underlie making essential medicines available and used appropriately. The fishbone diagram is a useful theoretical framework for illustrating the complexity of translating research findings into clinical

  2. Identifying Barriers and Enablers in the Dietary Management of Type 2 Diabetes in M'Bour, Senegal.

    Science.gov (United States)

    Foley, Evan; BeLue, Rhonda

    2017-07-01

    The purpose of this study was to identify cultural enablers and barriers to dietary management of type 2 diabetes in M'Bour, Senegal. This qualitative study used the PEN-3 cultural model to explore diabetes dietary management within a cultural framework. Content analysis identified emergent themes based on the PEN-3 model. Forty-one individuals completed interviews. Themes reflecting ways that culture affects adherence to the diabetic diet included (a) having a different diet or eating separately from the communal family plate creates feelings of social isolation; (b) forgoing the diabetic diet sometimes occurs so that family members have enough food; (c) reducing servings of traditional foods feels like abandoning culture; and (d) women being responsible for preparing food, while men typically manage money for purchasing food yet do not provide input on what food is purchased. Results suggest that educating family units on the dietary management of diabetes may be more effective than individual education.

  3. Identifying critical recruitment bottlenecks limiting seedling establishment in a degraded seagrass ecosystem.

    Science.gov (United States)

    Statton, John; Montoya, Leonardo R; Orth, Robert J; Dixon, Kingsley W; Kendrick, Gary A

    2017-11-01

    Identifying early life-stage transitions limiting seagrass recruitment could improve our ability to target demographic processes most responsive to management. Here we determine the magnitude of life-stage transitions along gradients in physical disturbance limiting seedling establishment for the marine angiosperm, Posidonia australis. Transition matrix models and sensitivity analyses were used to identify which transitions were critical for successful seedling establishment during the first year of seed recruitment and projection models were used to predict the most appropriate environments and seeding densities. Total survival probability of seedlings was low (0.001), however, transition probabilities between life-stages differed across the environmental gradients; seedling recruitment was affected by grazing and bioturbation prevailing during the first life-stage transition (1 month), and 4-6 months later during the third life-stage transition when establishing seedlings are physically removed by winter storms. Models projecting population growth from different starting seed densities showed that seeds could replace other more labour intensive and costly methods, such as transplanting adult shoots, if disturbances are moderated sufficiently and if large numbers of seed can be collected in sufficient quantity and delivered to restoration sites efficiently. These outcomes suggest that by improving management of early demographic processes, we could increase recruitment in restoration programs.

  4. A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme.

    Science.gov (United States)

    Donaldson, Alex; Callaghan, Aisling; Bizzini, Mario; Jowett, Andrew; Keyzer, Patrick; Nicholson, Matthew

    2018-01-20

    Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme. Concept mapping with data collected from 19 soccer coaches and administrators. Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19). A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Using collective intelligence to identify barriers to teaching 12–19 year olds about the ocean in Europe

    DEFF Research Database (Denmark)

    Fauville, Géraldine; McHugh, Patricia; Domegan, Christine

    2018-01-01

    Since the degradation of the marine environment is strongly linked to human activities, having citizens who appreciate the ocean's influence on them and their influence on the ocean is important. Research has shown that citizens have a limited understanding of the ocean and it is this lack of ocean...... the ocean, highlighting how these barriers are interconnected and influence one another in a European Influence Map. The influence map shows 8 themes: Awareness and Perceived knowledge; Policies and Strategies; Engagement, formal education sector; the Ocean itself; Collaboration; Connections between humans...... and the ocean and the Blue Economy, having the greatest influence and impact on marine education. “Awareness and Perceived knowledge” in Stage 1, exerts the highest level of overall influence in teaching 12–19 year olds about the ocean. This map and study serves as a roadmap for policy makers to implement...

  6. Building resilience into practical conservation: identifying local management responses to global climate change in the southern Great Barrier Reef

    Science.gov (United States)

    Maynard, J. A.; Marshall, P. A.; Johnson, J. E.; Harman, S.

    2010-06-01

    Climate change is now considered the greatest long-term threat to coral reefs, with some future change inevitable despite mitigation efforts. Managers must therefore focus on supporting the natural resilience of reefs, requiring that resilient reefs and reef regions be identified. We develop a framework for assessing resilience and trial it by applying the framework to target management responses to climate change on the southern Great Barrier Reef. The framework generates a resilience score for a site based on the evaluation of 19 differentially weighted indicators known or thought to confer resilience to coral reefs. Scores are summed, and sites within a region are ranked in terms of (1) their resilience relative to the other sites being assessed, and (2) the extent to which managers can influence their resilience. The framework was applied to 31 sites in Keppel Bay of the southern Great Barrier Reef, which has a long history of disturbance and recovery. Resilience and ‘management influence potential’ were both found to vary widely in Keppel Bay, informing site selection for the staged implementation of resilience-based management strategies. The assessment framework represents a step towards making the concept of resilience operational to reef managers and conservationists. Also, it is customisable, easy to teach and implement and effective in building support among local communities and stakeholders for management responses to climate change.

  7. Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

    Science.gov (United States)

    Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

    2017-10-01

    Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

  8. Identifying motivators and barriers to older community-dwelling people participating in resistance training: A cross-sectional study.

    Science.gov (United States)

    Burton, Elissa; Lewin, Gill; Pettigrew, Simone; Hill, Anne-Marie; Bainbridge, Liz; Farrier, Kaela; Langdon, Trish; Airey, Phil; Hill, Keith D

    2017-08-01

    Participation rates of older people in resistance training (RT) are low despite increasing research showing many health benefits. To increase the number of older people participating in RT it is important to know what would motivate people to become involved, what motivates those who participate to continue, and the factors preventing many older people from commencing participation. To investigate these issues, a questionnaire was mailed to three groups of older people: (1) those receiving home care services, (2) members of a peak non-government seniors' organisation and (3) those participating in a specific gym-based RT programme. In total, 1327 questionnaires were returned (response rate = 42.5%). To feel good physically and mentally were the main reasons motivating participation among all three groups, and falls prevention was identified as an important motivator for the home care respondents. Pain, injury and illness were the main barriers to participating, or continuing to participate. However, medical advice was a factor influencing participation commencement. The results suggest organisations providing RT programmes for older people should tailor the promotion and delivery of programmes to address key motivators and barriers specific to each group to increase the proportion of older people initiating and continuing to engage in RT.

  9. Merging electricity and environment politics of Hong Kong: Identifying the barriers from the ways that sustainability is defined

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Alex Y.H. [Department of Geography, The University of Hong Kong, Hui Oi Chow Science Building, Pokfulam Road, Hong Kong SAR (China)

    2008-04-15

    The present paper presents a study of the electricity policy of Hong Kong in an environmental-political context. Through a critical review of the policy structure and rationale, it identifies the barriers to developing a truly sustainable electricity policy system and is expected to shed light on the forthcoming electricity market reform in the territory. The barriers stem from the path-dependent institutional set-ups that restrict a timely transformation of the roles of the actors. And this is coupled with the government's treatment that does not look beyond these structural constraints, overly appreciating scientific and economic rationalities than communicative actions. The author is of the view that these are intensified by the sharp changes in the local political economy. Positive signs of change are dampened by the minimal progress in democratic development in the near future and the extension of the power companies' monopolist status that will ruin the 'trust' between the stakeholders compounding the guilt of those rigid regulatory constraints. (author)

  10. A House Full of Trap Doors. Identifying barriers to resilient drylands in the toolbox of pastoral development

    Science.gov (United States)

    Krätli, Saverio; Kaufmann, Brigitte; Roba, Hassan; Hiernaux, Pierre; Li, Wenjun; Easdale, Marcos H.; Huelsebusch, Christian

    2016-04-01

    The theoretical understanding of drylands and pastoral systems has long undergone a U-turn from the initial perspective rooted in classical ecology. The shift has hinged on the way to represent asymmetric variability, from a disturbance in an ecosystem that naturally tends towards uniformity and stability, to a constitutive part of a dynamic ecosystem. Operationalising the new reversed perspective, including the need to update the methodological infrastructure to plan around drylands and pastoral development, remains a challenge. Underlying assumptions about stability and uniformity, that are a legacy of equilibrium thinking, remain embedded in the toolbox of pastoral development, starting from the technical language to talk about the subject. This effectively gets in the way of operationalizing state of the art understanding of pastoral systems and the drylands. Unless these barriers are identified, unpacked and managed, even the present calls for increasing the rigour and intensity of data collection - for example as part of the ongoing global process to revise and improve agricultural data - cannot deliver a realistic representation of pastoral systems in statistics and policy making. This contribution presents the case for understanding variability as an asset, and provides a range of examples of methodological barriers, including classifications of livestock systems, scale of observation, key parameters in animal production, indicators in the measurement of ecological efficiency, concepts of ecological fragility, natural resources, and pastoral risk. The need to update this legacy is a pressing challenge for policy makers concerned with both modernisation and resilience in the drylands.

  11. Merging electricity and environment politics of Hong Kong: Identifying the barriers from the ways that sustainability is defined

    International Nuclear Information System (INIS)

    Lo, Alex Y.H.

    2008-01-01

    The present paper presents a study of the electricity policy of Hong Kong in an environmental-political context. Through a critical review of the policy structure and rationale, it identifies the barriers to developing a truly sustainable electricity policy system and is expected to shed light on the forthcoming electricity market reform in the territory. The barriers stem from the path-dependent institutional set-ups that restrict a timely transformation of the roles of the actors. And this is coupled with the government's treatment that does not look beyond these structural constraints, overly appreciating scientific and economic rationalities than communicative actions. The author is of the view that these are intensified by the sharp changes in the local political economy. Positive signs of change are dampened by the minimal progress in democratic development in the near future and the extension of the power companies' monopolist status that will ruin the 'trust' between the stakeholders compounding the guilt of those rigid regulatory constraints

  12. Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review.

    Science.gov (United States)

    Costa, Deena Kelly; White, Matthew R; Ginier, Emily; Manojlovich, Milisa; Govindan, Sushant; Iwashyna, Theodore J; Sales, Anne E

    2017-08-01

    Improved outcomes are associated with the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE); however, implementation issues are common. As yet, no study has integrated the barriers to ABCDE to provide an overview of reasons for less successful efforts. The purpose of this review was to identify and catalog the barriers to ABCDE delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation. We searched MEDLINE via PubMed, CINAHL, and Scopus for original research articles from January 1, 2007, to August 31, 2016, that identified barriers to ABCDE implementation for adult patients in the ICU. Two reviewers independently reviewed studies, extracted barriers, and conducted thematic content analysis of the barriers, guided by the Consolidated Framework for Implementation Research. Discrepancies were discussed, and consensus was achieved. Our electronic search yielded 1,908 articles. After applying our inclusion/exclusion criteria, we included 49 studies. We conducted thematic content analysis of the 107 barriers and identified four classes of ABCDE barriers: (1) patient-related (ie, patient instability and safety concerns); (2) clinician-related (ie, lack of knowledge, staff safety concerns); (3) protocol-related (ie, unclear protocol criteria, cumbersome protocols to use); and, not previously identified in past reviews, (4) ICU contextual barriers (ie, interprofessional team care coordination). We provide the first, to our knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors. Our analysis offers a differential diagnosis checklist for clinicians planning ABCDE implementation to improve patient care and outcomes. Copyright © 2017 American College of Chest Physicians. All rights reserved.

  13. Clinical trial regulation in Argentina: overview and analysis of regulatory framework, use of existing tools, and researchers' perspectives to identify potential barriers.

    Science.gov (United States)

    White, Lauren; Ortiz, Zulma; Cuervo, Luis G; Reveiz, Ludovic

    2011-11-01

    To review and analyze the regulatory framework of clinical trial registration, use of existing tools (publicly accessible national/international registration databases), and users' perspectives to identify possible barriers to registration compliance by sponsors and researchers in Argentina. Internationally registered trials recruiting patients in Argentina were found through clincialtrials.gov and the International Clinical Trial Registration Platform (ICTRP) and compared with publically available clinical trials registered through the National Administration of Drugs, Foods, and Medical Devices (ANMAT). A questionnaire addressing hypothesized attitudinal, knowledge-related, idiomatic, technical, economic, and regulatory barriers that could discourage or impede registration of clinical trials was developed, and semi-structured, in-depth interviews were conducted with a purposively selected sample of researchers (investigators, sponsors, and monitors) in Argentina. A response rate of 74.3% (n = 29) was achieved, and 27 interviews were ultimately used for analysis. Results suggested that the high proportion of foreign-sponsored or multinational trials (64.8% of all protocols approved by ANMAT from 1994-2006) may contribute to a communication gap between locally based investigators and foreign-based administrative officials. A lack of knowledge about available international registration tools and limited awareness of the importance of registration were also identified as limiting factors for local investigators and sponsors. To increase compliance and promote clinical trial registration in Argentina, national health authorities, sponsors, and local investigators could take the following steps: implement a grassroots educational campaign to improve clinical trial regulation, support local investigator-sponsor-initiated clinical trials, and/or encourage local and regional scientific journal compliance with standards from the International Committee of Medical Journal

  14. A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Hansen, Carolina Malta; Rod, Morten Hulvej

    2017-01-01

    such as delayed access have been reported. The purpose of this study was to identify barriers to the implementation of defibrillator training of students and deployment of defibrillators in schools. Methods: A qualitative study based on semi-structured individual interviews and focus groups with a total of 25......Background: Student training in use of automated external defibrillators and deployment of such defibrillators in schools is recommended to increase survival after out-of-hospital cardiac arrest. Low implementation rates have been observed, and even at schools with a defibrillator, challenges...... to their perception of student training but not for their considerations on the relevance of their placement at schools. Conclusions: It is crucial for implementation of automated external defibrillators in schools to inform staff about how they work and are operated and that students are an appropriate target group...

  15. Barriers and Misperceptions Limiting Widespread Use of Intrauterine Contraception Among Canadian Women.

    Science.gov (United States)

    Hauck, Brian; Costescu, Dustin

    2015-07-01

    Unintended pregnancy is a major social and public health problem with adverse effects on neonatal and developmental outcomes, as well as maternal health and wellbeing. Traditionally, family planning policies have focused on increasing contraceptive uptake in non-users; however, rates of non-use are low in many developed nations. A high proportion of unintended pregnancies are attributable to contraceptive failure, particularly when using barrier and short-acting hormonal contraceptives. Intrauterine contraceptive devices (IUCDs) are highly effective and have been shown to reduce unintended pregnancy rates. Despite this, global utilization rates are low, and IUCD uptake in Canada has been particularly low. In this review we explore why IUCDs are not more widely used, and specifically focus on barriers and misperceptions that may influence IUCD uptake, particularly in Canada. We reviewed relevant articles published in English between 1990 and 2014, through searches of PubMed and Medline, including primary studies of any design containing information on the knowledge and attitudes of health care providers and women. Providing education to care providers, women, and policy makers may help overcome misperceptions about the use of IUCDs, and may facilitate greater use. Increased support from federal and provincial health programs may also encourage the use of IUCDs in Canadian women, and help to reduce unintended pregnancy rates.

  16. Limitations and barriers for adopting sustainable management practices in different farm types across Europe

    Science.gov (United States)

    Guzmán, Gema; Portero, Ángela; Vanwalleghem, Tom; Pedrera, Ana; Jesús Gaitán, Antonio; Ten Berge, Hein

    2014-05-01

    Although apparently the conservation of natural resources such as water and soil does not represent important concerns for our society, the evolution of the world population and the degradation of these resources pose a challenge to improving agricultural food production capacity and conserving, and in some cases restoring, the environmental quality. Unfortunately, the history contains numerous examples of abandonment of these resources (McNeill 1992, Montgomery 2007). Although most of the agronomic conservation practices have been known for millennia, their implementation has often been hindered by non-agricultural motives (Davis et al. 2012). The European project CATCH-C (ten Berge 2011) started last year with the aim of evaluating sustainable soil management practices and exploring the difficulties for their adoption, both at farm and institutional level, to overcome them in the near future. As a first step with that purpose, a selection of best management practices (BMPs) based on interviews with advisors and scientific knowledge were proposed for each of the considered farm typologies: arable crops, permanent crops and pasture. These farm types are representative of the Mediterranean area in terms of agroecological properties, extension, economical importance and soil degradation problems. Semi-structured interviews were carried out by addressing different profiles of farmers to identify in a qualitative way the main limitations for adopting these BMPs on their farms. Different questionnaires were prepared based on the farmers' responses and launched at a larger scale, with the aim of achieving approximately 100 responses per each farm typology. Finally, responses from the questionnaires will be analyzed to explore the causes that hinder or impede the adoption of BMPs in different farm typologies. References: Davis A.S. et al. 2012. Plos ONE 7(10): e4719. doi:10.1371/journalpone.0047149. McNeill, J.R. 1992. The mountains of the Mediterranean world. Cambridge

  17. Vasoinhibins regulate the inner and outer blood-retinal barrier and limit retinal oxidative stress.

    Science.gov (United States)

    Arredondo Zamarripa, David; Díaz-Lezama, Nundehui; Meléndez García, Rodrigo; Chávez Balderas, Jesús; Adán, Norma; Ledesma-Colunga, Maria G; Arnold, Edith; Clapp, Carmen; Thebault, Stéphanie

    2014-01-01

    Vasoinhibins are prolactin fragments present in the retina, where they have been shown to prevent the hypervasopermeability associated with diabetes. Enhanced bradykinin (BK) production contributes to the increased transport through the blood-retina barrier (BRB) in diabetes. Here, we studied if vasoinhibins regulate BRB permeability by targeting the vascular endothelium and retinal pigment epithelium (RPE) components of this barrier. Intravitreal injection of BK in male rats increased BRB permeability. Vasoinhibins prevented this effect, as did the B2 receptor antagonist Hoe-140. BK induced a transient decrease in mouse retinal and brain capillary endothelial monolayer resistance that was blocked by vasoinhibins. Both vasoinhibins and the nitric oxide (NO) synthase inhibitor L-NAME, but not the antioxidant N-acetyl cysteine (NAC), blocked the transient decrease in bovine umbilical vein endothelial cell (BUVEC) monolayer resistance induced by BK; this block was reversed by the NO donor DETANONOate. Vasoinhibins also prevented the BK-induced actin cytoskeleton redistribution, as did L-NAME. BK transiently decreased human RPE (ARPE-19) cell monolayer resistance, and this effect was blocked by vasoinhibins, L-NAME, and NAC. DETANONOate reverted the blocking effect of vasoinhibins. Similar to BK, the radical initiator Luperox induced a reduction in ARPE-19 cell monolayer resistance, which was prevented by vasoinhibins. These effects on RPE resistance coincided with actin cytoskeleton redistribution. Intravitreal injection of vasoinhibins reduced the levels of reactive oxygen species (ROS) in retinas of streptozotocin-induced diabetic rats, particularly in the RPE and capillary-containing layers. Thus, vasoinhibins reduce BRB permeability by targeting both its main inner and outer components through NO- and ROS-dependent pathways, offering potential treatment strategies against diabetic retinopathies.

  18. Vasoinhibins regulate the inner and outer blood-retinal barrier and limit retinal oxidative stress

    Directory of Open Access Journals (Sweden)

    David eArredondo Zamarripa

    2014-10-01

    Full Text Available Vasoinhibins are prolactin fragments present in the retina, where they have been shown to prevent the hypervasopermeability associated with diabetes. Enhanced bradykinin (BK production contributes to the increased transport through the blood-retina barrier (BRB in diabetes. Here, we studied if vasoinhibins regulate BRB permeability by targeting the vascular endothelium and retinal pigment epithelium (RPE components of this barrier. Intravitreal injection of BK in male rats increased BRB permeability. Vasoinhibins prevented this effect, as did the B2 receptor antagonist Hoe-140. BK induced a transient decrease in mouse retinal and brain capillary endothelial monolayer resistance that was blocked by vasoinhibins. Both vasoinhibins and the nitric oxide (NO synthase inhibitor L-NAME, but not the antioxidant N-acetyl cysteine (NAC, blocked the transient decrease in bovine umbilical vein endothelial cell (BUVEC monolayer resistance induced by BK; this block was reversed by the NO donor DETANONOate. Vasoinhibins also prevented the BK-induced actin cytoskeleton redistribution, as did L-NAME. BK transiently decreased human RPE (ARPE-19 cell monolayer resistance, and this effect was blocked by vasoinhibins, L-NAME, and NAC. DETANONOate reverted the blocking effect of vasoinhibins. Similar to BK, the radical initiator Luperox induced a reduction in ARPE-19 cell monolayer resistance, which was prevented by vasoinhibins. These effects on RPE resistance coincided with actin cytoskeleton redistribution. Intravitreal injection of vasoinhibins reduced the levels of reactive oxygen species (ROS in retinas of streptozotocin-induced diabetic rats, particularly in the RPE and capillary-containing layers. Thus, vasoinhibins reduce BRB permeability by targeting both its main inner and outer components through NO- and ROS-dependent pathways, offering potential treatment strategies against diabetic retinopathies.

  19. Integration of health into urban spatial planning through impact assessment: Identifying governance and policy barriers and facilitators

    International Nuclear Information System (INIS)

    Carmichael, Laurence; Barton, Hugh; Gray, Selena; Lease, Helen; Pilkington, Paul

    2012-01-01

    This article presents the results of a review of literature examining the barriers and facilitators in integrating health in spatial planning at the local, mainly urban level, through appraisals. Our literature review covered the UK and non UK experiences of appraisals used to consider health issues in the planning process. We were able to identify four main categories of obstacles and facilitators including first the different knowledge and conceptual understanding of health by different actors/stakeholders, second the types of governance arrangements, in particular partnerships, in place and the political context, third the way institutions work, the responsibilities they have and their capacity and resources and fourth the timeliness, comprehensiveness and inclusiveness of the appraisal process. The findings allowed us to draw some lessons on the governance and policy framework regarding the integration of health impact into spatial planning, in particular considering the pros and cons of integrating health impact assessment (HIA) into other forms of impact assessment of spatial planning decisions such as environmental impact assessment (EIA) and strategic environment assessment (SEA). In addition, the research uncovered a gap in the literature that tends to focus on the mainly voluntary HIA to assess health outcomes of planning decisions and neglect the analysis of regulatory mechanisms such as EIA and SEA. - Highlights: ► Governance and policy barriers and facilitators to the integration of health into urban planning. ► Review of literature on impact assessment methods used across the world. ► Knowledge, partnerships, management/resources and processes can impede integration. ► HIA evaluations prevail uncovering research opportunities for evaluating other techniques.

  20. Identifying Barriers to Appropriate Use of Metabolic/Bariatric Surgery for Type 2 Diabetes Treatment: Policy Lab Results

    Science.gov (United States)

    Rubin, Jennifer K.; Hesketh, Rachel; Martin, Adam; Herman, William H.; Rubino, Francesco

    2016-01-01

    Despite increasing recognition of the efficacy, safety, and cost-effectiveness of bariatric/metabolic surgery in the treatment of type 2 diabetes, few patients who may be appropriate candidates and may benefit from this type of surgery avail themselves of this treatment option. To identify conceptual and practical barriers to appropriate use of surgical procedures, a Policy Lab was hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes on 29 September 2015. Twenty-six stakeholders participated in the Policy Lab, including academics, clinicians, policy-makers, industry leaders, and patient representatives. Participants were provided with a summary of available evidence about the cost-effectiveness of bariatric/metabolic surgery and the costs of increasing the use of bariatric/metabolic surgery, using U.K. and U.S. scenarios as examples of distinct health care systems. There was widespread agreement among this group of stakeholders that bariatric/metabolic surgery is a legitimate and cost-effective approach to the treatment of type 2 diabetes in obese patients. The following four building blocks were identified to facilitate policy changes: 1) communicating the scale of the costs and harms associated with rising prevalence of type 2 diabetes; 2) properly articulating the role of bariatric/metabolic surgery for certain population groups; 3) identifying new funding sources for bariatric/metabolic surgery; and 4) incorporating bariatric/metabolic surgery into the appropriate clinical pathways. Although more research is needed to identify specific clinical scenarios for the prioritization of bariatric/metabolic surgery, the case appears to be strong enough to engage relevant policy-makers and practitioners in a concerted discussion of how to better use metabolic surgical resources in conjunction with other interventions in good diabetes practice. PMID:27222554

  1. Tetrapods on the EDGE: Overcoming data limitations to identify phylogenetic conservation priorities

    Science.gov (United States)

    Gray, Claudia L.; Wearn, Oliver R.; Owen, Nisha R.

    2018-01-01

    The scale of the ongoing biodiversity crisis requires both effective conservation prioritisation and urgent action. As extinction is non-random across the tree of life, it is important to prioritise threatened species which represent large amounts of evolutionary history. The EDGE metric prioritises species based on their Evolutionary Distinctiveness (ED), which measures the relative contribution of a species to the total evolutionary history of their taxonomic group, and Global Endangerment (GE), or extinction risk. EDGE prioritisations rely on adequate phylogenetic and extinction risk data to generate meaningful priorities for conservation. However, comprehensive phylogenetic trees of large taxonomic groups are extremely rare and, even when available, become quickly out-of-date due to the rapid rate of species descriptions and taxonomic revisions. Thus, it is important that conservationists can use the available data to incorporate evolutionary history into conservation prioritisation. We compared published and new methods to estimate missing ED scores for species absent from a phylogenetic tree whilst simultaneously correcting the ED scores of their close taxonomic relatives. We found that following artificial removal of species from a phylogenetic tree, the new method provided the closest estimates of their “true” ED score, differing from the true ED score by an average of less than 1%, compared to the 31% and 38% difference of the previous methods. The previous methods also substantially under- and over-estimated scores as more species were artificially removed from a phylogenetic tree. We therefore used the new method to estimate ED scores for all tetrapods. From these scores we updated EDGE prioritisation rankings for all tetrapod species with IUCN Red List assessments, including the first EDGE prioritisation for reptiles. Further, we identified criteria to identify robust priority species in an effort to further inform conservation action whilst

  2. Reinforcement of the Gas Barrier Properties of Polyethylene and Polyamide Through the Nanocomposite Approach: Key Factors and Limitations

    Directory of Open Access Journals (Sweden)

    Picard E.

    2015-02-01

    Full Text Available In this study, polyamide 6 (PA6 and polyethylene (PE nanocomposites were prepared from melt blending and a detailed characterization of the nanocomposite morphology and gas barrier properties was performed. The choice of the organoclay was adapted to each polymer matrix. Exfoliated morphology and improved gas transport properties were obtained by melt mixing the polar PA6 matrix and the organoclay, whereas a microcomposite with poor barrier properties was formed from the binary PE/organomodified clay mixture. Different modified polyethylenes were examined as compatibilizers for the polyethylene/organoclay system. The effect of compatibilizer molar mass, polarity and content was investigated on the clay dispersion and on the gas barrier properties. The optimal compatibilizer to clay weight ratio was found to be equal to 4 whatever the compatibilizer. However, a high degree of clay delamination was obtained with the high molar mass compatibilizer whereas highly swollen clay aggregates resulted from the incorporation of the low molar mass interfacial agents. Contrary to the PA based system, the barrier properties of PE nanocomposites were not directly related to the clay dispersion state but resulted also from the matrix/clay interfacial interactions. Oxidized wax was identified as a very promising interfacial agent and a step by step study was performed to optimize the gas transport properties of the systems based on PE, oxidized wax and organoclay. In particular, an interesting combination of oxidized wax and high molar mass maleic anhydride grafted polyethylene allowing dividing the gas permeability by a factor 2 in comparison with neat PE was proposed.

  3. Scoping review identifies significant number of knowledge translation theories, models and frameworks with limited use.

    Science.gov (United States)

    Strifler, Lisa; Cardoso, Roberta; McGowan, Jessie; Cogo, Elise; Nincic, Vera; Khan, Paul A; Scott, Alistair; Ghassemi, Marco; MacDonald, Heather; Lai, Yonda; Treister, Victoria; Tricco, Andrea C; Straus, Sharon E

    2018-04-13

    To conduct a scoping review of knowledge translation (KT) theories, models and frameworks that have been used to guide dissemination or implementation of evidence-based interventions targeted to prevention and/or management of cancer or other chronic diseases. We used a comprehensive multistage search process from 2000-2016, which included traditional bibliographic database searching, searching using names of theories, models and frameworks, and cited reference searching. Two reviewers independently screened the literature and abstracted data. We found 596 studies reporting on the use of 159 KT theories, models or frameworks. A majority (87%) of the identified theories, models or frameworks were used in five or fewer studies, with 60% used once. The theories, models and frameworks were most commonly used to inform planning/design, implementation and evaluation activities, and least commonly used to inform dissemination and sustainability/scalability activities. Twenty-six were used across the full implementation spectrum (from planning/design to sustainability/scalability) either within or across studies. All were used for at least individual-level behavior change, while 48% were used for organization-level, 33% for community-level and 17% for system-level change. We found a significant number of KT theories, models and frameworks with a limited evidence base describing their use. Copyright © 2018. Published by Elsevier Inc.

  4. Using Upland Rice Root Traits to Identify N Use Efficient Genotypes for Limited Soil Nutrient Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Traore, K.; Traore, O. [INERA / Station de Farakoba, Bobo-Dioulasso (Burkina Faso); Bado, V. B. [Africa Rice Center (AfricaRice), Saint Louis (Senegal)

    2013-11-15

    Crop production in the Sahelian countries of Africa is limited by many factors. The most important are low potential yields of local varieties, low inherent soil fertility and low applications of external inputs (organic and mineral fertilizers). A field experiment was conducted from 2007 to 2008 with the objective to develop and validate screening protocols for plant traits that enhance N acquisition and utilization in upland rice grown in low N soils of two hundred (200) upland rice (Oryza sativa L.) genotypes from WAB, NERICA, CNA, CNAX, IRAT and IR lines. An experiment in small pots was carried out in a greenhouse of Farakoba research center. The pots were filled with a sandy soil and upland rice genotypes were grown during three weeks, harvested and studied for their root characteristics (seminal root length, adventitious root number, lateral root length and number and roots hair density). The small pot method was reliable for root trait characterisation at the seedling stage. A large variability among genotypes was exhibited for the root characteristics. The variability was larger within the NERICA and WAB lines compared to the other lines. The length of the seminal roots varied from 10 to 40 cm, the lateral root number ranged between 3 and 15 and the number of adventitious roots varied between 2 and 7. The selected root traits can be used to identify high nutrients and water use efficient genotypes. (author)

  5. Utility and Limitations of Using Gene Expression Data to Identify Functional Associations.

    Directory of Open Access Journals (Sweden)

    Sahra Uygun

    2016-12-01

    Full Text Available Gene co-expression has been widely used to hypothesize gene function through guilt-by association. However, it is not clear to what degree co-expression is informative, whether it can be applied to genes involved in different biological processes, and how the type of dataset impacts inferences about gene functions. Here our goal is to assess the utility and limitations of using co-expression as a criterion to recover functional associations between genes. By determining the percentage of gene pairs in a metabolic pathway with significant expression correlation, we found that many genes in the same pathway do not have similar transcript profiles and the choice of dataset, annotation quality, gene function, expression similarity measure, and clustering approach significantly impacts the ability to recover functional associations between genes using Arabidopsis thaliana as an example. Some datasets are more informative in capturing coordinated expression profiles and larger data sets are not always better. In addition, to recover the maximum number of known pathways and identify candidate genes with similar functions, it is important to explore rather exhaustively multiple dataset combinations, similarity measures, clustering algorithms and parameters. Finally, we validated the biological relevance of co-expression cluster memberships with an independent phenomics dataset and found that genes that consistently cluster with leucine degradation genes tend to have similar leucine levels in mutants. This study provides a framework for obtaining gene functional associations by maximizing the information that can be obtained from gene expression datasets.

  6. Bottom-up communication. Identifying opportunities and limitations through an exploratory field-based evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, C.; Irvine, K.N. [Institute of Energy and Sustainable Development, De Montfort University, Leicester, LE1 9BH (United Kingdom)

    2013-02-15

    Communication to promote behaviours like energy saving can use significant resources. What is less clear is the comparative value of different approaches available to communicators. While it is generally agreed that 'bottom-up' approaches, where individuals are actively involved rather than passive, are preferable to 'top-down' authority-led projects, there is a dearth of evidence that verifies why this should be. Additionally, while the literature has examined the mechanics of the different approaches, there has been less attention paid to the associated psychological implications. This paper reports on an exploratory comparative study that examined the effects of six distinct communication activities. The activities used different communication approaches, some participative and others more top-down informational. Two theories, from behavioural studies and communication, were used to identify key variables for consideration in this field-based evaluation. The evaluation aimed to assess not just which activity might be most successful, as this has limited generalisability, but to also gain insight into what psychological impacts might contribute to success. Analysis found support for the general hypothesis that bottom-up approaches have more impact on behaviour change than top-down. The study also identified that, in this instance, the difference in reported behaviour across the activities related partly to the extent to which intentions to change behaviour were implemented. One possible explanation for the difference in reported behaviour change across the activities is that a bottom-up approach may offer a supportive environment where participants can discuss progress with like-minded individuals. A further possible explanation is that despite controlling for intention at an individual level, the pre-existence of strong intentions may have an effect on group success. These suggestive findings point toward the critical need for additional and larger-scale studies

  7. Energy renovation of Danish single-family houses Economy - barrier, motivation and limit

    DEFF Research Database (Denmark)

    Mortensen, Andrea; Heiselberg, Per Kvols; Plenge, Mary-Ann Knudstrup

    a large percentage who have not heard about the offers compared to the other income groups. There have been many reflections about energy saving initiatives and many of the initiatives have already been performed. There is however still a high number missing and particularly the depth of the renovation...... needs to be increased for Denmark to approach the defined objectives. The positive is that the listed tasks are predominantly carried out or considered to save energy, indicating that the homeowners are aware of this benefit. On the wish list presented to the homeowners, five wishes were selected.......000 DKK and 310.000DKK) are fair compared to the outcome, but when the needed investment is at 550.000 DKK and above, the majority think it is too expensive despite the benefits. The investment limit for the private renovations is defined on the basis on the homeowners’ interest in performing similar...

  8. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline

    NARCIS (Netherlands)

    Wees, P.J. van der; Zagers, C.A.; Die, S.E. de; Hendriks, E.J.; Nijhuis-Van der Sanden, M.W.G.; Bie, R.A. de

    2013-01-01

    BACKGROUND: Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation

  9. Why is it not working? Identifying barriers to the therapy of paediatric obesity in an intercultural setting.

    Science.gov (United States)

    Ciupitu, Carmen Cristina; Babitsch, Birgit

    2011-06-01

    Given the high overweight prevalence among children with a migration background in Germany, this paper describes barriers to the treatment of paediatric obesity in a specialized clinic providing services to an ethnically diverse population. In a cross-sectional mixed-method design, a two-week participant observation was followed by a cultural competence survey among the healthcare professionals employed at the clinic. The present study revealed barriers related to all categories of social actors involved in the therapy process. A major difficulty encountered by providers when working with ethnically diverse patients was the lack of mutual understanding, often associated with language barriers. Language barriers were most prevalent between providers and ethnically diverse mothers. Targeted education programs for adults (particularly women) with a migration background and cultural competence training for healthcare providers are needed in Germany. Special attention should be paid to scheduling appointments and enhancing patients' engagement in the therapy process.

  10. Combining the Power of Statistical Analyses and Community Interviews to Identify Adoption Barriers for Stormwater Best-Management Practices

    Science.gov (United States)

    Hoover, F. A.; Bowling, L. C.; Prokopy, L. S.

    2015-12-01

    Urban stormwater is an on-going management concern in municipalities of all sizes. In both combined or separated sewer systems, pollutants from stormwater runoff enter the natural waterway system during heavy rain events. Urban flooding during frequent and more intense storms are also a growing concern. Therefore, stormwater best-management practices (BMPs) are being implemented in efforts to reduce and manage stormwater pollution and overflow. The majority of BMP water quality studies focus on the small-scale, individual effects of the BMP, and the change in water quality directly from the runoff of these infrastructures. At the watershed scale, it is difficult to establish statistically whether or not these BMPs are making a difference in water quality, given that watershed scale monitoring is often costly and time consuming, relying on significant sources of funds, which a city may not have. Hence, there is a need to quantify the level of sampling needed to detect the water quality impact of BMPs at the watershed scale. In this study, a power analysis was performed on data from an urban watershed in Lafayette, Indiana, to determine the frequency of sampling required to detect a significant change in water quality measurements. Using the R platform, results indicate that detecting a significant change in watershed level water quality would require hundreds of weekly measurements, even when improvement is present. The second part of this study investigates whether the difficulty in demonstrating water quality change represents a barrier to adoption of stormwater BMPs. Semi-structured interviews of community residents and organizations in Chicago, IL are being used to investigate residents understanding of water quality and best management practices and identify their attitudes and perceptions towards stormwater BMPs. Second round interviews will examine how information on uncertainty in water quality improvements influences their BMP attitudes and perceptions.

  11. Method for identifying drivers, barriers and synergies related to the deployment of a CO2 pipeline network : A case study for the Iberian Peninsula and Morocco

    NARCIS (Netherlands)

    Berghout, Niels; Cabal, Helena; Gouveia, João Pedro; van den Broek, Machteld; Faaij, André

    2015-01-01

    This paper provides a method to identify drivers, barriers and synergies (DBS) related to the deployment of a CO2 pipeline network. The method was demonstrated for the West Mediterranean region (WMR) (i.e. Spain, Portugal and Morocco). The method comprises a literature review, analysis of

  12. Excess seawater nutrients, enlarged algal symbiont densities and bleaching sensitive reef locations: 1. Identifying thresholds of concern for the Great Barrier Reef, Australia.

    Science.gov (United States)

    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.

  13. Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals.

    Science.gov (United States)

    Debono, Deborah; Taylor, Natalie; Lipworth, Wendy; Greenfield, David; Travaglia, Joanne; Black, Deborah; Braithwaite, Jeffrey

    2017-03-27

    Medication errors harm hospitalised patients and increase health care costs. Electronic Medication Management Systems (EMMS) have been shown to reduce medication errors. However, nurses do not always use EMMS as intended, largely because implementation of such patient safety strategies requires clinicians to change their existing practices, routines and behaviour. This study uses the Theoretical Domains Framework (TDF) to identify barriers and targeted interventions to enhance nurses' appropriate use of EMMS in two Australian hospitals. This qualitative study draws on in-depth interviews with 19 acute care nurses who used EMMS. A convenience sampling approach was used. Nurses working on the study units (N = 6) in two hospitals were invited to participate if available during the data collection period. Interviews inductively explored nurses' experiences of using EMMS (step 1). Data were analysed using the TDF to identify theory-derived barriers to nurses' appropriate use of EMMS (step 2). Relevant behaviour change techniques (BCTs) were identified to overcome key barriers to using EMMS (step 3) followed by the identification of potential literature-informed targeted intervention strategies to operationalise the identified BCTs (step 4). Barriers to nurses' use of EMMS in acute care were represented by nine domains of the TDF. Two closely linked domains emerged as major barriers to EMMS use: Environmental Context and Resources (availability and properties of computers on wheels (COWs); technology characteristics; specific contexts; competing demands and time pressure) and Social/Professional Role and Identity (conflict between using EMMS appropriately and executing behaviours critical to nurses' professional role and identity). The study identified three potential BCTs to address the Environmental Context and Resources domain barrier: adding objects to the environment; restructuring the physical environment; and prompts and cues. Seven BCTs to address Social

  14. Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.

    Science.gov (United States)

    Flores, Glenn; Abreu, Milagros; Tomany-Korman, Sandra C

    2005-01-01

    Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. "Dose-response" relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar "dose-response" relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP

  15. Identifying barriers to effective management of widespread invasive alien trees: Prosopis species (mesquite) in South Africa as a case study

    CSIR Research Space (South Africa)

    Shackleton, RT

    2016-05-01

    Full Text Available and in some cases improve the benefits that some invasive species can provide. This study assesses the barriers that hinder the effective management of widespread tree invasions, drawing insights from a case study of invasions of Prosopis species (mesquite...

  16. Identifying the Barriers to Using Games and Simulations in Education: Creating a Valid and Reliable Survey Instrument

    Science.gov (United States)

    Justice, Lenora Jean

    2012-01-01

    The purpose of this study was to create a valid and reliable instrument to measure teacher perceived barriers to the adoption of games and simulations in instruction. Previous research, interviews with educators, a focus group, an expert review, and a think aloud protocol were used to design a survey instrument. After finalization, the survey was…

  17. Identifying the Barriers upon Development of Virtual Education in Engineering Majors (Case Study: The University of Isfahan)

    Science.gov (United States)

    Nikoonezhad, Sepideh; Nili, Mohammadreza; Esfahani, Ahmadreza Nasr

    2015-01-01

    The present study aims at investigating barriers upon development of virtual education in engineering majors at the University of Isfahan. The study has applied a mixed method (qualitative and quantitative) and its population consists all of the department members of the technical and engineering majors at the University of Isfahan including 125…

  18. Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation.

    Science.gov (United States)

    Worsley, Peter R; Clarkson, Paul; Bader, Dan L; Schoonhoven, Lisette

    2017-09-01

    To evaluate the barriers and facilitators for allied health professional's participation in pressure ulcer prevention. Mixed method cohort study. Single centre study in an acute university hospital trust. Five physiotherapists and four occupational therapists were recruited from the hospital trust. Therapists had been working in the National Health Service (NHS) for a minimum of one year. Therapist views and experiences were collated using an audio recorded focus group. This recording was analysed using constant comparison analysis. Secondary outcomes included assessment of attitudes and knowledge of pressure ulcer prevention using questionnaires. Key themes surrounding barriers to participation in pressure ulcer prevention included resources (staffing and equipment), education and professional boundaries. Fewer facilitators were described, with new training opportunities and communication being highlighted. Results from the questionnaires showed the therapists had a positive attitude towards pressure ulcer prevention with a median score of 81% (range 50 to 83%). However, there were gaps in knowledge with a median score of 69% (range 50 to 77%). The therapist reported several barriers to pressure ulcer prevention and few facilitators. The primary barriers were resources, equipment and education. Attitudes and knowledge in AHPs were comparable to data previously reported from experienced nursing staff. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Materials Genome in Action: Identifying the Performance Limits of Physical Hydrogen Storage

    Science.gov (United States)

    2017-01-01

    The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacity at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar. PMID:28413259

  20. Identifying the limitations of conventional biofiltration of diffuse methane emissions at long-term operation.

    Science.gov (United States)

    Gómez-Cuervo, S; Hernández, J; Omil, F

    2016-08-01

    There is growing international concern about the increasing levels of greenhouse gases in the atmosphere, particularly CO2 and methane. The emissions of methane derived from human activities are associated with large flows and very low concentrations, such as those emitted from landfills and wastewater treatment plants, among others. The present work was focused on the biological methane degradation at diffuse concentrations (0.2% vv(-1)) in a conventional biofilter using a mixture of compost, perlite and bark chips as carrier. An extensive characterization of the process was carried out at long-term operation (250 days) in a fully monitored pilot plant, achieving stable conditions during the entire period. Operational parameters such as waterings, nitrogen addition and inlet loads and contact time influences were evaluated. Obtained results indicate that empty bed residence times within 4-8 min are crucial to maximize elimination rates. Waterings and the type of nitrogen supplied in the nutrient solution (ammonia or nitrate) have a strong impact on the biofilter performance. The better results compatible with a stable operation were achieved using nitrate, with elimination capacities up to 7.6 ± 1.1 g CH4 m(-3 )h(-1). The operation at low inlet concentrations (IC) implied that removal rates obtained were quite limited (ranging 3-8 g CH4 m(-3 )h(-1)); however, these results could be significantly increased (up to 20.6 g CH4 m(-3) h(-1)) at higher IC, which indicates that the mass transfer from the gas to the liquid layer surrounding the biofilm is a key limitation of the process.

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

    Science.gov (United States)

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

    2011-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  3. Strategic Floodplain Reconnection Along the Lower Tisza and Lower Illinois Rivers: Identifying Opportunities, Tradeoffs, and Limitations

    Science.gov (United States)

    Guida, R.; Remo, J. W.; Secchi, S.; Swanson, T.; Kiss, T.

    2015-12-01

    During the late 19th and into the 20th Centuries, the Tisza and Illinois Rivers were highly altered through the construction of levees and dams to reclaim their floodplain-wetland systems for agriculture and to facilitate navigation. In recent decades, flood levels have continued to rise due to aggradation on the confined floodplains reducing flood-conveyance capacity. As a result, "Room for the River" proposals have gained more prominence. Our overarching hypothesis is that strategically reconnecting these rivers to their floodplains will reduce flood levels and increase ecological habitat while limiting socioeconomic impacts. In this study, we assessed several reconnection scenarios, including levee setbacks and removals, for the Lower Tisza River (LTR; Hungary) and the Lower Illinois River (LIR; Illinois, USA). To model water-surface elevations (WSELs) for the 5- through 500-year flood events, we employed HEC-RAS (1D) and SOBEK (1D/2D) hydraulic models. To determine socioeconomic tradeoffs using these modeled WSELs, we developed a corresponding suite of expected annual damages (EADs) using FEMA's Hazus-MH flood-loss modeling software for buildings and integrated geospatial and soil productivity indices to estimate agricultural losses. To assess ecosystem benefits of reconnection along the LTR, we used historic wetland extent as a proxy for increasing needed floodplain habitats. For the LIR, we performed habitat screening using Land Capability Potential Index and other assessment tools to estimate potential ecosystem benefits. Results indicate that levee removal and/or setbacks may reduce flood heights up to 1.6 m along the LTR and over 1.0 m along the LIR. While urban areas have the highest EADs, several lower-production agricultural areas show potential for reducing flood heights while minimizing damages. Strategic-floodplain reconnection benefits along the LTR and LIR include over half of historically-significant wetlands being reconnected and the creation of

  4. Coastal Barrier Resource Areas, Barrier Islands and Spits; s44gbb89; Barrier Beaches as defined by RI CRMC were barrier beaches as defined by RI CRMC were identified on quad maps and manually digitized from tablets, Published in 1989, 1:24000 (1in=2000ft) scale, Rhode Island and Providence Plantations.

    Data.gov (United States)

    NSGIC State | GIS Inventory — Coastal Barrier Resource Areas dataset current as of 1989. Barrier Islands and Spits; s44gbb89; Barrier Beaches as defined by RI CRMC were barrier beaches as defined...

  5. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.

    Science.gov (United States)

    Shahid, Shaouli; Durey, Angela; Bessarab, Dawn; Aoun, Samar M; Thompson, Sandra C

    2013-11-04

    Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians' perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers' (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs' views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006-September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. CSPs' lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients' limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient-provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people's distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs

  6. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers

    Science.gov (United States)

    2013-01-01

    Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff

  7. The limits of two-year bioassay exposure regimens for identifying chemical carcinogens.

    Science.gov (United States)

    Huff, James; Jacobson, Michael F; Davis, Devra Lee

    2008-11-01

    Chemical carcinogenesis bioassays in animals have long been recognized and accepted as valid predictors of potential cancer hazards to humans. Most rodent bioassays begin several weeks after birth and expose animals to chemicals or other substances, including workplace and environmental pollutants, for 2 years. New findings indicate the need to extend the timing and duration of exposures used in the rodent bioassay. In this Commentary, we propose that the sensitivity of chemical carcinogenesis bio-assays would be enhanced by exposing rodents beginning in utero and continuing for 30 months (130 weeks) or until their natural deaths at up to about 3 years. Studies of three chemicals of different structures and uses-aspartame, cadmium, and toluene-suggest that exposing experimental animals in utero and continuing exposure for 30 months or until their natural deaths increase the sensitivity of bioassays, avoid false-negative results, and strengthen the value and validity of results for regulatory agencies. Government agencies, drug companies, and the chemical industry should conduct and compare the results of 2-year bioassays of known carcinogens or chemicals for which there is equivocal evidence of carcinogenicity with longer-term studies, with and without in utero exposure. If studies longer than 2 years and/or with in utero exposure are found to better identify potential human carcinogens, then regulatory agencies should promptly revise their testing guidelines, which were established in the 1960s and early 1970s. Changing the timing and dosing of the animal bioassay would enhance protection of workers and consumers who are exposed to potentially dangerous workplace or home contaminants, pollutants, drugs, food additives, and other chemicals throughout their lives.

  8. Secondary Engineering Design Graphics Educator Service Load of Students with Identified Categorical Disabilities and Limited English Proficiency

    Science.gov (United States)

    Ernst, Jeremy V.; Li, Songze; Williams, Thomas O.

    2014-01-01

    The ever-changing student population of engineering design graphics students necessitates broader sets of instructor adeptness. Specifically, preparedness to educate and provide adequate educational access to content for students with identified categorical disabilities and Limited English Proficiency (LEP) is now an essential readiness skill for…

  9. Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

    Directory of Open Access Journals (Sweden)

    Johan Van Limbergen

    2015-01-01

    Full Text Available The treatment armamentarium in pediatric Crohn disease (CD is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet], which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario, inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies. Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

  10. Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care.

    Science.gov (United States)

    Tropea, Joanne; LoGiudice, Dina; Liew, Danny; Roberts, Carol; Brand, Caroline

    2017-03-01

    Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents' current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care. A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low. The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

  11. Funnel plot control limits to identify poorly performing healthcare providers when there is uncertainty in the value of the benchmark.

    Science.gov (United States)

    Manktelow, Bradley N; Seaton, Sarah E; Evans, T Alun

    2016-12-01

    There is an increasing use of statistical methods, such as funnel plots, to identify poorly performing healthcare providers. Funnel plots comprise the construction of control limits around a benchmark and providers with outcomes falling outside the limits are investigated as potential outliers. The benchmark is usually estimated from observed data but uncertainty in this estimate is usually ignored when constructing control limits. In this paper, the use of funnel plots in the presence of uncertainty in the value of the benchmark is reviewed for outcomes from a Binomial distribution. Two methods to derive the control limits are shown: (i) prediction intervals; (ii) tolerance intervals Tolerance intervals formally include the uncertainty in the value of the benchmark while prediction intervals do not. The probability properties of 95% control limits derived using each method were investigated through hypothesised scenarios. Neither prediction intervals nor tolerance intervals produce funnel plot control limits that satisfy the nominal probability characteristics when there is uncertainty in the value of the benchmark. This is not necessarily to say that funnel plots have no role to play in healthcare, but that without the development of intervals satisfying the nominal probability characteristics they must be interpreted with care. © The Author(s) 2014.

  12. Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms.

    Science.gov (United States)

    Werner, Nicole E; Stanislawski, Barbara; Marx, Katherine A; Watkins, Daphne C; Kobayashi, Marissa; Kales, Helen; Gitlin, Laura N

    2017-02-22

    Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer's Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. This study used a sociotechnical systems approach to identify barriers to meeting caregivers' information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies. We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver's needs and contexts, and 3) usable information that can directly inform how caregivers' manage behaviors. The sociotechnical system framework is a useful approach for identifying information

  13. Edible moisture barriers: how to assess of their potential and limits in food products shelf-life extension?

    Science.gov (United States)

    Bourlieu, C; Guillard, V; Vallès-Pamiès, B; Guilbert, S; Gontard, N

    2009-05-01

    Control of moisture transfer inside composite food products or between food and its environment remains today a major challenge in food preservation. A wide rage of film-forming compounds is now available and facilitates tailoring moisture barriers with optimized functional properties. Despite these huge potentials, a realistic assessment of the film or coating efficacy is still critical. Due to nonlinear water sorption isotherms, water-dependent diffusivities, and variations of physical state, modelling transport phenomena through edible barriers is complex. Water vapor permeability can hardly be considered as an inherent property of films and only gives a relative indication of the barrier efficacy. The formal or mechanistic models reported in literature that describe the influence of testing conditions on the barrier properties of edible films are reviewed and discussed. Most of these models have been validated on a narrow range of conditions. Conversely, few original predictive models based on Fick's Second Law have been developed to assess shelf-life extension of food products including barriers. These models, assuming complex and realistic hypothesis, have been validated in various model foods. The development of nondestructive methods of moisture content measurement should speed up model validation and allow a better comprehension of moisture transfer through edible films.

  14. Evaluation of storing hepatitis B vaccine outside the cold chain in the Solomon Islands: Identifying opportunities and barriers to implementation.

    Science.gov (United States)

    Breakwell, Lucy; Anga, Jenniffer; Dadari, Ibrahim; Sadr-Azodi, Nahad; Ogaoga, Divinal; Patel, Minal

    2017-05-15

    Monovalent Hepatitis B vaccine (HepB) is heat stable, making it suitable for storage outside cold chain (OCC) at 37°C for 1month. We conducted an OCC project in the Solomon Islands to determine the feasibility of and barriers to national implementation and to evaluate impact on coverage. Healthcare workers at 13 facilities maintained monovalent HepB birth dose (HepB-BD) OCC for up to 28days over 7months. Vaccination data were recorded for children born during the project and those born during 7months before the project. Timely HepB-BD coverage among facility and home births increased from 30% to 68% and from 4% to 24%, respectively. Temperature excursions above 37°C were rare, but vaccine wastage was high and shortages common. Storing HepB OCC can increase HepB-BD coverage in countries with insufficient cold chain capacity or numerous home births. High vaccine wastage and unreliable vaccine supply must be addressed for successful implementation. Published by Elsevier Ltd.

  15. Identifying the Barriers to Women's Agency in Domestic Violence: The Tensions between Women's Personal Experiences and Systemic Responses

    Directory of Open Access Journals (Sweden)

    Jo Aldridge

    2013-04-01

    Full Text Available Despite advances in knowledge and understanding about the impacts of domestic violence on women's lives, global research on violence against women shows there is a need for research that not only places women centre stage in research praxis, but also that involves them more collaboratively in genuine dialogue about their experiences, including their agentic stances. This is especially the case for marginalised and socially excluded women victims of domestic violence, such as those who are not known or do not present to services and who survive abusive relationships alone or with little outside support. Evidence from two studies reported here—secondary analysis of women with severe and enduring mental health problems and a collaborative narrative project with unsupported women victims of domestic violence—suggest that women's capacity for agency are compromised by a number of critical factors, and that these are also reflected in the tensions between micro–macro analyses and understanding of the impact of domestic violence on women. This article considers the barriers to women's agency from the women's perspective and in the context of broader, systemic dynamics, including the denial or obscuring of abuse by governments and states and the consequences of stringent fiscal retrenchment that put women at increased risk of domestic violence.

  16. Identifying barriers to receiving preventive dental services: expanding access to preventive dental hygiene services through affiliated practice.

    Science.gov (United States)

    Gross-Panico, Michelle L; Freeman, Wilbur K

    2012-01-01

    Minority children and children from lower income families are more likely to experience the burden of oral disease. Since oral disease reduces quality of life, it is a priority to utilize preventive dental services. The research questions ask if affiliated practice increases utilization of preventive dental services by underserved children from birth to 18 years of age, and what the barriers to receiving preventive dental services are and their level of importance. A survey was administered to parents/guardians of patients from birth to 18 years of age who received preventive dental services from Catholic Healthcare West East Valley Children's Dental Clinic, an affiliated practice dental clinic in Chandler, Arizona. Thirty-four surveys were completed: 21 completed in English and 13 completed in Spanish. The data was analyzed to provide descriptive statistics and non-parametrically analyzed using the Friedman's, Kendall's W and Wilcoxon Signed Ranks Tests. The cost of preventive dental services is more important to this population than both convenience of appointment time and distance traveled. As the cost increases for preventive dental services, this population will utilize preventive dental services less frequently. The study indicated that the increase of self-reported utilization of preventive dental services by underserved children, ranging in age from birth to 18 years old, in Arizona affiliated practice dental clinics, was primarily impacted by perceived reduced costs of receiving care. Funding efforts, reimbursement mechanisms and legislative policies should support this dental care delivery model to provide care to underserved children, adults and seniors throughout the U.S.

  17. Identifying barriers to Science, Technology, Society and environment (STSE) educational goals and pedagogy in science education: A case study of UMASS Lowell undergraduate engineering

    Science.gov (United States)

    Phaneuf, Tiffany

    The implementation of sustainable development in higher education is a global trend. Engineers, as gatekeepers of technological innovation, confront increasingly complex world issues ranging from economic and social to political and environmental. Recently, a multitude of government reports have argued that solving such complex problems requires changes in the pedagogy of engineering education, such as that prescribed by the Science, Technology, Society, and education (STS) movement that grew out of the environmental movement in the 70s. In STS students are engaged in the community by understanding that scientific progress is innately a sociopolitical process that involves dimensions of power, wealth and responsibility. United States accreditation criteria now demand "the broad education necessary to understand the impact of engineering solutions in a global, economic, environmental, and societal context" (ABET Engineering Accreditation Commission 2005). With such emphasis on STS education as necessary to address complex world issues, it is vital to assess the barriers in the traditional engineering curriculum that may inhibit the success of such educational reform. This study identifies barriers to STS goals and pedagogy in post secondary science education by using the Francis College of Engineering at UMASS Lowell as a single case study. The study draws on existing literature to develop a theoretical framework for assessing four hypothesized barriers to STS education in undergraduate engineering. Identification of barriers to STS education in engineering generates a critical reflection of post secondary science education and its role in preparing engineers to be active citizens in shaping a rapidly globalizing world. The study offers policy recommendations for enabling post secondary science education to incorporate STS education into its curriculum.

  18. Limitations of the hCMEC/D3 cell line as a model for Aβ clearance by the human blood-brain barrier.

    Science.gov (United States)

    Biemans, Elisanne A L M; Jäkel, Lieke; de Waal, Robert M W; Kuiperij, H Bea; Verbeek, Marcel M

    2017-07-01

    Alzheimer's disease and cerebral amyloid angiopathy are characterized by accumulation of amyloid-β (Aβ) at the cerebrovasculature due to decreased clearance at the blood-brain barrier (BBB). However, the exact mechanism of Aβ clearance across this barrier has not been fully elucidated. The hCMEC/D3 cell line has been characterized as a valid model for the BBB. In this study we evaluated the use of this model to study Aβ clearance across the BBB, with an emphasis on brain-to-blood directional permeability. Barrier integrity of hCMEC/D3 monolayers was confirmed for large molecules in both the apical to basolateral and the reverse direction. However, permeability for smaller molecules was substantially higher, especially in basolateral to apical direction, and barrier formation for Aβ was completely absent in this direction. In addition, hCMEC/D3 cells failed to develop a high TEER, possibly caused by incomplete formation of tight junctions. We conclude that the hCMEC/D3 model has several limitations to study the cerebral clearance of Aβ. Therefore, the model needs further characterization before this cell system can be generally applied as a model to study cerebral Aβ clearance. © 2016 The Authors Journal of Neuroscience Research Published by Wiley Periodicals, Inc. © 2016 The Authors Journal of Neuroscience Research Published by Wiley Periodicals, Inc.

  19. Older adults are mobile too!Identifying the barriers and facilitators to older adults' use of mHealth for pain management.

    Science.gov (United States)

    Parker, Samantha J; Jessel, Sonal; Richardson, Joshua E; Reid, M Cary

    2013-05-06

    Mobile health (mHealth) is a rapidly emerging field with the potential to assist older adults in the management of chronic pain (CP) through enhanced communication with providers, monitoring treatment-related side effects and pain levels, and increased access to pain care resources. Little is currently known, however, about older adults' attitudes and perceptions of mHealth or perceived barriers and facilitators to using mHealth tools to improve pain management. We conducted six focus groups comprised of 41 diverse older adults (≥60 years of age) with CP. Participants were recruited from one primary care practice and two multiservice senior community day-visit centers located in New York City that serve older adults in their surrounding neighborhoods. Focus group discussions were recorded and transcribed, and transcriptions were analyzed using direct content analysis to identify and quantify themes. Focus group discussions generated 38 individual themes pertaining to the use of mHealth to help manage pain and pain medications. Participants had low prior use of mHealth (5% of participants), but the vast majority (85%) were highly willing to try the devices. Participants reported that mHealth devices might help them reach their healthcare provider more expeditiously (27%), as well as help to monitor for falls and other adverse events in the home (15%). Barriers to device use included concerns about the cost (42%) and a lack of familiarity with the technology (32%). Facilitators to device use included training prior to device use (61%) and tailoring devices to the functional needs of older adults (34%). This study suggests that older adults with CP are interested and willing to use mHealth to assist in the management of pain. Participants in our study reported important barriers that medical professionals, researchers, and mHealth developers should address to help facilitate the development and evaluation of age-appropriate, and function-appropriate, m

  20. Modeling connectivity to identify current and future anthropogenic barriers to movement of large carnivores: A case study in the American Southwest.

    Science.gov (United States)

    McClure, Meredith L; Dickson, Brett G; Nicholson, Kerry L

    2017-06-01

    This study sought to identify critical areas for puma ( Puma concolor ) movement across the state of Arizona in the American Southwest and to identify those most likely to be impacted by current and future human land uses, particularly expanding urban development and associated increases in traffic volume. Human populations in this region are expanding rapidly, with the potential for urban centers and busy roads to increasingly act as barriers to demographic and genetic connectivity of large-bodied, wide-ranging carnivores such as pumas, whose long-distance movements are likely to bring them into contact with human land uses and whose low tolerance both for and from humans may put them at risk unless opportunities for safe passage through or around human-modified landscapes are present. Brownian bridge movement models based on global positioning system collar data collected during bouts of active movement and linear mixed models were used to model habitat quality for puma movement; then, a wall-to-wall application of circuit theory models was used to produce a continuous statewide estimate of connectivity for puma movement and to identify pinch points, or bottlenecks, that may be most at risk of impacts from current and future traffic volume and expanding development. Rugged, shrub- and scrub-dominated regions were highlighted as those offering high quality movement habitat for pumas, and pinch points with the greatest potential impacts from expanding development and traffic, although widely distributed, were particularly prominent to the north and east of the city of Phoenix and along interstate highways in the western portion of the state. These pinch points likely constitute important conservation opportunities, where barriers to movement may cause disproportionate loss of connectivity, but also where actions such as placement of wildlife crossing structures or conservation easements could enhance connectivity and prevent detrimental impacts before they occur.

  1. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis.

    Science.gov (United States)

    Egerton, T; Diamond, L E; Buchbinder, R; Bennell, K L; Slade, S C

    2017-05-01

    Primary care management of osteoarthritis (OA) is variable and often inconsistent with clinical practice guidelines (CPGs). This study aimed to identify and synthesize available qualitative evidence on primary care clinicians' views on providing recommended management of OA. Eligibility criteria included full reports published in peer-reviewed journals, with data collected directly from primary care clinicians using qualitative methods for collection and analysis. Five electronic databases (MEDLINE, Cochrane Central Register, EMBASE, CINAHL and PsychInfo) were searched to August 2016. Two independent reviewers identified eligible reports, conducted critical appraisal (based on Critical Appraisal Skills Programme (CASP) criteria), and extracted data. Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive new themes. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach was used to determine a confidence profile for each finding. Eight studies involving approximately 83 general practitioners (GPs), 24 practice nurses, 12 pharmacists and 10 physical therapists, from Australia, France, United Kingdom, Germany and Mexico were included. Four barriers were identified as themes 1) OA is not that serious, 2) Clinicians are, or perceive they are, under-prepared, 3) Personal beliefs at odds with providing recommended practice, and 4) Dissonant patient expectations. No themes were enablers. Confidence ratings were moderate or low. Synthesising available data revealed barriers that collectively point towards a need to address clinician knowledge gaps, and enhance clinician communication and behaviour change skills to facilitate patient adherence, enable effective conversations and manage dissonant patient expectations. PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543]. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  2. AN EVALUATION TO IDENTIFY THE BARRIERS TO THE FEASIBILITY OF URBAN DEVELOPMENT PLANS: FIVE DECADES OF EXPERIENCE IN URBAN PLANNING IN IRAN

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Maghsoodi Tilaki

    2014-01-01

    Full Text Available The rapid urbanization in many developing countries has indicat ed several challenges in different aspects. This is due t o inefficient urban planning ap proaches towards managing the development process. Similar to many other developing count ries, Iran has experienced rapid urbanization in recent decades. Although over the last few decades, urban planning processes have been applied to develop Iranian c ities, urban planning has failed to tackle the challenges facing the cities. This paper s eeks to identify the barriers that have prevented Iranian c ities from achieving the goals of urban planning. The purpose of this paper is to provide a comprehensive review of the curre nt literature on the concept of urban planning and to assess the urban development plan proc ess in Iranian cities. The required data were collected through a review of international theoretical studies, Iranian experimental research and governmental reports. The findings of this study reveal five major barriers to the feasibility of the urban planning process , including the urban plans context, structure of urban pla nning, related law and regulatio ns, public participation, and financial resources.

  3. Flip flops, dress clothes, and no coat: clothing barriers to children's physical activity in child-care centers identified from a qualitative study

    Directory of Open Access Journals (Sweden)

    Saelens Brian E

    2009-11-01

    Full Text Available Abstract Background Three-quarters of 3-6 year-old children in the U.S. spend time in childcare; many spend most of their waking hours in these settings. Daily physical activity offers numerous health benefits, but activity levels vary widely across centers. This study was undertaken to explore reasons why physical activity levels may vary. The purpose of this paper is to summarize an unexpected finding that child-care providers cited was a key barrier to children's physical activity. Methods Nine focus groups with 49 child-care providers (55% black from 34 centers (including inner-city, suburban, Head Start and Montessori were conducted in Cincinnati, OH. Three independent raters analyzed verbatim transcripts for themes. Several techniques were used to increase credibility of findings, including interviews with 13 caregivers. Results Two major themes about clothing were: 1 children's clothing was a barrier to children's physical activity in child-care, and 2 clothing choices were a significant source of conflict between parents and child-care providers. Inappropriate clothing items included: no coat/hat/gloves in the wintertime, flip flops or sandals, dress/expensive clothes, jewelry, and clothes that were either too loose or too tight. Child-care providers explained that unless there were enough extra coats at the center, a single child without a coat could prevent the entire class from going outside. Caregivers suggested several reasons why parents may dress their child inappropriately, including forgetfulness, a rushed morning routine, limited income to buy clothes, a child's preference for a favorite item, and parents not understanding the importance of outdoor play. Several child-care providers favored specific policies prohibiting inappropriate clothing, as many reported limited success with verbal or written reminders to bring appropriate clothing. Conclusion Inappropriate clothing may be an important barrier to children's physical

  4. Flip flops, dress clothes, and no coat: clothing barriers to children's physical activity in child-care centers identified from a qualitative study

    Science.gov (United States)

    2009-01-01

    Background Three-quarters of 3-6 year-old children in the U.S. spend time in childcare; many spend most of their waking hours in these settings. Daily physical activity offers numerous health benefits, but activity levels vary widely across centers. This study was undertaken to explore reasons why physical activity levels may vary. The purpose of this paper is to summarize an unexpected finding that child-care providers cited was a key barrier to children's physical activity. Methods Nine focus groups with 49 child-care providers (55% black) from 34 centers (including inner-city, suburban, Head Start and Montessori) were conducted in Cincinnati, OH. Three independent raters analyzed verbatim transcripts for themes. Several techniques were used to increase credibility of findings, including interviews with 13 caregivers. Results Two major themes about clothing were: 1) children's clothing was a barrier to children's physical activity in child-care, and 2) clothing choices were a significant source of conflict between parents and child-care providers. Inappropriate clothing items included: no coat/hat/gloves in the wintertime, flip flops or sandals, dress/expensive clothes, jewelry, and clothes that were either too loose or too tight. Child-care providers explained that unless there were enough extra coats at the center, a single child without a coat could prevent the entire class from going outside. Caregivers suggested several reasons why parents may dress their child inappropriately, including forgetfulness, a rushed morning routine, limited income to buy clothes, a child's preference for a favorite item, and parents not understanding the importance of outdoor play. Several child-care providers favored specific policies prohibiting inappropriate clothing, as many reported limited success with verbal or written reminders to bring appropriate clothing. Conclusion Inappropriate clothing may be an important barrier to children's physical activity in child

  5. Identifying and prioritizing export barriers to small and medium enterprises (SMEs regarding food Industry based on national competition diamond Cole Porter model

    Directory of Open Access Journals (Sweden)

    Hossein Rahmanyyoushanlouei

    2013-07-01

    Full Text Available Diamond model Cole Porter and approaches after that have been used in several investigations in most countries and the credit behind the model has been repeatedly confirmed. But any theory is contended with regard to the conditions and time scope of their own; and gets corrected with the emergence of new features and based on the environment of reform. Current study has tried to identify and prioritize export barriers to small and medium enterprises (SMEs regarding food industry based on national competition diamond Cole Porter model in Iran (East Azerbaijan province and its subject pool were 266 people who were given the questionnaires. The method used to analyze and get information from research was exploratory confirmation factor, particularly from the equations structural theories for examination. With regard to the results achieved all hypotheses were confirmed.

  6. Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

    Science.gov (United States)

    O'Donnell, Patrick; Tierney, Edel; O'Carroll, Austin; Nurse, Diane; MacFarlane, Anne

    2016-12-03

    The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.

  7. How Can Medical Students Add Value? Identifying Roles, Barriers, and Strategies to Advance the Value of Undergraduate Medical Education to Patient Care and the Health System.

    Science.gov (United States)

    Gonzalo, Jed D; Dekhtyar, Michael; Hawkins, Richard E; Wolpaw, Daniel R

    2017-09-01

    As health systems evolve, the education community is seeking to reimagine student roles that combine learning with meaningful contributions to patient care. The authors sought to identify potential stakeholders regarding the value of student work, and roles and tasks students could perform to add value to the health system, including key barriers and associated strategies to promote value-added roles in undergraduate medical education. In 2016, 32 U.S. medical schools in the American Medical Association's (AMA's) Accelerating Change in Education Consortium met for a two-day national meeting to explore value-added medical education; 121 educators, systems leaders, clinical mentors, AMA staff leadership and advisory board members, and medical students were included. A thematic qualitative analysis of workshop discussions and written responses was performed, which extracted key themes. In current clinical roles, students can enhance value by performing detailed patient histories to identify social determinants of health and care barriers, providing evidence-based medicine contributions at the point-of-care, and undertaking health system research projects. Novel value-added roles include students serving as patient navigators/health coaches, care transition facilitators, population health managers, and quality improvement team extenders. Six priority areas for advancing value-added roles are student engagement, skills, and assessments; balance of service versus learning; resources, logistics, and supervision; productivity/billing pressures; current health systems design and culture; and faculty factors. These findings provide a starting point for collaborative work to positively impact clinical care and medical education through the enhanced integration of value-added medical student roles into care delivery systems.

  8. Community voices: barriers and opportunities for programmes to successfully prevent vertical transmission of HIV identified through consultations among people living with HIV.

    Science.gov (United States)

    Anderson, Ginna; Caswell, Georgina; Edwards, Olive; Hsieh, Amy; Hull, Beri; Mallouris, Christoforos; Mason, Naisiadet; Nöstlinger, Christiana

    2012-07-11

    In 2010, two global networks of people living with HIV, the International Community of Women Living with HIV (ICW Global) and the Global Network of People living with HIV (GNP+) were invited to review a draft strategic framework for the global scale up of prevention of vertical transmission (PVT) through the primary prevention of HIV and the prevention of unintended pregnancies among women living with HIV. In order to ensure recommendations were based on expressed needs of people living with HIV, GNP+ and ICW Global undertook a consultation amongst people living with HIV which highlighted both facilitators and barriers to prevention services. This commentary summarizes the results of that consultation. The consultation was comprised of an online consultation (moderated chat-forum with 36 participants from 16 countries), an anonymous online e-survey (601 respondents from 58 countries), and focus-group discussions with people living with HIV in Jamaica (27 participants). The consultation highlighted the discrepancies across regions with respect to access to essential packages of PVT services. However, the consultation participants also identified common barriers to access, including a lack of trustworthy sources of information, service providers' attitudes, and gender-based violence. In addition, participant responses revealed common facilitators of access, including quality counselling on reproductive choices, male involvement, and decentralized services. The consultation provided some understanding and insight into the participants' experiences with and recommendations for PVT strategies. Participants agreed that successful, comprehensive PVT programming require greater efforts to both prevent primary HIV infection among young women and girls and, in particular, targeted efforts to ensure that women living with HIV and their partners are supported to avoid unintended pregnancies and to have safe, healthy pregnancies instead. In addition to providing the insights

  9. A novel PET imaging protocol identifies seizure-induced regional overactivity of P-glycoprotein at the blood-brain barrier

    Science.gov (United States)

    Bankstahl, Jens P.; Bankstahl, Marion; Kuntner, Claudia; Stanek, Johann; Wanek, Thomas; Meier, Martin; Ding, Xiao-Qi; Müller, Markus; Langer, Oliver; Löscher, Wolfgang

    2013-01-01

    About one third of epilepsy patients are pharmacoresistant. Overexpression of P-glycoprotein and other multidrug transporters at the blood-brain barrier is thought to play an important role in drug-refractory epilepsy. Thus, quantification of regionally different P-glycoprotein activity in the brain in vivo is essential to identify P-glycoprotein overactivity as the relevant mechanism for drug-resistance in an individual patient. Using the radiolabeled P-glycoprotein substrate (R)-[11C]verapamil and different doses of co-administered tariquidar, which is an inhibitor of P-glycoprotein, we evaluated whether small-animal positron emission tomography (PET) can quantify regional changes in transporter function in the rat brain at baseline and 48 h after a pilocarpine-induced status epilepticus. P-glycoprotein expression was additionally quantified by immunohistochemistry. To reveal putative seizure-induced changes in blood-brain barrier integrity, we performed gadolinium-enhanced magnetic resonance scans on a 7.0 Tesla small-animal scanner. Before P-glycoprotein modulation, brain uptake of (R)-[11C]verapamil was low in all regions investigated in control and post-status epilepticus rats. After administration of 3 mg/kg tariquidar, which inhibits P-glycoprotein only partially, we observed increased regional differentiation in brain activity uptake in post-status epilepticus versus control rats, which diminished after maximal P-glycoprotein inhibition. Regional increases in the efflux rate constant k2, but not in distribution volume VT or influx rate constant K1, correlated significantly with increases in P-glycoprotein expression measured by immunohistochemistry. This imaging protocol proves to be suitable to detect seizure-induced regional changes in P-glycoprotein activity and is readily applicable to humans, with the aim to detect relevant mechanisms of pharmacoresistance in epilepsy in vivo. PMID:21677164

  10. Internal photoemission for photovoltaic using p-type Schottky barrier: Band structure dependence and theoretical efficiency limits

    Science.gov (United States)

    Shih, Ko-Han; Chang, Yin-Jung

    2018-01-01

    Solar energy conversion via internal photoemission (IPE) across a planar p-type Schottky junction is quantified for aluminum (Al) and copper (Cu) in the framework of direct transitions with non-constant matrix elements. Transition probabilities and k-resolved group velocities are obtained based on pseudo-wavefunction expansions and realistic band structures using the pseudopotential method. The k-resolved number of direct transitions, hole photocurrent density, quantum yield (QY), and the power conversion efficiency (PCE) under AM1.5G solar irradiance are subsequently calculated and analyzed. For Al, the parabolic and "parallel-band" effect along the U-W-K path significantly enhances the transition rate with final energies of holes mainly within 1.41 eV below the Fermi energy. For Cu, d-state hot holes mostly generated near the upper edge of 3d bands dominate the hole photocurrent and are weekly (strongly) dependent on the barrier height (metal film thickness). Hot holes produced in the 4s band behave just oppositely to their d-state counterparts. Non-constant matrix elements are shown to be necessary for calculations of transitions due to time-harmonic perturbation in Cu. Compared with Cu, Al-based IPE in p-type Schottky shows the highest PCE (QY) up to about 0.2673% (5.2410%) at ΦB = 0.95 eV (0.5 eV) and a film thickness of 11 nm (20 nm). It is predicted that metals with relatively dispersionless d bands (such as Cu) in most cases do not outperform metals with photon-accessible parallel bands (such as Al) in photon energy conversion using a planar p-type Schottky junction.

  11. Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation.

    Science.gov (United States)

    Richmond, Helen; Hall, Amanda M; Hansen, Zara; Williamson, Esther; Davies, David; Lamb, Sarah E

    2018-03-01

    Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains. Three themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting. This study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments. Copyright © 2017 Chartered Society of Physiotherapy. All rights reserved.

  12. Offshore limit of coastal ocean variability identified from hydrography and altimeter data in the eastern Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Antony, M.K.; Swamy, G.N.; Somayajulu, Y.K.

    In this communication, we describe a hitherto-unknown offshore limit to the coastal ocean variability signatures away from the continental shelf in the eastern Arabian Sea, based on hydrographic observations and satellite altimeter (TOPEX...

  13. Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future.

    Science.gov (United States)

    Grabowski, Henry G; Guha, Rahul; Salgado, Maria

    2014-06-01

    In March 2010 Congress established an abbreviated Food and Drug Administration approval pathway for biosimilars-drugs that are very similar but not identical to a reference biological product and cost less. Because bringing biosimilars to the market currently requires large investments of money, fewer biosimilars are expected to enter the biologics market than has been the case with generic drugs entering the small-molecule drug market. Additionally, given the high regulatory hurdles to obtaining interchangeability-which would allow pharmacists to substitute a biosimilar for its reference product, subject to evolving state substitution laws-most biosimilars will likely compete as therapeutic alternatives instead of as therapeutic equivalents. In other words, biosimilars will need to compete with their reference product on the basis of quality; price; and manufacturer's reputation with physicians, insurers, and patient groups. Biosimilars also will face dynamic competition from new biologics in the same therapeutic class-including "biobetters," which offer incremental improvements on reference products, such as extended duration of action. The prospects for significant cost savings from the use of biosimilars appear to be limited for the next several years, but their use should increase over time because of both demand- and supply-side factors. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Smart parking barrier

    KAUST Repository

    Alharbi, Abdulrazaq M.

    2016-05-06

    Various methods and systems are provided for smart parking barriers. In one example, among others, a smart parking barrier system includes a movable parking barrier located at one end of a parking space, a barrier drive configured to control positioning of the movable parking barrier, and a parking controller configured to initiate movement of the parking barrier, via the barrier drive. The movable parking barrier can be positioned between a first position that restricts access to the parking space and a second position that allows access to the parking space. The parking controller can initiate movement of the movable parking barrier in response to a positive identification of an individual allowed to use the parking space. The parking controller can identify the individual through, e.g., a RFID tag, a mobile device (e.g., a remote control, smartphone, tablet, etc.), an access card, biometric information, or other appropriate identifier.

  15. Trait assembly of woody plants in communities across sub-alpine gradients: Identifying the role of limiting similarity

    NARCIS (Netherlands)

    Yan, B.; Zhang, J.; Liu, Y.; Li, Z.; Huang, X.; Yang, W.; Prinzing, A.

    2012-01-01

    Questions - Plant species can be assembled into communities through habitat filtering or species competition, but their relative roles are still debated. We do not know whether there is limited similarity between co-existing species when accounting for the parallel effect of abiotic habitat

  16. Increasing the Photoautotrophic Growth Rate of Synechocystis sp. PCC 6803 by Identifying the Limitations of Its Cultivation.

    Science.gov (United States)

    van Alphen, Pascal; Abedini Najafabadi, Hamed; Branco Dos Santos, Filipe; Hellingwerf, Klaas J

    2018-03-25

    Many conditions have to be optimized in order to be able to grow the cyanobacterium Synechocystis sp. PCC 6803 (Synechocystis) for an extended period of time under physiologically well-defined and constant conditions. It is still poorly understood what limits growth of this organism in batch and continuous cultures in BG-11, the standard medium used to grow Synechocystis. Through a series of batch experiments in flasks and continuous mode experiments in advanced photobioreactors, it is shown that the limiting nutrient during batch cultivation is sulfate, the depletion of which leads to ROS formation and rapid bleaching of pigments after entry into stationary phase. In continuous mode, however, the limiting nutrient is iron. Optimizing these growth conditions resulted in a so far highest growth rate of 0.16 h -1 (4.3 h doubling time), which is significantly higher than the textbook value of 0.09 h -1 (8 h doubling time). An improved medium, BG-11 for prolonged cultivation (BG-11-PC) is introduced, that allows for controlled, extended cultivation of Synechocystis, under well-defined physiological conditions. The data present here have implications for mass-culturing of cyanobacteria. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  17. Optical pre-screening in breast screening programs: Can we identify women who benefit most from limited mammography resources?

    Science.gov (United States)

    Walter, Jane; Loshchenov, Maxim; Zhilkin, Vladimir; Peake, Rachel; Stone, Jennifer; Lilge, Lothar

    2017-04-01

    Background: In excess of 60% of all cancers are detected in low and middle-income countries, with breast cancer (BC) the dominant malignancy for women. Incidence rates continue to climb, most noticeably in the less than 50-year-old population. Expansion of mammography infrastructure and resources is lacking, resulting in over 60% of women diagnosed with stage III/IV BC in the majority of these countries. Optical Breast Spectroscopy (OBS) was shown to correlate well with mammographic breast density (MBD). OBS could aid breast screening programs in low- and middle-income countries by lowering the number of mammographs required for complete population coverage. However, its performance needs to be tested in large population trails to ensure high sensitivity and acceptable specificity. Methods: For the planned studies in low- and middle-income countries in different continents, online methods need to be implemented to monitor the performance and data collection by these devices, operated by trained nurses. Based on existing datasets, procedures were developed to validate an individual woman's data integrity and to identify operator errors versus system malfunctions. Results: Using a dataset comprising spectra from 360 women collected by 2 instruments in different locations and with 3 different trained operators, automated methods were developed to identify 100% of the source or photodetector malfunctions as well as incorrect calibrations and 96% of instances of insufficient tissue contact. Conclusions: Implementing the dataset validation locally in each instrument and tethered to a cloud database will allow the planned clinical trials to proceed.

  18. Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study.

    Science.gov (United States)

    Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Ruland, Cornelia M

    2015-11-18

    Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers' beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR's strength of being broad and comprehensive also limits its

  19. What's on a decision makers mind? - Identifying barriers in information flows between actors in integrated water management using mental model mapping. Poster.

    NARCIS (Netherlands)

    Kolkman, Rien; van Os, A.G.; Geurts, Petrus A.T.M.; van der Veen, A.

    2004-01-01

    This research studies the relation between mental models and the decision process outcome, in the specific case of the Zwolle storm surge barrier. Differences in mental models between stakeholders will result in different lines of argumentation leading to different solution alternatives. The final

  20. Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment

    Science.gov (United States)

    Gruskin, Sofia; Ferguson, Laura; Alfven, Tobias; Rugg, Deborah; Peersman, Greet

    2013-01-01

    Introduction Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention. Conclusions Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in

  1. The Use of Online Posts to Identify Barriers to and Facilitators of HIV Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men: A Comparison to a Systematic Review of the Peer-Reviewed Literature.

    Science.gov (United States)

    Hannaford, Alisse; Lipshie-Williams, Madeleine; Starrels, Joanna L; Arnsten, Julia H; Rizzuto, Jessica; Cohen, Phillip; Jacobs, Damon; Patel, Viraj V

    2018-04-01

    Pre-exposure prophylaxis (PrEP) remains an under-utilized HIV prevention tool among men who have sex with men (MSM). To more comprehensively elucidate barriers and facilitators to PrEP use among US MSM, we conducted a systematic review of peer-reviewed published articles and content analysis of online posts about PrEP. We searched peer-reviewed databases (Medline, Web of Science, Google Scholar) using MESH headings and keywords about PrEP and/or HIV prevention from 2005 to 2015. We included original studies among MSM in the US that reported on barriers, facilitators, or other factors related to PrEP use. We also searched online posts and associated comments (news articles, opinion pieces, blogs and other social media posts) in diverse venues (Facebook, Slate Outward, Huffington Post Gay Voices, Queerty, and My PrEP Experience blog) to identify posts about PrEP. We used content analysis to identify themes and compare potential differences between the peer-reviewed literature and online posts. We identified 25 peer-reviewed articles and 28 online posts meeting inclusion criteria. We identified 48 unique barriers and 46 facilitators to using PrEP. These 94 themes fit into six overarching categories: (1) access (n = 14), (2) attitudes/beliefs (n = 24), (3) attributes of PrEP (n = 13), (4) behaviors (n = 11), (5) sociodemographic characteristics (n = 8), and (6) social network (n = 6). In all categories, analysis of online posts resulted in identification of a greater number of unique themes. Thirty-eight themes were identified in the online posts that were not identified in the peer-reviewed literature. We identified barriers and facilitators to PrEP in online posts that were not identified in a systematic review of the peer-reviewed literature. By incorporating data both from a systematic review of peer-reviewed articles and from online posts, we have identified salient and novel information about barriers to and facilitators of PrEP use. Traditional

  2. Extremal surface barriers

    International Nuclear Information System (INIS)

    Engelhardt, Netta; Wall, Aron C.

    2014-01-01

    We present a generic condition for Lorentzian manifolds to have a barrier that limits the reach of boundary-anchored extremal surfaces of arbitrary dimension. We show that any surface with nonpositive extrinsic curvature is a barrier, in the sense that extremal surfaces cannot be continuously deformed past it. Furthermore, the outermost barrier surface has nonnegative extrinsic curvature. Under certain conditions, we show that the existence of trapped surfaces implies a barrier, and conversely. In the context of AdS/CFT, these barriers imply that it is impossible to reconstruct the entire bulk using extremal surfaces. We comment on the implications for the firewall controversy

  3. Limites e possibilidades da identificação de risco de autismo no primeiro ano de vida Limits and possibilities of identifying autism within the first year of life

    Directory of Open Access Journals (Sweden)

    Mariana Luisa Garcia

    2011-01-01

    Full Text Available Identificar risco de autismo no primeiro ano de vida possibilita intervir precocemente para um prognóstico mais favorável em crianças com autismo. O objetivo deste artigo é discutir limites e possibilidades metodológicas que viabilizem a identificação de sinais de risco de autismo entre 0-12 meses. A metodologia empregada em 24 estudos (retrospectivos e prospectivos sobre identificação de sinais precoces e seus resultados foram analisados. Verificou-se que os limites da identificação de risco de autismo no primeiro ano parecem residir na buscar por categorias comportamentais discretas e que as possibilidades podem residir em analisar categorias de interação e de ordem afetiva.Identifying signs of autism in the first year of life is justified by early intervention and better prognostic. This article aims at discussing methodological limits and possibilities of identifying risk of autism at 0-12 months. Methodology from 24 retrospective and prospective early signs studies and their outcomes were analyzed. Limits of identifying risk of autism in the 1st year of life lies in observing discrete behavioral categories, and possibilities seem to lie in analyzing interactional and affective categories.

  4. Barriers to implement green supply chain management in automobile industry using interpretive structural modeling technique: An Indian perspective

    Directory of Open Access Journals (Sweden)

    Sunil Luthra

    2011-07-01

    Full Text Available Purpose: Green Supply Chain Management (GSCM has received growing attention in the last few years. Most of the automobile industries are setting up their own manufacturing plants in competitive Indian market. Due to public awareness, economic, environmental or legislative reasons, the requirement of GSCM has increased.  In this context, this study aims to develop a structural model of the barriers to implement GSCM in Indian automobile industry.Design/methodology/approach: We have identified various barriers and contextual relationships among the identified barriers. Classification of barriers has been carried out based upon dependence and driving power with the help of MICMAC analysis. In addition to this, a structural model of barriers to implement GSCM in Indian automobile industry has also been put forward using Interpretive Structural Modeling (ISM technique. Findings: Eleven numbers of relevant barriers have been identified from literature and subsequent discussions with experts from academia and industry. Out of which, five numbers of barriers have been identified as dependent variables; three number of barriers have been identified as the driver variables and three number of barriers have been identified as the linkage variables. No barrier has been identified as autonomous variable. Four barriers have been identified as top level barriers and one bottom level barrier. Removal of these barriers has also been discussed.Research limitations/implications: A hypothetical model of these barriers has been developed based upon experts’ opinions. The conclusions so drawn may be further modified to apply in real situation problem. Practical implications: Clear understanding of these barriers will help organizations to prioritize better and manage their resources in an efficient and effective way.Originality/value: Through this paper we contribute to identify the barriers to implement GSCM in Indian automobile industry and to prioritize them

  5. 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

    Science.gov (United States)

    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...

  6. Multilayer moisture barrier

    Science.gov (United States)

    Pankow, Joel W; Jorgensen, Gary J; Terwilliger, Kent M; Glick, Stephen H; Isomaki, Nora; Harkonen, Kari; Turkulainen, Tommy

    2015-04-21

    A moisture barrier, device or product having a moisture barrier or a method of fabricating a moisture barrier having at least a polymer layer, and interfacial layer, and a barrier layer. The polymer layer may be fabricated from any suitable polymer including, but not limited to, fluoropolymers such as polyethylene terephthalate (PET) or polyethylene naphthalate (PEN), or ethylene-tetrafluoroethylene (ETFE). The interfacial layer may be formed by atomic layer deposition (ALD). In embodiments featuring an ALD interfacial layer, the deposited interfacial substance may be, but is not limited to, Al.sub.2O.sub.3, AlSiO.sub.x, TiO.sub.2, and an Al.sub.2O.sub.3/TiO.sub.2 laminate. The barrier layer associated with the interfacial layer may be deposited by plasma enhanced chemical vapor deposition (PECVD). The barrier layer may be a SiO.sub.xN.sub.y film.

  7. Prevention of Filipino Youth Behavioral Health Disparities: Identifying Barriers and Facilitators to Participating in "Incredible Years," an Evidence-Based Parenting Intervention, Los Angeles, California, 2012.

    Science.gov (United States)

    Flores, Nicole; Supan, Jocelyn; Kreutzer, Cary B; Samson, Allan; Coffey, Dean M; Javier, Joyce R

    2015-10-22

    Evidence-based interventions for training parents are proven to prevent onset and escalation of childhood mental health problems. However, participation in such programs is low, especially among hard-to-reach, underserved populations such as Filipino Americans. Filipinos, the largest Asian subgroup in California, have significant behavioral health disparities compared with non-Hispanic whites and other Asian subgroups. The purpose of this study was to learn about Filipinos' barriers and facilitators to participating in "Incredible Years" (IY), a parenting program. We conducted 4 focus groups in Los Angeles, California, in 2012; the groups consisted of 20 Filipino parents of children aged 6 to 12 years who recently completed the IY parenting program, which was offered as a prevention workshop. Three reviewers, including two co-authors (A.S., J.J.) and a research assistant used content analysis to independently code the interview transcripts and extract subthemes. Grounded theory analytic methods were used to analyze interview transcripts. Parents' perceived benefits of participation in IY were learning more effective parenting techniques, networking with other parents, improved spousal relationships, and improvements in their children's behavior. Parents' most common motivating factor for enrollment in IY was to improve their parenting skills and their relationships with their children. The most common barriers to participation were being uncomfortable sharing problems with others and the fear of being stigmatized by others judging their parenting skills. Participants said that parent testimonials would be the most effective way to promote IY. Many recommended outreach at schools, pediatricians' offices, and churches. Increasing Filipino American parent enrollment in IY in culturally relevant ways will reduce the incidence of mental health disorders among children in this growing population.

  8. Bipolar affective disorder and medication therapy: identifying barriers Trastorno afectivo bipolar y por terapia medicamentoso: identificación de barreras Transtorno afetivo bipolar e terapêutica medicamentosa: identificando barreiras

    Directory of Open Access Journals (Sweden)

    Adriana Inocenti Miasso

    2008-08-01

    Full Text Available This study identified the barriers faced by people with bipolar affective disorder (BAD regarding the need for continuous medication. The qualitative approach was used, and the methodological framework was based on the Grounded Theory in the light of Symbolic Interactionism. In total, of 14 people with BAD, who were being attended at the Outpatient Unit for Mood Disorders of a university hospital, and 14 relatives indicated by them participated in the study. The data collection was carried out through interviews and observation. Two categories emerged from the results, describing the barriers faced by people with BAD: to have affective and cognitive losses and to have several limitations. People with BAD feel ambivalent regarding medication adherence, as they perceive that, no matter the direction they take, it will lead to a context of prejudice, losses and limitations in various spheres of daily life.Este estudio identificó las barreras enfrentadas por las personas con Trastorno Afectivo Bipolar (TAB ante la necesidad del usar continuamente medicamentos. De enfoque cualitativo, tuvo como referencia metodológico, a la Teoría Basada en los Datos, bajo la perspectiva de la Interacción Simbólica. Participaron del estudio 14 personas con TAB, las cuales seguían tratamiento en un servicio Ambulatorio para Trastornos del Humor de un hospital universitario y 14 familiares señalados por los mismos. Las principales formas de obtención de datos fueron la entrevista y la observación. Los resultados mostraron dos categorías que describen las barreras enfrentadas por las personas con TAB: manifestar olvidos afectivos y cognoscitivos y la aparición de varias limitaciones. Se constató que la persona con TAB sienten ambivalencia con relación al seguimiento medicamentoso, pues perciben que cualquiera que sea la dirección adoptada, las conducirá al preconcepto, pérdidas y limitaciones en las diversas esferas de su vida.Este estudo identificou as

  9. Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF).

    Science.gov (United States)

    Craig, Louise E; McInnes, Elizabeth; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A; Considine, Julie; Middleton, Sandy

    2016-11-28

    Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of "environmental, context and resources" (such as stressful working conditions or lack of resources) and "knowledge" (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of "knowledge" (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and "skills" (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were "focus on past success" and "information about health consequences." Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have

  10. Information barriers

    International Nuclear Information System (INIS)

    Fuller, J.L.; Wolford, J.

    2001-01-01

    measurement equipment, that the system is functioning properly and does not incorporate any hidden features (or 'switches') that allows the host to pass out-of-spec items. Authentication of information barrier systems is an extremely important concept to consider in designing and assembling these types of inspection systems. There are a limited set of straightforward approaches to authenticate such systems, when applied in conjunction with open and cooperative system design and fabrication, that will provide a high degree of confidence to both host and inspector that the system will prevent the release of classified information and yet still inspect items in a manner consistent with the objectives of an inspection agreement. These principles have been outlined in this paper, along with areas where additional studies would be helpful. (author)

  11. Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature.

    Science.gov (United States)

    Fischbach, Wolfgang; Elsome, Rory; Amlani, Bharat

    2018-06-05

    Colonoscopy provides less protection from colorectal cancer in the right colon than the left. Areas covered: This review examines patient outcomes and colonoscopy success rates to identify factors that limit the protective effect of colonoscopy in the right colon. The MEDLINE and Embase databases were searched for literature from 2000 onwards, on the long-term outcomes and differences in screening practice between the right and left colon. In total, 12 systematic reviews (including nine meta-analyses) and 44 primary data records were included. Differences in patient outcomes and colonoscopy practice were identified between the right and left colon, suggesting that several factors, many of which disproportionally affect the right colon, impact lesion detection rates. Shorter withdrawal times reduce detection rates, while longer times significantly increase detection; mostly of adenomas in the right colon. Colonoscope attachments often only show a significant improvement in detection rates in the right colon, suggesting detection is more challenging due to visibility of the right colonic mucosa. Higher bowel cleansing grades significantly improve detection rates in the right colon compared to the left. Expert commentary: These findings confirm the need for continued improvement of colonoscopy effectiveness, and obligatory quality assessment, overall and especially in the right colon.

  12. Special Experts Meeting: Identifying and Overcoming Barriers to the Effective Consideration of Human and Organizational Factors in Event Analysis and Root Cause Analysis. Nuclear Energy Agency / Working Group on Human and Organizational Factors

    International Nuclear Information System (INIS)

    2011-01-01

    The main mission of the Nuclear Energy Agency (NEA) Working Group on Human and Organisational Factors (WGHOF) is to improve the understanding and treatment of human and organisational factors (HOF) within the nuclear industry in order to support the continued safety performance of nuclear installations and improve the effectiveness of regulatory practices in member countries. WGHOF developed a CSNI (Committee on the Safety of Nuclear Installations) Activity Proposal Sheet (CAPS) outlining the work and milestones necessary towards achieving the following objectives: - Identify barriers to analyzing and correctly identifying the Human and Organisational Factors (HOF) causes of events; - Identify barriers to implementing lessons learned from these analyses; and - Develop recommendations for overcoming these barriers to: improve the identification of HOF causes of events and support the successful implementation of appropriate corrective actions The CAPS can be found in Appendix A. The first activity under the plan was the development of a questionnaire. This was distributed to WGHOF members and their counterparts from the Working Group on Operating Experience (WGOE). The questionnaire was comprised of 20 questions based on the objectives of the CSNI Activity Proposed Sheet. The intended survey participants were licensees with previous experience conducting root cause analyses. Responses were received from 26 respondents from 11 different countries. The results of the questionnaire were analyzed to identify themes for further discussion during a specialist meeting planned for September 2009. The following themes were presented during the WGHOF meeting in March of 2009 and endorsed for further work: - Roles and Influence of Senior Management, - Skills and Knowledge of the Investigators, - Qualitative Nature of HOF, - Influence of the Regulator, - Systematic Approach to Investigation. A summary of the questionnaire responses is provided in Appendix B

  13. Self-Centric and Altruistic Unmet Needs for Ebola : Barriers to International Preparedness

    NARCIS (Netherlands)

    Van de Burgwal, Linda H M; Reperant, Leslie A; Osterhaus, Albert D M E; Iancu, Sorana C; Pronker, Esther S; Claassen, H.J.H.M.

    2016-01-01

    OBJECTIVE: Barriers to international Ebola preparedness may be elucidated by identifying heterogeneities in arguments to invest in countermeasures during "peace time." METHODS: For each patent family (related patent documents that differed only by limited alterations to the same invention)

  14. Barriers to guideline-compliant psoriasis care: analyses and concepts.

    Science.gov (United States)

    Eissing, L; Radtke, M A; Zander, N; Augustin, M

    2016-04-01

    Despite the availability of effective therapeutics and evidence-based treatment guidelines, a substantial proportion of patients with moderate-to-severe psoriasis does not receive appropriate care. This under-provision of health care may cause further worsening of health, remarkable limitations of the patient's quality of life, and indirect costs for the health care system. In order to provide guideline-compliant care for every psoriasis patient, it is important to identify barriers obstructing optimal care. Studies have identified various barriers on the physician's and on the patient's side; however, respective studies approached only single barriers, and not all of them in the context of psoriasis. Other publications that describe barriers systematically did not focus on psoriasis either. The objective of this literature review was to identify barriers and facilitators, based on studies analysing quality of care and single barriers, resulting in a comprehensive model of causal factors. Our analyses revealed three categories of barriers - patient-related, physician-related and external factors: On the patient side, we found non-adherence to therapies to be an important barrier, often in close association with psychiatric factors. Barriers on the physician's side predominantly are incomplete knowledge of the guidelines as well as the complexity of psoriasis comorbidity. In some countries, payment for patients with complex disease status is poor and inconsistent reimbursement regulations potentially interfere with optimal care. The current analysis indicates that most barriers are interdependent. Thus, measures approaching related barriers simultaneously are required. To improve care for psoriasis patients, further studies systematically addressing all potentially relevant barriers in conjoint are needed. © 2015 European Academy of Dermatology and Venereology.

  15. Limitations of variable number of tandem repeat typing identified through whole genome sequencing of Mycobacterium avium subsp. paratuberculosis on a national and herd level.

    Science.gov (United States)

    Ahlstrom, Christina; Barkema, Herman W; Stevenson, Karen; Zadoks, Ruth N; Biek, Roman; Kao, Rowland; Trewby, Hannah; Haupstein, Deb; Kelton, David F; Fecteau, Gilles; Labrecque, Olivia; Keefe, Greg P; McKenna, Shawn L B; De Buck, Jeroen

    2015-03-08

    identify closely and distantly related isolates, limiting the applicability of using this typing scheme to study the molecular epidemiology of MAP at a national and herd-level.

  16. Identification of barriers to medication adherence in a Latino population.

    Science.gov (United States)

    Compton, Sheryl; Haack, Sally; Phillips, Charles R

    2010-12-01

    Barriers to medication adherence may present differently in diverse patient populations. Because of changing U.S. demographics, health care providers will be required to identify alternative strategies for managing increasingly diverse patient populations. This pilot project identified barriers that may hinder medication adherence in a Latino population. The results of the survey may identify trends in barriers allowing for the development of interventions aimed at improving medication adherence. The study used a convenience sample of Spanish-labeled prescriptions that had not been picked up from a community pharmacy after a 2-week period to identify study subjects. Patients were contacted by phone and surveyed regarding reasons for not picking up their prescription medication. The 24-item survey instrument consisted of demographic and medication-related questions, reasons for, and associated barriers with failure to pick up medications. The most common classes of medications patients failed to pick up were chronic medications. More than 90% of the patients thought that the medication in question was helpful to them, and nearly 80% thought that the medicine was still needed. Patients cited communication issues (ie, content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications, whereas nearly 40% failed to identify any barriers. Barriers identified by patients that could be improved included confusion regarding when their prescription was ready and limited hours of pharmacy operation. Most of the patients were comfortable using the American health care system. The barriers to medication adherence identified did not appear to be the result of cultural influences. This could be because the community pharmacy had bilingual staff and interpreters available for patient education and prescription processing. Alternative methods are needed to further identify reasons for

  17. Fish oil improves motor function, limits blood-brain barrier disruption, and reduces Mmp9 gene expression in a rat model of juvenile traumatic brain injury.

    Science.gov (United States)

    Russell, K L; Berman, N E J; Gregg, P R A; Levant, B

    2014-01-01

    The effects of an oral fish oil treatment regimen on sensorimotor, blood-brain barrier, and biochemical outcomes of traumatic brain injury (TBI) were investigated in a juvenile rat model. Seventeen-day old Long-Evans rats were given a 15mL/kg fish oil (2.01g/kg EPA, 1.34g/kg DHA) or soybean oil dose via oral gavage 30min prior to being subjected to a controlled cortical impact injury or sham surgery, followed by daily doses for seven days. Fish oil treatment resulted in less severe hindlimb deficits after TBI as assessed with the beam walk test, decreased cerebral IgG infiltration, and decreased TBI-induced expression of the Mmp9 gene one day after injury. These results indicate that fish oil improved functional outcome after TBI resulting, at least in part from decreased disruption of the blood-brain barrier through a mechanism that includes attenuation of TBI-induced expression of Mmp9. © 2013 Elsevier Ltd. All rights reserved.

  18. Missed opportunities for catch-up human papillomavirus vaccination among university undergraduates: Identifying health decision-making behaviors and uptake barriers.

    Science.gov (United States)

    Ragan, Kathleen R; Bednarczyk, Robert A; Butler, Scott M; Omer, Saad B

    2018-01-04

    Suboptimal adolescent human papillomavirus (HPV) vaccine rates in the US highlight the need for catch-up vaccination. When teenagers enter college, there may be a shift in healthcare decision-making from parents and guardians to the students themselves. Little is known about factors influencing college students' healthcare decision-making processes. We evaluated HPV vaccine decision-making among 18-to-26-year-old college students through a self-administered, anonymous, cross-sectional survey. This survey was distributed to a sample of men and women in classroom settings at two universities. Categorical data comparisons were conducted using Chi-square and Fisher's exact tests. Multivariate Poisson regression was used to model initiation of HPV vaccine and compute prevalence ratios while controlling for key influential covariates at the 0.05 alpha level. A total of 527 students participated (response proportion=93.1%). Overall, 55.8% of participants received the HPV vaccine. Encouraging conversations with doctors and/or parents/guardians were identified as one of the most influential factors to increase vaccine uptake. Among students who received encouragement from both a doctor and parent, 95.8% received the vaccine. Campaigns about cancer prevention were viewed as more influential than those that focus on preventing genital warts. Approximately one-third of students indicated they didn't know where to get the HPV vaccine. Women were more likely to report that their parents would not let them get the HPV vaccine compared to men (26.7% vs. 2.3%). The majority of students (77.3%) indicated their parents were sometimes, equally, or mostly involved in making decisions about receiving vaccines (other than flu). Students' decision-making is greatly influenced by their parents; therefore, interventions for this population should work to increase students' control over decision-making while also addressing parental concerns. Copyright © 2017 Elsevier Ltd. All rights

  19. Homozygous ALOXE3 Nonsense Variant Identified in a Patient with Non-Bullous Congenital Ichthyosiform Erythroderma Complicated by Superimposed Bullous Majocchi’s Granuloma: The Consequences of Skin Barrier Dysfunction

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2015-09-01

    Full Text Available Non-bullous congenital ichthyosiform erythroderma (NBCIE is a hereditary disorder of keratinization caused by pathogenic variants in genes encoding enzymes important to lipid processing and terminal keratinocyte differentiation. Impaired function of these enzymes can cause pathologic epidermal scaling, significantly reduced skin barrier function. In this study, we have performed a focused, genetic analysis of a probrand affected by NBCIE and extended this to his consanguineous parents. Targeted capture and next-generation sequencing was performed on NBCIE associated genes in the proband and his unaffected consanguineous parents. We identified a homozygous nonsense variant c.814C>T (p.Arg272* in ALOXE3 (NM_001165960.1 in the proband and discovered that his parents are both heterozygous carriers of the variant. The clinical manifestations of the proband’s skin were consistent with NBCIE, and detailed histopathological assessment revealed epidermal bulla formation and Majocchi’s granuloma. Infection with Trichophyton rubrum was confirmed by culture. The patient responded to oral terbinafine antifungal treatment. Decreased skin barrier function, such as that caused by hereditary disorders of keratinization, can increase the risk of severe cutaneous fungal infections and the formation of Majocchi’s granuloma and associated alopecia. Patients with NBCIE should be alerted to the possible predisposition for developing dermatophytoses and warrant close clinical follow-up.

  20. The yeast three-hybrid system as an experimental platform to identify proteins interacting with small signaling molecules in plant cells: Potential and limitations

    Directory of Open Access Journals (Sweden)

    Stéphanie eCottier

    2011-12-01

    Full Text Available Chemical genetics is a powerful scientific strategy that utilizes small bioactive molecules as experimental tools to unravel biological processes. Bioactive compounds occurring in nature represent an enormous diversity of structures that can be used to dissect functions of biological systems. Once the bioactivity of a natural or synthetic compound has been critically evaluated the challenge remains to identify its molecular target and mode of action, which usually is a time consuming and labor-intensive process. To facilitate this task, we decided to implement the yeast three-hybrid (Y3H technology as a general experimental platform to scan the whole Arabidopsis proteome for targets of small signaling molecules. The Y3H technology is based on the yeast two-hybrid system and allows direct cloning of proteins that interact in vivo with a synthetic hybrid ligand, which comprises the biologically active molecule of interest covalently linked to methotrexate (Mtx. In yeast nucleus the hybrid ligand connects two fusion proteins: the Mtx part binding to dihydrofolate reductase fused to a DNA binding domain (encoded in the yeast strain, and the bioactive molecule part binding to its potential protein target fused to a DNA activating domain (encoded on a cDNA expression vector. During cDNA library screening, the formation of this ternary, transcriptional activator complex leads to reporter gene activation in yeast cells, and thereby allows selection of the putative targets of small bioactive molecules of interest. Here we present the strategy and experimental details for construction and application of a Y3H platform, including chemical synthesis of different hybrid ligands, construction of suitable cDNA libraries, the choice of yeast strains, and appropriate screening conditions. Based on the results obtained and the current literature we discussed the perspectives and limitations of the Y3H approach for identifying targets of small bioactive molecules.

  1. Protective barrier development: Overview

    International Nuclear Information System (INIS)

    Wing, N.R.; Gee, G.W.

    1990-01-01

    Protective barrier and warning marker systems are being developed to isolate wastes disposed of near the earth's surface at the Hanford Site. The barrier is designed to function in an arid to semiarid climate, to limit infiltration and percolation of water through the waste zone to near-zero, to be maintenance free, and to last up to 10,000 yr. Natural materials (e.g., fine soil, sand, gravel, riprap, clay, asphalt) have been selected to optimize barrier performance and longevity and to create an integrated structure with redundant features. These materials isolate wastes by limiting water drainage; reducing the likelihood of plant, animal, and human intrusion; controlling emission of noxious gases; and minimizing erosion. Westinghouse Hanford Company and Pacific Northwest Laboratory efforts to assess the performance of various barrier and marker designs will be discussed

  2. Inflammatory Response and Barrier Dysfunction by Different e-Cigarette Flavoring Chemicals Identified by Gas Chromatography-Mass Spectrometry in e-Liquids and e-Vapors on Human Lung Epithelial Cells and Fibroblasts.

    Science.gov (United States)

    Gerloff, Janice; Sundar, Isaac K; Freter, Robert; Sekera, Emily R; Friedman, Alan E; Robinson, Risa; Pagano, Todd; Rahman, Irfan

    2017-03-01

    Recent studies suggest that electronic cigarette (e-cig) flavors can be harmful to lung tissue by imposing oxidative stress and inflammatory responses. The potential inflammatory response by lung epithelial cells and fibroblasts exposed to e-cig flavoring chemicals in addition to other risk-anticipated flavor enhancers inhaled by e-cig users is not known. The goal of this study was to evaluate the release of the proinflammatory cytokine (interleukin-8 [IL-8]) and epithelial barrier function in response to different e-cig flavoring chemicals identified in various e-cig e-liquid flavorings and vapors by chemical characterization using gas chromatography-mass spectrometry analysis. Flavorings, such as acetoin (butter), diacetyl, pentanedione, maltol (malt), ortho-vanillin (vanilla), coumarin, and cinnamaldehyde in comparison with tumor necrosis factor alpha (TNFα), were used in this study. Human bronchial epithelial cells (Beas2B), human mucoepidermoid carcinoma epithelial cells (H292), and human lung fibroblasts (HFL-1) were treated with each flavoring chemical for 24 hours. The cells and conditioned media were then collected and analyzed for toxicity (viability %), lung epithelial barrier function, and proinflammatory cytokine IL-8 release. Cell viability was not significantly affected by any of the flavoring chemicals tested at a concentration of 10 μM to 1 mM. Acetoin and diacetyl treatment induced IL-8 release in Beas2B cells. Acetoin- and pentanedione-treated HFL-1 cells produced a differential, but significant response for IL-8 release compared to controls and TNFα. Flavorings, such as ortho-vanillin and maltol, induced IL-8 release in Beas2B cells, but not in H292 cells. Of all the flavoring chemicals tested, acetoin and maltol were more potent inducers of IL-8 release than TNFα in Beas2B and HFL-1 cells. Flavoring chemicals rapidly impaired epithelial barrier function in human bronchial epithelial cells (16-HBE) as measured by electric cell surface

  3. Barriers to the future

    Energy Technology Data Exchange (ETDEWEB)

    Massey, C T

    1986-09-01

    Opportunities for the British coal industry seem vast yet there are still barriers to progress. Seven areas are identified and discussed: mining mobility (for example, longwall mining systems are rigid and inflexible compared with American stall and pillar working); mine structure (many mines are more suitable to pit ponies than to large pieces of equipment); financial barriers (Government requires the industry to break even in 1987/88); personnel barriers (less specialization, better use of skills); safety barriers (increased use of remote control, ergonomics and robotics to protect workers); microelectronic management (nationalization has cushioned management from the market place; there is a need for a more multidisciplinary approach to the industry); and legal barriers (most legislation in the past has been in response to accidents; legislation external to the industry but affecting it is more fundamental).

  4. Design of engineered sorbent barriers

    International Nuclear Information System (INIS)

    Jones, E.O.; Freeman, H.D.

    1988-08-01

    A sorbent barrier uses sorbent material such as activated carbon or natural zeolites to prevent the migration of radionuclides from a low-level waste site to the aquifer. The sorbent barrier retards the movement of radioactive contaminants, thereby providing time for the radionuclides to decay. Sorbent barriers can be a simple, effective, and inexpensive method for reducing the migration of radionuclides to the environment. Designing a sorbent barrier consists of using soil and sorbent material properties and site conditions as input to a model which will determine the necessary sorbent barrier thickness to meet contaminant limits. The paper will cover the following areas: techniques for measuring sorption properties of barrier materials and underlying soils, use of a radionuclide transport model to determine the required barrier thickness and performance under a variety of site conditions, and cost estimates for applying the barrier. 8 refs., 6 figs., 1 tab

  5. Design of engineered sorbent barriers

    International Nuclear Information System (INIS)

    Jones, E.O.; Freeman, H.D.

    1988-01-01

    A sorbent barrier uses sorbent material such as activated carbon or natural zeolites to prevent the migration of radionuclides from a low-level waste site to the aquifer. The sorbent barrier retards the movement of radioactive contaminants, thereby providing time for the radionuclides to decay. Sorbent barriers can be a simple, effective, and inexpensive method for reducing the migration of radionuclides to the environment. Designing a sorbent barrier consists of using soil and sorbent material properties and site conditions as input to a model which will determine the necessary sorbent barrier thickness to meet contaminant limits. The paper covers the following areas: techniques for measuring sorption properties of barrier materials and underlying soils, use of a radionuclide transport model to determine the required barrier thickness and performance under a variety of site conditions, and cost estimates for applying the barrier

  6. Experienced Barriers to Lean in Swedish Manufacturing and Health Care

    Directory of Open Access Journals (Sweden)

    Bengt Halling

    2013-12-01

    Full Text Available The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden. Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM and Porras and Robertson’s (1992 change model. : In both organizations, the view of Lean changed from a toolbox to a human behavior view. Eight barriers were experienced in both organizations. Three barriers were unique to manufacturing or to health care, respectively. Nine barriers were elements of social factors; five were elements of organizing arrangements. Only people practically involved and responsible for the implementation at the two organizations participated in the study. Persons responsible for implementing Lean should consider organizational arrangements and social factors in order to limit barriers to successful implementation. Most research on Lean has been about successful Lean implementations. This study focuses on how Lean is viewed and what barriers personnel in manufacturing and health care have experienced. In comparing the barriers to Lean experienced in the two groups, common, archetypical, and unique barriers for manufacturing and health care can be identified, thus contributing to knowledge about barriers to Lean implementation.

  7. Studies of the disruption prevention by ECRH at plasma current rise stage in limiter discharges/Possibility of an internal transport barrier producing under dominating electron transport in the T-10 tokamak

    International Nuclear Information System (INIS)

    Alikaev, V.V.; Borshegovskij, A.A.; Chistyakov, V.V.

    2001-01-01

    'Studies of the Disruption Prevention by ECRH at Plasma Current Rise Stage in Limiter Discharges' - Studies of disruption prevention by means of ECRH in T-10 at the plasma current rise phase in limiter discharges with circular plasma cross-section were performed. Reliable disruption prevention by ECRH at HF power (P HF ) min level equal to 20% of ohmic heating power P OH was demonstrated. m/n=2/1 mode MHD-activity developed before disruption (with characteristic time ∼ 120 ms) can be considered as disruption precursor and can be used in a feedback system. 'Possibility of an Internal Transport Barrier Producing under Dominating Electron Transport in the T-10 Tokamak' - The reversed shear experiments were carried out on T-10 at the HF power up to 1MW. The reversed shear in the core was produced by on-axis ECCD in direction opposite to the plasma current. There are no obvious signs of Internal Transport Barriers formation under condition when high-k turbulence determines the electron transport. (author)

  8. Calculation of the detection limits for radionuclides identified in gamma-ray spectra based on post-processing peak analysis results.

    Science.gov (United States)

    Korun, M; Vodenik, B; Zorko, B

    2018-03-01

    A new method for calculating the detection limits of gamma-ray spectrometry measurements is presented. The method is applicable for gamma-ray emitters, irrespective of the influences of the peaked background, the origin of the background and the overlap with other peaks. It offers the opportunity for multi-gamma-ray emitters to calculate the common detection limit, corresponding to more peaks. The detection limit is calculated by approximating the dependence of the uncertainty in the indication on its value with a second-order polynomial. In this approach the relation between the input quantities and the detection limit are described by an explicit expression and can be easy investigated. The detection limit is calculated from the data usually provided by the reports of peak-analyzing programs: the peak areas and their uncertainties. As a result, the need to use individual channel contents for calculating the detection limit is bypassed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Differences in perceived communication barriers among nurses and elderly patients in China.

    Science.gov (United States)

    Ruan, Jing; Lambert, Vickie A

    2008-06-01

    In China, limited information exists about nurses' and elderly patients' perceptions of barriers to the communication process. Therefore, the purposes of this study were to identify the major communication barriers (nurse-related, patient-related, and environment-related) perceived both by nurses and elderly patients and to determine the perceived differences in the level of importance of the communication barriers between nurses and elderly patients. The sample consisted of 84 nurses and 75 elderly patients who completed a demographic questionnaire and a communication barriers questionnaire. The findings suggested that the nurses and elderly patients often selected similar barriers related to the communication process. The nurses tended to assign higher values to the communication barriers that were found to be significantly different from those of the elderly patients. The study findings provide information about which type of barriers nurses need to address so as to facilitate effective communication with elderly patients.

  10. Vehicle barrier systems

    International Nuclear Information System (INIS)

    Sena, P.A.

    1986-01-01

    The ground vehicle is one of the most effective tools available to an adversary force. Vehicles can be used to penetrate many types of perimeter barriers, transport equipment and personnel rapidly over long distances, and deliver large amounts of explosives directly to facilities in suicide missions. The function of a vehicle barrier system is to detain or disable a defined threat vehicle at a selected distance from a protected facility. Numerous facilities are installing, or planning to install, vehicle barrier systems and many of these facilities are requesting guidance to do so adequately. Therefore, vehicle barriers are being evaluated to determine their stopping capabilities so that systems can be designed that are both balanced and capable of providing a desired degree of protection. Equally important, many of the considerations that should be taken into account when establishing a vehicle barrier system have been identified. These considerations which pertain to site preparation, barrier selection, system integration and operation, and vehicle/barrier interaction, are discussed in this paper

  11. Barriers and facilitators of mental health screening in pregnancy.

    Science.gov (United States)

    Kingston, Dawn; Austin, Marie-Paule; Heaman, Maureen; McDonald, Sheila; Lasiuk, Gerri; Sword, Wendy; Giallo, Rebecca; Hegadoren, Kathy; Vermeyden, Lydia; van Zanten, Sander Veldhuyzen; Kingston, Joshua; Jarema, Karly; Biringer, Anne

    2015-11-01

    Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening. However, few studies to date have identified barriers and facilitators that affect pregnant women's responses to mental health screening. The objective was to identify barriers and facilitators that influence pregnant women's responses to the screening process and factors associated with their identification. This multi-site, cross-sectional survey recruited pregnant women >16 years of age who spoke/read English in Alberta, Canada. Main outcomes were barriers and facilitators of mental health screening. Descriptive statistics were generated to identify the most common barriers and facilitators and multivariable logistic regression models were conducted to determine factors associated with barriers and facilitators. Study participation rate was 92% (460/500). Women's most common barriers were: significant others normalizing their emotional difficulties; desiring to handle mental health problems on their own; preferring to discuss feelings with significant others; and not knowing what emotions were 'normal'. Women who identified these barriers were more likely not to have been treated previously for mental illness, were primiparous, and could not be completely honest with their provider. Main facilitators were provider characteristics (sensitive, interested), reassurance that mental healthcare is a part of routine prenatal care, hearing that other women have emotional problems during pregnancy and knowing that help was available. The sample comprised largely Caucasian, well-educated, and partnered women, which limits generalizability of the findings. Personal and stigma-related barriers influence pregnant women's responses to mental health screening. Efforts to minimize barriers and enhance facilitators should be explored as potential strategies for optimizing prenatal mental health screening. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Barriers to health care for undocumented immigrants: a literature review

    Science.gov (United States)

    Hacker, Karen; Anies, Maria; Folb, Barbara L; Zallman, Leah

    2015-01-01

    With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts

  13. Limites politiques et barrières sociales dans le monde maya classique Political Limits and Social Barriers in the Classic Maya World: Reflections Based on a Few Archaeological Experiences

    Directory of Open Access Journals (Sweden)

    Dominique Michelet

    2012-12-01

    Full Text Available L’archéologie des Basses Terres mayas à l’époque classique est riche de données susceptibles de nous renseigner sur plusieurs types de « frontières » sociopolitiques. Si la question des limites territoriales des entités politiques du monde classique constitue, depuis les années 1970, un objectif tout à fait conscient de la recherche, bien d’autres éléments des partitionnements sociopolitiques existent, mais ils n’ont pas reçu, le plus souvent, l’attention qu’ils méritent. L’examen de quelques informations, empruntées aux résultats de projets de recherche collective récents, indique que les démarcations formelles plus ou moins minces durent être rares, qu’il y aurait même eu peu de bornages explicites et que les seuils étaient dotés d’une épaisseur certaine, leur franchissement obéissant à des codes précis et/ou impliquant des comportements ritualisés.The archaeology of the Maya Lowlands of the classical era is rich in data that are likely to have something to teach us about several types of sociopolitical “boundary”. Although research since the 1970s has consciously aimed to address the question of the territorial limits of classical-world political entities, many other elements of sociopolitical partitioning exist, but they have tended not to receive the attention they deserve. The examination of a few pieces of information, borrowed from the results of recent collective research projects, indicates that more-or-less thin formal demarcations must have been rare, that there would even have been few explicit boundary markings, and that the thresholds were endowed with a certain thickness, their crossing obeying precise codes and/or involving ritualised behaviours.

  14. Barriers to Employment Among Social Security Disability Insurance Beneficiaries in the Mental Health Treatment Study.

    Science.gov (United States)

    Milfort, Roline; Bond, Gary R; McGurk, Susan R; Drake, Robert E

    2015-12-01

    This study examined barriers to employment among Social Security Disability Insurance (SSDI) beneficiaries who received comprehensive vocational and mental health services but were not successful in returning to work. This study examined barriers to employment among 430 SSDI beneficiaries with mental disorders who received evidence-based vocational and mental health services for two years but worked less than one month or not at all. Comprehensive care teams, which included employment specialists, made consensus judgments for each participant, identifying the top three barriers to employment from a checklist of 14 common barriers. Teams most frequently identified three barriers to employment: poorly controlled symptoms of mental illness (55%), nonengagement in supported employment (44%), and poorly controlled general medical problems (33%). Other factors were identified much less frequently. Some SSDI beneficiaries, despite having access to comprehensive services, continued to experience psychiatric impairments, difficulty engaging in vocational services, and general medical problems that limited their success in employment.

  15. Tunnel superpenetrability of potential barriers

    International Nuclear Information System (INIS)

    Zakhariev, B N.

    1982-01-01

    The transmission of two particles through the same barrier is considered. The limiting cases are compared when the particles are joined together in a single particle with double mass-energy and potential and when they pass the barrier independently. As an intermediate case a pair of particles bound in a quasideuteron of a finite size is considered. It is shown that long-range collective correlations of particles (of the superfluidity type and others) simplify very much for them passing through high potential barriers. This happens due to the transfer of the additional energy from the particles outside the barriers to those inside it

  16. Identifying technology barriers in adapting a state-of-the-art gas turbine for IGCC applications and an experimental investigation of air extraction schemes for IGCC operations. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Tah-teh; Agrawal, A.K.; Kapat, J.S.

    1993-06-01

    Under contracted work with Morgantown Energy Technology Center, Clemson University, the prime contractor, and General Electric (GE) and CRSS, the subcontractors, made a comprehensive study in the first phase of research to investigate the technology barriers of integrating a coal gasification process with a hot gas cleanup scheme and the state-of-the-art industrial gas turbine, the GE MS-7001F. This effort focused on (1) establishing analytical tools necessary for modeling combustion phenomenon and emissions in gas turbine combustors operating on multiple species coal gas, (2) estimates the overall performance of the GE MS-7001F combined cycle plant, (3) evaluating material issues in the hot gas path, (4) examining the flow and temperature fields when air extraction takes place at both the compressor exit and at the manhole adjacent to the combustor, and (5) examining the combustion/cooling limitations of such a gas turbine by using 3-D numerical simulation of a MS-7001F combustor operated with gasified coal. In the second phase of this contract, a 35% cool flow model was built similar to GE`s MS-7001F gas turbine for mapping the flow region between the compressor exit and the expander inlet. The model included sufficient details, such as the combustor`s transition pieces, the fuel nozzles, and the supporting struts. Four cases were studied: the first with a base line flow field of a GE 7001F without air extraction; the second with a GE 7001F with air extraction; and the third and fourth with a GE 7001F using a Griffith diffuser to replace the straight wall diffuser and operating without air extraction and with extraction, respectively.

  17. Intra-family role expectations and reluctance to change identified as key barriers to expanding vegetable consumption patterns during interactive family-based program for Appalachian low-income food preparers.

    Science.gov (United States)

    Brown, J Lynne; Wenrich, Tionni R

    2012-08-01

    Few Americans eat sufficient vegetables, especially the protective deep orange and dark green vegetables. To address this, a community-based wellness program to broaden vegetables served at evening meals targeting Appalachian food preparers and their families was tested in a randomized, controlled intervention. Food preparers (n=50) were predominately married (88%), white (98%), and female (94%), with several children living at home. Experimental food preparers (n=25) attended the program sessions and controls (n=25) were mailed relevant handouts and recipes. At program sessions, participants received nutrition information, hands-on cooking instruction, and prepared recipes to take home for family evaluation. As qualitative assessment, 10 couples from each treatment group (n=20 couples) were randomly selected for baseline and immediate post-intervention interviews to explore impact on the food preparer's family. These in-depth interviews with the food preparer and their adult partner were tape-recorded and transcribed verbatim. Two researchers conducted thematic analysis using constant comparison. Family flexibility about food choices was assessed using roles, rules, and power concepts from Family Systems Theory. Interviews at baseline revealed dinner vegetable variety was very limited because food preparers served only what everyone liked (a role expectation) and deferred to male partner and children's narrow vegetable preferences (power). Control couples reported no change in vegetable dinner variety post-intervention. Most experimental couples reported in-home tasting and evaluation was worthwhile and somewhat broadened vegetables served at dinners. But the role expectation of serving only what everyone liked and the practice of honoring powerful family members' vegetable preferences remained major barriers to change. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  18. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

    Science.gov (United States)

    George, Siân; Daniels, Katy; Fioratou, Evridiki

    2018-04-03

    Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a

  19. Trends in drug delivery through tissue barriers containing tight junctions.

    Science.gov (United States)

    Tscheik, Christian; Blasig, Ingolf E; Winkler, Lars

    2013-04-01

    A limitation in the uptake of many drugs is the restricted permeation through tissue barriers. There are two general ways to cross barriers formed by cell layers: by transcytosis or by diffusion through the intercellular space. In the latter, tight junctions (TJs) play the decisive role in the regulation of the barrier permeability. Thus, transient modulation of TJs is a potent strategy to improve drug delivery. There have been extensive studies on surfactant-like absorption enhancers. One of the most effective enhancers found is sodium caprate. However, this modulates TJs in an unspecific fashion. A novel approach would be the specific modulation of TJ-associated marvel proteins and claudins, which are the main structural components of the TJs. Recent studies have identified synthetic peptidomimetics and RNA interference techniques to downregulate the expression of targeted TJ proteins. This review summarizes current progress and discusses the impact on TJs' barrier function.

  20. Barrier Systems

    NARCIS (Netherlands)

    Heteren, S. van

    2015-01-01

    Barrier-system dynamics are a function of antecedent topography and substrate lithology, Relative sea-level (RSL) changes, sediment availability and type, climate, vegetation type and cover, and various aero- and hydrodynamic processes during fair-weather conditions and extreme events. Global change

  1. Barriers to Leisure-Time Physical Activities in Individuals with Spinal Cord Injury.

    Science.gov (United States)

    Hwang, Eric J; Groves, Mary D; Sanchez, Jacqueline N; Hudson, Cassandra E; Jao, Rachel G; Kroll, Meghan E

    2016-07-01

    This study investigated the personal, environmental, and activity barriers to leisure-time physical activities (LTPAs) among individuals with spinal cord injury (SCI). A survey instrument was administered to 85 participants with SCI. Personal barriers to LTPAs included issues involving motivation, pain, scheduling, and financial resources. Environmental barriers marked the issues regarding availability and accessibility to specialized programs, activities, and professional services. Activity barriers included limitations in equipment, training, and personal skills required by the selected activities. Significant negative correlations were found between these barriers and the levels of physical activity and satisfaction with physical activity. While working with clients with SCI, occupational therapists should identify those LTPA barriers and possible solutions in order to establish individualized action plans for enhancing participation in LTPAs.

  2. Hierarchical super-structure identified by polarized light microscopy, electron microscopy and nanoindentation: Implications for the limits of biological control over the growth mode of abalone sea shells

    Directory of Open Access Journals (Sweden)

    Schneider Andreas S

    2012-09-01

    Full Text Available Abstract Background Mollusc shells are commonly investigated using high-resolution imaging techniques based on cryo-fixation. Less detailed information is available regarding the light-optical properties. Sea shells of Haliotis pulcherina were embedded for polishing in defined orientations in order to investigate the interface between prismatic calcite and nacreous aragonite by standard materialographic methods. A polished thin section of the interface was prepared with a defined thickness of 60 μm for quantitative birefringence analysis using polarized light and LC-PolScope microscopy. Scanning electron microscopy images were obtained for comparison. In order to study structural-mechanical relationships, nanoindentation experiments were performed. Results Incident light microscopy revealed a super-structure in semi-transparent regions of the polished cross-section under a defined angle. This super-structure is not visible in transmitted birefringence analysis due to the blurred polarization of small nacre platelets and numerous organic interfaces. The relative orientation and homogeneity of calcite prisms was directly identified, some of them with their optical axes exactly normal to the imaging plane. Co-oriented "prism colonies" were identified by polarized light analyses. The nacreous super-structure was also visualized by secondary electron imaging under defined angles. The domains of the super-structure were interpreted to consist of crystallographically aligned platelet stacks. Nanoindentation experiments showed that mechanical properties changed with the same periodicity as the domain size. Conclusions In this study, we have demonstrated that insights into the growth mechanisms of nacre can be obtained by conventional light-optical methods. For example, we observed super-structures formed by co-oriented nacre platelets as previously identified using X-ray Photo-electron Emission Microscopy (X-PEEM [Gilbert et al., Journal of the

  3. Market and policy barriers to energy storage deployment :

    Energy Technology Data Exchange (ETDEWEB)

    Bhatnagar, Dhruv; Currier, Aileen B.; Hernandez, Jacquelynne; Ma, Ookie; Kirby, Brendan

    2013-09-01

    Electric energy storage technologies have recently been in the spotlight, discussed as essential grid assets that can provide services to increase the reliability and resiliency of the grid, including furthering the integration of variable renewable energy resources. Though they can provide numerous grid services, there are a number of factors that restrict their current deployment. The most significant barrier to deployment is high capital costs, though several recent deployments indicate that capital costs are decreasing and energy storage may be the preferred economic alternative in certain situations. However, a number of other market and regulatory barriers persist, limiting further deployment. These barriers can be categorized into regulatory barriers, market (economic) barriers, utility and developer business model barriers, crosscutting barriers and technology barriers. This report, through interviews with stakeholders and review of regulatory filings in four regions roughly representative of the United States, identifies the key barriers restricting further energy storage development in the country. The report also includes a discussion of possible solutions to address these barriers and a review of initiatives around the country at the federal, regional and state levels that are addressing some of these issues. Energy storage could have a key role to play in the future grid, but market and regulatory issues have to be addressed to allow storage resources open market access and compensation for the services they are capable of providing. Progress has been made in this effort, but much remains to be done and will require continued engagement from regulators, policy makers, market operators, utilities, developers and manufacturers.

  4. Nurse-patient communication barriers in Iranian nursing.

    Science.gov (United States)

    Anoosheh, M; Zarkhah, S; Faghihzadeh, S; Vaismoradi, M

    2009-06-01

    Providing effective communication with patients is an essential aspect of nursing care. Understanding the barriers that inhibit nurse-patient communication can provide an opportunity to eliminate them. To investigate nurse-patient and environment-related communication barriers perceived by patients and nurses in Iranian nursing. A descriptive survey was carried out in three randomly selected educational hospitals in a large urban city in Iran. Data were collected by questionnaire; the study sample consisted of 61 patients and 75 nurses. Participants were asked to rate the importance of each communication barriers item. Finally, data were analysed using descriptive statistics, and to compare the perceived importance of communication barriers between patients and nurses, item means were calculated and the t-test for independent samples was applied. Similarities and differences between the two groups were identified. According to nurses' views, 'heavy nursing workload', 'hard nursing tasks' and 'lack of welfare facilities for nurses' were the main communication barriers. From patients' views, 'unfamiliarity of nurses with dialect', 'having contagious diseases' and 'sex differences between nurses and patients' were determined as the main communication barriers. The shared communication barriers were 'age difference', 'social class difference' and 'having contagious diseases'. It can be concluded that nursing managers and healthcare system planners should focus on eliminating or modifying the barriers stated by the two groups, particularly the shared ones. It is suggested that understanding the cultural aspects of nurse-patient communication barriers in various contexts can help nurses. The study relied on self-report by a limited sample of nurses and patients. The responses should now be tested by a larger sample and then by empirical research into actual practice in order to test whether the nurses' and patients' perceived ideas of communication barriers are

  5. Understanding barriers to glycaemic control from the patient's perspective

    Directory of Open Access Journals (Sweden)

    Janes R

    2013-06-01

    Full Text Available INTRODUCTION: To better understand barriers to glycaemic control from the patient's perspective. METHODS: An interpretative phenomenological approach was used to study the experiences of 15 adults with Type 2 diabetes. Participants each gave a semi-structured interview of their experiences of living with diabetes. Interviews were transcribed, and themes extracted and organised using a patientcentred framework. FINDINGS: Participants' stories confirmed many of the barriers in the literature, particularly those related to context, such as family, finances, work. Barriers also related to negative emotional reactions to diabetes: fear of new events (diagnosis, starting pills/insulin; guilt about getting diabetes and not controlling it; and shame about having diabetes. Barriers also related to unscientific beliefs and personal beliefs. There were additional barriers related to poor clinician-patient relationships. Overall, participants had a poor understanding of diabetes, and complained that their clinician simply 'told them what to do'. CONCLUSION: Using a patient-centred approach, this study identified many barriers to glycaemic control. We suggest that a key barrier is clinician ignorance of their patients' fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship; and of the limitations of a biomedical approach to patient non-adherence. Faced with both a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved.

  6. High Performance Multi Barrier Thermionic Devices

    National Research Council Canada - National Science Library

    Vashaee, Daryoosh; Shakouri, Ali

    2003-01-01

    Thermoelectric transport perpendicular to layers in multiple barrier superlattice structures is investigated theoretically in two limiting cases of no lateral momentum scattering and strong scattering...

  7. Floating barrier

    Energy Technology Data Exchange (ETDEWEB)

    1968-05-06

    This floating barrier consists of relatively long elements which can be connected to form a practically continuous assembly. Each element consists of an inflatable tube with an apron of certain height, made of impregnated fabric which is resistant to ocean water and also to hydrocarbons. Means for connecting one element to the following one, and means for attaching ballast to the apron are also provided.

  8. Legal barriers in accessing opioid medicines: results of the ATOME quick scan of national legislation of eastern European countries.

    Science.gov (United States)

    Vranken, Marjolein J M; Mantel-Teeuwisse, Aukje K; Jünger, Saskia; Radbruch, Lukas; Lisman, John; Scholten, Willem; Payne, Sheila; Lynch, Tom; Schutjens, Marie-Hélène D B

    2014-12-01

    Overregulation of controlled medicines is one of the factors contributing to limited access to opioid medicines. The purpose of this study was to identify legal barriers to access to opioid medicines in 12 Eastern European countries participating in the Access to Opioid Medication in Europa project, using a quick scan method. A quick scan method to identify legal barriers was developed focusing on eight different categories of barriers. Key experts in 12 European countries were requested to send relevant legislation. Legislation was quick scanned using World Health Organization guidelines. Overly restrictive provisions and provisions that contain stigmatizing language and incorrect definitions were identified. The selected provisions were scored into two categories: 1) barrier and 2) uncertain, and reviewed by two authors. A barrier was recorded if both authors agreed the selected provision to be a barrier (Category 1). National legislation was obtained from 11 of 12 countries. All 11 countries showed legal barriers in the areas of prescribing (most frequently observed barrier). Ten countries showed barriers in the areas of dispensing and showed stigmatizing language and incorrect use of definitions in their legislation. Most barriers were identified in the legislation of Bulgaria, Greece, Lithuania, Serbia, and Slovenia. The Cypriot legislation showed the fewest total number of barriers. The selected countries have in common as main barriers prescribing and dispensing restrictions, the use of stigmatizing language, and incorrect use of definitions. The practical impact of these barriers identified using a quick scan method needs to be validated by other means. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Perceptions regarding strategic and structural entry barriers

    NARCIS (Netherlands)

    Lutz, C.H.M.; Kemp, R.G.M.; Dijkstra, S.G.

    2010-01-01

    This article uses factor analysis to identify the underlying dimensions of strategic and structural entry barriers. We find that, in the perception of firms, both types of barriers are important and that the effectiveness of strategic barriers depends on attributes of the market structure. Based on

  10. Perceptions regarding strategic and structural entry barriers

    NARCIS (Netherlands)

    Lutz, Clemens H. M.; Kemp, Ron G. M.; Dijkstra, S. Gerhard

    This article uses factor analysis to identify the underlying dimensions of strategic and structural entry barriers. We find that, in the perception of firms, both types of barriers are important and that the effectiveness of strategic barriers depends on attributes of the market structure. Based on

  11. Faculty Perceptions about Barriers to Active Learning

    Science.gov (United States)

    Michael, Joel

    2007-01-01

    Faculty may perceive many barriers to active learning in their classrooms. Four groups of participants in a faculty development workshop were asked to list their perceived barriers to active learning. Many of the problems identified were present on more than one list. The barriers fall into three categories: student characteristics, issues…

  12. Barriers to Mammography among Inadequately Screened Women

    Science.gov (United States)

    Stoll, Carolyn R. T.; Roberts, Summer; Cheng, Meng-Ru; Crayton, Eloise V.; Jackson, Sherrill; Politi, Mary C.

    2015-01-01

    Mammography use has increased over the past 20 years, yet more than 30% of women remain inadequately screened. Structural barriers can deter individuals from screening, however, cognitive, emotional, and communication barriers may also prevent mammography use. This study sought to identify the impact of number and type of barriers on mammography…

  13. Uncertainties as Barriers for Knowledge Sharing with Enterprise Social Media

    DEFF Research Database (Denmark)

    Trier, Matthias; Fung, Magdalene; Hansen, Abigail

    2017-01-01

    become a barrier for the participants’ adoption. There is only limited existing research studying the types of uncertainties that employees perceive and their impact on knowledge transfer via social media. To address this gap, this article presents a qualitative interview-based study of the adoption...... of the Enterprise Social Media tool Yammer for knowledge sharing in a large global organization. We identify and categorize nine uncertainties that were perceived as barriers by the respondents. The study revealed that the uncertainty types play an important role in affecting employees’ participation...

  14. Smart parking barrier

    KAUST Repository

    Alharbi, Abdulrazaq M.

    2016-01-01

    positioning of the movable parking barrier, and a parking controller configured to initiate movement of the parking barrier, via the barrier drive. The movable parking barrier can be positioned between a first position that restricts access to the parking

  15. Barriers to wheelchair use in the winter.

    Science.gov (United States)

    Ripat, Jacquie D; Brown, Cara L; Ethans, Karen D

    2015-06-01

    To test the hypothesis that challenges to community participation posed by winter weather are greater for individuals who use scooters, manual and power wheelchairs (wheeled mobility devices [WMDs]) than for the general ambulatory population, and to determine what WMD users identify as the most salient environmental barriers to community participation during the winter. Cross-sectional survey organized around 5 environmental domains: technological, natural, physical, social/attitudinal, and policy. Urban community in Canada. Convenience sample of WMD users or their proxy (N=99). Not applicable. Not applicable. Forty-two percent identified reduced outing frequency in winter months, associated with increased age (χ(3)=6.4, P=.04), lack of access to family/friends for transportation (χ(2)=8.1, P=.04), and primary type of WMD used in the winter (scooter χ(2)=8.8, P=.003). Most reported tires/casters becoming stuck in the snow (95%) or slipping on the ice (91%), difficulty ascending inclines/ramps (92%), and cold hands while using controls or pushing rims (85%); fewer identified frozen wheelchair/scooter batteries, seat cushions/backrests, or electronics. Sidewalks/roads were reported to be problematic by 99%. Eighty percent reported needing additional help in the winter. Limited community access in winter led to a sense of loneliness/isolation, and fear/anxiety related to safety. Respondents identified policies that limited participation during winter. People who use WMDs decrease their community participation in cold weather because of multiple environmental barriers. Clinicians, researchers, and policymakers can take a multidimensional approach to mitigate these barriers in order to enhance community participation by WMD users in winter. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Market and Policy Barriers to Energy Storage Deployment

    Energy Technology Data Exchange (ETDEWEB)

    Bhatnagar, Dhruv [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Currier, Aileen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hernandez, Jacquelynne [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Ma, Ookie [Dept. of Energy (DOE), Washington DC (United States) Office of Energy Efficiency and Renewable Energy; Kirby, Brendan [Consultant

    2013-09-01

    Electric energy storage technologies can provide numerous grid services; there are a number of factors that restrict their current deployment. The most significant barrier to deployment is high capital costs, though several recent deployments indicate that capital costs are decreasing and energy storage may be the preferred economic alternative in certain situations. However, a number of other market and regulatory barriers persist, limiting further deployment. These barriers can be categorized into regulatory barriers, market (economic) barriers, utility and developer business model barriers, cross-cutting barriers and technology barriers.

  17. Potential and barrier study. Energy efficiency in Norwegian vocational buildings; Potensial- og barrierestudie. Energieffektivisering i norske yrkesbygg

    Energy Technology Data Exchange (ETDEWEB)

    Boehn, Trond Ivar; Palm, Linn Therese; Bakken, Line; Nossum, Aase; Jordell, Hanne

    2012-07-01

    On behalf of Enova SF, Multiconsult AS and Analyse og Strategi AS conducted an analysis to identify potential and barriers related to commercial buildings energy performance. The aim of this study was to determine what is the potential for energy efficiency for Norwegian vocational buildings that distinguishes between theoretical, technical, financial and real potential. Technical potential is the percentage of the theoretical potential that is technically feasible. Economic potential is the proportion of technical potential that is economically profitable to implement. Economic potential varies with the energy price. Build a small part of the total potential in 2020. In the calculation of the real potential is taken into account induced potential in terms of that, each year, a percentage actually implementing energy conservation measures (energy efficiency ratio 2%), a percentage rehabilitating / upgrading existing buildings (rehab rate 1.5%), and that a proportion of new buildings built better than regulatory requirements (rate 10%). In real potential for energy efficiency is the proportion of the economic potential that is not natural triggered but which is limited by various barriers. In real potential also varies with energy price. Respondents in our study is particularly concerned with the economic barriers, and least concerned the technical barriers. Attitudes and knowledge barriers are also very important. Lack of knowledge the effects and benefits of energy efficiency means that negative attitudes persist and that myths about the lack of profitability continues to exist. Many believe this is due to lack the knowledge and can be the cause of other types of barriers such as economic barriers. It has been analyzed which part of the real potential bounded by the barriers, and which type of institutions in society that can reduce these barriers with various categories of instrument. Main barriers for existing buildings practical barriers, economic barriers and

  18. Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective.

    Science.gov (United States)

    Spitaels, David; Vankrunkelsven, Patrik; Desfosses, Jurgen; Luyten, Frank; Verschueren, Sabine; Van Assche, Dieter; Aertgeerts, Bert; Hermens, Rosella

    2017-02-01

    Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated. Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software. In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers. Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account. © 2016 John Wiley & Sons, Ltd.

  19. Barriers associated with reduced physical activity in COPD patients.

    Science.gov (United States)

    Amorim, Priscila Batista; Stelmach, Rafael; Carvalho, Celso Ricardo Fernandes; Fernandes, Frederico Leon Arrabal; Carvalho-Pinto, Regina Maria; Cukier, Alberto

    2014-10-01

    To evaluate the ability of COPD patients to perform activities of daily living (ADL); to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT), and an ADL limitation score. In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL) scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5 ± 25.8 min/day vs. 105.2 ± 49.4 min/day; p barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.

  20. Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: a qualitative study from the Bruthas cohort.

    Science.gov (United States)

    Arnold, Emily A; Weeks, John; Benjamin, Michael; Stewart, William R; Pollack, Lance M; Kegeles, Susan M; Operario, Don

    2017-01-28

    There is little research regarding the ability of Black men who have sex with men and women (BMSMW) to access and maintain HIV-related health care and treatment adherence. This population, who often insist on secrecy about their same-sex desire, may experience unique barriers to seeking regular care and treatment. From March 2011-April 2014, we recruited 396 BMSMW in the San Francisco Bay Area to be enrolled in our randomized controlled trial. At baseline we administered a behavioral survey assessing: demographics, homelessness, employment, history of incarceration, HIV status and disclosure practices, care and treatment adherence. 64 men reported living with HIV at intake. To learn more about their experiences, we recruited N = 25 to participate in qualitative interviews, which were conducted April-December 2014. Topics included: current living situation, diagnosis story, disclosure practices, experiences of accessing and maintaining care and treatment, and HIV-related stigma. Recordings were transcribed and coded for major themes. Despite being located in an area where treatment is plentiful, men faced social and economic barriers to maintaining regular care and treatment adherence. Several findings emerged to shed light on this quandary: (1) Competing needs particularly around attaining stable housing, food security, and money created barriers to treatment and care; (2) Side effects of HIV medications discouraged men from adhering to treatment; (3) Provider and Institutional level characteristics influenced care engagement; (4) Disclosure and social support made a difference in care and treatment behaviors; and (5) Participants expressed a desire for group-based intervention activities to support treatment and care among HIV+ BMSMW. Inadequate engagement in the continuum of care for HIV was born out in the quantitative data where 28% of participants did not know their Viral Load. A holistic approach to HIV health for BMSMW would appear to translate to better

  1. Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the Quality in Acute Stroke Care (QASC) Project--a mixed methods study.

    Science.gov (United States)

    Dale, Simeon; Levi, Christopher; Ward, Jeanette; Grimshaw, Jeremy M; Jammali-Blasi, Asmara; D'Este, Catherine; Griffiths, Rhonda; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Cheung, N Wah; Middleton, Sandy

    2015-02-01

    The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at

  2. Knowledge Exchange and Management Research: Barriers and Potentials

    DEFF Research Database (Denmark)

    Bager, Torben

    2018-01-01

    Purpose: The growing involvement of management researchers in knowledge exchange activities and collaborative research does not seem to be reflected in a growing academic output. The purpose of this paper is to explore barriers for academic output from these activities as well as the potential...... for ‘interesting’ papers. Design/methodology/approach: The paper uses secondary data and statistics as well as an illustrative case study to trace knowledge exchange activities and barriers for academic output based on these activities. Findings: The paper identifies a number of barriers for the turning of data...... derived from knowledge exchange activities and Mode 2 research into academic papers such as low priority of case study research in leading management journals, a growing practice orientation in the research funding systems, methodological challenges due to limited researcher control, and disincentives...

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

    Science.gov (United States)

    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

  4. Implementation of renewable technologies - Opportunities and barriers. Zimbabwe country study

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    . The committee was tasked with the responsibility of coming up with recommendations to barrier removal and promotion of RETs. After interested stake holders had presented their candidate projects proposals, the committee started the process of identifying barriers to the projects and selecting feasible projects. A final workshop was then held in August 2000 where the findings of the whole process were presented to all stake holders for discussion and analysis. The problem of barriers was found to be very complex. A good number of RETs projects in the country were successfully implemented. The success of such projects was underpinned by the following factors, addressing the immediate and basic needs of the people, participatory approach, awareness creation and enabling income generation activities. Some projects were also not very successful as they faced a lot of barriers like poor institutional framework, limited financial resources, lack of appreciation of associated benefits and technology failure. A close analysis of barriers revealed that there are two classes of barrier namely primary barriers and secondary barriers. Primary barriers are the real barriers while secondary barriers are more of the effects of primary barriers. (BA)

  5. Barriers to Cleft Lip and Palate Repair Around the World.

    Science.gov (United States)

    Massenburg, Benjamin B; Jenny, Hillary E; Saluja, Saurabh; Meara, John G; Shrime, Mark G; Alonso, Nivaldo

    2016-10-01

    Cleft lip and/or palate (CLP) is estimated to occur in 1 out of every 700 births, but for many people residing in low- and middle-income countries this deformity may be repaired late in life or not at all. This study aims to analyze worldwide provider-perceived barriers to the surgical repair of CLP in low- and middle-income countries. From 2011 to 2014, Smile Train distributed a multiple-choice, voluntary survey to healthcare providers to identify areas of need in CLP care worldwide. Data on provider-reported barriers to care were aggregated by year, country, and larger world regions. A total of 1997 surveys were completed by surgeons and healthcare providers (60.7% response rate). The most commonly reported barriers were "patient travel costs" (60.7%), "lack of patient awareness" (54.1%), and "lack of financial support" (52.8%). "Patient travel costs" was the most commonly reported barrier in sub-Saharan Africa, the Middle East and North Africa, and South and Southeast Asia. "Lack of financial support" was the most commonly reported barrier in the Americas, Eastern Europe, and East Asia. This is the largest intercontinental study on healthcare provider-identified barriers to care, representing the limitations experienced by healthcare professionals in providing corrective surgery for CLP around the world. Financial risk protection from hidden costs, such as patient travel costs, is essential. Community health workers and nurses are critical for communication and linking CLP care to the rest of the community. Recognition of these barriers can inform future policy decisions, targeted by region, for surgical systems delivering care for patients with CLP worldwide.

  6. Assessment of skin barrier function and biochemical changes of ex vivo human skin in response to physical and chemical barrier disruption.

    Science.gov (United States)

    Döge, Nadine; Avetisyan, Araks; Hadam, Sabrina; Pfannes, Eva Katharina Barbosa; Rancan, Fiorenza; Blume-Peytavi, Ulrike; Vogt, Annika

    2017-07-01

    Topical dermatotherapy is intended to be used on diseased skin. Novel drug delivery systems even address differences between intact and diseased skin underlining the need for pre-clinical assessment of different states of barrier disruption. Herein, we studied how short-term incubation in culture media compared to incubation in humidified chambers affects human skin barrier function and viability. On both models we assessed different types and intensities of physical and chemical barrier disruption methods with regard to structural integrity, biophysical parameters and cytokine levels. Tissue degeneration and proliferative activity limited the use of tissue cultures to 48h. Viability is better preserved in cultured tissue. Tape-stripping (50×TS) and 4h sodium lauryl sulfate (SLS) pre-treatment were identified as highly reproducible and effective procedures for barrier disruption. Transepidermal water loss (TEWL) values reproducibly increased with the intensity of disruption while sebum content and skin surface pH were of limited value. Interleukin (IL)-6/8 and various chemokines and proteases were increased in tape-stripped skin which was more pronounced in SLS-treated skin tissue extracts. Thus, albeit limited to 48h, cultured full-thickness skin maintained several barrier characteristics and responded to different intensities of barrier disruption. Potentially, these models can be used to assess pre-clinically the efficacy and penetration of anti-inflammatory compounds. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. The barriers

    Indian Academy of Sciences (India)

    ... than for other diseases, which results in chronic underinvestment; reduced investment in TB drug R&D,. Pfizer withdrawal from TB R&D; AstraZeneca abandon TB R&D & close site; Novartis pull out; 4/22 Big Pharma producing antibacterials. Limited financial support to progress preclinical drug candidates from public sector.

  8. A Learner Perspective on Barriers to E-Learning

    Science.gov (United States)

    Becker, Karen; Newton, Cameron; Sawang, Sukanlaya

    2013-01-01

    This study aims to identify and categorize barriers to e-learning adoption and the relative impact of those barriers on learners. It contributes to the understanding of learner perceptions of barriers, the different types of barriers and their relative importance. This study used a quantitative methodology grounded in previous literature. The…

  9. Barriers to health care for undocumented immigrants: a literature review

    Directory of Open Access Journals (Sweden)

    Hacker K

    2015-10-01

    Full Text Available Karen Hacker,1,2 Maria Anies,2 Barbara L Folb,2,3 Leah Zallman4–6 1Allegheny County Health Department, Pittsburgh, PA, USA; 2Graduate School of Public Health, 3Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA; 4Institute for Community Health, Cambridge, MA, USA; 5Cambridge Health Alliance, Cambridge, MA, USA; 6Harvard School of Medicine, Boston, MA, USA Abstract: With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase

  10. Enershield : energy saving air barriers

    Energy Technology Data Exchange (ETDEWEB)

    Hallihan, D. [Enershield Industries Ltd., Edmonton, AB (Canada)

    2008-07-01

    Enershield Industries is a leader in air barrier technology and provides solution for the Canadian climate. This presentation described the advantages of air barriers and the impact of rising energy costs. An air barrier is used to separate areas of differing environments and makes existing building systems more efficient. This presentation discussed how an air barrier works. It also identified how Enershield Industries calculates energy savings. It described air barrier applications and those who use barrier technology. These include the commercial and industrial sector as well as the personnel and retail sector. Barrier technology can be used for cold storage; vehicle and equipment washes; food processing; and environmental separation. Features and benefits such as the ability to create seal, acoustic insulation, and long term durability were also discussed. Last, the presentation addressed model selection and design criteria issues. Design criteria that were presented included a discussion of acoustic installation, articulating nozzles, scroll cased fans, and structural frame. Other design criteria presented were galvanized frames, telescopic sliders, and off the shelf parts. It was concluded that the ability to reduce energy consumption and enhance employee/client comfort is beneficial to the employer as well as to the employee. figs.

  11. Sprache als Barriere (Language as a Barrier)

    Science.gov (United States)

    Mattheier, Klaus

    1974-01-01

    The concept of language barrier has its derivations in the fields of dialectology, sociology and psychology. In contemporary usage however, the concept has two meanings i.e. regional-cultural barrier and socio-cultural barrier. (Text is in German.) (DS)

  12. Barriers and facilitators to Electronic Medical Records usage in the Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana

    Directory of Open Access Journals (Sweden)

    Adwoa Gyamfi

    2017-12-01

    Discussion: The EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics, and staff commitment represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation.

  13. Prevention of Filipino Youth Behavioral Health Disparities: Identifying Barriers and Facilitators to Participating in “Incredible Years,” an Evidence-Based Parenting Intervention, Los Angeles, California, 2012

    Science.gov (United States)

    Flores, Nicole; Supan, Jocelyn; Kreutzer, Cary B.; Samson, Allan; Coffey, Dean M.

    2015-01-01

    Introduction Evidence-based interventions for training parents are proven to prevent onset and escalation of childhood mental health problems. However, participation in such programs is low, especially among hard-to-reach, underserved populations such as Filipino Americans. Filipinos, the largest Asian subgroup in California, have significant behavioral health disparities compared with non-Hispanic whites and other Asian subgroups. The purpose of this study was to learn about Filipinos’ barriers and facilitators to participating in “Incredible Years” (IY), a parenting program. Methods We conducted 4 focus groups in Los Angeles, California, in 2012; the groups consisted of 20 Filipino parents of children aged 6 to 12 years who recently completed the IY parenting program, which was offered as a prevention workshop. Three reviewers, including two co-authors (A.S., J.J.) and a research assistant used content analysis to independently code the interview transcripts and extract subthemes. Grounded theory analytic methods were used to analyze interview transcripts. Results Parents’ perceived benefits of participation in IY were learning more effective parenting techniques, networking with other parents, improved spousal relationships, and improvements in their children's behavior. Parents’ most common motivating factor for enrollment in IY was to improve their parenting skills and their relationships with their children. The most common barriers to participation were being uncomfortable sharing problems with others and the fear of being stigmatized by others judging their parenting skills. Participants said that parent testimonials would be the most effective way to promote IY. Many recommended outreach at schools, pediatricians’ offices, and churches. Conclusion Increasing Filipino American parent enrollment in IY in culturally relevant ways will reduce the incidence of mental health disorders among children in this growing population. PMID:26491813

  14. Patient-Reported Barriers to the Prekidney Transplant Evaluation in an At-Risk Population in the United States.

    Science.gov (United States)

    Lockwood, Mark B; Saunders, Milda R; Nass, Rachel; McGivern, Claire L; Cunningham, Patrick N; Chon, W James; Josephson, Michelle A; Becker, Yolanda T; Lee, Christopher S

    2017-06-01

    Despite our knowledge of barriers to the early stages of the transplant process, we have limited insight into patient-reported barriers to the prekidney transplant medical evaluation in populations largely at-risk for evaluation failure. One-hundred consecutive adults were enrolled at an urban, Midwestern transplant center. Demographic, clinical, and quality of life data were collected prior to patients visit with a transplant surgeon/nephrologist (evaluation begins). Patient-reported barriers to evaluation completion were collected using the Subjective Barriers Questionnaire 90-days after the initial medical evaluation appointment (evaluation ends), our center targeted goal for transplant work-up completion. At 90 days, 40% of participants had not completed the transplant evaluation. Five barrier categories were created from the 85 responses to the Subjective Barriers Questionnaire. Patient-reported barriers included poor communication, physical health, socioeconomics, psychosocial influences, and access to care. In addition, determinants for successful evaluation completion included being of white race, higher income, free of dialysis, a lower comorbid burden, and reporting higher scores on the Kidney Disease Quality of Life subscale role-emotional. Poor communication between patients and providers, and among providers, was the most prominent patient-reported barrier identified. Barriers were more prominent in marginalized groups such as ethnic minorities and people with low income. Understanding the prevalence of patient-reported barriers may aid in the development of patient-centered interventions to improve completion rates.

  15. (Limiting the greenhouse effect)

    Energy Technology Data Exchange (ETDEWEB)

    Rayner, S.

    1991-01-07

    Traveler attended the Dahlem Research Conference organized by the Freien Universitat, Berlin. The subject of the conference was Limiting the Greenhouse Effect: Options for Controlling Atmospheric CO{sub 2} Accumulation. Like all Dahlem workshops, this was a meeting of scientific experts, although the disciplines represented were broader than usual, ranging across anthropology, economics, international relations, forestry, engineering, and atmospheric chemistry. Participation by scientists from developing countries was limited. The conference was divided into four multidisciplinary working groups. Traveler acted as moderator for Group 3 which examined the question What knowledge is required to tackle the principal social and institutional barriers to reducing CO{sub 2} emissions'' The working rapporteur was Jesse Ausubel of Rockefeller University. Other working groups examined the economic costs, benefits, and technical feasibility of options to reduce emissions per unit of energy service; the options for reducing energy use per unit of GNP; and the significant of linkage between strategies to reduce CO{sub 2} emissions and other goals. Draft reports of the working groups are appended. Overall, the conference identified a number of important research needs in all four areas. It may prove particularly important in bringing the social and institutional research needs relevant to climate change closer to the forefront of the scientific and policy communities than hitherto.

  16. The barrier to ice nucleation in monatomic water

    Science.gov (United States)

    Prestipino, Santi

    2018-03-01

    Crystallization from a supercooled liquid initially proceeds via the formation of a small solid embryo (nucleus), which requires surmounting an activation barrier. This phenomenon is most easily studied by numerical simulation, using specialized biased-sampling techniques to overcome the limitations imposed by the rarity of nucleation events. Here, I focus on the barrier to homogeneous ice nucleation in supercooled water, as represented by the monatomic-water model, which in the bulk exhibits a complex interplay between different ice structures. I consider various protocols to identify solidlike particles on a computer, which perform well enough for the Lennard-Jones model, and compare their respective impact on the shape and height of the nucleation barrier. It turns out that the effect is stronger on the nucleus size than on the barrier height. As a by-product of the analysis, I determine the structure of the nucleation cluster, finding that the relative amount of ice phases in the cluster heavily depends on the method used for classifying solidlike particles. Moreover, the phase which is most favored during the earlier stages of crystallization may happen, depending on the nucleation coordinate adopted, to be different from the stable polymorph. Therefore, the quality of a reaction coordinate cannot be assessed simply on the basis of the barrier height obtained. I explain how this outcome is possible and why it just points out the shortcoming of collective variables appropriate to simple fluids in providing a robust method of particle classification for monatomic water.

  17. Community pharmacists' perceptions of barriers to communication with migrants.

    Science.gov (United States)

    Cleland, Jennifer A; Watson, Margaret C; Walker, Leighton; Denison, Alan; Vanes, Neil; Moffat, Mandy

    2012-06-01

    Effective communication by pharmacists is essential to ensure patient safety in terms of provision and use of medications by patients. Global migration trends mean community pharmacists increasingly encounter patients with a variety of first languages. The aim of this study was to explore community pharmacists' perceptions of communication barriers during the provision of care to A8 (nationals from central/Eastern European states) migrants. A qualitative face-to-face interview study of purposively sampled community pharmacists, North East Scotland. Participants (n = 14) identified a number of barriers to providing optimal care to A8 migrants including: communication (information gathering and giving); confidentiality when using family/friends as translators; the impact of patient healthcare expectations on communication and the length of the consultation; and frustration with the process of the consultation. Several barriers were specific to A8 migrants but most seemed pertinent to any group with limited English proficiency and reflect those found in studies of healthcare professionals caring for more traditional UK migrant populations. Further research is needed using objective outcome measures, such as consultation recordings, to measure the impact of these perceived barriers on pharmacist-patient consultations. Language and cultural barriers impact on the quality of pharmacist-patient communication and thus may have patient safety and pharmacist training implications. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

  18. Barriers for realisation of energy savings in buildings; Barrierer for realisering af energibesparelser i bygninger

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, O.M.

    2004-07-01

    Many years' efforts within the energy labelling area have shown large saving potentials in heating and use of electricity in buildings. At the same time it has been proved that these saving potentials, even when economically advantageous, only are cashed to a limited extent. The reason to this is ascribed to barriers that meet the individual building owner who wants to start saving energy. Most barriers are known and a lot of these have been sought overcome for some time. The questions are how many barriers still exist, have new barriers arisen and the character of these barriers. On this background the objective of this survey has been to concretize and study the barriers, which are blocking reasonable energy savings. Focus has especially been on barriers for realisation of heating savings, but through a general evaluation of energy savings of barriers other forms of energy saving methods have been taken into consideration. Special interest has been directed towards houses, typically one family houses, which are affected by the Energy Labelling Scheme. The concept barriers include all kinds of barriers, also barriers that not are acknowledged as barriers by the individual house owner, or that on closer inspection turn out to be something else than actual barriers. This note suggests an alternative inertia model, in order to create an idea of the inertness characteristic of the many house owners who understand the message but fail to act on it. (BA)

  19. Barriers to accessing urethroplasty.

    Science.gov (United States)

    Consolo, Michael J; Syed, Kirin K; Robison, Christopher; McFadden, Jacob; Shalowitz, David I; Brown, Gordon A; Sussman, David O; Figler, Bradley D

    2016-01-01

    Urethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n 5 13, 15%) and concern about complications (n 5 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training.

  20. Perceived barriers to effective job performance among nursing assistants in long-term care.

    Science.gov (United States)

    Parmelee, Patricia A; Laszlo, Mary C; Taylor, Jo A

    2009-10-01

    This research explored perceived barriers to job performance among a national sample of nursing assistants (NAs). Specific objectives were (1) to clarify which of the problems identified by previous research are most troublesome for NAs, (2) to develop a reliable quantitative measure of perceived barriers to job performance, and (3) to test construct validity of the measure vis-à-vis work-related psychological empowerment and job satisfaction. Nursing assistants attending the 2006 national conference of the National Association of Health Care Assistants completed a paper-and-pencil survey including 33 barriers to job performance and standardized measures of empowerment and job satisfaction. The barriers were also rated by a small sample of NAs at a single Georgia nursing home. Factor analysis of barriers items yielded a 30-item Nursing Assistants Barriers Scale (NABS) comprising 6 subscales: Teamwork, Exclusion, Respect, Workload, Work Stress, and New NAs. Lack of teamwork and exclusion from communication processes were rated as most problematic by both samples. The 6 NABS subscales were significantly and independently associated with empowerment and satisfaction; different barriers predicted the 2 constructs. This study is a first step toward quantitative assessment of NAs' perceptions of barriers to doing their jobs. Primary limitations are the select sample and use of a job satisfaction measure that may have artificially inflated correlations with the NABS. Nonetheless, results confirm the validity of the new scale as an operationalization of the barriers construct. The concept of barriers to job performance is a unique construct from work empowerment and satisfaction with one's job. Nursing assistants clearly differentiate various barriers, converging on workload and lack of teamwork as most problematic. Further work is needed to substantiate validity and reliability of the NABS, particularly with respect to NAs' actual job performance, intent to stay on the

  1. Material Barriers to Diffusive Mixing

    Science.gov (United States)

    Haller, George; Karrasch, Daniel

    2017-11-01

    Transport barriers, as zero-flux surfaces, are ill-defined in purely advective mixing in which the flux of any passive scalar is zero through all material surfaces. For this reason, Lagrangian Coherent Structures (LCSs) have been argued to play the role of mixing barriers as most repelling, attracting or shearing material lines. These three kinematic concepts, however, can also be defined in different ways, both within rigorous mathematical treatments and within the realm of heuristic diagnostics. This has lead to a an ever-growing number of different LCS methods, each generally identifying different objects as transport barriers. In this talk, we examine which of these methods have actual relevance for diffusive transport barriers. The latter barriers are arguably the practically relevant inhibitors in the mixing of physically relevant tracers, such as temperature, salinity, vorticity or potential vorticity. We demonstrate the role of the most effective diffusion barriers in analytical examples and observational data. Supported in part by the DFG Priority Program on Turbulent Superstructures.

  2. Barriers to Herbal Medicine Research in Nigeria; Researcher's ...

    African Journals Online (AJOL)

    This paper presents the barriers to herbal medicine research in Nigeria. This is with a view to formulating appropriate strategies that would be deployed to overcome the identified barriers to herbal medicine research. The paper therefore identified and discussed some of these inherent barriers such as the standardization of ...

  3. Barriers and Solutions to Fieldwork Education in Hand Therapy.

    Science.gov (United States)

    Short, Nathan; Sample, Shelby; Murphy, Malachi; Austin, Brittany; Glass, Jillian

    2017-08-09

    Survey. Fieldwork education is a vital component of training the next generation of CHTs. Barriers and solutions to fieldwork rotations in hand therapy are examined, as well as proposed solutions, including recommendations for student preparation. This descriptive study examined barriers for certified hand therapist clinicians to accept students for clinical rotations and clinicians' preferences for student preparation before a rotation in a hand setting. A survey was developed, peer reviewed, and distributed using the electronic mailing list of the Hand Therapy Certification Commission via SurveyMonkey. Aggregate responses were analyzed to identify trends including barriers to student clinical rotations and recommendations for students to prepare for hand rotations. A total of 2080 participants responded to the survey, representing a 37% response rate. Common logistical barriers were identified for accepting students such as limited clinical time and space. Many clinicians (32% agree and 8% strongly agree) also felt that the students lack the clinical knowledge to be successful. Areas of knowledge, skill set, and experience were surveyed for development before a clinical rotation in a hand setting. Most respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences are presented as well. Student preparation before a clinical rotation in a hand setting appears to be a significant barrier based on the survey results. Areas of recommended knowledge, skill set, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced certified hand therapists to the next generation. Although logistical barriers may be difficult to overcome, hand-specific preparation based on clinician' recommendations may facilitate student acceptance and success in hand

  4. Barriers to optimizing investments in the built environment to reduce youth obesity: policy-maker perspectives.

    Science.gov (United States)

    Grant, Jill L; MacKay, Kathryn C; Manuel, Patricia M; McHugh, Tara-Leigh F

    2010-01-01

    To identify factors which limit the ability of local governments to make appropriate investments in the built environment to promote youth health and reduce obesity outcomes in Atlantic Canada. Policy-makers and professionals participated in focus groups to discuss the receptiveness of local governments to introducing health considerations into decision-making. Seven facilitated focus groups involved 44 participants from Atlantic Canada. Thematic discourse analysis of the meeting transcripts identified systemic barriers to creating a built environment that fosters health for youth aged 12-15 years. Participants consistently identified four categories of barriers. Financial barriers limit the capacities of local government to build, maintain and operate appropriate facilities. Legacy issues mean that communities inherit a built environment designed to facilitate car use, with inadequate zoning authority to control fast food outlets, and without the means to determine where schools are built or how they are used. Governance barriers derive from government departments with distinct and competing mandates, with a professional structure that privileges engineering, and with funding programs that encourage competition between municipalities. Cultural factors and values affect outcomes: people have adapted to car-oriented living; poverty reduces options for many families; parental fears limit children's mobility; youth receive limited priority in built environment investments. Participants indicated that health issues have increasing profile within local government, making this an opportune time to discuss strategies for optimizing investments in the built environment. The focus group method can foster mutual learning among professionals within government in ways that could advance health promotion.

  5. Subsurface barrier verification technologies, informal report

    International Nuclear Information System (INIS)

    Heiser, J.H.

    1994-06-01

    One of the more promising remediation options available to the DOE waste management community is subsurface barriers. Some of the uses of subsurface barriers include surrounding and/or containing buried waste, as secondary confinement of underground storage tanks, to direct or contain subsurface contaminant plumes and to restrict remediation methods, such as vacuum extraction, to a limited area. To be most effective the barriers should be continuous and depending on use, have few or no breaches. A breach may be formed through numerous pathways including: discontinuous grout application, from joints between panels and from cracking due to grout curing or wet-dry cycling. The ability to verify barrier integrity is valuable to the DOE, EPA, and commercial sector and will be required to gain full public acceptance of subsurface barriers as either primary or secondary confinement at waste sites. It is recognized that no suitable method exists for the verification of an emplaced barrier's integrity. The large size and deep placement of subsurface barriers makes detection of leaks challenging. This becomes magnified if the permissible leakage from the site is low. Detection of small cracks (fractions of an inch) at depths of 100 feet or more has not been possible using existing surface geophysical techniques. Compounding the problem of locating flaws in a barrier is the fact that no placement technology can guarantee the completeness or integrity of the emplaced barrier. This report summarizes several commonly used or promising technologies that have been or may be applied to in-situ barrier continuity verification

  6. Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents

    Directory of Open Access Journals (Sweden)

    Taveras Elsie M

    2009-12-01

    Full Text Available Abstract Background Parents are integral to the implementation of obesity prevention and management recommendations for children. Exploration of barriers to and facilitators of parental decisions to adopt obesity prevention recommendations will inform future efforts to reduce childhood obesity. Methods We conducted 4 focus groups (2 English, 2 Spanish among a total of 19 parents of overweight (BMI ≥ 85th percentile children aged 5-17 years. The main discussion focused on 7 common obesity prevention recommendations: reducing television (TV watching, removing TV from child's bedroom, increasing physically active games, participating in community or school-based athletics, walking to school, walking more in general, and eating less fast food. Parents were asked to discuss what factors would make each recommendation more difficult (barriers or easier (facilitators to follow. Participants were also asked about the relative importance of economic (time and dollar costs/savings barriers and facilitators if these were not brought into the discussion unprompted. Results Parents identified many barriers but few facilitators to adopting obesity prevention recommendations for their children. Members of all groups identified economic barriers (time and dollar costs among a variety of pertinent barriers, although the discussion of dollar costs often required prompting. Parents cited other barriers including child preference, difficulty with changing habits, lack of information, lack of transportation, difficulty with monitoring child behavior, need for assistance from family members, parity with other family members, and neighborhood walking safety. Facilitators identified included access to physical activity programs, availability of alternatives to fast food and TV which are acceptable to the child, enlisting outside support, dietary information, involving the child, setting limits, making behavior changes gradually, and parental change in shopping

  7. Barriers Approach to Innovation in Academic Libraries

    Directory of Open Access Journals (Sweden)

    Fu-Hsuan Chuang

    2016-11-01

    Full Text Available Innovation in academic libraries is not a brand new issue. Academic libraries can benefit from successful innovation, since innovation is a key contributor to gaining and sustaining competitive advantage for survival. Building on two case studies, 28 participants from leadership teams to practitioners are involved, the qualitative findings identified the specific two types of barriers that academic libraries face by applying a barriers approach to innovation, that’s, environmental and organizational barriers. Especially, seven dimensions of two types of barriers to innovation are found.

  8. Communication barriers in the family

    Directory of Open Access Journals (Sweden)

    BARBARA KOC-KOZŁOWIEC

    2017-10-01

    Full Text Available The art of communication – listening and speaking – is a major life skill, with a thorough influence on every human life. Remaining silent while the interlocutor speaks is not all that there is to the act of listening to messages. True listening is based on an intention to get involved in understanding of the other person, enjoying his or her presence, learning something from the conversation, giving assistance, or comforting the interlocutor. In the article the author describes obstacles (barriers, which render true listening impossible. These barriers have been identified by a group of young adults.

  9. Barriers to evidence-based medicine: a systematic review.

    Science.gov (United States)

    Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

    2014-12-01

    Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.

  10. Linguistic Barriers and Bridges

    DEFF Research Database (Denmark)

    Thuesen, Frederik

    2016-01-01

    The influence of language on social capital in low-skill and ethnically diverse workplaces has thus far received very limited attention within the sociology of work. As the ethnically diverse workplace is an important social space for the construction of social relations bridging different social...... groups, the sociology of work needs to develop a better understanding of the way in which linguistic diversity influences the formation of social capital, i.e. resources such as the trust and reciprocity inherent in social relations in such workplaces. Drawing on theories about intergroup contact...... and intercultural communication, this article analyses interviews with 31 employees from two highly ethnically diverse Danish workplaces. The article shows how linguistic barriers such as different levels of majority language competence and their consequent misunderstandings breed mistrust and hostility, whilst...

  11. Overcoming barriers to wind project finance in Australia

    International Nuclear Information System (INIS)

    Kann, Shayle

    2009-01-01

    The wind power industry in Australia is expected to grow rapidly over the next decade, primarily due to a forthcoming expanded national renewable energy target (RET) which will mandate that renewable sources provide approximately 20% of Australia's electricity production by 2020. However, development of new wind generation in Australia has stalled as a result of several barriers to project finance, the mechanism through which most wind farms have been developed historically. This paper provides an overview of wind power financing in Australia in light of recent political and financial trends. Drawing upon existing literature and a series of stakeholder interviews, it identifies three primary barriers to project finance: regulatory risk surrounding legislation of the RET, semi-privatization of electricity retailers in New South Wales, and limited capital availability resulting from the recent global credit crisis. The paper concludes that the confluence of these barriers limits the availability of long-term contracts that provide revenue certainty for pre-construction wind projects, while simultaneously making these contracts a necessity in order to obtain project finance. In an attempt to mitigate these effects, this paper identifies four alternative development strategies that can be pursued.

  12. Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care.

    Science.gov (United States)

    Diamond, Lisa C; Jacobs, Elizabeth A

    2010-05-01

    Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency (LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients. For example, studies suggest that teaching "Medical Spanish" or related courses may actually contribute to health care disparities if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one's own limited non-English language skills.

  13. Blood-CNS Barrier Impairment in ALS Patients versus an Animal Model

    Directory of Open Access Journals (Sweden)

    Svitlana eGarbuzova-Davis

    2014-02-01

    Full Text Available Amyotrophic lateral sclerosis (ALS is a severe neurodegenerative disease with a compli-cated and poorly understood pathogenesis. Recently, alterations in the blood-Central Nervous System barrier (B-CNS-B have been recognized as a key factor possibly aggravating motor neuron damage. The majority of findings on ALS microvascular pathology have been deter-mined in mutant SOD1 rodent models, identifying barrier damage during disease develop-ment which might similarly occur in familial ALS patients carrying the SOD1 mutation. However, our knowledge of B-CNS-B competence in sporadic ALS (SALS has been limited. We recently showed structural and functional impairment in postmortem gray and white mat-ter microvessels of medulla and spinal cord tissue from SALS patients, suggesting pervasive barrier damage. Although numerous signs of barrier impairment (endothelial cell degenera-tion, capillary leakage, perivascular edema, downregulation of tight junction proteins, and microhemorrhages are indicated in both mutant SOD1 animal models of ALS and SALS pa-tients, other pathogenic barrier alterations have as yet only been identified in SALS patients. Pericyte degeneration, perivascular collagen IV expansion, and white matter capillary abnor-malities in SALS patients are significant barrier related pathologies yet to be noted in ALS SOD1 animal models. In the current review, these important differences in blood-CNS barrier damage between ALS patients and animal models, which may signify altered barrier transport mechanisms, are discussed. Understanding discrepancies in barrier condition between ALS patients and animal models may be crucial for developing effective therapies.

  14. Self-organization and forcing templates in coastal barrier response to storms

    Science.gov (United States)

    Lazarus, E.

    2015-12-01

    When a storm event pushes water up and over a coastal barrier, cross-shore flow transports sediment from the barrier face to the back-barrier environment. This natural physical process is called "overwash", and "washover" is the sedimentary deposit it forms. Overwash and washover support critical coastal habitats, and enable barriers to maintain their height and width relative to rising sea level. On developed barrier coasts, overwash constitutes a natural hazard, which sea-level rise will exacerbate. Overwash is also a prerequisite for barrier breaching and coastal flooding. Predicting occurrence and characteristics of overwash and washover has significant societal value. Hazard models typically assume that pre-storm barrier morphology determines how the barrier changes during a storm. However, classic work has documented the absence of a relationship between pre/post-storm topography in some cases, and has also identified rhythmic patterns in washover alongshore. Previous explanations for these spatial patterns have looked to forcing templates, forms that get imprinted in the barrier shape. An alternative explanation is that washover patterns self-organize, emerging from feedbacks between water flow and sediment transport. Self-organization and forcing templates are often framed as mutually exclusive, but patterns likely form across a continuum of conditions. Here, I use data from a new physical experiment to suggest that spatial patterns in washover can self-organize within the limit of a forcing template of some critical "strength", beyond which pre/post-storm morphologies are highly correlated. Quantifying spatial patterns in washover deposits opens exciting questions regarding coastal morphodynamic response to storms. Measurement of relative template strength over extended spatial (and temporal) scales has the potential to improve hazard assessment and prediction, particularly where template strength is low and self-organization dominates barrier change.

  15. Clinical trial regulation in Argentina: overview and analysis of regulatory framework, use of existing tools, and researchers' perspectives to identify potential barriers Reglamentación de ensayos clínicos en la Argentina: panorama y análisis del marco normativo, uso de los instrumentos existentes y perspectivas de los investigadores para identificar posibles obstáculos

    Directory of Open Access Journals (Sweden)

    Lauren White

    2011-11-01

    Full Text Available OBJECTIVE: To review and analyze the regulatory framework of clinical trial registration, use of existing tools (publicly accessible national/international registration databases, and users' perspectives to identify possible barriers to registration compliance by sponsors and researchers in Argentina. METHODS: Internationally registered trials recruiting patients in Argentina were found through clincialtrials.gov and the International Clinical Trial Registration Platform (ICTRP and compared with publically available clinical trials registered through the National Administration of Drugs, Foods, and Medical Devices (ANMAT. A questionnaire addressing hypothesized attitudinal, knowledge-related, idiomatic, technical, economic, and regulatory barriers that could discourage or impede registration of clinical trials was developed, and semi-structured, in-depth interviews were conducted with a purposively selected sample of researchers (investigators, sponsors, and monitors in Argentina. RESULTS: A response rate of 74.3% (n = 29 was achieved, and 27 interviews were ultimately used for analysis. Results suggested that the high proportion of foreign-sponsored or multinational trials (64.8% of all protocols approved by ANMAT from 1994-2006 may contribute to a communication gap between locally based investigators and foreign-based administrative officials. A lack of knowledge about available international registration tools and limited awareness of the importance of registration were also identified as limiting factors for local investigators and sponsors. CONCLUSIONS: To increase compliance and promote clinical trial registration in Argentina, national health authorities, sponsors, and local investigators could take the following steps: implement a grassroots educational campaign to improve clinical trial regulation, support local investigator-sponsor-initiated clinical trials, and/or encourage local and regional scientific journal compliance with

  16. Passive Barriers to Inadvertent Human Intrusion for Use at the Nevada Test Site

    International Nuclear Information System (INIS)

    NSTec Environmental Management

    2007-01-01

    In July1996, BN transmitted Passive Barriers to Inadvertent Human Intrusion for Use at the Nevada Test Site to the United States Department of Energy, under Contract DE-AC08-91NV10833. The 1996 paper had a limited distribution and was not reviewed for public release. In 2007, National Security Technologies LLC (NSTec) made minor revisions to conform to current editorial standards of the NNSA/NSO and to meet current security requirements for public release. The primary purpose of this study was to identify types of engineered passive barriers that could deter future intrusion into buried low-level radioactive waste, particularly intrusion by drilling water wells. The study considered drilling technology, many natural and man-made materials, and both underground and above-ground barriers. Based on cost and effectiveness, the report recommended underground barriers consisting of a layer of rubble or tires. An aboveground barrier mound might also prove effective, but would cost more, and may become an attractive nuisance (e.g., might, after their purpose has been forgotten, encourage exploration for the sake of satisfying curiosity). Advances in drilling technology could render any engineered barriers ineffective if there is motivation to penetrate the barriers

  17. Barriers to Physical Activity Among African American Women: An Integrative Review of the Literature.

    Science.gov (United States)

    Joseph, Rodney P; Ainsworth, Barbara E; Keller, Colleen; Dodgson, Joan E

    2015-01-01

    A key aspect for researchers to consider when developing culturally appropriate physical activity (PA) interventions for African American (AA) women are the specific barriers AA women face that limit their participation in PA. Identification and critical examination of these barriers is the first step in developing comprehensive culturally relevant approaches to promote PA and help resolve PA-related health disparities in this underserved population. We conducted a systematic integrative literature review to identify barriers to PA among AA women. Five electronic databases were searched, and forty-two studies (twenty-seven qualitative, fourteen quantitative, one mixed method) published since 1990 (range 1998-2013) in English language journals met inclusion criteria for review. Barriers were classified as intrapersonal, interpersonal, or environment/community according to their respective level of influence within our social ecological framework. Intrapersonal barriers included lack of time, knowledge, and motivation; physical appearance concerns; health concerns; monetary cost of exercise facilities; and tiredness/fatigue. Interpersonal barriers included family/caregiving responsibilities; lack of social support; and lack of a PA partner. Environmental barriers included safety concerns; lack of facilities; weather concerns; lack of sidewalks; and lack of physically active AA role models. Results provide key leverage points for researchers to consider when developing culturally relevant PA interventions for AA women.

  18. Community Participation and Barriers in Rural Tourism: A Case Study in Kiulu, Sabah

    Directory of Open Access Journals (Sweden)

    Velnisa Paimin N. F.

    2014-01-01

    Full Text Available The paper presents an investigation on local community participation and barriers in rural tourism. It identifies two sides of community participation in tourism as identified by Timothy [5], which are; the benefits point of view and from the decision making process perspective. It also identifies the communities’ barriers in engaging in tourism and uses Tosun’s [18] approach in examining the barriers. A total of eighty-three questionnaire forms were completed by respondents from seven villages in Kiulu, Sabah, Malaysia. Respondents involved in tourism were mainly engaged as river guides, homestay operators and Tagal participants. Their involvement in the decision making process were limited to attending meetings and giving ideas and opinions only. The main barriers to participate in tourism were related to their limited knowledge about tourism, lack of capital, unable to communicate well in English, lack of information about tourism development in Kiulu, and limited incentives or support from the government for tourism development. The findings have significant implication to community participation in tourism especially in rural settings. More efforts should be made to ensure many more communities participate in tourism so as to share the benefits of tourism.

  19. Barrier cell sheath formation

    International Nuclear Information System (INIS)

    Kesner, J.

    1980-04-01

    The solution for electrostatic potential within a simply modeled tandem mirror thermal barrier is seen to exhibit a sheath at each edge of the cell. The formation of the sheath requires ion collisionality and the analysis assmes that the collisional trapping rate into the barrier is considerably slower than the barrier pump rate

  20. Analysis of the barriers and enablers to implementing lifestyle management practices for women with PCOS in Singapore.

    Science.gov (United States)

    Ko, Henry; Teede, Helena; Moran, Lisa

    2016-06-16

    Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Evidence-based PCOS guidelines recommend lifestyle management first line for infertility. In Singapore women with PCOS can attend the PCOS Clinic at the Kandang Kerbau Women and Children's Hospital for infertility treatment. However lifestyle integration into infertility management is currently limited and barriers and enablers to progress remain unclear. All PCOS clinic staff undertook semi-structured interviews to investigate perceived barriers for staff and consumers for the integration of lifestyle into infertility management. This study utilised various tools including an 8P Ishikawa diagram model to identify and categorise barriers. A modified Hanlon method was then used to prioritise barriers within the Singaporean context considering organisational, cultural and financial constraints. Propriety, economics, acceptability, resources and legality (PEARL) criteria were also incorporated into this decision-making tool. In the 8P model, there were five factors contributing to the 'procedure (consultations and referral processes)' barrier, one 'policy (government and hospitals)' factor, five 'place' factors, two 'product (lifestyle management programme)' barriers, two 'people (programme capacity)' factors, four 'process (integration)' factors, three 'promotion' barriers and three 'price' factors. Of the prioritised barriers, two were identified across each of 'procedures', 'place', 'product' and 'people' and four related to 'processes'. There were no barriers identified that for 'policies', 'promotion' and 'price' that can be addressed. There is a clear need to integrate lifestyle into infertility management in PCOS, in line with current national and international evidence-based guidelines. The highest priority identified improvement opportunity was to develop a collaborative lifestyle management

  1. In silico serotyping of E. coli from short read data identifies limited novel O-loci but extensive diversity of O:H serotype combinations within and between pathogenic lineages.

    Science.gov (United States)

    Ingle, Danielle J; Valcanis, Mary; Kuzevski, Alex; Tauschek, Marija; Inouye, Michael; Stinear, Tim; Levine, Myron M; Robins-Browne, Roy M; Holt, Kathryn E

    2016-07-01

    The lipopolysaccharide (O) and flagellar (H) surface antigens of Escherichia coli are targets for serotyping that have traditionally been used to identify pathogenic lineages. These surface antigens are important for the survival of E. coli within mammalian hosts. However, traditional serotyping has several limitations, and public health reference laboratories are increasingly moving towards whole genome sequencing (WGS) to characterize bacterial isolates. Here we present a method to rapidly and accurately serotype E. coli isolates from raw, short read WGS data. Our approach bypasses the need for de novo genome assembly by directly screening WGS reads against a curated database of alleles linked to known and novel E. coli O-groups and H-types (the EcOH database) using the software package srst2. We validated the approach by comparing in silico results for 197 enteropathogenic E. coli isolates with those obtained by serological phenotyping in an independent laboratory. We then demonstrated the utility of our method to characterize isolates in public health and clinical settings, and to explore the genetic diversity of >1500 E. coli genomes from multiple sources. Importantly, we showed that transfer of O- and H-antigen loci between E. coli chromosomal backbones is common, with little evidence of constraints by host or pathotype, suggesting that E. coli ' strain space' may be virtually unlimited, even within specific pathotypes. Our findings show that serotyping is most useful when used in combination with strain genotyping to characterize microevolution events within an inferred population structure.

  2. Richards Barrier LA Reference Design Feature Evaluation

    International Nuclear Information System (INIS)

    N.E. Kramer

    1999-01-01

    The Richards Barrier is one of the design features of the repository to be considered for the License Application (LA), Richards was a soil scientist who first described the diversion of moisture between two materials with different hydrologic properties. In this report, a Richards Barrier is a special type of backfill with a fine-grained material (such as sand) overlaying a coarse-grained material (such as gravel). Water that enters an emplacement drift will first encounter the fine-grained material and be transported around the coarse-grained material covering the waste package, thus protecting the waste package from contact with most of the groundwater. The objective of this report is to discuss the benefits and liabilities to the repository by the inclusion of a Richards Barrier type backfill in emplacement drifts. The Richards Barrier can act as a barrier to water flow, can reduce the waste package material dissolution rate, limit mobilization of the radionuclides, and can provide structural protection for the waste package. The scope of this report is to: (1) Analyze the behavior of barrier materials following the intrusion of groundwater for influxes of 1 to 300 mm per year. The report will demonstrate diversion of groundwater intrusions into the barrier over an extended time period when seismic activity and consolidation may cause the potential for liquefaction and settlement of the Richards Barrier. (2) Review the thermal effects of the Richards Barrier on material behavior. (3) Analyze the effect of rockfall on the performance of the Richards Barrier and the depth of the barrier required to protect waste packages under the barrier. (4) Review radiological and heating conditions on placement of multiple layers of the barrier. Subsurface Nuclear Safety personnel will perform calculations to determine the radiation reduction-time relationship and shielding capacity of the barrier. (5) Evaluate the effects of ventilation on cooling of emplacement drifts and

  3. Social Barriers to Effective Communication in Old Age

    OpenAIRE

    Anna Sanecka

    2014-01-01

    Some communication barriers apply particularly to elderly people. The social barriers to effective communication in old age are the barriers caused by stereotypes of old age/elderly people and the barriers arising from limitations in using mass communication by seniors. Stereotypes of old age/elderly people embrace views regarding old people’s communication skills and the ideas about the correct way of communication with them. Therefore the communication problems of old people are correlated ...

  4. Reactive barriers for 137Cs retention

    International Nuclear Information System (INIS)

    Krumhansl, James L.; Brady, Patrick V.; Anderson, Howard L.

    2000-01-01

    137 Cs was dispersed globally by cold war activities and, more recently, by the Chernobyl accident. Engineered extraction of 137 Cs from soils and groundwaters is exceedingly difficult. Because the half life of 137 Cs is only 30.2 years, remediation might be more effective (and less costly) if 137 Cs bioavailability could be demonstrably limited for even a few decades by use of a reactive barrier. Essentially permanent isolation must be demonstrated in those few settings where high nuclear level wastes contaminated the environment with 135 Cs (half life 2.3x10 6 years) in addition to 137 Cs. Clays are potentially a low-cost barrier to Cs movement, though their long-term effectiveness remains untested. To identify optimal clays for Cs retention Cs resorption was measured for five common clays: Wyoming Montmorillonite (SWy-1), Georgia Kaolinites (KGa-1 and KGa-2), Fithian Illite (F-Ill), and K-Metabentonite (K-Mbt). Exchange sites were pre-saturated with 0.16 M CsCl for 14 days and readily exchangeable Cs was removed by a series of LiNO 3 and LiCl washes. Washed clay were then placed into dialysis bags and the Cs release to the deionized water outside the bags measured. Release rates from 75 to 139 days for SWy-1, K-Mbt and F- 111 were similar; 0.017 to 0.021% sorbed Cs released per day. Both kaolinites released Cs more rapidly (0.12 to 0.05% of the sorbed Cs per day). In a second set of experiments, clays were doped for 110 days and subjected to an extreme and prolonged rinsing process. All the clays exhibited some capacity for irreversible Cs uptake so most soils have some limited ability to act as a natural barrier to Cs migration. However, the residual loading was greatest on K-Mbt (∼ 0.33 wt% Cs). Thus, this clay would be the optimal material for constructing artificial reactive barriers

  5. Barriers to Participation in Learning Management Systems in Saudi Arabian Universities

    Directory of Open Access Journals (Sweden)

    Abdullah Alenezi

    2018-01-01

    Full Text Available This study was designed to identify various barriers that have hindered the adoption of LMSs in Saudi Arabian universities. Learning management systems (LMSs have been adopted in many learning institutions because of their functionalities and applications to improve pedagogy. Universities have been encouraged to use LMSs to enhance the collaborative working environment among students and between the students and their instructors. This study was done by administering 150 questionnaires to students in three universities in Saudi Arabia. Findings from the study revealed that the main barriers to the use of LMSs were inadequate technical support by the universities, negative attitude toward technology, and inadequate training on the LMS platforms. Minor barriers identified include poor Internet access and networking, limited infrastructure to support the LMS, lack of hardware and software to run the LMS, and challenges in English language proficiency.

  6. Pay More Attention: a national mixed methods study to identify the barriers and facilitators to ensuring equal access to high-quality hospital care and services for children and young people with and without learning disabilities and their families.

    Science.gov (United States)

    Oulton, Kate; Wray, Jo; Carr, Lucinda; Hassiotis, Angela; Jewitt, Carey; Kerry, Sam; Tuffrey-Wijne, Irene; Gibson, Faith

    2016-12-09

    the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. SPARQL-enabled identifier conversion with Identifiers.org

    Science.gov (United States)

    Wimalaratne, Sarala M.; Bolleman, Jerven; Juty, Nick; Katayama, Toshiaki; Dumontier, Michel; Redaschi, Nicole; Le Novère, Nicolas; Hermjakob, Henning; Laibe, Camille

    2015-01-01

    Motivation: On the semantic web, in life sciences in particular, data is often distributed via multiple resources. Each of these sources is likely to use their own International Resource Identifier for conceptually the same resource or database record. The lack of correspondence between identifiers introduces a barrier when executing federated SPARQL queries across life science data. Results: We introduce a novel SPARQL-based service to enable on-the-fly integration of life science data. This service uses the identifier patterns defined in the Identifiers.org Registry to generate a plurality of identifier variants, which can then be used to match source identifiers with target identifiers. We demonstrate the utility of this identifier integration approach by answering queries across major producers of life science Linked Data. Availability and implementation: The SPARQL-based identifier conversion service is available without restriction at http://identifiers.org/services/sparql. Contact: sarala@ebi.ac.uk PMID:25638809

  8. SPARQL-enabled identifier conversion with Identifiers.org.

    Science.gov (United States)

    Wimalaratne, Sarala M; Bolleman, Jerven; Juty, Nick; Katayama, Toshiaki; Dumontier, Michel; Redaschi, Nicole; Le Novère, Nicolas; Hermjakob, Henning; Laibe, Camille

    2015-06-01

    On the semantic web, in life sciences in particular, data is often distributed via multiple resources. Each of these sources is likely to use their own International Resource Identifier for conceptually the same resource or database record. The lack of correspondence between identifiers introduces a barrier when executing federated SPARQL queries across life science data. We introduce a novel SPARQL-based service to enable on-the-fly integration of life science data. This service uses the identifier patterns defined in the Identifiers.org Registry to generate a plurality of identifier variants, which can then be used to match source identifiers with target identifiers. We demonstrate the utility of this identifier integration approach by answering queries across major producers of life science Linked Data. The SPARQL-based identifier conversion service is available without restriction at http://identifiers.org/services/sparql. © The Author 2015. Published by Oxford University Press.

  9. Barriers to fusion

    International Nuclear Information System (INIS)

    Berriman, A.C.; Butt, R.D.; Dasgupta, M.; Hinde, D.J.; Morton, C.R.; Newton, J.O.

    1999-01-01

    The fusion barrier is formed by the combination of the repulsive Coulomb and attractive nuclear forces. Recent research at the Australian National University has shown that when heavy nuclei collide, instead of a single fusion barrier, there is a set of fusion barriers. These arise due to intrinsic properties of the interacting nuclei such deformation, rotations and vibrations. Thus the range of barrier energies depends on the properties of both nuclei. The transfer of matter between nuclei, forming a neck, can also affect the fusion process. High precision data have been used to determine fusion barrier distributions for many nuclear reactions, leading to new insights into the fusion process

  10. Safety- barrier diagrams

    DEFF Research Database (Denmark)

    Duijm, Nijs Jan

    2008-01-01

    Safety-barrier diagrams and the related so-called 'bow-tie' diagrams have become popular methods in risk analysis. This paper describes the syntax and principles for constructing consistent and valid safety-barrier diagrams. The relation of safety-barrier diagrams to other methods such as fault...... trees and Bayesian networks is discussed. A simple method for quantification of safety-barrier diagrams is proposed. It is concluded that safety-barrier diagrams provide a useful framework for an electronic data structure that integrates information from risk analysis with operational safety management....

  11. Safety-barrier diagrams

    DEFF Research Database (Denmark)

    Duijm, Nijs Jan

    2007-01-01

    Safety-barrier diagrams and the related so-called "bow-tie" diagrams have become popular methods in risk analysis. This paper describes the syntax and principles for constructing consistent and valid safety-barrier diagrams. The relation with other methods such as fault trees and Bayesian networks...... are discussed. A simple method for quantification of safety-barrier diagrams is proposed, including situations where safety barriers depend on shared common elements. It is concluded that safety-barrier diagrams provide a useful framework for an electronic data structure that integrates information from risk...... analysis with operational safety management....

  12. Iranian entrepreneur nurses' perceived barriers to entrepreneurship: A qualitative study.

    Science.gov (United States)

    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.

  13. Iranian entrepreneur nurses’ perceived barriers to entrepreneurship: A qualitative study

    Science.gov (United States)

    Jahani, Simin; Abedi, Heidarali; Elahi, Nasrin; Fallahi-Khoshknab, Masoud

    2016-01-01

    Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:26985222

  14. THE TOURISM BARRIERS OF THE DISABLED

    Directory of Open Access Journals (Sweden)

    Nagy Andreea

    2011-07-01

    Full Text Available This article seeks to address a very sensitive issue in Romania, the disabled tourism. The natural question is whether tourism can respond and meet the needs of such people. Internationally, the researches in detail about tourism for people with disabilities are limited in this direction, and those who exist are focused more on lack of physical access to certain services in the hotel units.-As for the problems (barriers that a person with disabilities may face when seeking to participate in the act of travel there were found numerous internal and external barriers in trying to participate in tourism activities-The study seeks to identify how normal people behave towards people with disabilities and aims to demonstrate the existence of correlations between the responses of the interviewees, which would lead to the presentation as close to the truth as possible of the results from the sample (section, transposed over the population from which the sample belongs and also lead to finding conclusions on which there could be made several proposals.

  15. Barriers associated with reduced physical activity in COPD patients

    Directory of Open Access Journals (Sweden)

    Priscila Batista Amorim

    2014-10-01

    Full Text Available OBJECTIVE: To evaluate the ability of COPD patients to perform activities of daily living (ADL; to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT, and an ADL limitation score. METHODS: In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. RESULTS: We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5 ± 25.8 min/day vs. 105.2 ± 49.4 min/day; p < 0.001, as was the distance walked (3.9 ± 1.9 km/day vs. 6.4 ± 3.2 km/day; p < 0.001. The COPD patients also walked fewer steps/day. The most common self-reported barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. CONCLUSIONS: Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.

  16. Barriers to health care professionals in detecting more domestic violence

    Directory of Open Access Journals (Sweden)

    Knežević Snežana B.

    2017-01-01

    Full Text Available Introduction. Identification of victims of domestic violence among the women using the healthcare is not sufficient. Objective. The aim of this study is to identify the barriers that prevent health care professionals in identifying domestic violence more often. Method. A questionnaire was distributed to health workers in the Health center of Kraljevo, by e-mail. Results. The study comprised 136 health care workers, 73.3% female and 26.7% male. 70.6% were doctors and 29.4% technicians. The mean age of respondents was 38.93 ± 7.7, (range 31-50, with the average 11.36 ± 7.74 years of service. The social barriers were significantly more present among female health workers (p=0.037. The most frequent answer is the lack of guidelines. This answer is significantly in correlation with professional qualification (p=0.002. The prominent institutional barriers are overwork (53.7%, lack of information about the procedures (significantly present among doctors, p=0.003, and the fear for their own safety (46.3%. Barriers associated to the health care workers themselves have the least number of responses, with limited time as the most important, followed by lack of training (44.9% and lack of knowledge, that is significantly related to gender (p=0.002 and to qualifications (p=0.009. Women expect more authority in their work, p=0.035. Among the 4 groups of barriers, the majority of answers is related to the victims of violence themselves (43.9%, statistically more significant among doctors, p=0.004, predominantly responding that victims hide the violent behavior of their partners (65.4%. Conclusion. Provide continuous education about domestic violence and evaluation of knowledge, encourage the victims to trust the health system, raise awareness about the judgment of violence, and skillfully inform the women of resources in the community.

  17. Pharmacogenetics in Europe: barriers and opportunities.

    Science.gov (United States)

    Gurwitz, D; Zika, E; Hopkins, M M; Gaisser, S; Ibarreta, D

    2009-01-01

    This paper reviews the current situation in the field of pharmacogenetics/pharmacogenomics (PGx) in Europe. High expectations surrounding the clinical application of PGx remain largely unmet, as only a limited number of such applications have actually reached the market and clinical practice. Thus, the potential impact of PGx-based diagnostics on healthcare and its socio-economic implications are still unclear. With the aim of shedding some light on these uncertainties, the Institute for Prospective Technological Studies (IPTS) of the European Commission's Joint Research Centre (JRC) has conducted a review of the 'state of the art' and a further analysis on the use of pharmacogenetics diagnostics for preventing toxic drug reactions and improving drug efficacy in Europe. The paper presents highlights from the JRC-IPTS studies and discusses possibilities for improving translation of PGx research in Europe by comparing some experiences in the USA. We also illustrate the related barriers for the clinical uptake of PGx in Europe with specific case-studies. Most of the barriers identified extend beyond the European context. This reflects the global problems of scarcity of data demonstrating proven clinical validity or utility and favorable cost-effectiveness studies to support the clinical application of PGx diagnostic tests in the clinical setting. Another key barrier is the lack of incentives for the private sector to invest in the development and licensing of PGx diagnostic tests for improving the safety and efficacy of out-of-patent drugs. It therefore seems that one key aspect where policy can affect the clinical uptake of PGx is via sustaining large-scale industry-academia collaborations for developing and proving the utility of PGx diagnostics. Copyright 2009 S. Karger AG, Basel.

  18. Barriers to healthcare for transgender individuals.

    Science.gov (United States)

    Safer, Joshua D; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae

    2016-04-01

    Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

  19. Legal Barriers in Accessing Opioid Medicines : Results of the ATOME Quick Scan of National Legislation of Eastern European Countries

    NARCIS (Netherlands)

    Vranken, Marjolein J M; Mantel-Teeuwisse, Aukje K; Jünger, Saskia; Radbruch, Lukas; Lisman, John; Scholten, Willem; Payne, Sheila; Lynch, Tom; Schutjens, Marie-Hélène D B

    2014-01-01

    CONTEXT: Overregulation of controlled medicines is one of the factors contributing to limited access to opioid medicines. OBJECTIVES: The purpose of this study was to identify legal barriers to access to opioid medicines in 12 Eastern European countries participating in the Access to Opioid

  20. A Survey to Assess Barriers to Urban Teaching Careers

    Science.gov (United States)

    Creasey, Gary; Mays, Jennifer; Lee, Robert; D'Santiago, Verenice

    2016-01-01

    The "Urban Teaching Barriers" survey was created to assess barriers to urban teaching careers. Pre-service teachers (N = 377) completed this instrument, along with questionnaires that assessed urban teaching intentions and urban teaching self-efficacy. Six barrier domains were identified that tapped concerns over (a) lack of resources,…

  1. SME's perceptions regarding strategic and structural entry barriers

    NARCIS (Netherlands)

    Lutz, Clemens; Kemp, Ron; Dijkstra, S. Gerhard

    2007-01-01

    Abstract Extant literature discusses a large number of different entry barriers that may hamper market efficiency or entrepreneurial activity. In practice several of these barriers cohere and stem from the same root. Factor analysis is used to identify the underlying dimensions of these barriers. 7

  2. Overcoming Branding Barriers in Nonprofit, Private Colleges and Universities

    Science.gov (United States)

    Chyr, Fred

    2017-01-01

    Purpose: The purpose of this Delphi study was to explore the views of experts in the field of nonprofit private colleges and universities in the United States to define branding and identify current barriers to branding, to discover how those barriers can be overcome, and to determine what barriers to branding are likely to occur 5 years in the…

  3. 10 CFR 63.115 - Requirements for multiple barriers.

    Science.gov (United States)

    2010-01-01

    ... Requirements for multiple barriers. Demonstration of compliance with § 63.113(a) must: (a) Identify those design features of the engineered barrier system, and natural features of the geologic setting, that are... 10 Energy 2 2010-01-01 2010-01-01 false Requirements for multiple barriers. 63.115 Section 63.115...

  4. Regulatory barriers for activating flexibility in the Nordic-Baltic electricity market

    DEFF Research Database (Denmark)

    Bergaentzlé, Claire; Skytte, Klaus; Soysal, Emilie Rosenlund

    2017-01-01

    to flexibility. We find that the most restrictive barriers against flexibility are emitted by public authorities as part of broader policy strategies. Overall, we find that current regulatory and market framework conditions do not hinder flexibility. However, despite that, flexibility remains limited due......, load adjustment or to a greater coupling to other energy sectors. In this paper, we identify the framework conditions that influence the provision of VRE-friendly flexibility in the Nordic and Baltic electricity sector, i.e., the market and regulatory settings that act as drivers or barriers...... to a lack of coherent instruments intended to both the demand and supply-side to effectively act flexibly....

  5. Barriers and Facilitators of Physical Activity in Children of a South Asian Ethnicity

    Directory of Open Access Journals (Sweden)

    Lee Smith

    2018-03-01

    Full Text Available Children of South Asian ethnicity residing in England have low levels of physical activity. Limited literature exists on correlates, barriers, and facilitators to activity in South Asian children. The aim of this study was to fill this gap in the literature. Interviews were conducted with 10 parents of South Asian ethnicity residing in the UK. Interviews covered a description of the family setup, participants’ opinions of physical activity including barriers and facilitators and their children’s participation, as well as approaches to general parenting, and how children spend their free time. Data were analysed using thematic analysis. Key themes identified included (i restraints on parents’ and children’s time to be physically active; (ii the role of the family in children’s physical activity participation; (iii situational barriers to physical activity; (iv physical activity not a priority; (v opportunities to be active; and (vi perception of activity level and health. A number of key barriers to South Asian children’s participation in physical activity were identified, including (i restraints on parents and children’s time; (ii parents providing limited support for physical activity; and (iii physical activity having a low priority. A number of facilitators were also identified (i play; (ii school-time; and (iii extra-curricular clubs. In this sample of South Asian parents residing in the UK several socio-cultural barriers and facilitators of their children’s physical activity have been identified. The study provides preliminary data for a larger study to ascertain if such barriers and facilitators are representative of the wider South Asian community, so that recommendations for intervention and policies can be made.

  6. "People will say that I am proud": a qualitative study of barriers to bed net use away from home in four Ugandan districts.

    Science.gov (United States)

    Monroe, April; Harvey, Steven A; Lam, Yukyan; Muhangi, Denis; Loll, Dana; Kabali, Asaph Turinde; Weber, Rachel

    2014-03-06

    Despite increased access and ownership, barriers to insecticide-treated bed net (ITN) use persist. While barriers within the home have been well documented, the challenges to net use when sleeping away from home remain relatively unexplored. This study examines common situations in which people sleep away from home and the barriers to ITN use in those situations. To explore these issues, a group of researchers conducted 28 in-depth interviews and four focus groups amongst adults from net-owning households in four Ugandan districts. In addition to sleeping outside during hot season, participants identified social events, livelihood activities, and times of difficulty as circumstances in which large numbers of people sleep away from home. Associated challenges to ITN use included social barriers such as fear of appearing proud, logistical barriers such as not having a place to hang a net, and resource limitations such as not having an extra net with which to travel. Social disapproval emerged as an important barrier to ITN use in public settings. Unique barriers to ITN use exist when people spend the night away from home. It is essential to identify and address these barriers in order to reduce malaria exposure in such situations. For events like funerals or religious "crusades" where large numbers of people sleep away from home, alternative approaches, such as spatial repellents may be more appropriate than ITNs. Additional research is required to identify the acceptability and feasibility of alternative prevention strategies in situations where ITNs are unlikely to be effective.

  7. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence.

    Science.gov (United States)

    Coll, Carolina V N; Domingues, Marlos R; Gonçalves, Helen; Bertoldi, Andréa D

    2017-01-01

    Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy. PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016. A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers. Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources. A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  8. Municipal Officials’ Perceived Barriers to Consideration of Physical Activity in Community Design Decision Making

    Science.gov (United States)

    Goins, Karin Valentine; Schneider, Kristin L.; Brownson, Ross; Carnoske, Cheryl; Evenson, Kelly; Eyler, Amy; Heinrich, Katie; Litt, Jill; Lyn, Rodney; Maddock, Jay; Reed, Hannah; Tompkins, Nancy O’Hara; Lemon, Stephenie C.

    2016-01-01

    Context Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to consideration of physical activity in decision making. Objective This study aimed to 1) identify barriers to the consideration of physical activity in community design and planning decisions among municipal decision makers and 2) explore differences in these barriers among a wide range of job functions and departments in a geographically diverse sample. Design A web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50,000 residents in eight states. Participants 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures responded to the survey. Main Outcome Measures Five barriers to consideration of physical activity in community design and layout were assessed. Results The most common barriers included lack of political will (23.5%), limited staff (20.4%) and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Compared to other professionals, public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments. They were also more likely to report lack of political will compared to city managers or mayors and municipal legislators. Conclusions Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will

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

    Science.gov (United States)

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

    2013-08-19

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

  10. Psychological Barriers to Behavior Change: How to indentify the barriers that inhibit change

    OpenAIRE

    Olson, James M.

    1992-01-01

    Adopting a healthy lifestyle often requires changing patterns of behavior. This article describes three categories of psychological barriers to behavior change: those that prevent the admission of a problem, those that interfere with initial attempts to change behavior, and those that make long-term change difficult. Strategies are identified that family physicians can use to overcome the barriers.

  11. Markers for blood-brain barrier integrity

    DEFF Research Database (Denmark)

    Saunders, Norman R; Dziegielewska, Katarzyna M; Møllgård, Kjeld

    2015-01-01

    In recent years there has been a resurgence of interest in brain barriers and various roles their intrinsic mechanisms may play in neurological disorders. Such studies require suitable models and markers to demonstrate integrity and functional changes at the interfaces between blood, brain......, and cerebrospinal fluid. Studies of brain barrier mechanisms and measurements of plasma volume using dyes have a long-standing history, dating back to the late nineteenth-century. Their use in blood-brain barrier studies continues in spite of their known serious limitations in in vivo applications. These were well...... known when first introduced, but seem to have been forgotten since. Understanding these limitations is important because Evans blue is still the most commonly used marker of brain barrier integrity and those using it seem oblivious to problems arising from its in vivo application. The introduction...

  12. Unified Model of Dynamic Forced Barrier Crossing in Single Molecules

    Energy Technology Data Exchange (ETDEWEB)

    Friddle, R W

    2007-06-21

    Thermally activated barrier crossing in the presence of an increasing load can reveal kinetic rate constants and energy barrier parameters when repeated over a range of loading rates. Here we derive a model of the mean escape force for all relevant loading rates--the complete force spectrum. Two well-known approximations emerge as limiting cases; one of which confirms predictions that single-barrier spectra should converge to a phenomenological description in the slow loading limit.

  13. Barriers to investment in emerging power markets

    Energy Technology Data Exchange (ETDEWEB)

    Beardsworth, Jr, J J [Hunton and Williams, Richmond, VA (United States)

    1994-12-31

    Investing in private power projects in developing countries is a very different issue from investment in the US or the UK. There are many investment barriers not present in developed nations. Firstly investment barriers need to be identified. Trouble may be encountered with legal authorization; the regulatory framework; government guarantees; fuel supply security; lender protection; labour laws and local commercial restrictions such as profits repatriation, currency convertibility, and taxes. Political barriers may also be encountered in the form of: government commitments and support; funding sources; political unrest; religion; and relationships with other countries. Investment barriers may be minimised by persuading the government to remove any legal barriers; the contract has then to be agreed. Factors in a successful contract include: power purchase agreements; fuel agreements; and implementation agreements. It is vital to have a source of information on local rules and customs, by working with local companies and employing local attorneys.

  14. Barriers to physical activity among working mothers.

    Science.gov (United States)

    Dombrowski, Jill J

    2011-04-01

    Working mothers experience several barriers to physical activity. If these barriers can be identified by occupational health nurses and they can partner with working mothers to reduce these perceived barriers, the health of these workers can be improved and chronic disease risk prevented. The purpose of this study was to measure the effect of self-regulatory efficacy on physical activity among working mothers and to describe specific barriers to physical activity. The Barriers Specific Self-Efficacy Scale (BARSE) and the Kaiser Physical Activity Survey (KPAS) were used to measure the variables. Self-regulatory efficacy was found to be a strong predictor of physical activity in a diverse sample of working mothers who did not meet current recommendations for physical activity. Occupational health nurses can use these findings to design programs for groups and for counseling individuals. Copyright 2011, SLACK Incorporated.

  15. Contextual and interdependent causes of climate change adaptation barriers: Insights from water management institutions in Himachal Pradesh, India.

    Science.gov (United States)

    Azhoni, Adani; Holman, Ian; Jude, Simon

    2017-01-15

    Research on adaptation barriers is increasing as the need for climate change adaptation becomes evident. However, empirical studies regarding the emergence, causes and sustenance of adaptation barriers remain limited. This research identifies key contextual causes of adaptation barriers in water institutions in the mountainous Himalayan state of Himachal Pradesh in northern India. Semi-structured interviews were carried out with representatives from twenty-six key governmental, non-governmental, academic and research institutions in the State with responsibilities spanning domestic water supply, irrigation and hydropower generation, environmental monitoring and research. It identified low knowledge capacity and resources, policy implementation gaps, normative attitudes, and unavailability and inaccessibility of data and information compounded with weak interinstitutional networks as key adaptation barriers. Although these barriers are similar to those reported elsewhere, they have important locally-contextual root causes. For instance, inadequate resources result from fragmented resources allocation due to competing developmental priorities and the desire of the political leadership to please diverse electors, rather than climate scepticism. The identified individual barriers are found to be highly inter-dependent and closely intertwined which enables the identification of leverage points for interventions to maximise barrier removal. For instance, breaking down key barriers hindering accessibility to data and information, which are shaped by systemic bureaucracies and cultural attitudes, will involve attitudinal change through sensitisation to the importance of accurate and accessible data and information and the building trust between different actors, in addition to institutional structural changes through legislation and inter-institutional agreements. Approaching barriers as a system of contextually interconnected cultural, systemic, geographical and political

  16. Barrier penetration database

    International Nuclear Information System (INIS)

    Fainberg, A.; Bieber, A.M. Jr.

    1978-11-01

    This document is intended to supply the NRC and nuclear power plant licensees with basic data on the times required to penetrate forcibly the types of barriers commonly found in nuclear plants. These times are necessary for design and evaluation of the physical protection system required under 10CFR73.55. Each barrier listed is described in detail. Minor variations in basic barrier construction that result in the same penetration time, are also described

  17. Identifying Barriers to Knowledge Management in the US Military

    Science.gov (United States)

    2002-12-16

    Knowledge Age In his 1980s best-seller, Megatrends , John Naisbitt proposed that our industrial society had transformed itself into an information society...considered to be representations of the world that consist of objects and events, and the challenge of a cognitive system, computational or biological ...Naisbitt, J. (1984). Megatrends . New York: Warner Books, Inc. Nguyen, B. (2000). Building a Knowledge-Centric United States Air Force. 1250 AF

  18. Research aims to identify and remove barriers faced by Africa's ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2013-07-10

    Jul 10, 2013 ... Across Africa, men and women are increasingly entering the marketplace as small ... that prevent them from growing, improving their performance, and increasing earnings. This is ... Woman working in a small shop in Ghana.

  19. Identifying barriers for ICT development in companies' registration office

    Directory of Open Access Journals (Sweden)

    Rasool Mehdian

    2014-10-01

    Full Text Available One of the necessary issues in business development is to register it with government, which helps an organization gain an official identification. However, registering a firm with government often involves with many challenges in different countries. The recent advances in information technology have created tremendous opportunities to expedite the process of business development. This paper presents an empirical investigation to prioritize various factors influencing on information and communication technology development in noncommercial business registration office in Iran. The proposed study designs a questionnaire with eight categories and distributes it among some experts. The results of our survey indicate that Creating a sense of urgency is number one important factor followed by Appropriate planning, Form a coalition FAQ, Fixed improvements, Empowering, Creating a good perspective, New approaches to institution-building and Explanation of Vision.

  20. Identifying Barriers and Facilitators in Implementing Schoolwide Positive Behavior Support

    Science.gov (United States)

    Kincaid, Don; Childs, Karen; Blase, Karen A.; Wallace, Frances

    2007-01-01

    As the number of schools implementing systemic, schoolwide positive behavior support (PBS) processes expands (nationally, at least 5,000 schools are participating), increasing attention is being paid to the efficacy of implementation. This article describes a case study of the experiences of Florida's Positive Behavior Support Project, which used…

  1. Identifying the barriers to female leadership in Paramedicine

    Directory of Open Access Journals (Sweden)

    Paige Mason

    2017-06-01

    Full Text Available The main message is clear: women are not making it to the top in any profession, anywhere in the world, and the field of prehospital and academic medicine is not immune. Whether in the public or private sphere, from the highest levels of government decision-making to common households, women continue to be denied equal opportunity with men

  2. Transport barriers in plasmas

    International Nuclear Information System (INIS)

    Caldas, I L; Szezech, J D Jr; Kroetz, T; Marcus, F A; Roberto, M; Viana, R L; Lopes, S R

    2012-01-01

    We discuss the creation of transport barriers in magnetically confined plasmas with non monotonic equilibrium radial profiles. These barriers reduce the transport in the shearless region (i.e., where the twist condition does not hold). For the chaotic motion of particles in an equilibrium electric field with a nonmonotonic radial profile, perturbed by electrostatic waves, we show that a nontwist transport barrier can be created in the plasma by modifying the electric field radial profile. We also show non twist barriers in chaotic magnetic field line transport in the plasma near to the tokamak wall with resonant modes due to electric currents in external coils.

  3. Omnidirectional ventilated acoustic barrier

    Science.gov (United States)

    Zhang, Hai-long; Zhu, Yi-fan; Liang, Bin; Yang, Jing; Yang, Jun; Cheng, Jian-chun

    2017-11-01

    As an important problem in acoustics, sound insulation finds applications in a great variety of situations. In the existing schemes, however, there has always been a trade-off between the thinness of sound-insulating devices and their ventilating capabilities, limiting their potentials in the control of low-frequency sound in high ventilation environments. Here, we design and experimentally implement an omnidirectional acoustic barrier with a planar profile, subwavelength thickness ( 0.18 λ ), yet high ventilation. The proposed mechanism is based on the interference between the resonant scattering of discrete states and the background scattering of continuous states which induces a Fano-like asymmetric transmission profile. Benefitting from the binary-structured design of the coiled unit and hollow pipe, it maximally simplifies the design and fabrication while ensuring the ventilation for all the non-resonant units with open tubes. The simulated and measured results agree well, showing the effectiveness of our proposed mechanism to block low frequency sound coming from various directions while allowing 63% of the air flow to pass. We anticipate our design to open routes to design sound insulators and to enable applications in traditionally unattainable cases such as those calling for noise reduction and cooling simultaneously.

  4. Physiotherapy postgraduate studies in South Africa: Facilitators and barriers

    Directory of Open Access Journals (Sweden)

    Saul Cobbing

    2017-02-01

    Full Text Available Aim: To investigate the facilitators and barriers to attaining a postgraduate physiotherapy degree in South Africa. Methods: A quantitative, cross-sectional design using an internet-based survey was employed. The population of the study included all qualified physiotherapists who had completed community service and who were on the South African Society of Physiotherapy e-mailing list at the time of the study. Results: In all, 425 valid responses were received. The study participants were predominantly white women with a mean age of 36.9 and the majority were working in private practice. A total of 20.5% of respondents had completed a master’s or doctoral degree in physiotherapy, while a further 13% of respondents were registered for a postgraduate degree in physiotherapy at the time of the study. Study participants who had obtained a postgraduate degree identified the same main barriers (namely cost/lack of financial support, family commitments and lack of time and the same main facilitators (namely gaining of expertise, fulfilment of a personal goal and improvement of patient care as participants who had not obtained a postgraduate degree. Participants who had not obtained a postgraduate degree were significantly more likely (p < 0.05 to report concerns regarding their own ability and a lack of motivation as barriers to further study. Conclusion: South African physiotherapists with and without a postgraduate degree reported common facilitators and barriers to pursuing postgraduate studies. In order to ensure that a greater number and diversity of physiotherapists see postgraduate studies as a worthwhile career option, stakeholders in health and education in both the South African public and private sectors need to be engaged to limit the barriers to postgraduate study and seek novel methods of making postgraduate study a more attractive option from a personal development and career perspective.

  5. Saudi high school students' attitudes and barriers toward the use of computer technologies in learning English.

    Science.gov (United States)

    Sabti, Ahmed Abdulateef; Chaichan, Rasha Sami

    2014-01-01

    This study examines the attitudes of Saudi Arabian high school students toward the use of computer technologies in learning English. The study also discusses the possible barriers that affect and limit the actual usage of computers. Quantitative approach is applied in this research, which involved 30 Saudi Arabia students of a high school in Kuala Lumpur, Malaysia. The respondents comprised 15 males and 15 females with ages between 16 years and 18 years. Two instruments, namely, Scale of Attitude toward Computer Technologies (SACT) and Barriers affecting Students' Attitudes and Use (BSAU) were used to collect data. The Technology Acceptance Model (TAM) of Davis (1989) was utilized. The analysis of the study revealed gender differences in attitudes toward the use of computer technologies in learning English. Female students showed high and positive attitudes towards the use of computer technologies in learning English than males. Both male and female participants demonstrated high and positive perception of Usefulness and perceived Ease of Use of computer technologies in learning English. Three barriers that affected and limited the use of computer technologies in learning English were identified by the participants. These barriers are skill, equipment, and motivation. Among these barriers, skill had the highest effect, whereas motivation showed the least effect.

  6. Help seeking in older Asian people with dementia in Melbourne: using the Cultural Exchange Model to explore barriers and enablers.

    Science.gov (United States)

    Haralambous, Betty; Dow, Briony; Tinney, Jean; Lin, Xiaoping; Blackberry, Irene; Rayner, Victoria; Lee, Sook-Meng; Vrantsidis, Freda; Lautenschlager, Nicola; Logiudice, Dina

    2014-03-01

    The prevalence of dementia is increasing in Australia. Limited research is available on access to Cognitive Dementia and Memory Services (CDAMS) for people with dementia from Culturally and Linguistically Diverse (CALD) communities. This study aimed to determine the barriers and enablers to accessing CDAMS for people with dementia and their families of Chinese and Vietnamese backgrounds. Consultations with community members, community workers and health professionals were conducted using the "Cultural Exchange Model" framework. For carers, barriers to accessing services included the complexity of the health system, lack of time, travel required to get to services, language barriers, interpreters and lack of knowledge of services. Similarly, community workers and health professionals identified language, interpreters, and community perceptions as key barriers to service access. Strategies to increase knowledge included providing information via radio, printed material and education in community group settings. The "Cultural Exchange Model" enabled engagement with and modification of the approaches to meet the needs of the targeted CALD communities.

  7. Barriers to treatment for older adults seeking psychological therapy.

    Science.gov (United States)

    Wuthrich, Viviana M; Frei, Jacqueline

    2015-07-01

    Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults. Sixty older adults (aged 60-79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline. The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues. The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.

  8. Converse Barrier Certificate Theorems

    DEFF Research Database (Denmark)

    Wisniewski, Rafael; Sloth, Christoffer

    2016-01-01

    This paper shows that a barrier certificate exists for any safe dynamical system. Specifically, we prove converse barrier certificate theorems for a class of structurally stable dynamical systems. Other authors have developed a related result by assuming that the dynamical system has neither...

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

    Science.gov (United States)

    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

  10. Barriers in the implementation of a physical activity intervention in primary care settings: lessons learned.

    Science.gov (United States)

    Josyula, Lakshmi K; Lyle, Roseann M

    2013-01-01

    Barriers encountered in implementing a physical activity intervention in primary health care settings, and ways to address them, are described in this paper. A randomized comparison trial was designed to examine the impact of health care providers' written prescriptions for physical activity, with or without additional physical activity resources, to adult, nonpregnant patients on preventive care or chronic disease monitoring visits. Following abysmal recruitment outcomes, the research protocol was altered to make it more appealing to all the participants, i.e., health care providers, office personnel, and patients. Various barriers--financial, motivational, and executive--to the implementation of health promotion interventions in primary health care settings were experienced and identified. These barriers have been classified by the different participants in the research process, viz., healthcare providers, administrative personnel, researchers, and patients. Some of the barriers identified were lack of time and reimbursement for health promotion activities, and inadequate practice capacity, for health care providers; increased time and labor demands for administrative personnel; constrained access to participants, and limited funding, for researchers; and superseding commitments, and inaccurate comprehension of the research protocol, for patients. Solutions suggested to overcome these barriers include financial support, e.g., funding for researchers, remuneration for health care organization personnel, reimbursement for providers, payment for participants, and free or subsidized postage, and use of health facilities; motivational strategies such as inspirational leadership, and contests within health care organizations; and partnerships, with other expert technical and creative entities, to improve the quality, efficiency, and acceptability of health promotion interventions.

  11. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies.

    Science.gov (United States)

    Rai, Sharan K; Choi, Hyon K; Choi, Sally H J; Townsend, Anne F; Shojania, Kam; De Vera, Mary A

    2018-04-17

    Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

  12. Skin barrier function

    DEFF Research Database (Denmark)

    2016-01-01

    Renowned experts present the latest knowledge Although a very fragile structure, the skin barrier is probably one of the most important organs of the body. Inward/out it is responsible for body integrity and outward/in for keeping microbes, chemicals, and allergens from penetrating the skin. Since...... the role of barrier integrity in atopic dermatitis and the relationship to filaggrin mutations was discovered a decade ago, research focus has been on the skin barrier, and numerous new publications have become available. This book is an interdisciplinary update offering a wide range of information...... on the subject. It covers new basic research on skin markers, including results on filaggrin and on methods for the assessment of the barrier function. Biological variation and aspects of skin barrier function restoration are discussed as well. Further sections are dedicated to clinical implications of skin...

  13. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.

    Science.gov (United States)

    Vlaeyen, Ellen; Stas, Joke; Leysens, Greet; Van der Elst, Elisa; Janssens, Elise; Dejaeger, Eddy; Dobbels, Fabienne; Milisen, Koen

    2017-05-01

    To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Systematic review. Review registration number on PROSPERO: CRD42013004655. Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills

  14. Barriers against implementing and managing quality in information technology industry of Pakistan

    International Nuclear Information System (INIS)

    Ahsan, A.

    2010-01-01

    This research paper presents major barriers to implement quality in IT sector of Pakistan. The paper not only explores (exploration w.r.t quality management covering discussion like what is done, what is not done, what are the loopholes, what must be done and / or what must not be done), but also presents detailed explanation of the main highlights by performing necessary qualitative analysis. In addition to exploration and explanation of barriers (the paper specifically talks of barriers concerning behavior, management and culture) to quality within IT sector of Pakistan, the paper also explains all the important issues arising due to the deprived quality management. As a result of detailed analysis performed, the paper finally identifies important remedies for revitalization of quality management function as recommendations. Mainly, exploration, explanation and analysis of reasons and remedial actions are focused. Discussion and analysis is limited to behavioral, cultural and managerial perspective. (author)

  15. Implementation of renewable energy technologies - Opportunities and barriers. Ghana country study

    Energy Technology Data Exchange (ETDEWEB)

    Edjekumhene, I.; Atakora, S.B.; Atta-Konadu, R.; Brew-Hammond, A. [Kumasi Inst. og Technology and Environment (Ghana)

    2001-07-01

    This report presents the experience of Ghana in the development, utilisation and promotion of Renewable Energy Technologies (RETs). The report gives a general overview of the state of RETs, describes past/existing institutional, regulatory and policy framework, identifies key barriers to and opportunities for RETs, and recommends directional changes needed to remove barriers and promote wide-scale adoption of RETs in Ghana. A total of eight RETs - biomass-fired dryers, sawdust stoves, sawdust briquette, biogas, solar crop dryer, solar water heater, solar water pump and small hydro power - are covered in the report. Analyses of barriers to the eight RETs are carried out using a framework approach that categorises barriers into socio-technical, economic and crosscutting barriers. Financial analyses, as opposed to economic analyses, have been carried out for all the selected RETs. The report also incorporates stake holders' perspectives and views on barriers and how they can be removed. Ghana is endowed with several renewable energy resources like solar radiation, small hydro, biomass, and wind. Exploitation of Ghana's renewable energy resources has been carried out under two main policy regimes - PND Law 62 (1983) and the Energy Sector Development Programme (ESDP). Several measures and instruments have been employed in the implementation of renewable energy policies. The main measures used are research and development, information and eduction, and some normative measures (like the passing of PNDC Law 62 and the Energy Commission Law). Some economic instruments, such as subsidies, taxes, pricing, financing and duty waiver/reduction, have been used as well but only to a limited extent. The effective development, implementation and dissemination of all the RETs studied are hampered by several barriers, which can be grouped into three main categories - Socio-technical barriers, economic barriers and crosscutting barriers. Socio-technical barriers refer to

  16. Implementation of renewable energy technologies - Opportunities and barriers. Ghana country study

    Energy Technology Data Exchange (ETDEWEB)

    Edjekumhene, I; Atakora, S B; Atta-Konadu, R; Brew-Hammond, A [Kumasi Inst. og Technology and Environment (Ghana)

    2001-07-01

    This report presents the experience of Ghana in the development, utilisation and promotion of Renewable Energy Technologies (RETs). The report gives a general overview of the state of RETs, describes past/existing institutional, regulatory and policy framework, identifies key barriers to and opportunities for RETs, and recommends directional changes needed to remove barriers and promote wide-scale adoption of RETs in Ghana. A total of eight RETs - biomass-fired dryers, sawdust stoves, sawdust briquette, biogas, solar crop dryer, solar water heater, solar water pump and small hydro power - are covered in the report. Analyses of barriers to the eight RETs are carried out using a framework approach that categorises barriers into socio-technical, economic and crosscutting barriers. Financial analyses, as opposed to economic analyses, have been carried out for all the selected RETs. The report also incorporates stake holders' perspectives and views on barriers and how they can be removed. Ghana is endowed with several renewable energy resources like solar radiation, small hydro, biomass, and wind. Exploitation of Ghana's renewable energy resources has been carried out under two main policy regimes - PND Law 62 (1983) and the Energy Sector Development Programme (ESDP). Several measures and instruments have been employed in the implementation of renewable energy policies. The main measures used are research and development, information and eduction, and some normative measures (like the passing of PNDC Law 62 and the Energy Commission Law). Some economic instruments, such as subsidies, taxes, pricing, financing and duty waiver/reduction, have been used as well but only to a limited extent. The effective development, implementation and dissemination of all the RETs studied are hampered by several barriers, which can be grouped into three main categories - Socio-technical barriers, economic barriers and crosscutting barriers. Socio-technical barriers refer to resource

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Benchmarking the interactions among barriers in third-party logistics implementation

    DEFF Research Database (Denmark)

    Diabat, A.; Khreishah, A.; Govindan, Kannan

    2013-01-01

    Purpose: The purpose of this paper is to analyze the interaction among some of the major barriers that may hinder the implementation of third-party logistics (TPL) in manufacturing industries. Design/methodology/approach: This paper uses an interpretive structural modeling (ISM) methodology...... to analyze the interactions among the barriers. Findings: It is beneficial for the management of any firm to be aware of significant barriers and to diagnose those that could be integral to the organization's future survival. Many works have focused on identifying barriers for TPL implementation, but a model...... for such barriers is lacking. This paper attempts to develop a model for the barriers using an ISM methodology and analyzes the mutual interactions among the barriers. The model differentiates between the barriers so that driving barriers, which can intensify other barriers, and dependent barriers are identified...

  19. Shakeoff Ionization near the Coulomb Barrier Energy

    Science.gov (United States)

    Sharma, Prashant; Nandi, T.

    2017-11-01

    We measure the projectile K x-ray spectra as a function of the beam energies around the Coulomb barrier in different collision systems. The energy is scanned in small steps around the barrier aiming to explore the nuclear effects on the elastically scattered projectile ions. The variation of the projectile x-ray energy with the ion-beam energies exhibits an unusual increase in between the interaction barrier and fusion barrier energies. This additional contribution to the projectile ionization can be attributed to the shakeoff of outer-shell electrons of the projectile ions due to the sudden nuclear recoil (˜10-21 sec ) caused by the attractive nuclear potential, which gets switched on near the interaction barrier energy. In the sudden approximation limit, the theoretical shakeoff probability calculation due to the nuclear recoil explains the observed data well. In addition to its fundamental interest, such processes can play a significant role in dark matter detection through the possible mechanism of x-ray emissions, where the weakly interacting massive particle-nucleus elastic scattering can lead to the nuclear-recoil-induced inner-shell vacancy creations. Furthermore, the present work may provide new prospects for atomic physics research at barrier energies as well as provide a novel technique to perform barrier distribution studies for two-body systems.

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

    Science.gov (United States)

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

    2008-05-01

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

  1. A comparison of freeway median crash frequency, severity, and barrier strike outcomes by median barrier type.

    Science.gov (United States)

    Russo, Brendan J; Savolainen, Peter T

    2018-08-01

    Median-crossover crashes are among the most hazardous events that can occur on freeways, often resulting in severe or fatal injuries. The primary countermeasure to reduce the occurrence of such crashes is the installation of a median barrier. When installation of a median barrier is warranted, transportation agencies are faced with the decision among various alternatives including concrete barriers, beam guardrail, or high-tension cable barriers. Each barrier type differs in terms of its deflection characteristics upon impact, the required installation and maintenance costs, and the roadway characteristics (e.g., median width) where installation would be feasible. This study involved an investigation of barrier performance through an in-depth analysis of crash frequency and severity data from freeway segments where high-tension cable, thrie-beam, and concrete median barriers were installed. A comprehensive manual review of crash reports was conducted to identify crashes in which a vehicle left the roadway and encroached into the median. This review also involved an examination of crash outcomes when a barrier strike occurred, which included vehicle containment, penetration, or re-direction onto the travel lanes. The manual review of crash reports provided critical supplementary information through narratives and diagrams not normally available through standard fields on police crash report forms. Statistical models were estimated to identify factors that affect the frequency, severity, and outcomes of median-related crashes, with particular emphases on differences between segments with varying median barrier types. Several roadway-, traffic-, and environmental-related characteristics were found to affect these metrics, with results varying across the different barrier types. The results of this study provide transportation agencies with important guidance as to the in-service performance of various types of median barrier. Copyright © 2018 Elsevier Ltd. All rights

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

    Science.gov (United States)

    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

  3. Barriers to Quality Care for Dying Patients in Rural Communities

    Science.gov (United States)

    Van Vorst, Rebecca F.; Crane, Lori A.; Barton, Phoebe Lindsey; Kutner, Jean S.; Kallail, K. James; Westfall, John M.

    2006-01-01

    Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self-administered survey was sent to health care…

  4. Devices for overcoming biological barriers: the use of physical forces to disrupt the barriers.

    Science.gov (United States)

    Mitragotri, Samir

    2013-01-01

    Overcoming biological barriers including skin, mucosal membranes, blood brain barrier as well as cell and nuclear membrane constitutes a key hurdle in the field of drug delivery. While these barriers serve the natural protective function in the body, they limit delivery of drugs into the body. A variety of methods have been developed to overcome these barriers including formulations, targeting peptides and device-based technologies. This review focuses on the use of physical methods including acoustic devices, electric devices, high-pressure devices, microneedles and optical devices for disrupting various barriers in the body including skin and other membranes. A summary of the working principles of these devices and their ability to enhance drug delivery is presented. Copyright © 2012. Published by Elsevier B.V.

  5. Threshold concepts as barriers to understanding climate science

    Science.gov (United States)

    Walton, P.

    2013-12-01

    Whilst the scientific case for current climate change is compelling, the consequences of climate change have largely failed to permeate through to individuals. This lack of public awareness of the science and the potential impacts could be considered a key obstacle to action. The possible reasons for such limited success centre on the issue that climate change is a complex subject, and that a wide ranging academic, political and social research literature on the science and wider implications of climate change has failed to communicate the key issues in an accessible way. These failures to adequately communicate both the science and the social science of climate change at a number of levels results in ';communication gaps' that act as fundamental barriers to both understanding and engagement with the issue. Meyer and Land (2003) suggest that learners can find certain ideas and concepts within a discipline difficult to understand and these act as a barrier to deeper understanding of a subject. To move beyond these threshold concepts, they suggest that the expert needs to support the learner through a range of learning experiences that allows the development of learning strategies particular to the individual. Meyer and Land's research into these threshold concepts has been situated within Economics, but has been suggested to be more widely applicable though there has been no attempt to either define or evaluate threshold concepts to climate change science. By identifying whether common threshold concepts exist specifically in climate science for cohorts of either formal or informal learners, scientists will be better able to support the public in understanding these concepts by changing how the knowledge is communicated to help overcome these barriers to learning. This paper reports on the findings of a study that examined the role of threshold concepts as barriers to understanding climate science in a UK University and considers its implications for wider

  6. Safety barriers to prevent release of hydrocarbons during production of oil and gas

    OpenAIRE

    Sklet, Snorre; Hauge, Stein

    2004-01-01

    This report documents a set of scenarios related to release of hydrocarbons during production on oil and gas platforms. For each release scenario, initiating events, barrier functions aimed to prevent loss of containment, and barrier systems that realize these barrier functions are identified and described. Safety barriers to prevent release of hydrocarbons during production of oil and gas

  7. Converse Barrier Certificate Theorem

    DEFF Research Database (Denmark)

    Wisniewski, Rafael; Sloth, Christoffer

    2013-01-01

    This paper presents a converse barrier certificate theorem for a generic dynamical system.We show that a barrier certificate exists for any safe dynamical system defined on a compact manifold. Other authors have developed a related result, by assuming that the dynamical system has no singular...... points in the considered subset of the state space. In this paper, we redefine the standard notion of safety to comply with generic dynamical systems with multiple singularities. Afterwards, we prove the converse barrier certificate theorem and illustrate the differences between ours and previous work...

  8. Overcoming barriers to work participation for patients with postpoliomyelitis syndrome

    NARCIS (Netherlands)

    ten Katen, Kim; Beelen, Anita; Nollet, Frans; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2011-01-01

    Purpose. This study aimed to explore the perceived work ability of patients with postpoliomyelitis syndrome (PPS), to identify barriers and factors that are impeding or conducive, respectively, to work participation, and to identify possible interventions. Methods. Qualitative cross-sectional

  9. Permanent isolation surface barrier development plan

    International Nuclear Information System (INIS)

    Wing, N.R.

    1994-01-01

    The exhumation and treatment of wastes may not always be the preferred alternative in the remediation of a waste site. In-place disposal alternatives, under certain circumstances, may be the most desirable alternatives to use in the protection of human health and the environment. The implementation of an in-place disposal alternative will likely require some type of protective covering that will provide long-term isolation of the wastes from the accessible environment. Even if the wastes are exhumed and treated, a long-term barrier may still be needed to adequately dispose of the treated wastes or any remaining waste residuals. Currently, no open-quotes provenclose quotes long-term barrier is available. The Hanford Site Permanent Isolation Surface Barrier Development Program (BDP) was organized to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site. The permanent isolation barrier technology also could be used at other sites. Permanent isolation barriers use engineered layers of natural materials to create an integrated structure with redundant protective features. Drawings of conceptual permanent isolation surface barriers are shown. The natural construction materials (e.g., fine soil, sand, gravel, riprap, asphalt) have been selected to optimize barrier performance and longevity. The objective of current designs is to use natural materials to develop a maintenance-free permanent isolation surface barrier that isolates wastes for a minimum of 1,000 years by limiting water drainage to near-zero amounts; reducing the likelihood of plant, animal, and human intrusion; controlling the exhalation of noxious gases; and minimizing erosion-related problems

  10. Permanent isolation surface barrier development plan

    Energy Technology Data Exchange (ETDEWEB)

    Wing, N.R.

    1994-01-01

    The exhumation and treatment of wastes may not always be the preferred alternative in the remediation of a waste site. In-place disposal alternatives, under certain circumstances, may be the most desirable alternatives to use in the protection of human health and the environment. The implementation of an in-place disposal alternative will likely require some type of protective covering that will provide long-term isolation of the wastes from the accessible environment. Even if the wastes are exhumed and treated, a long-term barrier may still be needed to adequately dispose of the treated wastes or any remaining waste residuals. Currently, no {open_quotes}proven{close_quotes} long-term barrier is available. The Hanford Site Permanent Isolation Surface Barrier Development Program (BDP) was organized to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site. The permanent isolation barrier technology also could be used at other sites. Permanent isolation barriers use engineered layers of natural materials to create an integrated structure with redundant protective features. Drawings of conceptual permanent isolation surface barriers are shown. The natural construction materials (e.g., fine soil, sand, gravel, riprap, asphalt) have been selected to optimize barrier performance and longevity. The objective of current designs is to use natural materials to develop a maintenance-free permanent isolation surface barrier that isolates wastes for a minimum of 1,000 years by limiting water drainage to near-zero amounts; reducing the likelihood of plant, animal, and human intrusion; controlling the exhalation of noxious gases; and minimizing erosion-related problems.

  11. Magnetic- and material-limiter discharges in Tokapole II

    International Nuclear Information System (INIS)

    Moyer, R.A.

    1988-01-01

    Disruptive instabilities were studied in Tokapole II, a small poloidal-divertor tokamak, in magnetic- and material-limiter configurations. In the magnetic limiter configuration, the divertor separatrix defines the tokamak current channel boundary. Limiters or neutralizer plate are not used to remove plasma in the scrape-off region. The relatively hot, dense plasma in the scrape-off region carries 5-20% of the current. In the material-limiter configuration, limiter plates are inserted to the separatrix to remove plasma and current in the scrape-off region. The plates vary the tokamak current-channel boundary condition in a controlled manner, and provide a benchmark for comparison with other tokamaks. Internal and external disruptions have been studied, and several unique features in the magnetic-limiter configuration were identified. The magnetic-limiter configuration enables routine passing of the stability barriers at q(a) = 2 and q(a) = 1, where q(a) is the edge safety factor, without a close-fitting wall, external windings, or detailed profile control techniques. Passing the q(a) = 1 barrier permits operation in the q < 1 regime where total reconnection of the sawtooth does not occur

  12. Ballistic transport through graphene nanostructures of velocity and potential barriers

    International Nuclear Information System (INIS)

    Krstajic, P M; Vasilopoulos, P

    2011-01-01

    We investigate the electronic properties of graphene nanostructures when the Fermi velocity and the electrostatic potential vary in space. First, we consider the transmission T and conductance G through single and double barriers. We show that G for velocity barriers differs markedly from that for potential barriers for energies below the height of the latter and it exhibits periodic oscillations as a function of the energy for strong velocity modulation. Special attention is given to superlattices (SLs). It is shown that an applied bias can efficiently widen or shrink the allowed minibands of velocity-modulated SLs. The spectrum in the Kronig-Penney limit is periodic in the strength of the barriers. Collimation of an electron beam incident on an SL with velocity and potential barriers is present but it disappears when the potential barriers are absent. The number of additional Dirac points may change considerably if barriers and wells have sufficiently different Fermi velocities.

  13. Patients' reports of barriers to expressing concerns during cancer consultations.

    Science.gov (United States)

    Brandes, Kim; Linn, Annemiek J; Smit, Edith G; van Weert, Julia C M

    2015-03-01

    To identify cancer patients' most influential barriers to expressing concerns during cancer consultations in a new manner by examining patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Two online focus groups (N=16) and an online survey (N=236) were conducted among cancer patients and cancer survivors. The online focus groups and survey were used to examine two elements of patients' barriers, i.e., patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Composite scores of these two elements were calculated to determine influential barriers. Results showed that the most influential barriers were related to providers' behavior (e.g., providers do not explicitly invite patients to express concerns) and the environment where the consultation takes place (e.g., perceived lack of time). The results of this study indicate that influential barriers to expressing concerns are barriers that patients cannot overcome themselves (i.e., they are related to providers' behavior or the environment of the consultation). A collaborative approach between researchers, providers and policy makers is needed to overcome these barriers. The results of this study can be used to develop strategies to overcome barriers to patients expressing concerns. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Information barriers and authentication

    International Nuclear Information System (INIS)

    MacArthur, D.W.; Wolford, J.K.

    2001-01-01

    Acceptance of nuclear materials into a monitoring regime is complicated if the materials are in classified shapes or have classified composition. An attribute measurement system with an information barrier can be emplo,yed to generate an unclassified display from classified measurements. This information barrier must meet two criteria: (1) classified information cannot be released to the monitoring party, and (2) the monitoring party must be convinced that the unclassified output accurately represents the classified input. Criterion 1 is critical to the host country to protect the classified information. Criterion 2 is critical to the monitoring party and is often termed the 'authentication problem.' Thus, the necessity for authentication of a measurement system with an information barrier stems directly from the description of a useful information barrier. Authentication issues must be continually addressed during the entire development lifecycle of the measurement system as opposed to being applied only after the system is built.

  15. Barrier Infrared Detector (BIRD)

    Data.gov (United States)

    National Aeronautics and Space Administration — A recent breakthrough in MWIR detector design, has resulted in a high operating temperature (HOT) barrier infrared detector (BIRD) that is capable of spectral...

  16. Engineered barriers: current status

    International Nuclear Information System (INIS)

    Atkinson, A.; Marsh, G.P.

    1988-01-01

    This report summarises the current state of research relevant to assessing the performance of engineered barriers made of steel and concrete in radioactive waste repositories. The objective of these barriers is to contain the radionuclides within them by providing both physical and chemical impediment to their release. The physical barriers are of most value for highly soluble isotopes with relatively short half-lives (eg 137 Cs), since they can provide containment until a large fraction of the activity has decayed. In addition they can facilitate retrievability for some period after disposal. The chemical barriers operate by beneficial conditioning of the near field groundwater and providing sites for sorption of radionuclides. Both of these reduce the aqueous concentration of radionuclides in the near field. (author)

  17. Barrier island community change: What controls it?

    Science.gov (United States)

    Dows, B.; Young, D.; Zinnert, J.

    2014-12-01

    Conversion from grassland to woody dominated communities has been observed globally. In recent decades, this pattern has been observed in coastal communities along the mid-Atlantic U.S. In coastal environments, a suite of biotic and abiotic factors interact as filters to determine plant community structure and distribution. Microclimatic conditions: soil and air temperature, soil moisture and salinity, and light attenuation under grass cover were measured across a grassland-woody encroachment gradient on a Virginia barrier island; to identify the primary factors that mediate this change. Woody establishment was associated with moderately dense (2200 shoots/m2) grass cover, but reduced at high (> 6200 shoots/ m2) and low (Moderately dense grass cover reduced light attenuation (82.50 % reduction) to sufficiently reduce soil temperature thereby limiting soil moisture evaporation. However, high grass density reduced light attenuation (98.7 % reduction) enough to inhibit establishment of woody species; whereas low grass density attenuated much less light (48.7 % reduction) which allowed for greater soil moisture evaporation. Soil salinity was dynamic as rainfall, tidal inundation, and sea spray produce spatiotemporal variation throughout the barrier island landscape. The importance of light and temperature were compounded as they also indirectly affect soil salinity via their affects on soil moisture. Determining how these biotic and abiotic factors relate to sea level rise and climate change will improve understanding coastal community response as global changes proceed. Understanding how community shifts affect ecosystem function and their potential to affect adjacent systems will also improve predictive ability of coastal ecosystem responses.

  18. Skin barrier composition

    International Nuclear Information System (INIS)

    Osburn, F.G.

    1985-01-01

    A skin barrier composition comprises a mixture of a copolymer resin of ethylene and vinyl acetate (EVA), and a water-insoluble dry tack-providing elastomer such as polyisobutylene. The composition after mixing and molding, is subjected to ionizing irradiation to form cross-linked polymer networks of the EVA. The compositions have exceptional properties for use as barrier sheets, rings, or strips in ostomy, wound drainage, and incontinence devices. (author)

  19. Skin barrier composition

    Energy Technology Data Exchange (ETDEWEB)

    Osburn, F G

    1985-06-12

    A skin barrier composition comprises a mixture of a copolymer resin of ethylene and vinyl acetate (EVA), and a water-insoluble dry tack-providing elastomer such as polyisobutylene. The composition after mixing and molding, is subjected to ionizing irradiation to form cross-linked polymer networks of the EVA. The compositions have exceptional properties for use as barrier sheets, rings, or strips in ostomy, wound drainage, and incontinence devices.

  20. Selected socioeconomic barriers of education in Sub-Saharan Africa

    OpenAIRE

    Tillová, Petra

    2015-01-01

    Selected socioeconomic barriers of education in Sub-Saharan Africa Abstract The aim of bachelor thesis is to describe and understand the process of education in Sub-Saharan Africa and analyze components that cause limited access to education. The first part of the thesis describes the process of education in Sub-Saharan Africa using selected indicators. The second main part focuses on the description and possible relations between selected socioeconomic barriers and literacy. Selected barrier...

  1. Barriers analysis for green supply chain management implementation in Indian industries using analytic hierarchy process

    DEFF Research Database (Denmark)

    Govindan, Kannan; Kaliyan, Mathiyazhagan; Kannan, Devika

    2014-01-01

    to the implementation of a green supply chain management (Green SCM) based on procurement effectiveness. A total of 47 barriers were identified, both through detailed literature and discussion with industrial experts and through a questionnaire-based survey from various industrial sectors. Essential barriers......Manufacturing industries started adopting the green concept in their supply chain management recently to focus on environmental issues. But, industries still struggle to identify barriers hindering green supply chain management implementation. This work focuses on identifying barriers...

  2. Barriers and Facilitators to Adoption of a Lay-Delivered Community-Based Strength Training Program for Women in Rural Areas

    Science.gov (United States)

    Washburn, Lisa T.; Cornell, Carol E.; Traywick, LaVona; Felix, Holly C.; Phillips, Martha E.

    2017-01-01

    Background: Limited access to fitness programs for rural older adults make lay or volunteer delivery approaches potentially desirable to extend reach. However, factors affecting adoption of such approaches are not well explored. Purpose: This study sought to identify barriers and facilitators affecting adoption of a volunteer lay delivery approach…

  3. Magnetic and material limiter discharges in Tokapole II

    International Nuclear Information System (INIS)

    Moyer, R.A.

    1988-01-01

    Disruptive instabilities have been studied in Tokapole II, a small poloidal divertor tokamak, in magnetic and material limiter configurations. In the magnetic limiter configuration, the divertor separatrix defines the tokamak current channel boundary. Limiters or neutralizer plates are not used to remove plasma in the scrape-off region. The relatively hot, dense plasma in the scrape-off region carries 5--20% of the current. In the material limiter configuration, limiter plates are inserted to the separatrix to remove plasma and current in the scrape-off region. The plates vary the tokamak current channel boundary condition in a controlled manner, and provide a benchmark for comparison with other tokamaks. Internal and external disruptions have been studied, and several unique features in the magnetic limiter configuration have been identified. The magnitic limiter configuration enables routine passing of the stability barriers at q(a) = 2 and q(a) = 1, where q(a) is the the edge safety factor, without a close fitting wall, external windings, or detailed profile control techniques. Passing the q(a) = 1 barrier permits operation in the q < 1 regime where total reconnection of the sawtooth does not occur. Discharges with q < 1 are also obtained in the material limiter configuration, suggesting that partial reconnection is characteristic of the sawteeth, and not the magnetic limiter configuration. The magnetic limiter configuration suppresses current termination in a major disruption. Current termination occurs in material limiter discharges due to enhanced interaction with the inboard limiter following the post-disruptive shift in major radius

  4. Barriers facing junior doctors in rural practice.

    Science.gov (United States)

    Smith, Deborah M

    2005-01-01

    Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. Within the hospital setting, exposure to rural practice appears to be very limited during internship, and also to some extent, during the second postgraduate year and beyond. This is a major issue for those required to undertake country relieving, rural terms or who will be bonded to rural and remote practice for several years after internship. This research investigated the current issues and difficulties faced by junior doctors, required to undertake rural and remote practice in Queensland, Australia. An exploratory study was undertaken. Primary data were collected through semi-structured interviews held with key stakeholders. Stakeholders included: directors of clinical training; medical educators; junior doctors; rural practitioners; academic rural practitioners; and medical administrators. Of the 23 people approached, a total of 19 agreed to be interviewed. The response rate was 82.6%. Similar to the issues identified in the literature, there are currently a number of barriers influencing the ability of junior doctors to practise competently and confidently when undertaking practice in rural and remote communities. Minimal clinical experience, lack of supervision and on-site support, inadequate orientation and uninformed expectations, limited access to relevant education, and the influence of isolation, results in an overall lack of preparation both professionally and personally. When asked, respondents supported the identification of core skills and knowledge, and integration of these and other issues affecting rural practice, into their hospital-based programs. Current hospital-based education and training programs were not adequately preparing junior doctors for rural and remote practice. It was commented that orientation and education, with a rural emphasis, could assist junior doctors in their

  5. Current limiters

    Energy Technology Data Exchange (ETDEWEB)

    Loescher, D.H. [Sandia National Labs., Albuquerque, NM (United States). Systems Surety Assessment Dept.; Noren, K. [Univ. of Idaho, Moscow, ID (United States). Dept. of Electrical Engineering

    1996-09-01

    The current that flows between the electrical test equipment and the nuclear explosive must be limited to safe levels during electrical tests conducted on nuclear explosives at the DOE Pantex facility. The safest way to limit the current is to use batteries that can provide only acceptably low current into a short circuit; unfortunately this is not always possible. When it is not possible, current limiters, along with other design features, are used to limit the current. Three types of current limiters, the fuse blower, the resistor limiter, and the MOSFET-pass-transistor limiters, are used extensively in Pantex test equipment. Detailed failure mode and effects analyses were conducted on these limiters. Two other types of limiters were also analyzed. It was found that there is no best type of limiter that should be used in all applications. The fuse blower has advantages when many circuits must be monitored, a low insertion voltage drop is important, and size and weight must be kept low. However, this limiter has many failure modes that can lead to the loss of over current protection. The resistor limiter is simple and inexpensive, but is normally usable only on circuits for which the nominal current is less than a few tens of milliamperes. The MOSFET limiter can be used on high current circuits, but it has a number of single point failure modes that can lead to a loss of protective action. Because bad component placement or poor wire routing can defeat any limiter, placement and routing must be designed carefully and documented thoroughly.

  6. Barriers to addressing substance abuse in domestic violence court.

    Science.gov (United States)

    Riger, Stephanie; Bennett, Larry W; Sigurvinsdottir, Rannveig

    2014-03-01

    Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors' roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.

  7. Barriers to implementation of workplace health interventions: an economic perspective.

    Science.gov (United States)

    Cherniack, Martin; Lahiri, Supriya

    2010-09-01

    To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population. Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics. We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care. Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed.

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

    Science.gov (United States)

    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.

  9. Sociocultural Barriers Related to Late-Stage Presentation of Breast Cancer in Morocco.

    Science.gov (United States)

    Soliman, Ann A; Khouchani, Mouna; Renne, Elisha P

    2018-04-23

    Breast cancer is the most prevalent cancer affecting women globally and in Morocco, where more than one fourth of patients are diagnosed at advanced stages. This study aimed to investigate sociocultural barriers that contribute to delayed presentation and diagnosis of breast cancer among women in Marrakesh, Morocco. Qualitative interviews were conducted with 25 breast cancer patients who received care at the CHU Mohammed VI Hospital in Marrakesh to elicit barriers to diagnosis and treatment and ease of access to care. Interviews with breast cancer patients revealed several themes regarding structural and sociocultural barriers to initial diagnosis and treatment. Structural barriers included high treatment-associated costs for patients and their families, burden of transportation to central treatment centers, and limited access to appropriate health care resources. Sociocultural barriers included perceived attack on one's identity associated with breast cancer diagnosis and treatment, influence of the local community, and ideas of faith, spirituality, and conception of death. Findings from this study can help identify areas for improved access and education of patients in order to improve breast cancer diagnostic and treatment efforts and enhance opportunities for early detection.

  10. Health literacy and barriers to health information seeking: A nationwide survey in South Korea.

    Science.gov (United States)

    Jeong, Seok Hee; Kim, Hyun Kyung

    2016-11-01

    To identify the level of health literacy and barriers to information seeking and to explore the predictors of health literacy. A cross-sectional descriptive design was used. A total of 1000 Korean adults were recruited through proportional quota sampling. Health literacy, barriers to health information seeking, sociodemographics, and health-related characteristics were surveyed. Descriptive statistics and binary logistic regression were performed for data analysis. About 61% of participants were classified as inadequately health literate. "No health fairs/activities near home" was the most frequently reported barrier. Older age, lower education, living in the capital city, barriers regarding how to get information and access to expensive books and magazines were predictors of inadequate health literacy. Strategies for improving health literacy and reducing barriers to health information seeking should be designed. Education on how to access health-related information with easily accessible sources either free or inexpensive could be a way to help adults with limited health literacy. Health care professionals should assess clients' health literacy levels, particularly amongst those who are older or have less education. They should provide clients with information on how to access credible and readily available sources of health-related information, considering their health literacy level. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter?

    Directory of Open Access Journals (Sweden)

    Wei-Teng Yang

    2014-01-01

    Full Text Available Background. Tuberculosis (TB remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52% and delays (42%, 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0% and longer delays (presentation to diagnosis: 45% versus 0% than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.

  12. Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter?

    Science.gov (United States)

    Yang, Wei-Teng; Gounder, Celine R; Akande, Tokunbo; De Neve, Jan-Walter; McIntire, Katherine N; Chandrasekhar, Aditya; de Lima Pereira, Alan; Gummadi, Naveen; Samanta, Santanu; Gupta, Amita

    2014-01-01

    Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.

  13. Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India.

    Science.gov (United States)

    Joglekar, N; Paranjape, R; Jain, R; Rahane, G; Potdar, R; Reddy, K S; Sahay, S

    2011-12-01

    Adherence to ART is a patient specific issue influenced by a variety of situations that a patient may encounter, especially in resource-limited settings. A study was conducted to understand factors and influencers of adherence to ART and their follow ups among patients attending ART centres in Maharashtra, India. Between January and March 2009, barriers to ART adherence among 32 patients at three selected ART centres functioning under national ART roll-out programme in Maharashtra, India, were studied using qualitative methods. Consenting patients were interviewed to assess barriers to ART adherence. Constant comparison method was used to identify grounded codes. Patients reported multiple barriers to ART adherence and follow up as (i) Financial barriers where the contributing factors were unemployment, economic dependency, and debt, (ii) social norm of attending family rituals, and fulfilling social obligations emerged as socio-cultural barriers, (iii) patients' belief, attitude and behaviour towards medication and self-perceived stigma were the reasons for sub-optimal adherence, and (iv) long waiting period, doctor-patient relationship and less time devoted in counselling at the center contributed to missed visits. Mainstreaming ART can facilitate access and address 'missed doses' due to travel and migration. A 'morning' and 'evening' ART centre/s hours may reduce work absenteeism and help in time management. Proactive 'adherence probing' and probing on internalized stigma might optimize adherence. Adherence probing to prevent transitioning to suboptimal adherence among patients stable on ART is recommended.

  14. What are the barriers to initiating end-of-life conversations with patients in the last year of life?

    Science.gov (United States)

    Travers, Alice; Taylor, Vanessa

    2016-09-02

    Improving end of life care is a national imperative. Unsatisfactory care persists particularly in acute hospitals, with shortcomings, variability in communication and advance care planning identified as fundamental issues. This review explored the literature to identify what is known about the barriers to initiating end-of-life conversations with patients from the perspective of doctors and nurses in the acute hospital setting. Six electronic databases were searched for potentially relevant records published between 2008 and 2015. Studies were included if the authors reported on barriers to discussing end of life with families or patients as described by doctors or nurses in hospital settings, excluding critical care. Of 1267 potentially relevant records, 12 were included in the review. Although there is limited high-quality evidence available, several barriers were identified. Recurrent themes within the literature related to a lack of education and training, difficulty in prognostication, cultural differences and perceived reluctance of the patient or family. This study illustrated that, in addressing barriers to communication, consideration needs to be extended to include how to embed good communication practice between patients and health professionals into the culture of this setting. Board level commitment is required to raise awareness of, and familiarity with, policies and protocols concerning communication and end-of-life care. Communication training should include practical skills and tools, opportunities to explore the personal beliefs of practitioners and managing their emotions, opportunities to analyse the local organisational (physical and social environment) and team barriers.

  15. Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study

    Directory of Open Access Journals (Sweden)

    Rubenfeld Gordon D

    2008-11-01

    Full Text Available Abstract Background Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States. Methods We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions. Results We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers. Conclusion Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care.

  16. Fault current limiter

    Science.gov (United States)

    Darmann, Francis Anthony

    2013-10-08

    A fault current limiter (FCL) includes a series of high permeability posts for collectively define a core for the FCL. A DC coil, for the purposes of saturating a portion of the high permeability posts, surrounds the complete structure outside of an enclosure in the form of a vessel. The vessel contains a dielectric insulation medium. AC coils, for transporting AC current, are wound on insulating formers and electrically interconnected to each other in a manner such that the senses of the magnetic field produced by each AC coil in the corresponding high permeability core are opposing. There are insulation barriers between phases to improve dielectric withstand properties of the dielectric medium.

  17. Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

    Science.gov (United States)

    Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

    2015-12-01

    Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

  18. Investigating the status and barriers of science laboratory activities ...

    African Journals Online (AJOL)

    This study aims at investigating the barriers encountered by science teachers in laboratory activities in Rwandan teacher training colleges (TTCs) using questionnaires and interviews. The results confirmed that teachers face barriers like time limitation, material scarcity and lack of improvising skills in their everyday science ...

  19. The blood-brain barrier in migraine treatment

    DEFF Research Database (Denmark)

    Edvinsson, L; Tfelt-Hansen, P

    2008-01-01

    Salient aspects of the anatomy and function of the blood-barrier barrier (BBB) are reviewed in relation to migraine pathophysiology and treatment. The main function of the BBB is to limit the access of circulating substances to the neuropile. Smaller lipophilic substances have some access...

  20. Effect of glove occlusion on the skin barrier

    DEFF Research Database (Denmark)

    Tiedemann, Daniel; Clausen, Maja Lisa; John, Swen Malthe

    2016-01-01

    that the negative effect of occlusion in itself is limited, and that only extensive and long-term occlusion will cause barrier impairment. However, studies investigating combined effect of occlusion and exposure to soaps/detergents indicate that occlusion significantly enhances the skin barrier damage caused...... by detergents/soaps in a dose-response fashion....

  1. On the nature of barriers to climate change adaptation

    NARCIS (Netherlands)

    Biesbroek, G.R.; Klostermann, J.E.M.; Termeer, C.J.A.M.; Kabat, P.

    2013-01-01

    Considerable barriers can emerge in developing and implementing climate change adaptation strategies. Understanding the nature of barriers to adaptation is important so as to find strategic ways of dealing with them. However, our current understanding is limited and highly fragmented across the

  2. Quench limits

    International Nuclear Information System (INIS)

    Sapinski, M.

    2012-01-01

    With thirteen beam induced quenches and numerous Machine Development tests, the current knowledge of LHC magnets quench limits still contains a lot of unknowns. Various approaches to determine the quench limits are reviewed and results of the tests are presented. Attempt to reconstruct a coherent picture emerging from these results is taken. The available methods of computation of the quench levels are presented together with dedicated particle shower simulations which are necessary to understand the tests. The future experiments, needed to reach better understanding of quench limits as well as limits for the machine operation are investigated. The possible strategies to set BLM (Beam Loss Monitor) thresholds are discussed. (author)

  3. Barriers to Medicaid Participation among Florida Dentists

    Science.gov (United States)

    Logan, Henrietta L.; Catalanotto, Frank; Guo, Yi; Marks, John; Dharamsi, Shafik

    2015-01-01

    Background Finding dentists who treat Medicaid-enrolled children is a struggle for many parents. The purpose of this study was to identify non-reimbursement factors that influence the decision by dentists about whether or not to participate in the Medicaid program in Florida. Methods Data from a mailed survey was analyzed using a logistic regression model to test the association of Medicaid participation with the Perceived Barriers and Social Responsibility variables. Results General and pediatric dentists (n=882) who identified themselves as either Medicaid (14%) or Non-Medicaid (86%) participants responded. Five items emerged as significant predictors of Medicaid participation, with a final concordance index of 0.905. Two previously unreported barriers to participation in Medicaid emerged: 1) dentists’ perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred. Conclusions This study provides new information about non-reimbursement barriers to Medicaid participation. PMID:25702734

  4. Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative study.

    Science.gov (United States)

    Cavazos, J M; Naik, A D; Woofter, A; Abraham, N S

    2008-09-15

    Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.

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

    Science.gov (United States)

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

    2015-05-02

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

  6. Women leadership barriers in healthcare, academia and business

    OpenAIRE

    Kalaitzi, S.; Czabanowska, K.; Fowler-Davis, S.; Brand, H.

    2017-01-01

    Purpose\\ud \\ud \\ud \\ud This paper maps the barriers to women leadership across healthcare, academia and business, and identifies barriers prevalence across sectors. A Barriers Thematic Map (BTM), with quantitative logic, and a prevalence chart have been developed, with the aim to uncover inequalities and provide orientation to develop inclusion and equal opportunity strategies within different work environments.\\ud \\ud \\ud \\ud \\ud Design/methodology/approach\\ud \\ud \\ud A systematic literature...

  7. Chemical interaction of tetravalent actinides simulators and the engineering barrier

    International Nuclear Information System (INIS)

    Chain, Pablo; Alba, Maria D.; Castro, Miguel A.; Pavon, Esperanza; Mar Orta, M.

    2010-01-01

    Document available in extended abstract form only. The Deep Geological Repository (DGR) is the most internationally accepted option for the storage of high radioactive wastes. This confinement is based on the Multi-barrier Concept where the engineered barrier is a crucial safety wise. Nowadays, bentonite is accepted as the best argillaceous material in the engineered barrier of DGR. Additionally to its well-known physical role, a chemical interaction between lutetium, as actinide simulator, and the smectite has been demonstrated. The existence of a reaction mechanism, which was not previously described, based on the chemical interaction between the lanthanide cations and the orthosilicate anions of the lamellar structure has been identified. This finding has aroused the interest of the scientific community because lanthanides are used as simulators of high activity radionuclide (HAR) in agreement with the guidelines established in the bibliography. It has been observed that in conditions of moderate temperature and pressure a chemical interaction exists between smectites and rare earth elements (RE) and phases of insoluble di-silicate, RE 2 Si 2 O 7 , which would immobilize RE, are generated. It is remarkable that the reaction extends to all the set of the smectites, although they do not display the same reactivity, the saponite being the most reactive. The main isotopes present in the HLW belong to the actinide elements Np, Pu, Am and Cm, in addition to uranium generated by neutron capture during the fuel combustion process. The study of the mobilization of actinide (IV) thorough the bentonite barrier is limited because of their radioactivity. However, U(IV), Np(IV), Pu(IV) and Th(IV) can be simulated by the stable isotopes of the Zr(IV) and Hf(IV), because they exhibit ionic radius and physicochemical properties very similar to those of the actinide elements. It is the main objective of this research to investigate the chemical interaction of Zr(IV) as actinide

  8. Dose limits

    International Nuclear Information System (INIS)

    Fitoussi, L.

    1987-12-01

    The dose limit is defined to be the level of harmfulness which must not be exceeded, so that an activity can be exercised in a regular manner without running a risk unacceptable to man and the society. The paper examines the effects of radiation categorised into stochastic and non-stochastic. Dose limits for workers and the public are discussed

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

    Science.gov (United States)

    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.

  10. Compliance with tobacco control policies in India: an examination of facilitators and barriers.

    Science.gov (United States)

    Turner, M M; Rimal, R N; Lumby, E; Cohen, J; Surette, A; Roundy, V; Feighery, E; Shah, V

    2016-03-01

    India's Cigarettes and Other Tobacco Products Act (COTPA) prohibits smoking in public places, limits advertising at points of sale, and bans sales in close proximity to educational institutions. To examine key stakeholders' (i.e., tobacco retailers, hotel and restaurant owners/managers, law enforcement officials, school principals/administrators) perceptions of facilitators and barriers to compliance with COTPA. Using semi-structured in-depth interviews (n = 60), we identified a range of facilitators and barriers that varied across the venues. A number of simple measures to increase compliance were identified: provide signs to retailers, provide aesthetically pleasing signs more fitting for the atmosphere of the hotel/restaurant, etc., and empower law enforcement to implement the law. Priority should be placed on public awareness, as it can facilitate compliance in numerous venues. Communication efforts could be undertaken to change the public's residual negative attitudes toward the policy.

  11. Developing leadership as a trainee- opportunities, barriers and potential improvements.

    Science.gov (United States)

    Doherty, Rachel; Lawson, Sara; Mc Laughlin, Laura; Donaghy, Grainne; Courtney, Julia; Gardiner, Keith

    2018-05-01

    The General Medical Council explicitly state that doctors completing training should demonstrate capabilities in leadership and teamwork. 1 However, most trainees receive little formal training in leadership. In March 2017, at the Faculty of Medical Leadership and Management (FMLM) Northern Ireland Regional Conference, a workshop on developing leadership skills as a trainee was hosted and the views of doctors in training regarding current opportunities, potential barriers and improvements were sought. In Northern Ireland presently there are a number of opportunities available for trainees to gain experience in leadership - both by learning through observation and learning through experience. These range from informal activities which do not require significant time commitment to focused, immersive leadership experiences such as ADEPT (Achieve Develop Explore Programme for Trainees) 2 , and the Royal College of Physicians' Chief Registrar scheme. 3 Several barriers to developing leadership have been identified, including limited understanding of what constitutes leadership, a lack of senior support and little formal recognition for trainees leading teams. Time pressures, frequently rotating jobs, limited resources and difficulty upscaling can also undermine the sustainability of improvement and other leadership projects. Incorporating awareness of and training in leadership skills, as well as greater engagement with senior leaders and managers, at an early stage in training could promote understanding and encourage trainees. Formalising leadership roles within training posts may improve experience. Deaneries and Trusts can also enable leadership opportunities by facilitating study leave, raising awareness amongst supervisors, and providing career enhancing incentives for interested trainees.

  12. Fuzzy barrier distributions

    International Nuclear Information System (INIS)

    Piasecki, E.

    2009-01-01

    Heavy-ion collisions often produce a fusion barrier distribution with structures displaying a fingerprint of couplings to highly collective excitations [1]. Basically the same distribution can be obtained from large-angle quasi-elastic scattering, though here the role of the many weak direct-reaction channels is unclear. For 2 0N e + 9 0Z r we have observed the barrier structures expected for the highly deformed neon projectile, but for 2 0N e + 9 2Z r we find completely smooth distribution (see Fig.1). We find that transfer channels in these systems are of similar strength but single particle excitations are significantly stronger in the latter case. They apparently reduce the 'resolving power' of the quasi-elastic channel, what leads to smeared out, or 'fuzzy' barrier distribution. This is the first case when such a phenomenon has been observed.(author)

  13. Health Barriers to Learning

    Directory of Open Access Journals (Sweden)

    Delaney Gracy

    2014-01-01

    Full Text Available This article summarizes the results from a 2013 online survey with 408 principals and assistant principals in New York City public elementary and middle schools. The survey assessed three primary areas: health issues in the school, health issues perceived as barriers to learning for affected students, and resources needed to address these barriers. Eighteen of the 22 health conditions listed in the survey were considered a moderate or serious issue within their schools by at least 10% of respondents. All 22 of the health issues were perceived as a barrier to learning by between 12% and 87% of the respondents. Representatives from schools that serve a higher percentage of low-income students reported significantly higher levels of concern about the extent of health issues and their impact on learning. Respondents most often said they need linkages with organizations that can provide additional services and resources at the school, especially for mental health.

  14. Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

    Science.gov (United States)

    Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

    2017-07-01

    Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal.

    Directory of Open Access Journals (Sweden)

    Nagendra P Luitel

    Full Text Available There is limited research on the gap between the burden of mental disorders and treatment use in low- and middle-income countries.The aim of this study was to assess the treatment gap among adults with depressive disorder (DD and alcohol use disorder (AUD and to examine possible barriers to initiation and continuation of mental health treatment in Nepal.A three-stage sampling technique was used in the study to select 1,983 adults from 10 Village Development Committees (VDCs of Chitwan district. Presence of DD and AUD were identified with validated versions of the Patient Health Questionnaire (PHQ-9 and Alcohol Use Disorder Identification Test (AUDIT. Barriers to care were assessed with the Barriers to Access to Care Evaluation (BACE.In this sample, 11.2% (N = 228 and 5.0% (N = 96 screened positive for DD and AUD respectively. Among those scoring above clinical cut-off thresholds, few had received treatment from any providers; 8.1% for DD and 5.1% for AUD in the past 12 months, and only 1.8% (DD and 1.3% (AUD sought treatment from primary health care facilities. The major reported barriers to treatment were lacking financial means to afford care, fear of being perceived as "weak" for having mental health problems, fear of being perceived as "crazy" and being too unwell to ask for help. Barriers to care did not differ based on demographic characteristics such as age, sex, marital status, education, or caste/ethnicity.With more than 90% of the respondents with DD or AUD not participating in treatment, it is crucial to identify avenues to promote help seeking and uptake of treatment. Given that demographic characteristics did not influence barriers to care, it may be possible to pursue general population-wide approaches to promoting service use.

  16. Relativistic tunneling through two successive barriers

    International Nuclear Information System (INIS)

    Lunardi, Jose T.; Manzoni, Luiz A.

    2007-01-01

    We study the relativistic quantum mechanical problem of a Dirac particle tunneling through two successive electrostatic barriers. Our aim is to study the emergence of the so-called generalized Hartman effect, an effect observed in the context of nonrelativistic tunneling as well as in its counterparts and which is often associated with the possibility of superluminal velocities in the tunneling process. We discuss the behavior of both the phase (or group) tunneling time and the dwell time, and show that in the limit of opaque barriers the relativistic theory also allows the emergence of the generalized Hartman effect. We compare our results with the nonrelativistic ones and discuss their interpretation

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Building Information Modelling: Challenges and Barriers in Implement of BIM for Interior Design Industry in Malaysia

    Science.gov (United States)

    Hamid, A. B. Abd; Taib, M. Z. Mohd; Razak, A. H. N. Abdul; Embi, M. R.

    2018-04-01

    Building Information Modelling (BIM) is an innovative approach that has developed crossways the global in architecture, engineering and construction (AEC) industry. The construction industry of Malaysia has undergone a rapid development and dynamic technology adoption in advance and methods between the players industry and stakeholders. Consequently, limited technologies and devices have not been successful as it should have been. This study will be emphasizing scenarios of challenges and barriers in adopting BIM in interior design industry in Malaysia. The study was emphasizing the challenges and barriers in BIM usage from the designer’s perspective. The data are collected through the questionnaires as to identifying the barriers, knowledge, readiness and awareness and distributed to interior design firms were selected randomly. The finding of this research is to examine the barriers and causes of variables BIM usage for interior design industry in Malaysia. The outcome of this study is to identify the constraint of adoption BIM in interior design industry compare to others players in same industry.

  19. Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

    Directory of Open Access Journals (Sweden)

    Fontanella Bruno José Barcellos

    2005-01-01

    Full Text Available OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects; caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers; selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

  20. Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

    Directory of Open Access Journals (Sweden)

    Bruno José Barcellos Fontanella

    2005-12-01

    Full Text Available OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects; caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers; selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

  1. Tacit Knowledge Barriers in Franchising: Practical Solutions

    Science.gov (United States)

    Cumberland, Denise; Githens, Rod

    2012-01-01

    Purpose: The purpose of this paper is to identify barriers that hinder tacit knowledge transfer in a franchise environment and offer a compendium of solutions that encourage franchisees and franchisors to leverage tacit knowledge as a resource for competitive advantage. Design/methodology/approach: Drawing from the research on franchise…

  2. Prioritising the implementation of practices to overcome operational barriers in reverse logistics

    Directory of Open Access Journals (Sweden)

    Amanda Badenhorst

    2016-09-01

    Conclusion: The framework developed in this article will enable organisations to identify the operational barriers they experience in reverse logistics and the practices they can implement on a priority basis to overcome these barriers.

  3. Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel.

    Science.gov (United States)

    Bina, Rena; Barak, Adi; Posmontier, Barbara; Glasser, Saralee; Cinamon, Tali

    2018-01-01

    Research on evidence-based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers' perspectives of provider- and organisational-related barriers to implementing a brief eight-session interpersonal therapy (IPT) intervention, a time-limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners' attitudes toward implementation of EBPs, as part of standardised training protocols. © 2017 John Wiley & Sons Ltd.

  4. What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review.

    Science.gov (United States)

    Wood, Emily; Ohlsen, Sally; Ricketts, Thomas

    2017-05-01

    Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care. A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care. The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities. Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators. Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

    Science.gov (United States)

    Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

    2016-10-01

    Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

  6. A framework for understanding semi-permeable barrier effects on migratory ungulates

    Science.gov (United States)

    Sawyer, Hall; Kauffman, Matthew J.; Middleton, Arthur D.; Morrison, Thomas A.; Nielson, Ryan M.; Wyckoff, Teal B.

    2013-01-01

    1. Impermeable barriers to migration can greatly constrain the set of possible routes and ranges used by migrating animals. For ungulates, however, many forms of development are semi-permeable, and making informed management decisions about their potential impacts to the persistence of migration routes is difficult because our knowledge of how semi-permeable barriers affect migratory behaviour and function is limited. 2. Here, we propose a general framework to advance the understanding of barrier effects on ungulate migration by emphasizing the need to (i) quantify potential barriers in terms that allow behavioural thresholds to be considered, (ii) identify and measure behavioural responses to semi-permeable barriers and (iii) consider the functional attributes of the migratory landscape (e.g. stopovers) and how the benefits of migration might be reduced by behavioural changes. 3. We used global position system (GPS) data collected from two subpopulations of mule deer Odocoileus hemionus to evaluate how different levels of gas development influenced migratory behaviour, including movement rates and stopover use at the individual level, and intensity of use and width of migration route at the population level. We then characterized the functional landscape of migration routes as either stopover habitat or movement corridors and examined how the observed behavioural changes affected the functionality of the migration route in terms of stopover use. 4. We found migratory behaviour to vary with development intensity. Our results suggest that mule deer can migrate through moderate levels of development without any noticeable effects on migratory behaviour. However, in areas with more intensive development, animals often detoured from established routes, increased their rate of movement and reduced stopover use, while the overall use and width of migration routes decreased. 5. Synthesis and applications. In contrast to impermeable barriers that impede animal movement

  7. Drivers and barriers to heat stress resilience.

    Science.gov (United States)

    Hatvani-Kovacs, Gertrud; Belusko, Martin; Skinner, Natalie; Pockett, John; Boland, John

    2016-11-15

    Heatwaves are the most dangerous natural hazard to health in Australia. The frequency and intensity of heatwaves will increase due to climate change and urban heat island effects in cities, aggravating the negative impacts of heatwaves. Two approaches exist to develop population heat stress resilience. Firstly, the most vulnerable social groups can be identified and public health services can prepare for the increased morbidity. Secondly, the population level of adaptation and the heat stress resistance of the built environment can be increased. The evaluation of these measures and their efficiencies has been fragmented across research disciplines. This study explored the relationships between the elements of heat stress resilience and their potential demographic and housing drivers and barriers. The responses of a representative online survey (N=393) about heat stress resilience at home and work from Adelaide, South Australia were analysed. The empirical findings demonstrate that heat stress resistant buildings increased adaptation capacity and decreased the number of health problems. Air-conditioning increased dependence upon it, limited passive adaptation and only people living in homes with whole-house air-conditioning had less health problems during heatwaves. Tenants and respondents with pre-existing health conditions were the most vulnerable, particularly as those with health conditions were not aware of their vulnerability. The introduction of an Energy Performance Certificate is proposed and discussed as an effective incentive to increase the heat stress resistance of and the general knowledge about the built environment. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Barriers and Facilitators to Community Mobility for Assistive Technology Users

    Directory of Open Access Journals (Sweden)

    Natasha Layton

    2012-01-01

    Full Text Available Mobility is frequently described in terms of individual body function and structures however contemporary views of disability also recognise the role of environment in creating disability. Aim. To identify consumer perspectives regarding barriers and facilitators to optimal mobility for a heterogeneous population of impaired Victorians who use assistive technology in their daily lives. Method. An accessible survey investigated the impact of supports or facilitators upon actual and desired life outcomes and health-related quality of life, from 100 AT users in Victoria, Australia. This paper reports upon data pertaining to community mobility. Results. A range of barriers and enablers to community mobility were identified including access to AT devices, environmental interventions, public transport, and inclusive community environs. Substantial levels of unmet need result in limited personal mobility and community participation. Outcomes fall short of many principles enshrined in current policy and human rights frameworks. Conclusion. AT devices as well as accessible and inclusive home and community environs are essential to maximizing mobility for many. Given the impact of the environment upon the capacity of individuals to realise community mobility, this raises the question as to whether rehabilitation practitioners, as well as prescribing AT devices, should work to build accessible communities via systemic advocacy.

  9. Infant nutrition in Saskatoon: barriers to infant food security.

    Science.gov (United States)

    Partyka, Brendine; Whiting, Susan; Grunerud, Deanna; Archibald, Karen; Quennell, Kara

    2010-01-01

    We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.

  10. Inverse Limits

    CERN Document Server

    Ingram, WT

    2012-01-01

    Inverse limits provide a powerful tool for constructing complicated spaces from simple ones. They also turn the study of a dynamical system consisting of a space and a self-map into a study of a (likely more complicated) space and a self-homeomorphism. In four chapters along with an appendix containing background material the authors develop the theory of inverse limits. The book begins with an introduction through inverse limits on [0,1] before moving to a general treatment of the subject. Special topics in continuum theory complete the book. Although it is not a book on dynamics, the influen

  11. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective.

    Science.gov (United States)

    Alawadi, Zeinab M; Leal, Isabel; Phatak, Uma R; Flores-Gonzalez, Juan R; Holihan, Julie L; Karanjawala, Burzeen E; Millas, Stefanos G; Kao, Lillian S

    2016-03-01

    Enhanced Recovery After Surgery (ERAS) pathways are known to decrease complications and duration of stay in colorectal surgery patients. However, it is unclear whether an ERAS pathway would be feasible and effective at a safety-net hospital. The aim of this study was to identify local barriers and facilitators before the adoption of an ERAS pathway for patients undergoing colorectal operations at a safety-net hospital. Semistructured interviews were conducted to assess the perceived barriers and facilitators before ERAS adoption. Stratified purposive sampling was used. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. Analytic and investigator triangulation were used to establish credibility. Interviewees included 8 anesthesiologists, 5 surgeons, 6 nurses, and 18 patients. Facilitators identified across the different medical professions were (1) feasibility and alignment with current practice, (2) standardization of care, (3) smallness of community, (4) good teamwork and communication, and (5) caring for patients. The barriers were (1) difficulty in adapting to change, (2) lack of coordination between different departments, (3) special needs of a highly comorbid and socioeconomically disadvantaged patient population, (4) limited resources, and (5) rotating residents. Facilitators identified by the patients were (1) welcoming a speedy recovery, (2) being well-cared for and satisfied with treatment, (3) adequate social support, (4) welcoming early mobilization, and (5) effective pain management. The barriers were (1) lack of quiet and private space, (2) need for more patient education and counseling, and (3) unforeseen complications. Although limited hospital resources are perceived as a barrier to ERAS implementation at a safety-net hospital, there is strong support for such pathways and multiple factors were identified that may facilitate change. Inclusion of patient perspectives is critical to identifying challenges and

  12. Identifying emotional intelligence in professional nursing practice.

    Science.gov (United States)

    Kooker, Barbara Molina; Shoultz, Jan; Codier, Estelle E

    2007-01-01

    The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.

  13. The Gendered International School: Barriers to Women Managers' Progression

    Science.gov (United States)

    Sanderson, Ruth Elizabeth; Whitehead, Stephen

    2016-01-01

    Purpose: The purpose of this paper is to examine the barriers women identify to their promotion in international schools and also the ways in which women can overcome these barriers. Design/methodology/approach: The field of enquiry is international schools, with the study drawing on qualitative research. The researchers interviewed 11 women from…

  14. SOLUTIONS TO OVERCOME BARRIERS TO IMPLEMENTATION OF TREATMENT TECHNOLOGIES

    Science.gov (United States)

    To make treatment a viable option for remediation you must first identify the barriers to implementing treatment. The primary barrier is economics. Treatment options are relatively expensive and there is a lack of funds for treatment. The cost of technologies can be lowered by 1)...

  15. Barriers and facilitators to establishing a national public health observatory

    Directory of Open Access Journals (Sweden)

    Shalini Pooransingh

    Full Text Available OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1 provide information to support evidence-informed decision-making for health policy and strategic planning; 2 facilitate data management by establishing data policies, procedures, and standards; 3 increase the use of data by synthesizing and disseminating information; and 4 provide data for benchmarking. However, a number of barriers were identified, including 1 the perception that data collection is not valued; 2 untimely availability of data; 3 limited data synthesis, dissemination, and utilization to inform decision-making; and 4 challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

  16. Barriers and facilitators to establishing a national public health observatory.

    Science.gov (United States)

    Pooransingh, Shalini; Misir, Akenath; Ramdath, Dan; Ramsewak, Samuel; Jaglal, Susan; Cameron, Cathy; Goel, Vivek

    2015-11-01

    To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

  17. Efficient sound barrier calculations with the BEM

    DEFF Research Database (Denmark)

    Juhl, Peter Møller; Cutanda Henriquez, Vicente

    2018-01-01

    The Boundary Element Method has been used for calculating the effect of introducing sound barriers for some decades. The method has also been used for optimizing the shape of the barrier and in some cases the effects of introducing sound absorption. However, numerical calculations are still quite...... time consuming and inconvenient to use, which is limiting their use for many practical problems. Moreover, measurements are mostly taken in one-third or full octave bands opposed to the numerical computations at specific frequencies, which then has to be conducted using a fine density in frequencies....... This paper addresses some of the challenges and possible solutions for developing BEM into a more efficient tool for sound barrier calculations....

  18. Phonon tunneling through a double barrier system

    International Nuclear Information System (INIS)

    Villegas, Diosdado; León-Pérez, Fernando de; Pérez-Álvarez, R.; Arriaga, J.

    2015-01-01

    The tunneling of optical and acoustic phonons at normal incidence on a double-barrier is studied in this paper. Transmission coefficients and resonance conditions are derived theoretically under the assumption that the long-wavelength approximation is valid. It is shown that the behavior of the transmission coefficients for the symmetric double barrier has a Lorentzian form close to resonant frequencies and that Breit–Wigner's formula have a general validity in one-dimensional phonon tunneling. Authors also study the so-called generalized Hartman effect in the tunneling of long-wavelength phonons and show that this effect is a numerical artifact resulting from taking the opaque limit before exploring the variation with a finite barrier width. This study could be useful for the design of acoustic devices

  19. Phonon tunneling through a double barrier system

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Diosdado [Departamento de Física, Universidad Central “Marta Abreu” de Las Villas, CP 54830, Santa Clara, Villa Clara (Cuba); Instituto de Física, Universidad Autónoma de Puebla, 18 Sur y San Claudio, Edif. 110A, Ciudad Universitaria, 72570 Puebla (Mexico); León-Pérez, Fernando de [Centro Universitario de la Defensa de Zaragoza, Ctra. de Huesca s/n, E-50090 Zaragoza (Spain); Pérez-Álvarez, R. [Universidad Autónoma del Estado de Morelos, Av. Universidad 1001, CP 62209 Cuernavaca (Mexico); Arriaga, J., E-mail: arriaga@ifuap.buap.mx [Instituto de Física, Universidad Autónoma de Puebla, 18 Sur y San Claudio, Edif. 110A, Ciudad Universitaria, 72570 Puebla (Mexico)

    2015-04-15

    The tunneling of optical and acoustic phonons at normal incidence on a double-barrier is studied in this paper. Transmission coefficients and resonance conditions are derived theoretically under the assumption that the long-wavelength approximation is valid. It is shown that the behavior of the transmission coefficients for the symmetric double barrier has a Lorentzian form close to resonant frequencies and that Breit–Wigner's formula have a general validity in one-dimensional phonon tunneling. Authors also study the so-called generalized Hartman effect in the tunneling of long-wavelength phonons and show that this effect is a numerical artifact resulting from taking the opaque limit before exploring the variation with a finite barrier width. This study could be useful for the design of acoustic devices.

  20. Barriers for the introduction of bioenergy in the Netherlands

    International Nuclear Information System (INIS)

    Gerlagh, T.; Groenendaal, B.; Van Ree, R.; Dinkelbach, L.; Van Doorn, J.; Hemmes, K.

    2000-01-01

    The use of biomass for energy in the Netherlands is still limited despite the political incentives to make bio-energy a major source of renewable energy. The hesitation of many stake-holders is due to the limited insight into the potential of biomass in the Netherlands and the presence of numerous other barriers. Availability of biomass, emission regulation and waste treatment regulations are considered important barriers. Analyses of their current state show that these barriers are broadly recognised and possibilities to decrease their impact are present. Some barriers with a minor influence so far will be of increasing importance and could be a threat to the development of bio-energy in future. These are the fast liberalising of the energy market and sustainable energy market, the competition with other renewables and the unclear status of the current technology available. Future research should focus on the possibilities to overcome these new barriers. 5 refs

  1. Qualitative Analysis of Resources and Barriers for Borderline Personality Disorder in the U.S.

    Science.gov (United States)

    Lohman, Matthew C.; Whiteman, Karen L.; Yeomans, Frank E.; Cherico, Sheila A.; Christ, Winifred R.

    2016-01-01

    Objective Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. Experiences and preferences of individuals seeking care are seldom examined but important elements in determining challenges to obtaining appropriate care. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD, from the perspective of individuals seeking care. Methods Data came from transcripts of resource requests made to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics regarding requested BPD service types, demographic information, and national distribution of requests were generated for all eligible transcripts. Qualitative analysis was used to identify themes, challenges, and common experiences reported among a random subset of those seeking services (N=500). Results Primary services or resources requested were outpatient services (51%), informational materials (13%), and daycare programs (9%). Care-seekers identified family services, crisis intervention, and mental health literacy as areas where available resources did not meet current demand and which could be improved and/or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental healthcare systems, financial concerns, and comorbidity with psychiatric or medical disorders. Conclusions Individuals seeking supportive services and treatment for BPD face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care. PMID:27691382

  2. Geothermal(Ground-Source)Heat Pumps: Market Status, Barriers to Adoption, and Actions to Overcome Barriers

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, Patrick [ORNL

    2008-12-01

    More effective stewardship of our resources contributes to the security, environmental sustainability, and economic well-being of the nation. Buildings present one of the best opportunities to economically reduce energy consumption and limit greenhouse gas emissions. Geothermal heat pumps (GHPs), sometimes called ground-source heat pumps, have been proven capable of producing large reductions in energy use and peak demand in buildings. However, GHPs have received little attention at the policy level as an important component of a national strategy. Have policymakers mistakenly overlooked GHPs, or are GHPs simply unable to make a major contribution to the national goals for various reasons? This brief study was undertaken at DOE's request to address this conundrum. The scope of the study includes determining the status of global GHP markets and the status of the GHP industry and technology in the United States, assembling previous estimates of GHP energy savings potential, identifying key barriers to application of GHPs, and identifying actions that could accelerate market adoption of GHPs. The findings are documented in this report along with conclusions and recommendations.

  3. Barriers to Condom Use among High Risk Men Who Have Sex with Men in Uganda: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Geofrey Musinguzi

    Full Text Available Unprotected sexual intercourse is a major risk factor for HIV transmission. Men who have sex with men (MSM face challenges in accessing HIV prevention services, including condoms. However, there is limited in-depth assessment and documentation of the barriers to condom use among MSM in sub-Saharan Africa. In this paper, we examine the barriers to condom use among MSM in Uganda.The data for this study were extracted from a larger qualitative study conducted among 85 self-identified adult (>18 years MSM in 11 districts in Uganda between July and December 2013. Data on sexual behaviours and access and barriers to condom use were collected using semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. This paper presents an analysis of data for 33 MSM who did not use condoms at last sex, with a focus on barriers to condom use. Analysis was conducted using the content analysis approach.Six major barriers to condom use were identified: Difficulties with using condoms, access challenges, lack of knowledge and misinformation about condom use, partner and relationship related issues, financial incentives and socio-economic vulnerability, and alcohol consumption.The findings suggest that several reasons account for lack of condom use among high-risk MSM. The findings are valuable to inform interventions needed to increase condom use among MSM.

  4. Barrier Data Base user's guide

    International Nuclear Information System (INIS)

    Worrell, R.B.; Gould, D.J.; Wall, D.W.

    1977-06-01

    A special purpose data base for physical security barriers has been developed. In addition to barriers, the entities accommodated by the Barrier Data Base (BDB) include threats and references. A threat is established as a configuration of people and equipment which has been employed to penetrate (or attempt to penetrate) a barrier. References are used to cite publications pertinent to the barriers and threats in the data base. Utilization and maintenance of the Barrier Data Base is achieved with LIST, QUERY, ENTER, DELETE, and CHANGE commands which are used to manipulate the data base entities

  5. EVALUATION OF AMENDMENTS FOR MENDING THE INSITU REDOX MANIPULATION (ISRM) BARRIER

    Energy Technology Data Exchange (ETDEWEB)

    PETERSEN, S.W.

    2006-02-07

    In May of 2004, the U.S. Department of Energy (DOE) Richland and Fluor Hanford requested technical assistance from DOE Headquarters EM-23 to provide a team of technical experts to evaluate likely chemical/biological amendments for mending the In Situ Redox Manipulation (ISRM) Barrier in the 100-D Area of the Hanford Site. This request was a follow-on to an earlier request for assistance regarding the cause of chromium (Cr) breakthrough and recommendations for mending the barrier (March 2004 workshop). This report provides written documentation of the team's findings and recommendations. In 1995, a plume of dissolved hexavalent chromium [Cr(VI)] was discovered along the Columbia River shoreline and in the 100-D Area. Between 1999 and 2003, a reactive barrier using the ISRM technology, was installed at a distance of 680 meters along the river to reduce the Cr(VI) in the groundwater. The ISRM technology creates a treatment zone within the aquifer by injection of sodium dithionite, a strong reducing agent that scavenges dissolved oxygen (DO) from the aquifer and reduces ferric iron [Fe(III)], related metals, and oxy-ions. Bench-scale and field-scale treatability tests were conducted to demonstrate proof-of principle and to estimate barrier longevity, calculated to be in excess of twenty years. However, several years after initial and secondary treatment, groundwater in approximately 17 wells has been found to contain elevated Cr concentrations. The March 2004 technical assistance team (TAT) identified potential causes of Cr breakthrough as likely related to physical and chemical heterogeneity within the aquifer (including loss of reductive capacity within preferential flow paths) and the presence of other oxidants (DO and nitrate) significantly affecting the reductive capacity of the treated aquifer. These aquifer characteristics may limit the ability of alternative amendments to extend the reducing capacity of the barrier. A 2001 Bechtel Hanford report and

  6. Barriers to participation in vocational orientation programmes among prisoners

    Directory of Open Access Journals (Sweden)

    Dorien Brosens

    2015-11-01

    Full Text Available This study investigates the barriers to prisoners’ participation in vocational education, as well as the predictors of different types of barriers. Survey data derived from a project in a remand prison in Belgium (N=468 provided the empirical evidence for the analyses. The results indicate that facing situational and informational barriers are most common. Based on the different kinds of barriers, various types of non-participants can be distinguished and multinomial logistic regression analyses are conducted to identify in what way participants of vocational education differ from various types of non-participants. For instance, prisoners with a poor understanding of the Dutch language and those who never/rarely receive visitors participate less in vocational education as they are more likely to be confronted with informational barriers. We conclude this article by discussing paths for future research and implications for policy and practice to anticipate the barriers for those who want to participate in vocational education.

  7. Evaluation of reproductive barriers contributes to the development of novel interspecific hybrids in the Kalanchoë genus

    DEFF Research Database (Denmark)

    Kuligowska, Katarzyna; Lütken, Henrik Vlk; Christensen, Brian

    2015-01-01

    BackgroundInterspecific hybridization is a useful tool in ornamental breeding to increase genetic variability and introduce new valuable traits into existing cultivars. The successful formation of interspecific hybrids is frequently limited by the presence of pre- and post-fertilization barriers....... In the present study, we investigated the nature of hybridization barriers occurring in crosses between Kalancho? species and evaluated possibilities of obtaining interspecific hybrids.ResultsThe qualitative and quantitative analyses of pollen tube growth in situ were performed following intra- and interspecific...... pollinations. They revealed occurrence of pre-fertilization barriers associated with inhibition of pollen germination on the stigma and abnormal growth of pollen tubes. Unilateral incongruity related to differences in pistil length was also observed. The pollen quality was identified as a strong factor...

  8. Overcoming Barriers in Unhealthy Settings

    Directory of Open Access Journals (Sweden)

    Michael K. Lemke

    2016-03-01

    Full Text Available We investigated the phenomenon of sustained health-supportive behaviors among long-haul commercial truck drivers, who belong to an occupational segment with extreme health disparities. With a focus on setting-level factors, this study sought to discover ways in which individuals exhibit resiliency while immersed in endemically obesogenic environments, as well as understand setting-level barriers to engaging in health-supportive behaviors. Using a transcendental phenomenological research design, 12 long-haul truck drivers who met screening criteria were selected using purposeful maximum sampling. Seven broad themes were identified: access to health resources, barriers to health behaviors, recommended alternative settings, constituents of health behavior, motivation for health behaviors, attitude toward health behaviors, and trucking culture. We suggest applying ecological theories of health behavior and settings approaches to improve driver health. We also propose the Integrative and Dynamic Healthy Commercial Driving (IDHCD paradigm, grounded in complexity science, as a new theoretical framework for improving driver health outcomes.

  9. Geophysical characterization of subsurface barriers

    International Nuclear Information System (INIS)

    Borns, D.J.

    1995-08-01

    An option for controlling contaminant migration from plumes and buried waste sites is to construct a subsurface barrier of a low-permeability material. The successful application of subsurface barriers requires processes to verify the emplacement and effectiveness of barrier and to monitor the performance of a barrier after emplacement. Non destructive and remote sensing techniques, such as geophysical methods, are possible technologies to address these needs. The changes in mechanical, hydrologic and chemical properties associated with the emplacement of an engineered barrier will affect geophysical properties such a seismic velocity, electrical conductivity, and dielectric constant. Also, the barrier, once emplaced and interacting with the in situ geologic system, may affect the paths along which electrical current flows in the subsurface. These changes in properties and processes facilitate the detection and monitoring of the barrier. The approaches to characterizing and monitoring engineered barriers can be divided between (1) methods that directly image the barrier using the contrasts in physical properties between the barrier and the host soil or rock and (2) methods that reflect flow processes around or through the barrier. For example, seismic methods that delineate the changes in density and stiffness associated with the barrier represents a direct imaging method. Electrical self potential methods and flow probes based on heat flow methods represent techniques that can delineate the flow path or flow processes around and through a barrier

  10. Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth.

    Science.gov (United States)

    Sullivan, Brittney J; Esmaili, B Emily; Cunningham, Coleen K

    2017-01-01

    Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood. Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature. This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0-24 years of age. A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children. Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes.

  11. Chaotic correlations in barrier billiards with arbitrary barriers

    International Nuclear Information System (INIS)

    Osbaldestin, A H; Adamson, L N C

    2013-01-01

    We study autocorrelation functions in symmetric barrier billiards for golden mean trajectories with arbitrary barriers. Renormalization analysis reveals the presence of a chaotic invariant set and thus that, for a typical barrier, there are chaotic correlations. The chaotic renormalization set is the analogue of the so-called orchid that arises in a generalized Harper equation. (paper)

  12. Barriers To Successful Implementation of STEM Education

    Directory of Open Access Journals (Sweden)

    James A. Ejiwale

    2013-05-01

    Full Text Available The implementation of STEM education in schools across the globe is to prepare the future workforce with strong scientific and mathematical backgrounds to enhance skills development across STEM disciplines. However, for STEM education to achieve its goals and objectives, addressing the barriers to STEM education should start by fixing the problems at the elementary, junior and senior high school levels; the grassroots and potential feeders to colleges and universities. Since many nations including the United States of America is in dire need of the workforce with adequate preparation in science and mathematics to help address the nation’s economy that is in shambles, the barriers to its successful implementation should be identified and addressed. In this paper, (a the definition of STEM education and (b some barriers to successful implementation of STEM education are discussed and elaborated.

  13. Barriers to student success in engineering education

    Science.gov (United States)

    Boles, Wageeh; Whelan, Karen

    2017-07-01

    In the UK, the USA and Australia, there have been calls for an increase in the number of engineering graduates to meet the needs of current global challenges. Universities around the world have been grappling with how to both attract more engineering students and to then retain them. Attrition from engineering programmes is disturbingly high. This paper reports on an element of research undertaken through an Australian Learning and Teaching Council-funded Fellowship that investigated the factors leading to student attrition in engineering programmes, by identifying barriers to student success. Here, we contrast a review of the literature related to student barriers and success with student perceptions, gathered through a series of focus groups and interviews at three Australian universities. We also present recommendations for action to try to remove barriers to student success.

  14. Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

    Directory of Open Access Journals (Sweden)

    Youri P. A. Tan

    2018-03-01

    Full Text Available Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality.

  15. Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

    Science.gov (United States)

    Tan, Youri P. A.; Liverneaux, Philippe; Wong, Jason K. F.

    2018-01-01

    Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality. PMID:29740585

  16. Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa

    Directory of Open Access Journals (Sweden)

    W Barnett

    2013-11-01

    Full Text Available Background. The recent scale-up of antiretroviral therapy (ART coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART. Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers. Methods. Research was conducted at a large primary care tuberculosis (TB/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11, in-depth interviews with patients (n=10 and a Photovoice workshop (n=11. Responses and photographs were coded by content; data were transformed into variables and analysed accordingly. Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic. Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

  17. Barriers to the development of forest carbon offsetting: Insights from British Columbia, Canada.

    Science.gov (United States)

    Peterson St-Laurent, Guillaume; Hagerman, Shannon; Hoberg, George

    2017-12-01

    In recent years, the provision of economic incentives through carbon financing and carbon offsetting has been central to efforts at forest carbon mitigation. However, notwithstanding their potentially important roles in climate policy, forest carbon offsets face numerous barriers which have limited widespread implementation worldwide. This paper uses the case study of the Canadian province of British Columbia to explore the barriers associated with achieving widespread implementation of forest carbon offsets in the next several decades. Drawing on interviews with experts from government, non-governmental organizations, the private sector and First Nations, six main barriers are identified and discussed: (1) deficiencies of carbon markets, (2) limited economic benefits, (3) uncertain climate effectiveness, (4) negative public opinion, (5) limited and uncertain property rights, and (6) governance issues. While respondents from different sectors agreed on various points, divergence was also observed, notably on the trade-off between generating environmentally sound offsets and promoting cost-effective ways to achieve mitigation. We discuss these differences in the context of the goals and objectives of different actors, and offer insights for understanding the uptake (or not) of carbon offset policies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Evaluation of Barriers of Corporate Social Responsibility Using an Analytical Hierarchy Process under a Fuzzy Environment—A Textile Case

    Directory of Open Access Journals (Sweden)

    Lixin Shen

    2015-03-01

    Full Text Available The ventilating crisis of Corporate Social Responsibility (CSR issues in the textiles industry resulted in the engagement of many researchers in the analysis of CSR and its related factors throughout the globe. Some researchers in developed nations extend their policies beyond the boundary of CSR in the textiles industry, but some developing contexts are still limited to this boundary, including India, due to facts that have not yet been revealed. Hence, to fill this gap, this study reveals the factors that are resisting the implementation of CSR in the textiles industry with the assistance of a proposed model, and this model is validated with a case industry situated in southern India. Common barriers are collected through various reliable means, and among those common barriers, the essential barrier was identified with the assistance of the case industrial manager through an Analytical Hierarchy Process (AHP under a fuzzy environment. The results show that financial constraints comprise the main barrier to the implementation of CSR in the Indian textiles industry, which is then further validated with feedback from case industry managers. This study offers both societal and scientific insights, identifies limitations, and provides an approach that may be extended in the future once additional factors are implemented.

  19. Empirical investigation of energy efficiency barriers in Italian manufacturing SMEs

    International Nuclear Information System (INIS)

    Trianni, Andrea; Cagno, Enrico; Worrell, Ernst; Pugliese, Giacomo

    2013-01-01

    The paper identifies and evaluates barriers to industrial energy efficiency through the investigation of 48 manufacturing Small and Medium-sized Enterprises (SMEs) in Northern Italy. The research provides interesting suggestions both for enterprises and energy policy-makers. Firstly, economic and information barriers are perceived as the major obstacles to the adoption of energy-efficient technologies, whilst behavioural barriers do not seem to affect enterprises very much. Nonetheless, despite what declared, the most relevant barriers are the lack of interest in energy efficiency and the existence of other priorities, thus showing that decision-makers tend to downgrade energy efficiency to a marginal issue. Furthermore, perceived barriers do not take place exclusively in implementing energy-efficient technologies, but, with comparable importance, also in generating the interest and knowledge of the opportunities. Moreover, the study highlights that relevant differences can be appreciated for both perceived and real barriers even among SMEs, that thus should not be bundled together. In addition to that, other factors affect barriers, stimulating future research: indeed, lower real barriers can be observed with higher complexity of the production, high variability of the demand and strong competitors. -- Highlights: ► Evidence of existing misalignments between perceived and real barriers to the adoption of energy-efficient technologies. ► Relevance of barriers to the generation of interest towards energy efficiency. ► Evidence of firm's size (within SMEs) and energy expenditures on barriers to energy efficiency. ► Importance, for energy efficiency barriers, of avoid bundling SMEs as a whole. ► Preliminary evidence of factors related to supply chain complexity affecting barriers to energy efficiency.

  20. Near-Surface Engineered Environmental Barrier Integrity

    International Nuclear Information System (INIS)

    Piet, S.J.; Breckenridge, R.P.

    2002-01-01

    The INEEL Environmental Systems Research and Analysis (ESRA) program has launched a new R and D project on Near-Surface Engineered Environmental Barrier Integrity to increase knowledge and capabilities for using engineering and ecological components to improve the integrity of near-surface barriers used to confine contaminants from the public and the environment. The knowledge gained and the capabilities built will help verify the adequacy of past remedial decisions and enable improved solutions for future cleanup decisions. The research is planned to (a) improve the knowledge of degradation mechanisms (weathering, biological, geological, chemical, radiological, and catastrophic) in times shorter than service life, (b) improve modeling of barrier degradation dynamics, (c) develop sensor systems to identify degradation prior to failure, and (d) provide a better basis for developing and testing of new barrier systems to increase reliability and reduce the risk of failure. Our project combine s selected exploratory studies (benchtop and field scale), coupled effects accelerated aging testing and the meso-scale, testing of new monitoring concepts, and modeling of dynamic systems. The performance of evapo-transpiration, capillary, and grout-based barriers will be examined

  1. Surface stability test plan for protective barriers

    International Nuclear Information System (INIS)

    Ligotke, M.W.

    1989-01-01

    Natural-material protective barriers for long-term isolation of buried waste have been identified as integral components of a plan to isolate a number of Hanford defense waste sites. Standards currently being developed for internal and external barrier performance will mandate a barrier surface layer that is resistant to the eolian erosion processes of wind erosion (deflation) and windborne particle deposition (formation of sand dunes). Thus, experiments are needed to measure rates of eolian erosion processes impacting those surfaces under different surface and climatological conditions. Data from these studies will provide information for use in the evaluation of selected surface layers as a means of providing stable cover over waste sites throughout the design life span of protective barriers. The multi-year test plan described in this plan is directed at understanding processes of wind erosion and windborne particle deposition, providing measurements of erosion rates for models, and suggesting construction materials and methods for reducing the effect of long-term eolian erosion on the barrier. Specifically, this plan describes possible methods to measure rates of eolian erosion, including field and laboratory procedure. Advantages and disadvantages of laboratory (wind tunnel) tests are discussed, and continued wind tunnel tests are recommended for wind erosion studies. A comparison between field and wind tunnel erosive forces is discussed. Plans for testing surfaces are described. Guidance is also presented for studying the processes controlling sand dune and blowout formation. 24 refs., 7 figs., 3 tabs

  2. Current-voltage relation for thin tunnel barriers: Parabolic barrier model

    DEFF Research Database (Denmark)

    Hansen, Kim; Brandbyge, Mads

    2004-01-01

    We derive a simple analytic result for the current-voltage curve for tunneling of electrons through a thin uniform insulating layer modeled by a parabolic barrier. Our model, which goes beyond the Wentzel–Kramers–Brillouin approximation, is applicable also in the limit of highly transparant...

  3. Tank Farm Interim Surface Barrier Materials And Runoff Alternatives Study

    International Nuclear Information System (INIS)

    Holm, M.J.

    2009-01-01

    This report identifies candidate materials and concepts for interim surface barriers in the single-shell tank farms. An analysis of these materials for application to the TY tank farm is also provided.

  4. barriers to an effective diabetic retinopathy service in ibadan, nigeria

    African Journals Online (AJOL)

    like UK and USA,6,7 barriers identified include fear of ... blindness as well as the cost of attending clinic. Diabetic retinopathy .... cost of treatment for diabetic retinopathy - laser treatment ..... harness compliance to diabetic care, treatment and.

  5. Shottky-barrier formation

    International Nuclear Information System (INIS)

    Guines, F.; Sanchez-Dehesa, J.; Flores, F.

    1983-01-01

    In this paper a realistic selfconsistent calculation of an abrupt metal-semiconductor junction is presented by means of a tight-binding approach. A specific Si-Ag junction has been considered, and the charge neutrality level as well as the barrier height have been determined in good agreement with experiments. For a generaljunction it is shown that the interface properties depend essentially on the characteristics of the first metal layer and its interaction with the semiconductor. (Author) [pt

  6. Energy barrier to decoherence

    International Nuclear Information System (INIS)

    Mizel, Ari; Mitchell, M. W.; Cohen, Marvin L.

    2001-01-01

    We propose a ground-state approach to realizing quantum computers. This scheme is time-independent and inherently defends against decoherence by possessing an energy barrier to excitation. We prove that our time-independent qubits can perform the same algorithms as their time-dependent counterparts. Advantages and disadvantages of the time-independent approach are described. A model involving quantum dots is provided for illustration

  7. Performance of engineered barriers

    International Nuclear Information System (INIS)

    Rajaram, V.; Dean, P.V.; McLellan, S.A.

    1997-01-01

    Engineered barriers, both vertical and horizontal, have been used to isolate hazardous wastes from contact, precipitation, surface water and groundwater. The primary objective of this study was to determine the performance of subsurface barriers installed throughout the U.S. over the past 20 years to contain hazardous wastes. Evaluation of Resource Conservation and Recovery Act (RCRA) Subtitle C or equivalent caps was a secondary objective. A nationwide search was launched to select hazardous waste sites at which vertical barrier walls and/or caps had been used as the containment method. None of the sites selected had an engineered floor. From an initial list of 130 sites, 34 sites were selected on the basis of availability of monitoring data for detailed analysis of actual field performance. This paper will briefly discuss preliminary findings regarding the design, construction quality assurance/construction quality control (CQA/CQC), and monitoring at the 34 sites. In addition, the short-term performance of these sites (less than 5 years) is presented since very little long-term performance data was available

  8. Fluctuations in Schottky barrier heights

    International Nuclear Information System (INIS)

    Mahan, G.D.

    1984-01-01

    A double Schottky barrier is often formed at the grain boundary in polycrystalline semiconductors. The barrier height is shown to fluctuate in value due to the random nature of the impurity positions. The magnitude of the fluctuations is 0.1 eV, and the fluctuations cause the barrier height measured by capacitance to differ from the one measured by electrical conductivity

  9. Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Zara Shubber

    2016-11-01

    service-related barriers, including distance to clinic (adults 17.5%, 95% CI 13.0%-21.9% and stock outs (adults 16.1%, 95% CI 11.7%-20.4%, were also frequently reported. Limitations of this review relate to the fact that included studies differed in approaches to assessing adherence barriers and included variable durations of follow up. Studies that report self-reported adherence will likely underestimate the frequency of non-adherence. For children, barriers were mainly reported by caregivers, which may not correspond to the most important barriers faced by children.Patients on ART face multiple barriers to adherence, and no single intervention will be sufficient to ensure that high levels of adherence to treatment and virological suppression are sustained. For maximum efficacy, health providers should consider a more triaged approach that first identifies patients at risk of poor adherence and then seeks to establish the support that is needed to overcome the most important barriers to adherence.

  10. Barriers to pediatric pain management: a nursing perspective.

    Science.gov (United States)

    Czarnecki, Michelle L; Simon, Katherine; Thompson, Jamie J; Armus, Cheryl L; Hanson, Tom C; Berg, Kristin A; Petrie, Jodie L; Xiang, Qun; Malin, Shelly

    2011-09-01

    This study describes strategies used by the Joint Clinical Practice Council of Children's Hospital of Wisconsin to identify barriers perceived as interfering with nurses' (RNs) ability to provide optimal pain management. A survey was used to ascertain how nurses described optimal pain management and how much nurses perceived potential barriers as interfering with their ability to provide that level of care. The survey, "Barriers to Optimal Pain management" (adapted from Van Hulle Vincent & Denyes, 2004), was distributed to all RNs working in all patient care settings. Two hundred seventy-two surveys were returned. The five most significant barriers identified were insufficient physician (MD) orders, insufficient MD orders before procedures, insufficient time to premedicate patients before procedures, the perception of a low priority given to pain management by medical staff, and parents' reluctance to have patients receive pain medication. Additional barriers were identified through narrative comments. Information regarding the impact of the Acute Pain Service on patient care, RNs' ability to overcome barriers, and RNs' perception of current pain management practices is included, as are several specific interventions aimed at improving or ultimately eliminating identified barriers. Copyright © 2011 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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"