WorldWideScience

Sample records for identify critical barriers

  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 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

  3. 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.

  4. Internal transport barriers: critical physics issues?

    Energy Technology Data Exchange (ETDEWEB)

    Litaudon, X [Association Euratom-CEA, DSM, Departement de Recherches sur La Fusion Controlee, Centre d' Etudes de Cadarache, F-13108 Saint-Paul-Lez-Durance (France)

    2006-05-15

    Plasmas regimes with improved core energy confinement properties, i.e. with internal transport barriers (ITB), provide a possible route towards simultaneous high fusion performance and continuous tokamak reactor operation in a non-inductive current drive state. High core confinement regimes should be made compatible with a dominant fraction of the plasma current self-generated (pressure-driven) by the bootstrap effect while operating at high normalized pressure and moderate current. Furthermore, ITB regimes with 'non-stiff' plasma core pressure break the link observed in standard inductive operation between fusion performances and plasma pressure at the edge, thus offering a new degree of freedom in the tokamak operational space. Prospects and critical issues for using plasmas with enhanced thermal core insulation as a basis for steady tokamak reactor operation are reviewed in the light of the encouraging experimental and modelling results obtained recently (typically in the last two years). An extensive set of data from experiments carried out worldwide has been gathered on ITB regimes covering a wide range of parameters (q-profile, T{sub i}/T{sub e}, gradient length, shaping, normalized toroidal Larmor radius, collisionality, Mach number, etc). In the light of the progress made recently, the following critical physics issues relevant to the extrapolation of ITB regimes to next-step experiments, such as ITER, are addressed: 1. conditions for ITB formation and existence of a power threshold,; 2. ITB sustainment at T{sub i} {approx} T{sub e}, with low toroidal torque injection, low central particle fuelling but at high density and low impurity concentration,; 3. control of confinement for sustaining wide ITBs that encompass a large volume at high {beta}{sub N},; 4. real time profile control (q and pressure) with high bootstrap current and large fraction of alpha-heating and; 5. compatibility of core with edge transport barriers or with external core

  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. Breaking Barriers, Building Bridges: Critical Discussion of Social Issues.

    Science.gov (United States)

    Moss, Joy

    Noting that picture books can invite students to engage in critical discussion of complex issues of race, class, and gender, this lesson plan helps students to confront the injustice of barriers that separate human beings from one another and to examine the role of prejudice and stereotypes in sustaining these barriers. During the five 45-minute…

  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 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

  9. Seismic Barrier Protection of Critical Infrastructure

    Science.gov (United States)

    2017-05-14

    structures , earthquake mitigation I. Introduction Damage caused by earthquakes to critical structures such as nuclear power plants, regional hospitals...the seismic power drop in dB to magnitude drop using the seismic moment magnitude scale, Mw. In figures 5 and 6, the V-trench structure as modeled...representing geological media and V-shaped muffler borehole / trench component structures . Bottom: In this simple analysis, the power drop observed

  10. 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 ...

  11. 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.

  12. 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.

  13. BRAVO identifies critical success factors for logistics

    NARCIS (Netherlands)

    Kokke, C.J.T.M.; Donselaar, van K.H.; Allessie, M.

    1997-01-01

    Good operational performance depends on knowing which operational factors are critical to success. Bravo, a research project involving 150 transport and distribution companies in The Netherlands, has developed a tool now being adopted nationally by all companies in the sector to find opportunities

  14. Seismic Barrier Protection of Critical Infrastructure from Earthquakes

    Science.gov (United States)

    2017-05-01

    We observe that such barrier structures reduce seismic wave powers by 10 – 40 dB that would otherwise reach the foundation location. Moreover, the... structure composed of opposing boreholes or trenches to mitigate seismic waves from diffracting and traveling in the vertical plane. Computational...seismic wave propagation models suggest that air or fluid filled subsurface V- shaped muffler structures are critical to the redirection and self

  15. 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.

  16. 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.

  17. Two Ancient Gene Families Are Critical for Maintenance of the Mammalian Skin Barrier in Postnatal Life.

    Science.gov (United States)

    Cangkrama, Michael; Darido, Charbel; Georgy, Smitha R; Partridge, Darren; Auden, Alana; Srivastava, Seema; Wilanowski, Tomasz; Jane, Stephen M

    2016-07-01

    The skin barrier is critical for mammalian survival in the terrestrial environment, affording protection against fluid loss, microbes, toxins, and UV exposure. Many genes indispensable for barrier formation in the embryo have been identified, but loss of these genes in adult mice does not induce barrier regression. We describe a complex regulatory network centered on two ancient gene families, the grainyhead-like (Grhl) transcription factors and the protein cross-linking enzymes (tissue transglutaminases [Tgms]), which are essential for skin permeability barrier maintenance in adult mice. Embryonic deletion of Grhl3 induces loss of Tgm1 expression, which disrupts the cornified envelope, thus preventing permeability barrier formation leading to neonatal death. However, gene deletion of Grhl3 in adult mice does not disrupt the preformed barrier, with cornified envelope integrity maintained by Grhl1 and Tgm5, which are up-regulated in response to postnatal loss of Grhl3. Concomitant deletion of both Grhl factors in adult mice induced loss of Tgm1 and Tgm5 expression, perturbation of the cornified envelope, and complete permeability barrier regression that was incompatible with life. These findings define the molecular safeguards for barrier function that accompany the transition from intrauterine to terrestrial life. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  18. 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

  19. 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

  20. Identifying Critical Cross-Cultural School Psychology Competencies.

    Science.gov (United States)

    Rogers, Margaret R.; Lopez, Emilia C.

    2002-01-01

    Study sought to identify critical cross-cultural competencies for school psychologists. To identify the competencies, an extensive literature search about cross-cultural school psychology competencies was conducted, as well as a questionnaire to ask expert panelists. The 102 competencies identified cover 14 major domains of professional activities…

  1. Failure mode effects and criticality analysis: innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation.

    Science.gov (United States)

    Powell, Emilie S; O'Connor, Lanty M; Nannicelli, Anna P; Barker, Lisa T; Khare, Rahul K; Seivert, Nicholas P; Holl, Jane L; Vozenilek, John A

    2014-06-01

    Sepsis is an increasing problem in the practice of emergency medicine as the prevalence is increasing and optimal care to reduce mortality requires significant resources and time. Evidence-based septic shock resuscitation strategies exist, and rely on appropriate recognition and diagnosis, but variation in adherence to the recommendations and therefore outcomes remains. Our objective was to perform a multi-institutional prospective risk-assessment, using failure mode effects and criticality analysis (FMECA), to identify high-risk failures in ED sepsis resuscitation. We conducted a FMECA, which prospectively identifies critical areas for improvement in systems and processes of care, across three diverse hospitals. A multidisciplinary group of participants described the process of emergency department (ED) sepsis resuscitation to then create a comprehensive map and table listing all process steps and identified process failures. High-risk failures in sepsis resuscitation from each of the institutions were compiled to identify common high-risk failures. Common high-risk failures included limited availability of equipment to place the central venous catheter and conduct invasive monitoring, and cognitive overload leading to errors in decision-making. Additionally, we identified great variability in care processes across institutions. Several common high-risk failures in sepsis care exist: a disparity in resources available across hospitals, a lack of adherence to the invasive components of care, and cognitive barriers that affect expert clinicians' decision-making capabilities. Future work may concentrate on dissemination of non-invasive alternatives and overcoming cognitive barriers in diagnosis and knowledge translation.

  2. Identifying critical thinking indicators and critical thinker attributes in nursing practice.

    Science.gov (United States)

    Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Ming-Chang; Clark, Mary Jo; Tan, Jung-Ying

    2013-09-01

    Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

  3. 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.

  4. Healthcare librarians and the delivery of critical appraisal training: barriers to involvement.

    Science.gov (United States)

    Maden-Jenkins, Michelle

    2011-03-01

      Many healthcare librarians are undertaking training in critical appraisal but a significant number are not cascading the training to their end-users.   To examine the barriers to healthcare librarian involvement in delivering critical appraisal training.   A questionnaire survey of 57 library services across 48 NHS Trust Library Services in north west England followed up with 21 semi-structured interviews.   Two types of barriers were noted: extrinsic barriers (organisational, environmental, training, role expectations) and intrinsic barriers (knowledge, skills, attitude).   These barriers are not mutually exclusive and by overcoming one of them it does not necessarily follow that healthcare librarians will engage in delivering critical appraisal skills training. The challenge lies in developing strategies to deal effectively with these barriers to encourage and support healthcare librarians in the delivery of critical appraisal training at a level at which they feel confident and able. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. Simple Model for Identifying Critical Regions in Atrial Fibrillation

    Science.gov (United States)

    Christensen, Kim; Manani, Kishan A.; Peters, Nicholas S.

    2015-01-01

    Atrial fibrillation (AF) is the most common abnormal heart rhythm and the single biggest cause of stroke. Ablation, destroying regions of the atria, is applied largely empirically and can be curative but with a disappointing clinical success rate. We design a simple model of activation wave front propagation on an anisotropic structure mimicking the branching network of heart muscle cells. This integration of phenomenological dynamics and pertinent structure shows how AF emerges spontaneously when the transverse cell-to-cell coupling decreases, as occurs with age, beyond a threshold value. We identify critical regions responsible for the initiation and maintenance of AF, the ablation of which terminates AF. The simplicity of the model allows us to calculate analytically the risk of arrhythmia and express the threshold value of transversal cell-to-cell coupling as a function of the model parameters. This threshold value decreases with increasing refractory period by reducing the number of critical regions which can initiate and sustain microreentrant circuits. These biologically testable predictions might inform ablation therapies and arrhythmic risk assessment.

  10. The critical role of the barrier thickness in spin filter tunneling

    International Nuclear Information System (INIS)

    Miller, Casey W.

    2009-01-01

    Spin filter tunneling is considered in the low bias limit as functions of the temperature dependent barrier parameters. We demonstrate the generation of spin polarized tunneling currents in relation to the magnetic order parameter, and discuss how an interfacially suppressed order parameter leads to a temperature dependent tunneling current asymmetry. Analyzing the full parameter space reveals that the often overlooked barrier thickness plays a critical role in spin filter tunneling. With all else fixed, thicker barriers yield higher spin polarization, and allow a given polarization to be achieved at higher temperatures. This insight may open the door for new materials to serve as spin filter barriers.

  11. 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.

  12. 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.

  13. 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.

  14. Identifying Critical Thinking Styles to Enhance Volunteer Development

    Science.gov (United States)

    Gay, Keegan D.; Terry, Bryan; Lamm, Alexa J.

    2015-01-01

    Diversity in learning options can increase efficacy of volunteer development systems. The University of Florida Critical Thinking Inventory (UFCTI) is designed to explicate an individual's critical thinking style based upon a continuum from Seeking Information to Engagement. Static and interpretive materials are best used with individuals of a…

  15. 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.

  16. 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

  17. 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...

  18. 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

  19. 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.

  20. 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),…

  1. 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

  2. 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…

  3. 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,

  4. Protecting Critical Infrastructure by Identifying Pathways of Exposure to Risk

    Directory of Open Access Journals (Sweden)

    Philip O’Neill

    2013-08-01

    Full Text Available Increasingly, our critical infrastructure is managed and controlled by computers and the information networks that connect them. Cyber-terrorists and other malicious actors understand the economic and social impact that a successful attack on these systems could have. While it is imperative that we defend against such attacks, it is equally imperative that we realize how best to react to them. This article presents the strongest-path method of analyzing all potential pathways of exposure to risk – no matter how indirect or circuitous they may be – in a network model of infrastructure and operations. The method makes direct use of expert knowledge about entities and dependency relationships without the need for any simulation or any other models. By using path analysis in a directed graph model of critical infrastructure, planners can model and assess the effects of a potential attack and develop resilient responses.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. 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...

  10. 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...

  11. 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.

  12. A Critical Analysis of Anesthesiology Podcasts: Identifying Determinants of Success.

    Science.gov (United States)

    Singh, Devin; Alam, Fahad; Matava, Clyde

    2016-08-17

    Audio and video podcasts have gained popularity in recent years. Increasingly, podcasts are being used in the field of medicine as a tool to disseminate information. This format has multiple advantages including highly accessible creation tools, low distribution costs, and portability for the user. However, despite its ongoing use in medical education, there are no data describing factors associated with the success or quality of podcasts. The goal of the study was to assess the landscape of anesthesia podcasts in Canada and develop a methodology for evaluating the quality of the podcast. To achieve our objective, we identified the scope of podcasts in anesthesia specifically, constructed an algorithmic model for measuring success, and identified factors linked to both successful podcasts and a peer-review process. Independent reviewers performed a systematic search of anesthesia-related podcasts on iTunes Canada. Data and metrics recorded for each podcast included podcast's authorship, number posted, podcast series duration, target audience, topics, and social media presence. Descriptive statistics summarized mined data, and univariate analysis was used to identify factors associated with podcast success and a peer-review process. Twenty-two podcasts related to anesthesia were included in the final analysis. Less than a third (6/22=27%) were still active. The median longevity of the podcasts' series was just 13 months (interquartile range: 1-39 months). Anesthesiologists were the target audience for 77% of podcast series with clinical topics being most commonly addressed. We defined a novel algorithm for measuring success: Podcast Success Index. Factors associated with a high Podcast Success Index included podcasts targeting fellows (Spearman R=0.434; P=.04), inclusion of professional topics (Spearman R=0.456-0.603; P=.01-.03), and the use of Twitter as a means of social media (Spearman R=0.453;P=.03). In addition, more than two-thirds (16/22=73%) of podcasts

  13. 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.

  14. A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings.

    Science.gov (United States)

    Hoerbst, A; Schweitzer, M

    2015-08-13

    Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time. In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis. We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals. It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.

  15. 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.

  16. 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...

  17. Critical angular momentum dependence of the fission barriers and the stability of superheavy nuclei

    International Nuclear Information System (INIS)

    Magda, M.T.; Sandulescu, A.

    1978-10-01

    Measured complete fusion and evaporation cross section data are used to determine the critical angular momenta for which the fission barriers are vanishing in the region of nuclei with Z = 102 - 116. It is shown that, in order to fit these data, larger values of the critical angular momenta are obtained for superheavy nuclei (Z = 110 - 112) than for heavy ones (Z = 102 - 107), which indicates a relatively higher stability against fission for superheavy nuclei, in agreement with the theoretically predicted island of stability. (author)

  18. 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)

  19. 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

  20. Critical energy barrier for capillary condensation in mesopores: Hysteresis and reversibility

    International Nuclear Information System (INIS)

    Hiratsuka, Tatsumasa; Tanaka, Hideki; Miyahara, Minoru T.

    2016-01-01

    Capillary condensation in the regime of developing hysteresis occurs at a vapor pressure, P cond , that is less than that of the vapor-like spinodal. This is because the energy barrier for the vapor-liquid transition from a metastable state at P cond becomes equal to the energy fluctuation of the system; however, a detailed mechanism of the spontaneous transition has not been acquired even through extensive experimental and simulation studies. We therefore construct accurate atomistic silica mesopore models for MCM-41 and perform molecular simulations (gauge cell Monte Carlo and grand canonical Monte Carlo) for argon adsorption on the models at subcritical temperatures. A careful comparison between the simulation and experiment reveals that the energy barrier for the capillary condensation has a critical dimensionless value, W c * = 0.175, which corresponds to the thermal fluctuation of the system and depends neither on the mesopore size nor on the temperature. We show that the critical energy barrier W c * controls the capillary condensation pressure P cond and also determines a boundary between the reversible condensation/evaporation regime and the developing hysteresis regime.

  1. Critical energy barrier for capillary condensation in mesopores: Hysteresis and reversibility

    Science.gov (United States)

    Hiratsuka, Tatsumasa; Tanaka, Hideki; Miyahara, Minoru T.

    2016-04-01

    Capillary condensation in the regime of developing hysteresis occurs at a vapor pressure, Pcond, that is less than that of the vapor-like spinodal. This is because the energy barrier for the vapor-liquid transition from a metastable state at Pcond becomes equal to the energy fluctuation of the system; however, a detailed mechanism of the spontaneous transition has not been acquired even through extensive experimental and simulation studies. We therefore construct accurate atomistic silica mesopore models for MCM-41 and perform molecular simulations (gauge cell Monte Carlo and grand canonical Monte Carlo) for argon adsorption on the models at subcritical temperatures. A careful comparison between the simulation and experiment reveals that the energy barrier for the capillary condensation has a critical dimensionless value, Wc* = 0.175, which corresponds to the thermal fluctuation of the system and depends neither on the mesopore size nor on the temperature. We show that the critical energy barrier Wc* controls the capillary condensation pressure Pcond and also determines a boundary between the reversible condensation/evaporation regime and the developing hysteresis regime.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. Identifying the critical success factors in the coverage of low vision services using the classification analysis and regression tree methodology.

    Science.gov (United States)

    Chiang, Peggy Pei-Chia; Xie, Jing; Keeffe, Jill Elizabeth

    2011-04-25

    To identify the critical success factors (CSF) associated with coverage of low vision services. Data were collected from a survey distributed to Vision 2020 contacts, government, and non-government organizations (NGOs) in 195 countries. The Classification and Regression Tree Analysis (CART) was used to identify the critical success factors of low vision service coverage. Independent variables were sourced from the survey: policies, epidemiology, provision of services, equipment and infrastructure, barriers to services, human resources, and monitoring and evaluation. Socioeconomic and demographic independent variables: health expenditure, population statistics, development status, and human resources in general, were sourced from the World Health Organization (WHO), World Bank, and the United Nations (UN). The findings identified that having >50% of children obtaining devices when prescribed (χ(2) = 44; P 3 rehabilitation workers per 10 million of population (χ(2) = 4.50; P = 0.034), higher percentage of population urbanized (χ(2) = 14.54; P = 0.002), a level of private investment (χ(2) = 14.55; P = 0.015), and being fully funded by government (χ(2) = 6.02; P = 0.014), are critical success factors associated with coverage of low vision services. This study identified the most important predictors for countries with better low vision coverage. The CART is a useful and suitable methodology in survey research and is a novel way to simplify a complex global public health issue in eye care.

  11. 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.

  12. 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.

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

    Science.gov (United States)

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

    2013-09-01

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

  14. Mediating role of critical thinking disposition in the relationship between perceived barriers to research use and evidence-based practice.

    Science.gov (United States)

    Kim, Sun-Ae; Song, Youngshin; Sim, Hee-Sook; Ahn, Eun-Kyong; Kim, Jung-Hee

    2015-01-01

    Despite the importance of critical thinking in clinical and educational settings, little is known about its role in evidence-based practice (EBP). This study examined whether critical thinking disposition (CTD) mediates the relationship between perceived barriers to research use and EBP in clinical nurses (N=409). A path diagram using structural equation modeling was used to estimate the direct and indirect effects of perceived barriers to research use on EBP, controlling for CTD as a mediator. CTD partially mediated the relationship between perceived barriers to research use and EBP. Furthermore, the hypothesized mediation model demonstrated an appropriate fit to the data. Individual and organizational efforts are needed to help nurses further improve their critical thinking skills. CTD is important as research barriers to engage effectively in EBP. Without the skills to evaluate evidence carefully, research utilization may be compromised.

  15. Critical Thinking Skills among Elementary School Students: Comparing Identified Gifted and General Education Student Performance

    Science.gov (United States)

    Kettler, Todd

    2014-01-01

    Education reform efforts, including the current adoption of Common Core State Standards, have increased attention to teaching critical thinking skills to all students. This study investigated the critical thinking skills of fourth-grade students from a school district in Texas, including 45 identified gifted students and 163 general education…

  16. 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

  17. Relationships between duration of practice, educational level, and perception of barriers to implement evidence-based practice among critical care nurses.

    Science.gov (United States)

    Phillips, Carswella

    2015-12-01

    Globally, a greater emphasis has been placed on the delivery of safe, patient-centered, evidence-based nursing care. As point-of-care providers, critical care nurses play a key role in ensuring that patients receive the safest, most effective treatment available. In order to deliver scientific-based care, critical care nurses must stay abreast of the current trends, as well as engage in the evidence-based practice process. This study aimed to describe research activities, to identify barriers to implement evidence-based practice and to explore professional factors related to the use of evidence-based practice among critical care nurses at three teaching hospitals in south-eastern United States. A survey design and convenience sampling method was used. A sample of 30 critical care staff nurses participated in the study. A 61-item online questionnaire composed of a demographic survey - BARRIERS scale - and Evidence-Based Practice Questionnaire was used. Simple descriptive statistics, Pearson's product moment correlations, and independent-sample t test procedures were used to analyze the data. Critical care nurses' reported positive attitudes, but viewed knowledge and use of evidence-based practice less favorably. These results may indicate that having a positive attitude towards evidence-based practice does not necessarily translate to knowledge and use of the evidence-based practice process in clinical practice. An unwillingness to change and time constraints were identified as the top barriers to use evidence-based practice in this study. Perceptions of barriers to use evidence-based practice were higher in those critical care nurses who had less practical experience and educational preparation. The results suggest that critical care nurses possess the foundation to engage in the evidence-based practice process; however, their knowledge, practice, and attitudes just need to be cultivated and strengthened. Understanding the nurses' professional factors, current use

  18. 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.

  19. 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

  20. Advanced electrical current measurements of microdischarges: evidence of sub-critical pulses and ion currents in barrier discharge in air

    Science.gov (United States)

    Synek, Petr; Zemánek, Miroslav; Kudrle, Vít; Hoder, Tomáš

    2018-04-01

    Electrical current measurements in corona or barrier microdischarges are a challenge as they require both high temporal resolution and a large dynamic range of the current probe used. In this article, we apply a simple self-assembled current probe and compare it to commercial ones. An analysis in the time and frequency domain is carried out. Moreover, an improved methodology is presented, enabling both temporal resolution in sub-nanosecond times and current sensitivity in the order of tens of micro-amperes. Combining this methodology with a high-tech oscilloscope and self-developed software, a unique statistical analysis of currents in volume barrier discharge driven in atmospheric-pressure air is made for over 80 consecutive periods of a 15 kHz applied voltage. We reveal the presence of repetitive sub-critical current pulses and conclude that these can be identified with the discharging of surface charge microdomains. Moreover, extremely low, long-lasting microsecond currents were detected which are caused by ion flow, and are analysed in detail. The statistical behaviour presented gives deeper insight into the discharge physics of these usually undetectable current signals.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.

    Science.gov (United States)

    Mun, Mi Suk

    2010-02-01

    The development of students' critical thinking abilities is one of the greatest challenges facing contemporary nursing educators. Nursing educators should know about what kind of contents or situations need critical thinking. The research was undertaken to identify the critical thinking contexts that nursing students confront in psychiatric clinical practices. Students were asked to document their everyday experience. The narratives were analysed and interpreted from the philosophical notion of hermeneutics. Four themes emerged as critical thinking contexts: anxiety, conflict, hyper-awareness, dilemmas. Writing narratives appear to provide opportunities for reflection in addition to facilitating critical thinking and communicative skills in students. Also, for the instructor, students' clinical narratives could provide insight to understand how students are thinking and to share student's personal difficulties.

  7. 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...

  8. Clustering analysis of water distribution systems: identifying critical components and community impacts.

    Science.gov (United States)

    Diao, K; Farmani, R; Fu, G; Astaraie-Imani, M; Ward, S; Butler, D

    2014-01-01

    Large water distribution systems (WDSs) are networks with both topological and behavioural complexity. Thereby, it is usually difficult to identify the key features of the properties of the system, and subsequently all the critical components within the system for a given purpose of design or control. One way is, however, to more explicitly visualize the network structure and interactions between components by dividing a WDS into a number of clusters (subsystems). Accordingly, this paper introduces a clustering strategy that decomposes WDSs into clusters with stronger internal connections than external connections. The detected cluster layout is very similar to the community structure of the served urban area. As WDSs may expand along with urban development in a community-by-community manner, the correspondingly formed distribution clusters may reveal some crucial configurations of WDSs. For verification, the method is applied to identify all the critical links during firefighting for the vulnerability analysis of a real-world WDS. Moreover, both the most critical pipes and clusters are addressed, given the consequences of pipe failure. Compared with the enumeration method, the method used in this study identifies the same group of the most critical components, and provides similar criticality prioritizations of them in a more computationally efficient time.

  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 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…

  11. 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…

  12. 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

  13. Tool for identifying critical control points in embedded purchasing activities in SMEs

    NARCIS (Netherlands)

    Hagelaar, Geoffrey; Staal, Anne; Holman, Richard; Walhof, Gert

    2015-01-01

    This paper discusses risk and uncertainty aspects and proposes an assessment tool leading to identification of critical control points (CCPs) within purchasing-oriented activities of small and medium enterprises (SMEs). Identifying such CCPs is the basis for developing SME purchasing instruments to

  14. Simulation platform developed to study and identify critical cases in a future smart grid

    DEFF Research Database (Denmark)

    Mihet-Popa, Lucian; Zong, Yi; You, Shi

    2016-01-01

    simulation and planning tools, with a particular objective on the challenges faced by the introduction of Smart Grid technologies. Another important issue of the paper is to identify critical load cases, as well as the voltage variations with the highest potential, able to implement the grid model...

  15. Identifying critical issues in recreation planning and management: improving the management-research partnership

    Science.gov (United States)

    John H. Schomaker; David W. Lime

    1988-01-01

    The "nominal group" process is a proven technique to systematically arrive at a consensus about critical information needs in recreation planning and management. Using this process, 41 managers who attended a 1983 conference on river management identified 114 specific information needs grouped under 11 general questions. Clearly, some concerns of...

  16. Organisational Issues for E-Learning: Critical Success Factors as Identified by HE Practitioners

    Science.gov (United States)

    McPherson, Maggie; Nunes, Miguel Baptista

    2006-01-01

    Purpose: The purpose of this paper is to report on a research project that identified organisational critical success factors (CSFs) for e-learning implementation in higher education (HE). These CSFs can be used as a theoretical foundation upon which to base decision-making and strategic thinking about e-learning. Design/methodology/approach: The…

  17. 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…

  18. 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…

  19. 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

  20. 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.

  1. 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

  2. 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...

  3. 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.

  4. Implementation of Green New Product Development Among SMEs: Barriers and Critical Success Factors

    Directory of Open Access Journals (Sweden)

    Abu Noor Hidayah

    2018-01-01

    Full Text Available Green New Product Development (GNPD is very important due to environmental issues increasing. GNPD is defined as creating, designing and develop ecological product which could help in protecting the environment. Small and medium enterprise (SME firms is one of the contributor to the environmental issues but they could not afford to implement GNPD because there are several obstacles which prevent the successful of GNPD implementation. The objective of this paper are to identify the critical success factors and to determine the obstacles of GNPD implementation among SMEs. The method used in this study is conceptual review of previous literature in green and NPD area of research. The result finding of this paper consist of 9 critical success factors and 12 obstacles. All the critical success factors and obstacles will be grouped. The finding of this study could be a source and fundamental guideline for future study in developing framework for GNPD implementation especially for manufacturing SMEs in Malaysia. Besides that, the result of this study could help organization especially SMEs’s owner and manager in assessing their initiative to implement GNPD in organization.

  5. Identifying the Critical Links in Road Transportation Networks: Centrality-based approach utilizing structural properties

    Energy Technology Data Exchange (ETDEWEB)

    Chinthavali, Supriya [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-04-01

    Surface transportation road networks share structural properties similar to other complex networks (e.g., social networks, information networks, biological networks, and so on). This research investigates the structural properties of road networks for any possible correlation with the traffic characteristics such as link flows those determined independently. Additionally, we define a criticality index for the links of the road network that identifies the relative importance in the network. We tested our hypotheses with two sample road networks. Results show that, correlation exists between the link flows and centrality measures of a link of the road (dual graph approach is followed) and the criticality index is found to be effective for one test network to identify the vulnerable nodes.

  6. Identify and Classify Critical Success Factor of Agile Software Development Methodology Using Mind Map

    OpenAIRE

    Tasneem Abd El Hameed; Mahmoud Abd EL Latif; Sherif Kholief

    2016-01-01

    Selecting the right method, right personnel and right practices, and applying them adequately, determine the success of software development. In this paper, a qualitative study is carried out among the critical factors of success from previous studies. The factors of success match with their relative principles to illustrate the most valuable factor for agile approach success, this paper also prove that the twelve principles poorly identified for few factors resulting from qualitative and qua...

  7. 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...

  8. 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.

  9. 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

  10. 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.

  11. 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 ...

  12. Key Barriers to the Implementation of Solar Energy in Nigeria: A Critical Analysis

    Science.gov (United States)

    Abdullahi, D.; Suresh, S.; Renukappa, S.; Oloke, D.

    2017-08-01

    Nigeria, potentially, has abundant sunshine throughout the year, making it full thirst for solar energy generation. Even though, the country’s solar energy projects have not realised a fair result over the years, due to many barriers associated with initiatives implementation. Therefore, the entire power sector remains incapacitated to generate, transmit and distribute a clean, affordable and sustainable energy to assist economic growth. The research integrated five African counterpart’s solar energy initiatives, barriers, policies and strategies adopted as a lesson learned to Nigeria. Inadequate solar initiative’s research, lack of technological know-how, short-term policies, lack of awareness and political instability are the major barriers that made the implementation of solar initiatives almost impossible in Nigeria. The shock of the barriers therefore, constitutes a major negative contribution to the crippling of the power sector in the state. Future research will concentrate on initiatives for mitigating solar and other renewable energy barriers.

  13. 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.

  14. A quantitative metric to identify critical elements within seafood supply networks.

    Science.gov (United States)

    Plagányi, Éva E; van Putten, Ingrid; Thébaud, Olivier; Hobday, Alistair J; Innes, James; Lim-Camacho, Lilly; Norman-López, Ana; Bustamante, Rodrigo H; Farmery, Anna; Fleming, Aysha; Frusher, Stewart; Green, Bridget; Hoshino, Eriko; Jennings, Sarah; Pecl, Gretta; Pascoe, Sean; Schrobback, Peggy; Thomas, Linda

    2014-01-01

    A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI) identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical.

  15. A Quantitative Metric to Identify Critical Elements within Seafood Supply Networks

    Science.gov (United States)

    Plagányi, Éva E.; van Putten, Ingrid; Thébaud, Olivier; Hobday, Alistair J.; Innes, James; Lim-Camacho, Lilly; Norman-López, Ana; Bustamante, Rodrigo H.; Farmery, Anna; Fleming, Aysha; Frusher, Stewart; Green, Bridget; Hoshino, Eriko; Jennings, Sarah; Pecl, Gretta; Pascoe, Sean; Schrobback, Peggy; Thomas, Linda

    2014-01-01

    A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI) identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical. PMID:24633147

  16. A quantitative metric to identify critical elements within seafood supply networks.

    Directory of Open Access Journals (Sweden)

    Éva E Plagányi

    Full Text Available A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical.

  17. 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.

  18. 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

  19. A novel strategy to identify the critical conditions for growth-induced instabilities.

    Science.gov (United States)

    Javili, A; Steinmann, P; Kuhl, E

    2014-01-01

    Geometric instabilities in living structures can be critical for healthy biological function, and abnormal buckling, folding, or wrinkling patterns are often important indicators of disease. Mathematical models typically attribute these instabilities to differential growth, and characterize them using the concept of fictitious configurations. This kinematic approach toward growth-induced instabilities is based on the multiplicative decomposition of the total deformation gradient into a reversible elastic part and an irreversible growth part. While this generic concept is generally accepted and well established today, the critical conditions for the formation of growth-induced instabilities remain elusive and poorly understood. Here we propose a novel strategy for the stability analysis of growing structures motivated by the idea of replacing growth by prestress. Conceptually speaking, we kinematically map the stress-free grown configuration onto a prestressed initial configuration. This allows us to adopt a classical infinitesimal stability analysis to identify critical material parameter ranges beyond which growth-induced instabilities may occur. We illustrate the proposed concept by a series of numerical examples using the finite element method. Understanding the critical conditions for growth-induced instabilities may have immediate applications in plastic and reconstructive surgery, asthma, obstructive sleep apnoea, and brain development. © 2013 Elsevier Ltd. All rights reserved.

  20. msiDBN: A Method of Identifying Critical Proteins in Dynamic PPI Networks

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    Yuan Zhang

    2014-01-01

    Full Text Available Dynamics of protein-protein interactions (PPIs reveals the recondite principles of biological processes inside a cell. Shown in a wealth of study, just a small group of proteins, rather than the majority, play more essential roles at crucial points of biological processes. This present work focuses on identifying these critical proteins exhibiting dramatic structural changes in dynamic PPI networks. First, a comprehensive way of modeling the dynamic PPIs is presented which simultaneously analyzes the activity of proteins and assembles the dynamic coregulation correlation between proteins at each time point. Second, a novel method is proposed, named msiDBN, which models a common representation of multiple PPI networks using a deep belief network framework and analyzes the reconstruction errors and the variabilities across the time courses in the biological process. Experiments were implemented on data of yeast cell cycles. We evaluated our network construction method by comparing the functional representations of the derived networks with two other traditional construction methods. The ranking results of critical proteins in msiDBN were compared with the results from the baseline methods. The results of comparison showed that msiDBN had better reconstruction rate and identified more proteins of critical value to yeast cell cycle process.

  1. 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.

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

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    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

  3. Identifying hotspots and management of critical ecosystem services in rapidly urbanizing Yangtze River Delta Region, China.

    Science.gov (United States)

    Cai, Wenbo; Gibbs, David; Zhang, Lang; Ferrier, Graham; Cai, Yongli

    2017-04-15

    Rapid urbanization has altered many ecosystems, causing a decline in many ecosystem services, generating serious ecological crisis. To cope with these challenges, we presented a comprehensive framework comprising five core steps for identifying and managing hotspots of critical ecosystem services in a rapid urbanizing region. This framework was applied in the case study of the Yangtze River Delta (YRD) Region. The study showed that there was large spatial heterogeneity in the hotspots of ecosystem services in the region, hotspots of supporting services and regulating services aggregately distributing in the southwest mountainous areas while hotspots of provisioning services mainly in the northeast plain, and hotspots of cultural services widespread in the waterbodies and southwest mountainous areas. The regionalization of the critical ecosystem services was made through the hotspot analysis. This study provided valuable information for environmental planning and management in a rapid urbanizing region and helped improve China's ecological redlines policy at regional scale. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. 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.

  5. 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.

  6. Pathway cross-talk network analysis identifies critical pathways in neonatal sepsis.

    Science.gov (United States)

    Meng, Yu-Xiu; Liu, Quan-Hong; Chen, Deng-Hong; Meng, Ying

    2017-06-01

    Despite advances in neonatal care, sepsis remains a major cause of morbidity and mortality in neonates worldwide. Pathway cross-talk analysis might contribute to the inference of the driving forces in bacterial sepsis and facilitate a better understanding of underlying pathogenesis of neonatal sepsis. This study aimed to explore the critical pathways associated with the progression of neonatal sepsis by the pathway cross-talk analysis. By integrating neonatal transcriptome data with known pathway data and protein-protein interaction data, we systematically uncovered the disease pathway cross-talks and constructed a disease pathway cross-talk network for neonatal sepsis. Then, attract method was employed to explore the dysregulated pathways associated with neonatal sepsis. To determine the critical pathways in neonatal sepsis, rank product (RP) algorithm, centrality analysis and impact factor (IF) were introduced sequentially, which synthetically considered the differential expression of genes and pathways, pathways cross-talks and pathway parameters in the network. The dysregulated pathways with the highest IF values as well as RPpathways in neonatal sepsis. By integrating three kinds of data, only 6919 common genes were included to perform the pathway cross-talk analysis. By statistic analysis, a total of 1249 significant pathway cross-talks were selected to construct the pathway cross-talk network. Moreover, 47 dys-regulated pathways were identified via attract method, 20 pathways were identified under RPpathways with the highest IF were also screened from the pathway cross-talk network. Among them, we selected 8 common pathways, i.e. critical pathways. In this study, we systematically tracked 8 critical pathways involved in neonatal sepsis by integrating attract method and pathway cross-talk network. These pathways might be responsible for the host response in infection, and of great value for advancing diagnosis and therapy of neonatal sepsis. Copyright © 2017

  7. 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.

  8. The use of arithmetic average method in identifying critical success criteria for Homestay Programmes

    Science.gov (United States)

    Daud, Shahidah Md; Ramli, Razamin; Kasim, Maznah Mat; Kayat, Kalsom; Razak, Rafidah Abd

    2015-12-01

    Malaysian Homestay is very unique. It is classified as Community Based Tourism (CBT). Homestay Programme which is a community events where a tourist stays together with a host family for a period of time and enjoying cultural exchange besides having new experiences. Homestay programme has booming the tourism industry since there is over 100 Homestay Programme currently being registered with the Ministry of Culture and Tourism Malaysia. However, only few Homestay Programme enjoying the benefits of success Homestay Programme. Hence, this article seeks to identify the critical success factors for a Homestay Programme in Malaysia. An Arithmetic Average method is utilized to further evaluate the identified success factors in a more meaningful way. The findings will help Homestay Programme function as a community development tool that manages tourism resources. Thus, help the community in improving local economy and creating job opportunities.

  9. Life support decision making in critical care: Identifying and appraising the qualitative research evidence.

    Science.gov (United States)

    Giacomini, Mita; Cook, Deborah; DeJean, Deirdre

    2009-04-01

    The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and

  10. Critical analysis of key determinants and barriers to digital innovation adoption among architectural organizations

    Directory of Open Access Journals (Sweden)

    Runddy Ramilo

    2014-12-01

    Full Text Available The development and use of design technology for architecture in the modern world have led to the emergence of various design methodologies. Current design research has focused on a computationally mediated design process. This method is essentially concerned with finding forms and building performance simulation, i.e., structural, environmental, constructional, and cost performance, by integrating physics and algorithms. From the emergence of this process, design practices have been increasingly aided by and dependent on the technology, which has resulted in a major paradigm shift. Advancement of the new technology has the potential to improve design and productivity dramatically. However, related literature shows that substantial technical and organizational barriers exist. These barriers inhibit the effective adoption of these technologies. The effect of these obstacles on architectural practice varies depending on the size of an architectural organization. To further understand the problem, we conducted an in-depth study on several small, medium, and large architectural organizations. This study involves in-depth evaluation of technological, financial, organizational, governmental, psychological, and process barriers encountered in the adoption of digital innovation. Results reveal relevant attributes and patterns of variables, which can be used to establish a framework for digital innovation adoption. Valuable findings of this study reveal that smaller architectural organizations present more barriers to digital innovation compared with their larger counterparts. This study is important because it contributes to the research on digital innovation in architecture and addresses the barriers faced by different sizes of architectural organizations.

  11. 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.

  12. Structural identifiability of systems biology models: a critical comparison of methods.

    Directory of Open Access Journals (Sweden)

    Oana-Teodora Chis

    Full Text Available Analysing the properties of a biological system through in silico experimentation requires a satisfactory mathematical representation of the system including accurate values of the model parameters. Fortunately, modern experimental techniques allow obtaining time-series data of appropriate quality which may then be used to estimate unknown parameters. However, in many cases, a subset of those parameters may not be uniquely estimated, independently of the experimental data available or the numerical techniques used for estimation. This lack of identifiability is related to the structure of the model, i.e. the system dynamics plus the observation function. Despite the interest in knowing a priori whether there is any chance of uniquely estimating all model unknown parameters, the structural identifiability analysis for general non-linear dynamic models is still an open question. There is no method amenable to every model, thus at some point we have to face the selection of one of the possibilities. This work presents a critical comparison of the currently available techniques. To this end, we perform the structural identifiability analysis of a collection of biological models. The results reveal that the generating series approach, in combination with identifiability tableaus, offers the most advantageous compromise among range of applicability, computational complexity and information provided.

  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. Critical current density of BiSrCaCuO superconductors: effect of surface barriers

    International Nuclear Information System (INIS)

    Konczykowski, M.; Chikumoto, N.

    1992-01-01

    Effects of surface barriers on vortex motion in BiSrCaCuO-2212 high-temperature superconducting crystals is summarized. Characteristic features of this phenomenon appear in the hysteresis loop (shape of its ascending and descending branches), in the effect of 2.5 MeV electron irradiation, and in flux creep measurements (magnetization dependence to the crystal lateral dimension, size of the flux-creep barrier and the crossover as a function of temperature and time persistent current density). (A.B.). 25 refs., 3 figs

  17. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

  18. 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.

  19. 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.

  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. A new approach to hazardous materials transportation risk analysis: decision modeling to identify critical variables.

    Science.gov (United States)

    Clark, Renee M; Besterfield-Sacre, Mary E

    2009-03-01

    We take a novel approach to analyzing hazardous materials transportation risk in this research. Previous studies analyzed this risk from an operations research (OR) or quantitative risk assessment (QRA) perspective by minimizing or calculating risk along a transport route. Further, even though the majority of incidents occur when containers are unloaded, the research has not focused on transportation-related activities, including container loading and unloading. In this work, we developed a decision model of a hazardous materials release during unloading using actual data and an exploratory data modeling approach. Previous studies have had a theoretical perspective in terms of identifying and advancing the key variables related to this risk, and there has not been a focus on probability and statistics-based approaches for doing this. Our decision model empirically identifies the critical variables using an exploratory methodology for a large, highly categorical database involving latent class analysis (LCA), loglinear modeling, and Bayesian networking. Our model identified the most influential variables and countermeasures for two consequences of a hazmat incident, dollar loss and release quantity, and is one of the first models to do this. The most influential variables were found to be related to the failure of the container. In addition to analyzing hazmat risk, our methodology can be used to develop data-driven models for strategic decision making in other domains involving risk.

  3. Betweenness-Based Method to Identify Critical Transmission Sectors for Supply Chain Environmental Pressure Mitigation.

    Science.gov (United States)

    Liang, Sai; Qu, Shen; Xu, Ming

    2016-02-02

    To develop industry-specific policies for mitigating environmental pressures, previous studies primarily focus on identifying sectors that directly generate large amounts of environmental pressures (a.k.a. production-based method) or indirectly drive large amounts of environmental pressures through supply chains (e.g., consumption-based method). In addition to those sectors as important environmental pressure producers or drivers, there exist sectors that are also important to environmental pressure mitigation as transmission centers. Economy-wide environmental pressure mitigation might be achieved by improving production efficiency of these key transmission sectors, that is, using less upstream inputs to produce unitary output. We develop a betweenness-based method to measure the importance of transmission sectors, borrowing the betweenness concept from network analysis. We quantify the betweenness of sectors by examining supply chain paths extracted from structural path analysis that pass through a particular sector. We take China as an example and find that those critical transmission sectors identified by betweenness-based method are not always identifiable by existing methods. This indicates that betweenness-based method can provide additional insights that cannot be obtained with existing methods on the roles individual sectors play in generating economy-wide environmental pressures. Betweenness-based method proposed here can therefore complement existing methods for guiding sector-level environmental pressure mitigation strategies.

  4. USE OF PORTABLE GAMMA SPECTROMETERS FOR IDENTIFYING PERSONS EXPOSED IN A NUCLEAR CRITICALITY

    Energy Technology Data Exchange (ETDEWEB)

    Veinot, K. G. [Y-12 National Security Complex; Gose, B. T. [Y-12 National Security Complex; Bogard, James S [ORNL

    2009-01-01

    At Y-12 triage-style assessments are used to identify persons potentially exposed to high doses from criticality accident radiations using portable instruments by assessing the presence of activated sodium atoms in a person's blood. Historically, simple hand-held Geiger-Mueller (G-M) probes were used for these purposes although it was recognized that, since these instruments contain no information on incident photon energy, it was impossible to differentiate between photons emitted by contamination on the potentially exposed worker from activation of sodium in the person s blood. This works examines the use of a portable gamma spectrometer for assessing blood sodium activation. Irradiations of a representative phantom were performed using two neutron source configurations (unmoderated and polyethylene-moderated 252Cf) and measurements were made using the spectrometer and a G-M detector following irradiation. Detection limits in terms of personnel neutron dose are given for two neutron fields representing metaland solution criticality spectra. Both Geiger-Mueller and spectrometer results indicate a low minimum detectable neutron dose indicating that both instrument are useful as an emergency response instrument. The spectrometer has the added benefit of discriminating between surface contamination and blood sodium activation.

  5. USE OF PORTABLE GAMMA SPECTROMETERS FOR IDENTIFYING PERSONS EXPOSED IN A NUCLEAR CRITICALITY

    International Nuclear Information System (INIS)

    Veinot, K.G.; Gose, B.T.; Bogard, James S.

    2009-01-01

    At Y-12 triage-style assessments are used to identify persons potentially exposed to high doses from criticality accident radiations using portable instruments by assessing the presence of activated sodium atoms in a person's blood. Historically, simple hand-held Geiger-Mueller (G-M) probes were used for these purposes although it was recognized that, since these instruments contain no information on incident photon energy, it was impossible to differentiate between photons emitted by contamination on the potentially exposed worker from activation of sodium in the persons blood. This works examines the use of a portable gamma spectrometer for assessing blood sodium activation. Irradiations of a representative phantom were performed using two neutron source configurations (unmoderated and polyethylene-moderated 252Cf) and measurements were made using the spectrometer and a G-M detector following irradiation. Detection limits in terms of personnel neutron dose are given for two neutron fields representing metal and solution criticality spectra. Both Geiger-Mueller and spectrometer results indicate a low minimum detectable neutron dose indicating that both instrument are useful as an emergency response instrument. The spectrometer has the added benefit of discriminating between surface contamination and blood sodium activation.

  6. Baccalaureate Nursing Students' Abilities in Critically Identifying and Evaluating the Quality of Online Health Information.

    Science.gov (United States)

    Theron, Maggie; Redmond, Anne; Borycki, Elizabeth M

    2017-01-01

    Both the Internet and social media have become important tools that patients and health professionals, including health professional students, use to obtain information and support their decision-making surrounding health care. Students in the health sciences require increased competence to select, appraise, and use online sources to adequately educate and support patients and advocate for patient needs and best practices. The purpose of this study was to ascertain if second year nursing students have the ability to critically identify and evaluate the quality of online health information through comparisons between student and expert assessments of selected online health information postings using an adapted Trust in Online Health Information scale. Interviews with experts provided understanding of how experts applied the selected criteria and what experts recommend for implementing nursing informatics literacy in curriculums. The difference between student and expert assessments of the quality of the online information is on average close to 40%. Themes from the interviews highlighted several possible factors that may influence informatics competency levels in students, specifically regarding the critical appraisal of the quality of online health information.

  7. Identifying Critical Factors in the Eco-Efficiency of Remanufacturing Based on the Fuzzy DEMATEL Method

    Directory of Open Access Journals (Sweden)

    Qianwang Deng

    2015-11-01

    Full Text Available Remanufacturing can bring considerable economic and environmental benefits such as cost saving, conservation of energy and resources, and reduction of emissions. With the increasing awareness of sustainable manufacturing, remanufacturing gradually becomes the research priority. Most studies concentrate on the analysis of influencing factors, or the evaluation of the economic and environmental performance in remanufacturing, while little effort has been devoted to investigating the critical factors influencing the eco-efficiency of remanufacturing. Considering the current development of the remanufacturing industry in China, this paper proposes a set of factors influencing the eco-efficiency of remanufacturing and then utilizes a fuzzy Decision Making Trial and Evaluation Laboratory (DEMATEL method to establish relation matrixes reflecting the interdependent relationships among these factors. Finally, the contributions of each factor to eco-efficiency and mutual influence values among them are obtained, and critical factors in eco-efficiency of remanufacturing are identified. The results of the present work can provide theoretical supports for the government to make appropriate policies to improve the eco-efficiency of remanufacturing.

  8. An exploratory study to identify critical factors of innovation culture in organizations

    Directory of Open Access Journals (Sweden)

    Hamed Asgari

    2013-07-01

    Full Text Available During the past two decades, there has been a growing trend on knowledge-based organizations. Innovation, on the other hand, plays essential role on building competitive business units. In this paper, we present an exploratory study to identify critical factors of innovation culture in organizations. We detect important factors influencing innovation culture in construction industry based on the implementation of factor analysis. The proposed study designs a questionnaire and distributes it among 400 experts who are involved in construction industry. Cronbach alpha has been calculated as 0.779, which validates the overall questionnaire. The results of factor analysis have indicated that six factors of building cultural infrastructures, education, organizational vision, established culture, strategic culture and flexible culture are the most important items influencing innovation culture.

  9. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    Directory of Open Access Journals (Sweden)

    Henry T Stelfox

    Full Text Available Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap. We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14 and pediatric (n = 2 medical-surgical intensive care units (ICUs in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38 and frontline providers (n = 1,790. Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate evaluated the priorities, and rated 9 as 'necessary' (median score 7-9. Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs.A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  10. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    Science.gov (United States)

    Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

    2015-01-01

    Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  11. Cross-species epigenetics identifies a critical role for VAV1 in SHH subgroup medulloblastoma maintenance.

    Science.gov (United States)

    Lindsey, J C; Kawauchi, D; Schwalbe, E C; Solecki, D J; Selby, M P; McKinnon, P J; Olson, J M; Hayden, J T; Grundy, R G; Ellison, D W; Williamson, D; Bailey, S; Roussel, M F; Clifford, S C

    2015-09-03

    The identification of key tumorigenic events in Sonic Hedgehog (SHH) subgroup medulloblastomas (MBSHH) will be essential for the development of individualized therapies and improved outcomes. However, beyond confirmation of characteristic SHH pathway mutations, recent genome-wide sequencing studies have not revealed commonly mutated genes with widespread relevance as potential therapeutic targets. We therefore examined any role for epigenetic DNA methylation events in MBSHH using a cross-species approach to candidate identification, prioritization and validation. MBSHH-associated DNA methylation events were first identified in 216 subgrouped human medulloblastomas (50 MBSHH, 28 Wnt/Wingless, 44 Group 3 and 94 Group 4) and their conservation then assessed in tumors arising from four independent murine models of Shh medulloblastoma, alongside any role in tumorigenesis using functional assessments in mouse and human models. This strategy identified widespread regional CpG hypo-methylation of VAV1, leading to its elevated expression, as a conserved aberrant epigenetic event, which characterizes the majority of MBSHH tumors in both species, and is associated with a poor outcome in MBSHH patients. Moreover, direct modulation of VAV1 in mouse and human models revealed a critical role in tumor maintenance, and its abrogation markedly reduced medulloblastoma growth. Further, Vav1 activity regulated granule neuron precursor germinal zone exit and migration initiation in an ex vivo model of early postnatal cerebellar development. These findings establish VAV1 as a critical epigenetically regulated oncogene with a key role in MBSHH maintenance, and highlight its potential as a validated therapeutic target and prognostic biomarker for the improved therapy of medulloblastoma.

  12. Identify fracture-critical regions inside the proximal femur using statistical parametric mapping

    Science.gov (United States)

    Li, Wenjun; Kornak, John; Harris, Tamara; Keyak, Joyce; Li, Caixia; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

    2009-01-01

    We identified regions inside the proximal femur that are most strongly associated with hip fracture. Bone densitometry based on such fracture-critical regions showed improved power in discriminating fracture patients from controls. Introduction Hip fractures typically occur in lateral falls, with focal mechanical failure of the sub-volumes of tissue in which the applied stress exceeds the strength. In this study, we describe a new methodology to identify proximal femoral tissue elements with highest association with hip fracture. We hypothesize that bone mineral density (BMD) measured in such sub-volumes discriminates hip fracture risk better than BMD in standard anatomic regions such as the femoral neck and trochanter. Materials and Methods We employed inter-subject registration to transform hip QCT images of 37 patients with hip fractures and 38 age-matched controls into a voxel-based statistical atlas. Within voxels, we performed t-tests between the two groups to identify the regions which differed most. We then randomly divided the 75 scans into a training set and a test set. From the training set, we derived a fracture-driven region of interest (ROI) based on association with fracture. In the test set, we measured BMD in this ROI to determine fracture discrimination efficacy using ROC analysis. Additionally, we compared the BMD distribution differences between the 29 patients with neck fractures and the 8 patients with trochanteric fractures. Results By evaluating fracture discrimination power based on ROC analysis, the fracture-driven ROI had an AUC (area under curve) of 0.92, while anatomic ROIs (including the entire proximal femur, the femoral neck, trochanter and their cortical and trabecular compartments) had AUC values between 0.78 and 0.87. We also observed that the neck fracture patients had lower BMD (p=0.014) in a small region near the femoral neck and the femoral head, and patients with trochanteric fractures had lower BMD in trochanteric regions

  13. 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.

  14. Addendum 4 to CSAR 81-001, Installation of an Official Critical Drain on the Plexiglass Contamination Barrier in HC-227T Hood

    International Nuclear Information System (INIS)

    Chiao, T.

    1995-12-01

    This report defines the maximum space allowed between the floor surface and the lower edge of an official criticality drain which is to be installed on the plexiglas contamination barrier in HC-227T Hood

  15. Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study

  16. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. 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.

  18. Barriers and Critical Success Factors for the Implementation of Cooperation Mechanisms

    DEFF Research Database (Denmark)

    Hansen, Lise-Lotte Pade; Klinge Jacobsen, Henrik

    This document reports activities and results of Task 3.1 of the Intelligent Energy Europe supported project RES4Less. This work is the initial analyses and survey of barriers for implementing cooperation mechanisms in the EU countries. This work builds on earlier Intelligent Energy Europe projects...... also shared and enriched by comments from other members of the RES4Less Team during internal meetings of the project....

  19. Non-Critical-Care Nurses' Perceptions of Facilitators and Barriers to Rapid Response Team Activation.

    Science.gov (United States)

    Jenkins, Sheryl Henry; Astroth, Kim Schafer; Woith, Wendy Mann

    2015-01-01

    Rapid response teams can save lives but are only effective when activated. We surveyed 50 nurses for their perceptions of facilitators and barriers to activation. Findings showed that participants need more education on their role and when to activate the rapid response team. Nurses who comprise the team need help building their communication skills. We recommend nursing professional development specialists increase the frequency of offerings and expand the focus on roles, activation criteria, and communication skills.

  20. Making Sense of Crisis: Cognitive Barriers of Learning in Critical Situations

    Directory of Open Access Journals (Sweden)

    Ramona PERGHEL

    2013-09-01

    Full Text Available This paper explores the role of cognitive issues in learning from crisis situations, in particular the managers’ mental representations of crisis and the relationship of these “maps” with the learning process through “sense-making”, as well as the possible cognitive barriers that might prevent the process of learning from crisis and thus allow the incubation of crises to develop in the company. Reviewing secondary data from the current literature, the paper focuses on the complexity of human “sense-making” and understanding the phenomena of crisis and the meaning people assign to it. Considerable attention and analysis has been done in order to assess the manner in which organizations can effectively learn to prevent crisis situations, addressing the theoretical frameworks that analyse the barriers that might occur in the learning from crisis process at an individual and group level, pointing out the need of recognition and sense-making that sometimes the current state of knowledge is not well. The paper argues that the effective organizational learning from crises requires changes in the core beliefs, values and assumptions of organizational members, which translate into sustained behavioural changes and that these changes are possible through intense cognitive processes, in particular through the way managers make sense of crisis situations.  Keywords: crisis, learning, cognitive barriers, sense-making, managers, literature review

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. Trophic transfer of microplastics in aquatic ecosystems: Identifying critical research needs.

    Science.gov (United States)

    Au, Sarah Y; Lee, Cindy M; Weinstein, John E; van den Hurk, Peter; Klaine, Stephen J

    2017-05-01

    To evaluate the process of trophic transfer of microplastics, it is important to consider various abiotic and biotic factors involved in their ingestion, egestion, bioaccumulation, and biomagnification. Toward this end, a review of the literature on microplastics has been conducted to identify factors influencing their uptake and absorption; their residence times in organisms and bioaccumulation; the physical effects of their aggregation in gastrointestinal tracts; and their potential to act as vectors for the transfer of other contaminants. Limited field evidence from higher trophic level organisms in a variety of habitats suggests that trophic transfer of microplastics may be a common phenomenon and occurs concurrently with direct ingestion. Critical research needs include standardizing methods of field characterization of microplastics, quantifying uptake and depuration rates in organisms at different trophic levels, quantifying the influence that microplastics have on the uptake and/or depuration of environmental contaminants among different trophic levels, and investigating the potential for biomagnification of microplastic-associated chemicals. More integrated approaches involving computational modeling are required to fully assess trophic transfer of microplastics. Integr Environ Assess Manag 2017;13:505-509. © 2017 SETAC. © 2017 SETAC.

  11. Competing endogenous RNA network analysis identifies critical genes among the different breast cancer subtypes.

    Science.gov (United States)

    Chen, Juan; Xu, Juan; Li, Yongsheng; Zhang, Jinwen; Chen, Hong; Lu, Jianping; Wang, Zishan; Zhao, Xueying; Xu, Kang; Li, Yixue; Li, Xia; Zhang, Yan

    2017-02-07

    Although competing endogenous RNAs (ceRNAs) have been implicated in many solid tumors, their roles in breast cancer subtypes are not well understood. We therefore generated a ceRNA network for each subtype based on the significance of both, positive co-expression and the shared miRNAs, in the corresponding subtype miRNA dys-regulatory network, which was constructed based on negative regulations between differentially expressed miRNAs and targets. All four subtype ceRNA networks exhibited scale-free architecture and showed that the common ceRNAs were at the core of the networks. Furthermore, the common ceRNA hubs had greater connectivity than the subtype-specific hubs. Functional analysis of the common subtype ceRNA hubs highlighted factors involved in proliferation, MAPK signaling pathways and tube morphogenesis. Subtype-specific ceRNA hubs highlighted unique subtype-specific pathways, like the estrogen response and inflammatory pathways in the luminal subtypes or the factors involved in the coagulation process that participates in the basal-like subtype. Ultimately, we identified 29 critical subtype-specific ceRNA hubs that characterized the different breast cancer subtypes. Our study thus provides new insight into the common and specific subtype ceRNA interactions that define the different categories of breast cancer and enhances our understanding of the pathology underlying the different breast cancer subtypes, which can have prognostic and therapeutic implications in the future.

  12. Targeting Policy for Obesity Prevention: Identifying the Critical Age for Weight Gain in Women

    Directory of Open Access Journals (Sweden)

    Trevor J. B. Dummer

    2012-01-01

    Full Text Available The obesity epidemic requires the development of prevention policy targeting individuals most likely to benefit. We used self-reported prepregnancy body weight of all women giving birth in Nova Scotia between 1988 and 2006 to define obesity and evaluated socioeconomic, demographic, and temporal trends in obesity using linear regression. There were 172,373 deliveries in this cohort of 110,743 women. Maternal body weight increased significantly by 0.5 kg per year from 1988, and lower income and rural residence were both associated significantly with increasing obesity. We estimated an additional 82,000 overweight or obese women in Nova Scotia in 2010, compared to the number that would be expected from obesity rates of just two decades ago. The critical age for weight gain was identified as being between 20 and 24 years. This age group is an important transition age between adolescence and adulthood when individuals first begin to accept responsibility for food planning, purchasing, and preparation. Policy and public health interventions must target those most at risk, namely, younger women and the socially deprived, whilst tackling the marketing of low-cost energy-dense foods at the expense of healthier options.

  13. 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.

  14. What's My Lane? Identifying the State Government Role in Critical Infrastructure Protection

    OpenAIRE

    Donnelly, Timothy S.

    2012-01-01

    Approved for public release; distribution is unlimited What constitutes an effective Critical Infrastructure and Key Resources (CIKR) protection program for Massachusetts This study evaluates existing literature regarding CIKR to extrapolate an infrastructure protection role for Massachusetts. By reviewing historical events and government strategies regarding infrastructure protection, Chapters I and II will provide scope and context for issues surrounding critical infrastructure. Chapter ...

  15. 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.

  16. 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

  17. Barriers to critical thinking: workflow interruptions and task switching among nurses.

    Science.gov (United States)

    Cornell, Paul; Riordan, Monica; Townsend-Gervis, Mary; Mobley, Robin

    2011-10-01

    Nurses are increasingly called upon to engage in critical thinking. However, current workflow inhibits this goal with frequent task switching and unpredictable demands. To assess workflow's cognitive impact, nurses were observed at 2 hospitals with different patient loads and acuity levels. Workflow on a medical/surgical and pediatric oncology unit was observed, recording tasks, tools, collaborators, and locations. Nineteen nurses were observed for a total of 85.2 hours. Tasks were short with a mean duration of 62.4 and 81.6 seconds on the 2 units. More than 50% of the recorded tasks were less than 30 seconds in length. An analysis of task sequence revealed few patterns and little pairwise repetition. Performance on specific tasks differed between the 2 units, but the character of the workflow was highly similar. The nonrepetitive flow and high amount of switching indicate nurses experience a heavy cognitive load with little uninterrupted time. This implies that nurses rarely have the conditions necessary for critical thinking.

  18. Core and edge aspects of quiescent double barrier operation on DIII-D, with relevance to critical ITB physics issues

    International Nuclear Information System (INIS)

    Doyle, E.J.; Casper, T.A.; Burrell, K.H.

    2003-01-01

    Recent results from DIII-D address critical internal transport barrier (ITB) research issues relating to sustainability, impurity accumulation and ITB control, and have also demonstrated successful application of general profile control tools. In addition, substantial progress has been made in understanding the physics of the Quiescent Double Barrier (QDB) regime, increasing the demonstrated operating space for the regime and improving performance. Highlights include: (1) A clear demonstration of q-profile modification using electron cyclotron current drive (ECCD); (2) Successful use of localized profile control using electron cyclotron heating (ECH) or ECCD to reduce central high-Z impurity accumulation associated with density peaking; (3) Theory based modeling codes are now being used to design experiments; (4) The operating space for Quiescent H-mode (QH-mode) has been substantially broadened, in particular higher density operation has been achieved; (5) Both absolute (β≤ 3.8%, neutron rate S n ≤ 5.5x10 15 s -1 ) and relative (β N H 89 = 7 for 10τ E ) performance has been increased; (6) With regard to sustainment, QDB plasmas have been run for 3.8 s or 26 τ E . These results emphasize that it is possible to produce sustained high quality H-mode performance with an edge localized mode (ELM)-free edge, directly addressing a major issue in fusion research, of how to ameliorate or eliminate ELM induced pulsed divertor particle and heat loads. (author)

  19. Communication barriers in the debate between supporters and critics of Israeli Palestinian policy

    Directory of Open Access Journals (Sweden)

    Wilhelm Kempf

    2018-04-01

    Full Text Available Based on findings of the Anti-Semitism and the Criticism of Israel (ASCI Survey, this paper examines difficulties hindering constructive dialogue between supporters and opponents of Israeli Palestinian policy. While none of the two sides wants to stand idly by watching injustice being committed before their eyes, hardliners on both sides hold diametrically opposed beliefs that make the slightest deviation from their doctrines be experienced as double standards, delegitimation and demonization. Since Natan Sharanski mistakenly declared these 3 Ds to be unique features of anti-Israeli anti-Semitism, these communication difficulties have increased even more and are not only suited to destroy the ability of Jews to engage with a peace settlement between Israel and the Palestinians, but in the end also to obstruct the struggle against anti-Semitism.

  20. Critical temperature gradient length signatures in heat wave propagation across internal transport barriers in the Joint European Torus

    International Nuclear Information System (INIS)

    Casati, Alessandro; Mantica, P.; Eester, D. van; Hawkes, N.; De Vries, P.; Imbeaux, F.; Joffrin, E.; Marinoni, A.; Ryter, F.; Salmi, A.; Tala, T.

    2007-01-01

    New results on electron heat wave propagation using ion cyclotron resonance heating power modulation in the Joint European Torus (JET) [P. H. Rebut et al., Nucl. Fusion 25, 1011 (1985)] plasmas characterized by internal transport barriers (ITBs) are presented. The heat wave generated outside the ITB, and traveling across it, always experiences a strong damping in the ITB layer, demonstrating a low level of transport and loss of stiffness. In some cases, however, the heat wave is strongly inflated in the region just outside the ITB, showing features of convective-like behavior. In other cases, a second maximum in the perturbation amplitude is generated close to the ITB foot. Such peculiar types of behavior can be explained on the basis of the existence of a critical temperature gradient length for the onset of turbulent transport. Convective-like features appear close to the threshold (i.e., just outside the ITB foot) when the value of the threshold is sufficiently high, with a good match with the theoretical predictions for the trapped electron mode threshold. The appearance of a second maximum is due to the oscillation of the temperature profile across the threshold in the case of a weak ITB. Simulations with an empirical critical gradient length model and with the theory based GLF23 [R. E. Waltz et al., Phys. Plasmas, 4, 2482 (1997)] model are presented. The difference with respect to previous results of cold pulse propagation across JET ITBs is also discussed

  1. A microcomputer-based model for identifying urban and suburban roadways with critical large truck accident rates

    International Nuclear Information System (INIS)

    Brogan, J.D.; Cashwell, J.W.

    1992-01-01

    This paper presents an overview of techniques for merging highway accident record and roadway inventory files and employing the combined data set to identify spots or sections on highway facilities in urban and suburban areas with unusually high large truck accident rates. A statistical technique, the rate/quality control method, is used to calculate a critical rate for each location of interest. This critical rate may then be compared to the location's actual accident rate to identify locations for further study. Model enhancements and modifications are described to enable the technique to be employed in the evaluation of routing alternatives for the transport of radioactive material

  2. What’s My Lane? Identifying the State Government Role in Critical Infrastructure Protection

    Science.gov (United States)

    2012-03-01

    Marsh Commission. The GMU research program was developed with Congressional funding, the results of which have produced numerous research papers ...acknowledging that not all attacks or accidents can be prevented, turn to criticality as a crutch —pouring more and more resources into all

  3. 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

  4. Identifying the most critical project complexity factors using Delphi method: the Iranian construction industry

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Mozaffari

    2012-09-01

    Full Text Available Complexity is one of the most important issues influencing success of any construction project and there are literally different studies devoted to detect important factors increasing complexity of projects. During the past few years, there have been growing interests in developing mass construction projects in Iran. The proposed study of this paper uses Delphi technique to find out about important factors as barriers of construction projects in Iran. The results show that among 47 project complexity factors, 19 factors are more important than others are. The study groups different factors into seven categories including environmental, organizational, objectives, tasks, stakeholders, technological, information systems and determines the relative importance of each. In each group, many other sub group activities are determined and they are carefully investigated. The study provides some detailed suggestions on each category to reduce the complexity of construction project.

  5. 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

  6. 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.

  7. Identifying groups of critical edges in a realistic electrical network by multi-objective genetic algorithms

    International Nuclear Information System (INIS)

    Zio, E.; Golea, L.R.; Rocco S, C.M.

    2012-01-01

    In this paper, an analysis of the vulnerability of the Italian high-voltage (380 kV) electrical transmission network (HVIET) is carried out for the identification of the groups of links (or edges, or arcs) most critical considering the network structure and flow. Betweenness centrality and network connection efficiency variations are considered as measures of the importance of the network links. The search of the most critical ones is carried out within a multi-objective optimization problem aimed at the maximization of the importance of the groups and minimization of their dimension. The problem is solved using a genetic algorithm. The analysis is based only on information on the topology of the network and leads to the identification of the most important single component, couples of components, triplets and so forth. The comparison of the results obtained with those reported by previous analyses indicates that the proposed approach provides useful complementary information.

  8. Survey to identify depth of penetration of critical incident reporting systems in Austrian healthcare facilities.

    Science.gov (United States)

    Sendlhofer, Gerald; Eder, Harald; Leitgeb, Karina; Gorges, Roland; Jakse, Heidelinde; Raiger, Marianne; Türk, Silvia; Petschnig, Walter; Pregartner, Gudrun; Kamolz, Lars-Peter; Brunner, Gernot

    2018-01-01

    Incident reporting systems or so-called critical incident reporting systems (CIRS) were first recommended for use in health care more than 15 years ago. The uses of these CIRS are highly variable among countries, ranging from being used to report critical incidents, falls, or sentinel events resulting in death. In Austria, CIRS have only been introduced to the health care sector relatively recently. The goal of this work, therefore, was to determine whether and specifically how CIRS are used in Austria. A working group from the Austrian Society for Quality and Safety in Healthcare (ASQS) developed a survey on the topic of CIRS to collect information on penetration of CIRS in general and on how CIRS reports are used to increase patient safety. Three hundred seventy-one health care professionals from 274 health care facilities were contacted via e-mail. Seventy-eight respondents (21.0%) completed the online survey, thereof 66 from hospitals and 12 from other facilities (outpatient clinics, nursing homes). In all, 64.1% of the respondents indicated that CIRS were used in the entire health care facility; 20.6% had not yet introduced CIRS and 15.4% used CIRS only in particular areas. Most often, critical incidents without any harm to patients were reported (76.9%); however, some health care facilities also use their CIRS to report patient falls (16.7%), needle stick injuries (17.9%), technical problems (51.3%), or critical incidents involving health care professionals. CIRS are not yet extensively or homogeneously used in Austria. Inconsistencies exist with respect to which events are reported as well as how they are followed up and reported to health care professionals. Further recommendations for general use are needed to support the dissemination in Austrian health care environments.

  9. 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.

  10. Identifying Hot Spots of Critical Forage Supply in Dryland Nomadic Pastoralist Areas: A Case Study for the Afar Region, Ethiopia

    NARCIS (Netherlands)

    Sonneveld, B.G.J.S.; Keyzer, M.A.; van Wesenbeeck, C.F.A.; Georgis, Kidane; Beyene, Fekadu; Urbano, Ferdinando; Meroni, Michele; Leo, Olivier; Yimer, Merkebu; Abdullatif, Mohammed

    2017-01-01

    This study develops a methodology to identify hot spots of critical forage supply in nomadic pastoralist areas, using the Afar Region, Ethiopia, as a special case. It addresses two main problems. First, it makes a spatially explicit assessment of fodder supply and demand extracted from a data poor

  11. 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.

  12. The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study.

    Science.gov (United States)

    Atashi, Vajihe; Yousefi, Hojatollah; Mahjobipoor, Hosein; Yazdannik, Ahmadreza

    2018-03-01

    The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. Qualitative descriptive design was used. In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention. © 2017 John Wiley & Sons Ltd.

  13. Identifying the Critical Factors Affecting Safety Program Performance for Construction Projects within Pakistan Construction Industry

    Directory of Open Access Journals (Sweden)

    Zubair Ahmed Memon

    2013-04-01

    Full Text Available Many studies have shown that the construction industry one of the most hazardous industries with its high rates of fatalities and injuries and high financial losses incurred through work related accident. To reduce or overcome the safety issues on construction sites, different safety programs are introduced by construction firms. A questionnaire survey study was conducted to highlight the influence of the Construction Safety Factors on safety program implementation. The input from the questionnaire survey was analyzed by using AIM (Average Index Method and rank correlation test was conducted between different groups of respondents to measure the association between different groups of respondent. The finding of this study highlighted that management support is the critical factor for implementing the safety program on projects. From statistical test, it is concluded that all respondent groups were strongly in the favor of management support factor as CSF (Critical Success Factor. The findings of this study were validated on selected case studies. Results of the case studies will help to know the effect of the factors on implementing safety programs during the execution stage.

  14. Identifying Critical Success Factors for TQM and Employee Performance in Malaysian Automotive Industry: A Literature Review

    Science.gov (United States)

    Nadia Dedy, Aimie; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Ariff, Mohd Shoki Md; Chin, Thoo Ai; Zameri Mat Saman, Muhamad

    2016-05-01

    TQM is a management philosophy embracing all activities through which the needs and expectations of the customer and the community and the goals of the companies are satisfied in the most efficient and cost effective way by maximizing the potential of all workers in a continuing drive for total quality improvement. TQM is very important to the company especially in automotive industry in order for them to survive in the competitive global market. The main objective of this study is to review a relationship between TQM and employee performance. Authors review updated literature on TQM study with two main targets: (a) evolution of TQM considering as a set of practice, (b) and its impacts to employee performance. Therefore, two research questions are proposed in order to review TQM constructs and employee performance measure: (a) Is the set of critical success factors associated with TQM valid as a whole? (b) What is the critical success factors should be considered to measure employee performance in automotive industry?

  15. 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

  16. Perinatal bisphenol A exposure and adult glucose homeostasis: identifying critical windows of exposure.

    Directory of Open Access Journals (Sweden)

    Jingli Liu

    Full Text Available Bisphenol A (BPA is a widespread endocrine-disrupting chemical used as the building block for polycarbonate plastics. Epidemiological evidence has correlated BPA exposure with higher risk of heart disease and type 2 diabetes. However, it remains unknown whether there are critical windows of susceptibility to BPA exposure on the development of dysglycemia. This study was an attempt to investigate the critical windows and the long-term consequences of perinatal exposure to BPA on glucose homeostasis. Pregnant mice were given either vehicle or BPA (100 µg/kg/day at different time of perinatal stage: 1 on days 1-6 of pregnancy (P1-P6, preimplantation exposure; 2 from day 6 of pregnancy until postnatal day (PND 0 (P6-PND0, fetal exposure; 3 from lactation until weaning (PND0-PND21, neonatal exposure; and 4 from day 6 of gestation until weaning (P6-PND21, fetal and neonatal exposure. At 3, 6 and 8 months of age, offspring in each group were challenged with glucose and insulin tolerance tests. Then islet morphometry and β-cell function were measured. The glucose homeostasis was impaired in P6-PND0 mice from 3 to 6 months of age, and this continued to 8 months in males, but not females. While in PND0-PND21 and P6-PND21 BPA-treated groups, only the 3-month-old male offspring developed glucose intolerance. Moreover, at the age of 3 months, perinatal exposure to BPA resulted in the increase of β-cell mass mainly due to the coordinate changes in cell replication, neogenesis, and apoptosis. The alterations of insulin secretion and insulin sensitivity, rather than β-cell mass, were consistent with the development of glucose intolerance. Our findings suggest that BPA may contribute to metabolic disorders relevant to glucose homeostasis and the effects of BPA were dose, sex, and time-dependent. Fetal development stage may be the critical window of susceptibility to BPA exposure.

  17. An empirical study on identifying critical success factors on chaos management

    Directory of Open Access Journals (Sweden)

    Naser Azad

    2012-08-01

    Full Text Available Chaos management is one of the most necessary efforts on managing business units. Many organizations fail to cope with undesirable circumstances, which may happen without any prior notice and as a result, they may face with significant financial losses. In this paper, we present an empirical study to determine critical success factors, which could help handle any possible chaos in organizations. The proposed study of this paper is implemented for a set of travel agencies located in Tehran, Iran. Chronbach alpha is calculated as 0.821, which is well above the minimum desirable level. In addition, we have also performed factor analysis, which yields a KMO value of 0.576 with the level of significance of 0.000. The results indicate that there are six important factors including effective management strategy, internal environmental factors, creative and innovative attitudes, external environmental factors and top level management thoughts.

  18. Identifying Critical Elements of Treatment: Examining the Use of Turn Taking in Autism Intervention

    Science.gov (United States)

    Reith, Sarah R.; Stahmer, Aubyn C.; Suhrheinrich, Jessica; Schreibman, Laura; Kennedy, Joanna; Ross, Benjamin

    2014-01-01

    Evidence-based treatments for autism spectrum disorders (ASD) are comprised of components that identify therapist behavior necessary to implement the treatment with integrity. Some components are shared across approaches from diverse theoretical backgrounds. One component included in several interventions that has not been researched in isolation…

  19. Blood Brain Barrier and Neuroinflammation Are Critical Targets of IGF-1-Mediated Neuroprotection in Stroke for Middle-Aged Female Rats

    Science.gov (United States)

    Bake, Shameena; Selvamani, Amutha; Cherry, Jessica; Sohrabji, Farida

    2014-01-01

    Ischemia-induced cerebral infarction is more severe in older animals as compared to younger animals, and is associated with reduced availability of insulin-like growth factor (IGF)-1. This study determined the effect of post-stroke IGF-1 treatment, and used microRNA profiling to identify mechanisms underlying IGF-1’s neuroprotective actions. Post-stroke ICV administration of IGF-1 to middle-aged female rats reduced infarct volume by 39% when measured 24h later. MicroRNA analyses of ischemic tissue collected at the early post-stroke phase (4h) indicated that 8 out of 168 disease-related miRNA were significantly downregulated by IGF-1. KEGG pathway analysis implicated these miRNA in PI3K-Akt signaling, cell adhesion/ECM receptor pathways and T-and B-cell signaling. Specific components of these pathways were subsequently analyzed in vehicle and IGF-1 treated middle-aged females. Phospho-Akt was reduced by ischemia at 4h, but elevated by IGF-1 treatment at 24h. IGF-1 induced Akt activation was preceded by a reduction of blood brain barrier permeability at 4h post-stroke and global suppression of cytokines including IL-6, IL-10 and TNF-α. A subset of these cytokines including IL-6 was also suppressed by IGF-1 at 24h post-stroke. These data are the first to show that the temporal and mechanistic components of post-stroke IGF-1 treatment in older animals, and that cellular components of the blood brain barrier may serve as critical targets of IGF-1 in the aging brain. PMID:24618563

  20. Identifying the critical physical demanding tasks of paramedic work: Towards the development of a physical employment standard.

    Science.gov (United States)

    Fischer, Steven L; Sinden, Kathryn E; MacPhee, Renee S

    2017-11-01

    Public safety related occupations including police, fire and military commonly apply physical employment standard (PES) to facilitate job matching, an approach to evaluate if candidates demonstrate acceptable physical capabilities as required to perform the job safely and effectively. In Canada, paramedics remain as one of the few public safety occupations without an evidence-based, validated PES. The purpose of this study was to document and describe the physical demands of paramedic work and to identify the most physically demanding tasks. These outcomes are essential to inform the design and development of an evidence-based PES for the paramedic sector. Physical demands of paramedic work were documented and described using a direct observation-based task analysis technique. Five paramedic's were trained to document the physical demands of their work, then applied their training to observe more than 90 calls over the course of 20 full 12-h work shifts. Physical demands data were then listed in a survey, administered service-wide, where 155 frontline paramedics identified critically demanding tasks and rank-ordered physical demands from not physically demanding to very strongly demanding. Critically important and physically demanding tasks were identified such as: transferring a patient; loading or unloading a stretcher in to or out of the ambulance; performing CPR; and, raising and lowering a stretcher. It is important that a paramedic-based PES evaluate a candidate's physical capabilities to perform the critical and physically demanding tasks identified in this study. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. A cross-study gene set enrichment analysis identifies critical pathways in endometriosis

    Directory of Open Access Journals (Sweden)

    Bai Chunyan

    2009-09-01

    Full Text Available Abstract Background Endometriosis is an enigmatic disease. Gene expression profiling of endometriosis has been used in several studies, but few studies went further to classify subtypes of endometriosis based on expression patterns and to identify possible pathways involved in endometriosis. Some of the observed pathways are more inconsistent between the studies, and these candidate pathways presumably only represent a fraction of the pathways involved in endometriosis. Methods We applied a standardised microarray preprocessing and gene set enrichment analysis to six independent studies, and demonstrated increased concordance between these gene datasets. Results We find 16 up-regulated and 19 down-regulated pathways common in ovarian endometriosis data sets, 22 up-regulated and one down-regulated pathway common in peritoneal endometriosis data sets. Among them, 12 up-regulated and 1 down-regulated were found consistent between ovarian and peritoneal endometriosis. The main canonical pathways identified are related to immunological and inflammatory disease. Early secretory phase has the most over-represented pathways in the three uterine cycle phases. There are no overlapping significant pathways between the dataset from human endometrial endothelial cells and the datasets from ovarian endometriosis which used whole tissues. Conclusion The study of complex diseases through pathway analysis is able to highlight genes weakly connected to the phenotype which may be difficult to detect by using classical univariate statistics. By standardised microarray preprocessing and GSEA, we have increased the concordance in identifying many biological mechanisms involved in endometriosis. The identified gene pathways will shed light on the understanding of endometriosis and promote the development of novel therapies.

  2. Identifying housing that poisons: a critical step in eliminating childhood lead poisoning.

    Science.gov (United States)

    Reyes, Nimia L; Wong, Lee-Yang; MacRoy, Patrick M; Curtis, Gerald; Meyer, Pamela A; Evens, Anne; Brown, Mary Jean

    2006-01-01

    The purpose of our study was to develop a method to identify and prioritize "high-risk" buildings in Chicago that could be targeted for childhood lead poisoning prevention activities. We defined "high-risk" buildings as those where multiple children younger than 6 years with elevated blood lead levels (BLLs) had lived and where lead hazards were previously identified on environmental inspection. By linking 1997-2003 Chicago elevated blood lead surveillance, environmental inspection, and building footprint data, we found that 49,362 children younger than 6 years with elevated BLLs lived at 30,742 buildings. Of those, 67 were "high-risk" buildings and these were associated with 994 children with elevated BLLs. On average, 15 children with elevated BLLs had lived in each building (range: 10-53, median: 13). Almost two thirds (n = 43) of the high-risk buildings had two or more referrals for inspection to the same apartment or housing unit; of those, 40 percent (n = 17) failed to maintain lead-safe status after compliance. Linking blood lead surveillance, environmental inspection, and building footprint databases allowed us to identify individual high-risk buildings. This approach prioritizes lead hazard control efforts and may help health, housing, and environmental agencies in targeting limited resources to increase lead-safe housing for children.

  3. 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...

  4. 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…

  5. 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…

  6. 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.

  7. Identifying the critical factors of green supply chain management: Environmental benefits in Pakistan.

    Science.gov (United States)

    Mumtaz, Ubaidullah; Ali, Yousaf; Petrillo, Antonella; De Felice, Fabio

    2018-05-30

    Pakistan is a developing country characterized by a growing industrialization, which is the major cause of environmental pollution in the country. To control the significant increase in pollution a green incentive has started, aiming to moderate the adverse effects of environmental pollution. Thus, Green Supply Chain Management (GSCM) plays an important role in influencing the total environment impact of any organizations. This study considers ten Pakistani industries that have implemented GSCM practices. The Decision-Making Trial and Evaluation Laboratory technique (DEMATEL) is used to find influential factors in selecting GSCM criteria. The results show that organizational involvement is the most important dimension useful to implement GSCM practices. In addition, commitment from senior managers, ISO 14000 certification of suppliers and recycle of waste heat are considered significant factors. The paper also signifies the casual relationship among the dimensions and the factors in the form of diagraphs. The main management implication of the paper is to help decision makers to focus on the critical dimensions/factors in order to implement the GSCM practices more effectively in Pakistan. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. 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

  9. 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.

  10. 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.

  11. Identifying the poor for premium exemption: a critical step towards universal health coverage in Sub-Saharan Africa.

    Science.gov (United States)

    Umeh, Chukwuemeka A

    2017-01-01

    Premium exemption for the poor is a critical step towards achieving universal health coverage in sub-Saharan Africa due to the large proportion of the population living in extreme poverty who cannot pay premium. However, identifying the poor for premium exemption has been a big challenge for SSA countries. This paper is a succinct review of four methods available for identifying the poor, outlining the ideal conditions under which each of the methods should be used and the drawbacks associated with using each of the methods.

  12. Identifying Critical Factors Influencing the Rents of Public Rental Housing Delivery by PPPs: The Case of Nanjing

    Directory of Open Access Journals (Sweden)

    Jingfeng Yuan

    2017-02-01

    Full Text Available The occupancy rate of Public Rental Housing (PRH in China is relatively low due to the unreasonable rents. At the same time, the development of PRH using Public Private Partnerships (PPPs increases the complexity of the rents. Therefore, the critical factors influencing the rents of PRH delivery by PPPs should be identified. Based on the comprehensive literature, this article identified a conceptual model for the factors influencing the rents of PRH delivery by PPPs in China, composed of 14 factors grouped in three factor packages, and discussed the relationships among three factor packages. A survey based on Nanjing was conducted to assess the relative significance of 14 factors. According to the results, six critical factors were identified: construction costs, household income, floor area and structure, transportation, market rents in the same district and public facilities. In addition, the proposed conceptual model had a good fit. The results also supported two hypothetical relationships among three factor packages: (1 the increase of the affordability of the target tenants had a positive effect on the increase of profits of private sectors; and (2 the increase of the affordability of the target tenants had a positive effect on the increase of level of the characteristics of PRH units. For future research, six critical factors and the relationships among three factor packages can be used to determine the reasonable rents for PRH delivery by PPPs in China.

  13. Critical research needs for identifying future changes in Gulf coral reef ecosystems

    Science.gov (United States)

    Feary, David A.; Burt, John A.; Bauman, Andrew G.; Al Hazeem, Shaker; Abdel-Moati, Mohamed A.; Al-Khalifa, Khalifa A.; Anderson, Donald M.; Amos, Carl; Baker, Andrew; Bartholomew, Aaron; Bento, Rita; Cavalcante, Geórgenes H.; Chen, Chaolun Allen; Coles, Steve L.; Dab, Koosha; Fowler, Ashley M.; George, David; Grandcourt, Edwin; Hill, Ross; John, David M.; Jones, David A.; Keshavmurthy, Shashank; Mahmoud, Huda; Moradi Och Tapeh, Mahdi; Mostafavi, Pargol Ghavam; Naser, Humood; Pichon, Michel; Purkis, Sam; Riegl, Bernhard; Samimi-Namin, Kaveh; Sheppard, Charles; Vajed Samiei, Jahangir; Voolstra, Christian R.; Wiedenmann, Joerg

    2014-01-01

    Expert opinion was assessed to identify current knowledge gaps in determining future changes in Arabian/ Persian Gulf (thereafter ‘Gulf’) coral reefs. Thirty-one participants submitted 71 research questions that were peer-assessed in terms of scientific importance (i.e., filled a knowledge gap and was a research priority) and efficiency in resource use (i.e., was highly feasible and ecologically broad). Ten research questions, in six major research areas, were highly important for both understanding Gulf coral reef ecosystems and also an efficient use of limited research resources. These questions mirrored global evaluations of the importance of understanding and evaluating biodiversity, determining the potential impacts of climate change, the role of anthropogenic impacts in structuring coral reef communities, and economically evaluating coral reef communities. These questions provide guidance for future research on coral reef ecosystems within the Gulf, and enhance the potential for assessment and management of future changes in this globally significant region. PMID:23643407

  14. Critical research needs for identifying future changes in Gulf coral reef ecosystems

    KAUST Repository

    Feary, David A.

    2013-07-01

    Expert opinion was assessed to identify current knowledge gaps in determining future changes in Arabian/Persian Gulf (thereafter \\'Gulf\\') coral reefs. Thirty-one participants submitted 71 research questions that were peer-assessed in terms of scientific importance (i.e., filled a knowledge gap and was a research priority) and efficiency in resource use (i.e., was highly feasible and ecologically broad). Ten research questions, in six major research areas, were highly important for both understanding Gulf coral reef ecosystems and also an efficient use of limited research resources. These questions mirrored global evaluations of the importance of understanding and evaluating biodiversity, determining the potential impacts of climate change, the role of anthropogenic impacts in structuring coral reef communities, and economically evaluating coral reef communities. These questions provide guidance for future research on coral reef ecosystems within the Gulf, and enhance the potential for assessment and management of future changes in this globally significant region. © 2013 Elsevier Ltd.

  15. Critical research needs for identifying future changes in Gulf coral reef ecosystems

    KAUST Repository

    Feary, David A.; Burt, John A.; Bauman, Andrew G.; Al Hazeem, Shaker; Abdel-Moati, Mohamed A R; Al-Khalifa, Khalifa A.; Anderson, Donald M.; Amos, Carl L.; Baker, Andrew C.; Bartholomew, Aaron; Bento, Rita; Cavalcante, Geó rgenes H.; Chen, Chaolun Allen; Coles, Steve L.; Dab, Koosha; Fowler, Ashley M.; George, David Glen; Grandcourt, Edwin Mark; Hill, Ross; John, David Michael; Jones, David Alan; Keshavmurthy, Shashank; Mahmoud, Huda M A; Moradi Och Tapeh, Mahdi; Mostafavi, Pargol Ghavam; Naser, Humood A.; Pichon, Michel; Purkis, Sam J.; Riegl, Bernhard M.; Samimi-Namin, Kaveh; Sheppard, Charles R C; Vajed Samiei, Jahangir; Voolstra, Christian R.; Wiedenmann, Jö rg

    2013-01-01

    Expert opinion was assessed to identify current knowledge gaps in determining future changes in Arabian/Persian Gulf (thereafter 'Gulf') coral reefs. Thirty-one participants submitted 71 research questions that were peer-assessed in terms of scientific importance (i.e., filled a knowledge gap and was a research priority) and efficiency in resource use (i.e., was highly feasible and ecologically broad). Ten research questions, in six major research areas, were highly important for both understanding Gulf coral reef ecosystems and also an efficient use of limited research resources. These questions mirrored global evaluations of the importance of understanding and evaluating biodiversity, determining the potential impacts of climate change, the role of anthropogenic impacts in structuring coral reef communities, and economically evaluating coral reef communities. These questions provide guidance for future research on coral reef ecosystems within the Gulf, and enhance the potential for assessment and management of future changes in this globally significant region. © 2013 Elsevier Ltd.

  16. Identifying critical constraints for the maximum loadability of electric power systems - analysis via interior point method

    Energy Technology Data Exchange (ETDEWEB)

    Barboza, Luciano Vitoria [Sul-riograndense Federal Institute for Education, Science and Technology (IFSul), Pelotas, RS (Brazil)], E-mail: luciano@pelotas.ifsul.edu.br

    2009-07-01

    This paper presents an overview about the maximum load ability problem and aims to study the main factors that limit this load ability. Specifically this study focuses its attention on determining which electric system buses influence directly on the power demand supply. The proposed approach uses the conventional maximum load ability method modelled by an optimization problem. The solution of this model is performed using the Interior Point methodology. As consequence of this solution method, the Lagrange multipliers are used as parameters that identify the probable 'bottlenecks' in the electric power system. The study also shows the relationship between the Lagrange multipliers and the cost function in the Interior Point optimization interpreted like sensitivity parameters. In order to illustrate the proposed methodology, the approach was applied to an IEEE test system and to assess its performance, a real equivalent electric system from the South- Southeast region of Brazil was simulated. (author)

  17. Identifying the critical financial ratios for stocks evaluation: A fuzzy delphi approach

    Science.gov (United States)

    Mokhtar, Mazura; Shuib, Adibah; Mohamad, Daud

    2014-12-01

    Stocks evaluation has always been an interesting and challenging problem for both researchers and practitioners. Generally, the evaluation can be made based on a set of financial ratios. Nevertheless, there are a variety of financial ratios that can be considered and if all ratios in the set are placed into the evaluation process, data collection would be more difficult and time consuming. Thus, the objective of this paper is to identify the most important financial ratios upon which to focus in order to evaluate the stock's performance. For this purpose, a survey was carried out using an approach which is based on an expert judgement, namely the Fuzzy Delphi Method (FDM). The results of this study indicated that return on equity, return on assets, net profit margin, operating profit margin, earnings per share and debt to equity are the most important ratios.

  18. A molecular systems approach to modelling human skin pigmentation: identifying underlying pathways and critical components.

    Science.gov (United States)

    Raghunath, Arathi; Sambarey, Awanti; Sharma, Neha; Mahadevan, Usha; Chandra, Nagasuma

    2015-04-29

    Ultraviolet radiations (UV) serve as an environmental stress for human skin, and result in melanogenesis, with the pigment melanin having protective effects against UV induced damage. This involves a dynamic and complex regulation of various biological processes that results in the expression of melanin in the outer most layers of the epidermis, where it can exert its protective effect. A comprehensive understanding of the underlying cross talk among different signalling molecules and cell types is only possible through a systems perspective. Increasing incidences of both melanoma and non-melanoma skin cancers necessitate the need to better comprehend UV mediated effects on skin pigmentation at a systems level, so as to ultimately evolve knowledge-based strategies for efficient protection and prevention of skin diseases. A network model for UV-mediated skin pigmentation in the epidermis was constructed and subjected to shortest path analysis. Virtual knock-outs were carried out to identify essential signalling components. We describe a network model for UV-mediated skin pigmentation in the epidermis. The model consists of 265 components (nodes) and 429 directed interactions among them, capturing the manner in which one component influences the other and channels information. Through shortest path analysis, we identify novel signalling pathways relevant to pigmentation. Virtual knock-outs or perturbations of specific nodes in the network have led to the identification of alternate modes of signalling as well as enabled determining essential nodes in the process. The model presented provides a comprehensive picture of UV mediated signalling manifesting in human skin pigmentation. A systems perspective helps provide a holistic purview of interconnections and complexity in the processes leading to pigmentation. The model described here is extensive yet amenable to expansion as new data is gathered. Through this study, we provide a list of important proteins essential

  19. 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...

  20. Capacity, responsibility, and motivation: a critical qualitative evaluation of patient and practitioner views about barriers to self-management in people with multimorbidity.

    Science.gov (United States)

    Coventry, Peter A; Fisher, Louise; Kenning, Cassandra; Bee, Penny; Bower, Peter

    2014-10-31

    Primary care is increasingly focussed on the care of people with two or more long-term conditions (multimorbidity). The UK Department of Health strategy for long term conditions is to use self-management support for the majority of patients but there is evidence of limited engagement among primary care professionals and patients with multimorbidity. Furthermore, multimorbidity is more common in areas of socioeconomic deprivation but deprivation may act as a barrier to patient engagement in self-management practices. Effective self-management is considered critical to meet the needs of people living with long term conditions but achieving this is a significant challenge in patients with multimorbidity. This study aimed to explore patient and practitioner views on factors influencing engagement in self-management in the context of multimorbidity. A qualitative study using individual semi-structured interviews with 20 patients and 20 practitioners drawn from four general practices in Greater Manchester situated in areas of high and low social deprivation. Three main factors were identified as influencing patient engagement in self-management: capacity (access and availability of socio-economic resources and time; knowledge; and emotional and physical energy), responsibility (the degree to which patients and practitioners agreed about the division of labour about chronic disease management, including self-management) and motivation (willingness to take-up types of self-management practices). Socioeconomic deprivation negatively impacted on all three factors. Motivation was especially reduced in the presence of mental and physical multimorbidity. Full engagement in self-management practices in multimorbidity was only present where patients' articulated a sense of capacity, responsibility, and motivation. Patient 'know-how' or interpretive capacity to self-manage multimorbidity is potentially an important precursor to responsibility and motivation, and might be a

  1. Developing a workbook to support the contextualisation of global health systems guidance: a case study identifying steps and critical factors for success in this process at WHO.

    Science.gov (United States)

    Alvarez, Elizabeth; Lavis, John N; Brouwers, Melissa; Schwartz, Lisa

    2018-03-02

    Global guidance can help countries strengthen their health systems to deliver effective interventions to their populations. However, to have an impact, guidance needs to be contextualised or adapted to local settings; this process includes consideration of health system arrangements and political system factors. To date, methods to support contextualisation do not exist. In response, a workbook was designed to provide specific methods and strategies to enable the contextualisation of WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance at the national or subnational level. The objective of this study was to describe the process of developing the workbook and identify key steps of the development process, barriers that arose and facilitators that helped overcome some of these barriers. A qualitative single case study design was carried out. Interviews, documents and a reflexive journal were used. Constant comparison and an edit-style of organisation were used during data analysis to develop concepts, themes, subthemes and relationships among them. Thirteen interviews were conducted and 52 documents were reviewed. Three main steps were identified in the process of developing the workbook for health systems guidance contextualisation, namely (1) determining the need for and gaining approval to develop the workbook, (2) developing the workbook (taking on the task, creating the structure of the workbook, operationalising its components, undergoing approval processes and editing it), and (3) implementing the workbook both at the WHO level and at the national/subnational level. Five barriers and/or facilitators emerged relevant to each step, namely (1) having well-placed and credible champions, (2) creating and capitalising on opportunities, (3) finding the right language to engage various actors and obtain buy-in, (4) obtaining and maintaining meaningful buy-in, and (5) ensuring access to resources. Understanding the key

  2. Investigating the Impact of Maternal Residential Mobility on Identifying Critical Windows of Susceptibility to Ambient Air Pollution During Pregnancy.

    Science.gov (United States)

    Warren, Joshua L; Son, Ji-Young; Pereira, Gavin; Leaderer, Brian P; Bell, Michelle L

    2018-05-01

    Identifying periods of increased vulnerability to air pollution during pregnancy with respect to the development of adverse birth outcomes can improve understanding of possible mechanisms of disease development and provide guidelines for protection of the child. Exposure to air pollution during pregnancy is typically based on the mother's residence at delivery, potentially resulting in exposure misclassification and biasing the estimation of critical windows of pregnancy. In this study, we determined the impact of maternal residential mobility during pregnancy on defining weekly exposure to particulate matter less than or equal to 10 μm in aerodynamic diameter (PM10) and estimating windows of susceptibility to term low birth weight. We utilized data sets from 4 Connecticut birth cohorts (1988-2008) that included information on all residential addresses between conception and delivery for each woman. We designed a simulation study to investigate the impact of increasing levels of mobility on identification of critical windows. Increased PM10 exposure during pregnancy weeks 16-18 was associated with an increased probability of term low birth weight. Ignoring residential mobility when defining weekly exposure had only a minor impact on the identification of critical windows for PM10 and term low birth weight in the data application and simulation study. Identification of critical pregnancy windows was robust to exposure misclassification caused by ignoring residential mobility in these Connecticut birth cohorts.

  3. Analyzing the topological, electrical and reliability characteristics of a power transmission system for identifying its critical elements

    International Nuclear Information System (INIS)

    Zio, E.; Golea, L.R.

    2012-01-01

    The subject of this paper is the analysis of an electrical transmission system with the objective of identifying its most critical elements with respect to failures and attacks. The methodological approach undertaken is based on graph-theoretical (topological) network analysis. Four different perspectives of analysis are considered within the formalism of weighed networks, adding to the purely topological analysis of the system, the reliability and electrical characteristics of its components. In each phase of the analysis: i) a graph-theoretical representation is offered to highlight the structure of the most important system connections according to the particular characteristics examined (topological, reliability, electrical or electrical-reliability), ii) the classical degree index of a network node is extended to account for the different characteristics considered. The application of these concepts of analysis to an electrical transmission system of literature confirms the importance of different perspectives of analysis on such a critical infrastructure. - Highlights: ► We analyze a power system from topological, reliability and electrical perspectives. ► We rank critical components within a vulnerability assessment framework. ► We compute an extended degree to rank critical energy paths. ► We compare several analytical approaches and provide a table for choosing among them. ► We suggest network changes to increase the reliability of highly loaded energy paths.

  4. 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.

  5. 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.

  6. 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...

  7. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

    Science.gov (United States)

    Hou, Wen-Hsuan; Kang, Chun-Mei; Ho, Mu-Hsing; Kuo, Jessie Ming-Chuan; Chen, Hsiao-Lien; Chang, Wen-Yin

    2017-03-01

    To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Secondary data analysis. A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely

  8. PDB2Graph: A toolbox for identifying critical amino acids map in proteins based on graph theory.

    Science.gov (United States)

    Niknam, Niloofar; Khakzad, Hamed; Arab, Seyed Shahriar; Naderi-Manesh, Hossein

    2016-05-01

    The integrative and cooperative nature of protein structure involves the assessment of topological and global features of constituent parts. Network concept takes complete advantage of both of these properties in the analysis concomitantly. High compatibility to structural concepts or physicochemical properties in addition to exploiting a remarkable simplification in the system has made network an ideal tool to explore biological systems. There are numerous examples in which different protein structural and functional characteristics have been clarified by the network approach. Here, we present an interactive and user-friendly Matlab-based toolbox, PDB2Graph, devoted to protein structure network construction, visualization, and analysis. Moreover, PDB2Graph is an appropriate tool for identifying critical nodes involved in protein structural robustness and function based on centrality indices. It maps critical amino acids in protein networks and can greatly aid structural biologists in selecting proper amino acid candidates for manipulating protein structures in a more reasonable and rational manner. To introduce the capability and efficiency of PDB2Graph in detail, the structural modification of Calmodulin through allosteric binding of Ca(2+) is considered. In addition, a mutational analysis for three well-identified model proteins including Phage T4 lysozyme, Barnase and Ribonuclease HI, was performed to inspect the influence of mutating important central residues on protein activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. 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.

  10. 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.

  11. Market barriers to energy efficiency: A critical reappraisal of the rationale for public policies to promote energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Golove, W.H.; Eto, J.H. [Lawrence Berkeley National Lab., CA (United States). Energy and Environment Div.

    1996-03-01

    This report reviews current perspectives on market barriers to energy efficiency. Ratepayer-funded utility energy-efficiency programs are likely to change in scope, size, and nature as the deregulation process proceeds; the authors research focuses on understanding to what extent some form of future intervention may be warranted and how they might judge the success of particular interventions, especially those funded by ratepayers. They find that challenges to the existence of market barriers have, for the most part, failed to provide a testable alternative explanation for evidence suggesting that there is a substantial ``efficiency gap`` between a consumer`s actual investments in energy efficiency and those that appear to be in the consumer`s own interest. They then suggest that differences of opinion about the appropriateness of public policies stem not from disputes about whether market barriers exist, but from different perceptions of the magnitude of the barriers, and the efficacy and (possibly unintended) consequences of policies designed to overcome them. They conclude that there are compelling justifications for future energy-efficiency policies. Nevertheless, in order to succeed, they must be based on a sound understanding of the market problems they seek to correct and a realistic assessment of their likely efficacy. This understanding can only emerge from detailed investigations of the current operation of individual markets.

  12. Spatial-temporal modeling of the association between air pollution exposure and preterm birth: identifying critical windows of exposure.

    Science.gov (United States)

    Warren, Joshua; Fuentes, Montserrat; Herring, Amy; Langlois, Peter

    2012-12-01

    Exposure to high levels of air pollution during the pregnancy is associated with increased probability of preterm birth (PTB), a major cause of infant morbidity and mortality. New statistical methodology is required to specifically determine when a particular pollutant impacts the PTB outcome, to determine the role of different pollutants, and to characterize the spatial variability in these results. We develop a new Bayesian spatial model for PTB which identifies susceptible windows throughout the pregnancy jointly for multiple pollutants (PM(2.5) , ozone) while allowing these windows to vary continuously across space and time. We geo-code vital record birth data from Texas (2002-2004) and link them with standard pollution monitoring data and a newly introduced EPA product of calibrated air pollution model output. We apply the fully spatial model to a region of 13 counties in eastern Texas consisting of highly urban as well as rural areas. Our results indicate significant signal in the first two trimesters of pregnancy with different pollutants leading to different critical windows. Introducing the spatial aspect uncovers critical windows previously unidentified when space is ignored. A proper inference procedure is introduced to correctly analyze these windows. © 2012, The International Biometric Society.

  13. Identifying critical success factors (CSFs) of Facilities Management (FM) in non-low cost high-rise residential buildings

    Science.gov (United States)

    Dahlan, F. M.; Zainuddin, A.

    2018-02-01

    Critical success factors (CSFs) are important key areas of activity that must be performed well in any Facilities Management (FM) organisation to achieve its missions, objectives or goals. Before implementing CSFs, an FM organisation must identify the key areas where things must be done properly to enable the business to flourish. Although many performance measurements in FM organisation have been discussed in previous research, not much research has been done on CSFs from the perspective of FM business in non-low cost high-rise residential buildings. The purpose of this study is to develop a methodology in developing the CSFs group and CSFs for FM organisation in non-low cost residential buildings. This research will involve three (3) phases of research strategy to achieve the objective of this research.

  14. 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

  15. 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

  16. Antimicrobial peptides in the female reproductive tract: a critical component of the mucosal immune barrier with physiological and clinical implications.

    Science.gov (United States)

    Yarbrough, Victoria L; Winkle, Sean; Herbst-Kralovetz, Melissa M

    2015-01-01

    At the interface of the external environment and the mucosal surface of the female reproductive tract (FRT) lies a first-line defense against pathogen invasion that includes antimicrobial peptides (AMP). Comprised of a unique class of multifunctional, amphipathic molecules, AMP employ a wide range of functions to limit microbial invasion and replication within host cells as well as independently modulate the immune system, dampen inflammation and maintain tissue homeostasis. The role of AMP in barrier defense at the level of the skin and gut has received much attention as of late. Given the far reaching implications for women's health, maternal and fetal morbidity and mortality, and sexually transmissible and polymicrobial diseases, we herein review the distribution and function of key AMP throughout the female reproductive mucosa and assess their role as an essential immunological barrier to microbial invasion throughout the reproductive cycle of a woman's lifetime. A comprehensive search in PubMed/Medline was conducted related to AMP general structure, function, signaling, expression, distribution and barrier function of AMP in the FRT, hormone regulation of AMP, the microbiome of the FRT, and AMP in relation to implantation, pregnancy, fertility, pelvic inflammatory disease, complications of pregnancy and assisted reproductive technology. AMP are amphipathic peptides that target microbes for destruction and have been conserved throughout all living organisms. In the FRT, several major classes of AMP are expressed constitutively and others are inducible at the mucosal epithelium and by immune cells. AMP expression is also under the influence of sex hormones, varying throughout the menstrual cycle, and dependent on the vaginal microbiome. AMP can prevent infection with sexually transmissible and opportunistic pathogens of the female reproductive tissues, although emerging understanding of vaginal dysbiosis suggests induction of a unique AMP profile with increased

  17. 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

  18. Identifying a breeding habitat of a critically endangered fish, Acheilognathus typus, in a natural river in Japan

    Science.gov (United States)

    Sakata, Masayuki K.; Maki, Nobutaka; Sugiyama, Hideki; Minamoto, Toshifumi

    2017-12-01

    Freshwater biodiversity has been severely threatened in recent years, and to conserve endangered species, their distribution and breeding habitats need to be clarified. However, identifying breeding sites in a large area is generally difficult. Here, by combining the emerging environmental DNA (eDNA) analysis with subsequent traditional collection surveys, we successfully identified a breeding habitat for the critically endangered freshwater fish Acheilognathus typus in the mainstream of Omono River in Akita Prefecture, Japan, which is one of the original habitats of this species. Based on DNA cytochrome B sequences of A. typus and closely related species, we developed species-specific primers and a probe that were used in real-time PCR for detecting A. typus eDNA. After verifying the specificity and applicability of the primers and probe on water samples from known artificial habitats, eDNA analysis was applied to water samples collected at 99 sites along Omono River. Two of the samples were positive for A. typus eDNA, and thus, small fixed nets and bottle traps were set out to capture adult fish and verify egg deposition in bivalves (the preferred breeding substrate for A. typus) in the corresponding regions. Mature female and male individuals and bivalves containing laid eggs were collected at one of the eDNA-positive sites. This was the first record of adult A. typus in Omono River in 11 years. This study highlights the value of eDNA analysis to guide conventional monitoring surveys and shows that combining both methods can provide important information on breeding sites that is essential for species' conservation.

  19. Identifying a breeding habitat of a critically endangered fish, Acheilognathus typus, in a natural river in Japan.

    Science.gov (United States)

    Sakata, Masayuki K; Maki, Nobutaka; Sugiyama, Hideki; Minamoto, Toshifumi

    2017-11-14

    Freshwater biodiversity has been severely threatened in recent years, and to conserve endangered species, their distribution and breeding habitats need to be clarified. However, identifying breeding sites in a large area is generally difficult. Here, by combining the emerging environmental DNA (eDNA) analysis with subsequent traditional collection surveys, we successfully identified a breeding habitat for the critically endangered freshwater fish Acheilognathus typus in the mainstream of Omono River in Akita Prefecture, Japan, which is one of the original habitats of this species. Based on DNA cytochrome B sequences of A. typus and closely related species, we developed species-specific primers and a probe that were used in real-time PCR for detecting A. typus eDNA. After verifying the specificity and applicability of the primers and probe on water samples from known artificial habitats, eDNA analysis was applied to water samples collected at 99 sites along Omono River. Two of the samples were positive for A. typus eDNA, and thus, small fixed nets and bottle traps were set out to capture adult fish and verify egg deposition in bivalves (the preferred breeding substrate for A. typus) in the corresponding regions. Mature female and male individuals and bivalves containing laid eggs were collected at one of the eDNA-positive sites. This was the first record of adult A. typus in Omono River in 11 years. This study highlights the value of eDNA analysis to guide conventional monitoring surveys and shows that combining both methods can provide important information on breeding sites that is essential for species' conservation.

  20. Using multiobjective tradeoff sets and Multivariate Regression Trees to identify critical and robust decisions for long term water utility planning

    Science.gov (United States)

    Smith, R.; Kasprzyk, J. R.; Balaji, R.

    2017-12-01

    In light of deeply uncertain factors like future climate change and population shifts, responsible resource management will require new types of information and strategies. For water utilities, this entails potential expansion and efficient management of water supply infrastructure systems for changes in overall supply; changes in frequency and severity of climate extremes such as droughts and floods; and variable demands, all while accounting for conflicting long and short term performance objectives. Multiobjective Evolutionary Algorithms (MOEAs) are emerging decision support tools that have been used by researchers and, more recently, water utilities to efficiently generate and evaluate thousands of planning portfolios. The tradeoffs between conflicting objectives are explored in an automated way to produce (often large) suites of portfolios that strike different balances of performance. Once generated, the sets of optimized portfolios are used to support relatively subjective assertions of priorities and human reasoning, leading to adoption of a plan. These large tradeoff sets contain information about complex relationships between decisions and between groups of decisions and performance that, until now, has not been quantitatively described. We present a novel use of Multivariate Regression Trees (MRTs) to analyze tradeoff sets to reveal these relationships and critical decisions. Additionally, when MRTs are applied to tradeoff sets developed for different realizations of an uncertain future, they can identify decisions that are robust across a wide range of conditions and produce fundamental insights about the system being optimized.

  1. Critical features of acute stress-induced cross-sensitization identified through the hypothalamic-pituitary-adrenal axis output.

    Science.gov (United States)

    Belda, Xavier; Nadal, Roser; Armario, Antonio

    2016-08-11

    Stress-induced sensitization represents a process whereby prior exposure to severe stressors leaves animals or humans in a hyper-responsive state to further stressors. Indeed, this phenomenon is assumed to be the basis of certain stress-associated pathologies, including post-traumatic stress disorder and psychosis. One biological system particularly prone to sensitization is the hypothalamic-pituitary-adrenal (HPA) axis, the prototypic stress system. It is well established that under certain conditions, prior exposure of animals to acute and chronic (triggering) stressors enhances HPA responses to novel (heterotypic) stressors on subsequent days (e.g. raised plasma ACTH and corticosterone levels). However, such changes remain somewhat controversial and thus, the present study aimed to identify the critical characteristics of the triggering and challenging stressors that affect acute stress-induced HPA cross-sensitization in adult rats. We found that HPA cross-sensitization is markedly influenced by the intensity of the triggering stressor, whereas the length of exposure mainly affects its persistence. Importantly, HPA sensitization is more evident with mild than strong challenging stressors, and it may remain unnoticed if exposure to the challenging stressor is prolonged beyond 15 min. We speculate that heterotypic HPA sensitization might have developed to optimize biologically adaptive responses to further brief stressors.

  2. Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective.

    Science.gov (United States)

    Or, Calvin; Dohan, Michael; Tan, Joseph

    2014-09-01

    This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve

  3. 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.

  4. Identifying critical nitrogen application rate for maize yield and nitrate leaching in a Haplic Luvisol soil using the DNDC model.

    Science.gov (United States)

    Zhang, Yitao; Wang, Hongyuan; Liu, Shen; Lei, Qiuliang; Liu, Jian; He, Jianqiang; Zhai, Limei; Ren, Tianzhi; Liu, Hongbin

    2015-05-01

    Identification of critical nitrogen (N) application rate can provide management supports for ensuring grain yield and reducing amount of nitrate leaching to ground water. A five-year (2008-2012) field lysimeter (1 m × 2 m × 1.2 m) experiment with three N treatments (0, 180 and 240 kg Nha(-1)) was conducted to quantify maize yields and amount of nitrate leaching from a Haplic Luvisol soil in the North China Plain. The experimental data were used to calibrate and validate the process-based model of Denitrification-Decomposition (DNDC). After this, the model was used to simulate maize yield production and amount of nitrate leaching under a series of N application rates and to identify critical N application rate based on acceptable yield and amount of nitrate leaching for this cropping system. The results of model calibration and validation indicated that the model could correctly simulate maize yield and amount of nitrate leaching, with satisfactory values of RMSE-observation standard deviation ratio, model efficiency and determination coefficient. The model simulations confirmed the measurements that N application increased maize yield compared with the control, but the high N rate (240 kg Nha(-1)) did not produce more yield than the low one (120 kg Nha(-1)), and that the amount of nitrate leaching increased with increasing N application rate. The simulation results suggested that the optimal N application rate was in a range between 150 and 240 kg ha(-1), which would keep the amount of nitrate leaching below 18.4 kg NO₃(-)-Nha(-1) and meanwhile maintain acceptable maize yield above 9410 kg ha(-1). Furthermore, 180 kg Nha(-1) produced the highest yields (9837 kg ha(-1)) and comparatively lower amount of nitrate leaching (10.0 kg NO₃(-)-Nha(-1)). This study will provide a valuable reference for determining optimal N application rate (or range) in other crop systems and regions in China. Copyright © 2015 Elsevier B.V. All rights reserved.

  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. 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

  8. 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.

  9. Signal one and two blockade are both critical for non-myeloablative murine HSCT across a major histocompatibility complex barrier.

    Directory of Open Access Journals (Sweden)

    Kia J Langford-Smith

    Full Text Available Non-myeloablative allogeneic haematopoietic stem cell transplantation (HSCT is rarely achievable clinically, except where donor cells have selective advantages. Murine non-myeloablative conditioning regimens have limited clinical success, partly through use of clinically unachievable cell doses or strain combinations permitting allograft acceptance using immunosuppression alone. We found that reducing busulfan conditioning in murine syngeneic HSCT, increases bone marrow (BM:blood SDF-1 ratio and total donor cells homing to BM, but reduces the proportion of donor cells engrafting. Despite this, syngeneic engraftment is achievable with non-myeloablative busulfan (25 mg/kg and higher cell doses induce increased chimerism. Therefore we investigated regimens promoting initial donor cell engraftment in the major histocompatibility complex barrier mismatched CBA to C57BL/6 allo-transplant model. This requires full myeloablation and immunosuppression with non-depleting anti-CD4/CD8 blocking antibodies to achieve engraftment of low cell doses, and rejects with reduced intensity conditioning (≤75 mg/kg busulfan. We compared increased antibody treatment, G-CSF, niche disruption and high cell dose, using reduced intensity busulfan and CD4/8 blockade in this model. Most treatments increased initial donor engraftment, but only addition of co-stimulatory blockade permitted long-term engraftment with reduced intensity or non-myeloablative conditioning, suggesting that signal 1 and 2 T-cell blockade is more important than early BM niche engraftment for transplant success.

  10. Signal one and two blockade are both critical for non-myeloablative murine HSCT across a major histocompatibility complex barrier.

    Science.gov (United States)

    Langford-Smith, Kia J; Sandiford, Zara; Langford-Smith, Alex; Wilkinson, Fiona L; Jones, Simon A; Wraith, J Ed; Wynn, Robert F; Bigger, Brian W

    2013-01-01

    Non-myeloablative allogeneic haematopoietic stem cell transplantation (HSCT) is rarely achievable clinically, except where donor cells have selective advantages. Murine non-myeloablative conditioning regimens have limited clinical success, partly through use of clinically unachievable cell doses or strain combinations permitting allograft acceptance using immunosuppression alone. We found that reducing busulfan conditioning in murine syngeneic HSCT, increases bone marrow (BM):blood SDF-1 ratio and total donor cells homing to BM, but reduces the proportion of donor cells engrafting. Despite this, syngeneic engraftment is achievable with non-myeloablative busulfan (25 mg/kg) and higher cell doses induce increased chimerism. Therefore we investigated regimens promoting initial donor cell engraftment in the major histocompatibility complex barrier mismatched CBA to C57BL/6 allo-transplant model. This requires full myeloablation and immunosuppression with non-depleting anti-CD4/CD8 blocking antibodies to achieve engraftment of low cell doses, and rejects with reduced intensity conditioning (≤75 mg/kg busulfan). We compared increased antibody treatment, G-CSF, niche disruption and high cell dose, using reduced intensity busulfan and CD4/8 blockade in this model. Most treatments increased initial donor engraftment, but only addition of co-stimulatory blockade permitted long-term engraftment with reduced intensity or non-myeloablative conditioning, suggesting that signal 1 and 2 T-cell blockade is more important than early BM niche engraftment for transplant success.

  11. WORKSHOP TO IDENTIFY CRITICAL WINDOWS OF EXPOSURE FOR CHILDREN'S HEALTH: REPRODUCTIVE HEALTH IN CHILDREN AND ADOLESCENTS WORK GROUP SUMMARY

    Science.gov (United States)

    This workgroup report addresses the central question: what are the critical windows during development (pre-conception through puberty) when exposure to xenobiotics may have the greatest adverse impact on subsequent reproductive health. The reproductive system develops in stages...

  12. 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

  13. 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

  14. Charting the pipeline: Identifying the critical elements in the development of successful African American scientists, engineers, and mathematicians

    Science.gov (United States)

    Williams, Brian Anthony

    Many educational researchers are concerned with the apparent poor performance of different racial and ethnic groups in the fields of science, engineering, and mathematics in the United States. Despite improvements in the performance of African Americans, Hispanic Americans, and Native Americans in these areas over the past decade, these groups are still less likely to enroll in advanced math and science courses or score at or above the proficient level in mathematics. Furthermore, these groups continue to be underrepresented in the nation's technical and scientific workforce. The purpose of this study was to identify the critical elements related to the success of African Americans in science, engineering, and mathematics. Specifically, this study was designed to answer the following questions as they pertained to African American graduate students: What factors were perceived to have contributed to the students' initial interest in science, engineering, or mathematics? What factors were perceived to have contributed to the students' decisions to continue their studies in their specific areas of interest? What factors, associated with the K--12 schooling experience, were perceived to have contributed to the students' success in science, engineering, or mathematics? The data for the study were acquired from interviews with 32 African American students (16 males and 16 females) who were engaged in graduate work in science, engineering, or mathematics. Four major themes emerged from the analysis of the interview data. The first was that all students were involved in experiences that allowed a significant level of participation in science, engineering, and mathematics. Second, all of the students experienced some form of positive personal intervention by another person. Third, all students possessed perceptions of these fields that involved some sort of positive outcome. Finally, all of the of the students believed they possessed intrinsic qualities that qualified and

  15. 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.

  16. Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review.

    Science.gov (United States)

    Asl, Aminabadi Naser; Shokravi, Marzieh; Jamali, Zahra; Shirazi, Sajjad

    Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry. A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children. 104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia. The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

  17. 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.

  18. National Assessment of College Student Learning: Identifying College Graduates' Essential Skills in Writing, Speech and Listening, and Critical Thinking. Final Project Report.

    Science.gov (United States)

    Jones, Elizabeth A.; And Others

    This study used an iterative Delphi survey process of about 600 faculty, employers, and policymakers to identify writing, speech and listening, and critical thinking skills that college graduates should achieve to become effective employees and citizens (National Education Goal 6). Participants reached a consensus about the importance in critical…

  19. Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV response in sub-Saharan Africa.

    Science.gov (United States)

    Watts, Charlotte; Seeley, Janet

    2014-01-01

    In Africa, women and girls represent 57% of people living with HIV, with gender inequality and violence being an important structural determinant of their vulnerability. This commentary draws out lessons for a more effective combination response to the HIV epidemic from three papers recently published in JIAS. Hatcher and colleagues present qualitative data from women attending ante-natal clinics in Johannesburg, describing how HIV diagnosis during pregnancy and subsequent partner disclosure are common triggers for violence within relationships. The authors describe the challenges women face in adhering to medication or using services. Kyegombe and colleagues present a secondary analysis of a randomized controlled trial in Uganda of SASA! - a community violence prevention programme. Along with promising community impacts on physical partner violence, significantly lower levels of sexual concurrency, condom use and HIV testing were reported by men in intervention communities. Remme and her colleagues present a systematic review of evidence on the costs and cost-effectiveness of gender-responsive HIV interventions. The review identified an ever-growing evidence base, but a paucity of accompanying economic analyses, making it difficult to assess the costs or value for money of gender-focused programmes. There is a need to continue to accumulate evidence on the effectiveness and costs of different approaches to addressing gender inequality and violence as part of a combination HIV response. A clearer HIV-specific and broader synergistic vision of financing and programming needs to be developed, to ensure that the potential synergies between HIV-specific and broader gender-focused development investments can be used to best effect to address vulnerability of women and girls to both violence and HIV.

  20. 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.

  1. How to Identify Negative Attitudes towards Inclusive Education: Critical Discourse Analysis of Russian Transcripts Using Role and Reference Grammar

    Directory of Open Access Journals (Sweden)

    Mariia Rubtcova

    2016-09-01

    Full Text Available This paper presents the Role and Reference Grammar (RRG analysis that aims to reveal possibilities required for carrying out the interdisciplinary research development within Critical Discourse Analysis (CDA. It takes a closer look at conflicts, considering the example of a conflict situation occurred in reaction to the opening of the inclusive academic programme at one of St. Petersburg’s secondary schools. Role and Reference Grammar application demonstrates that the use of different verb types and macroroles has led to the various interpretations. These findings confirm that RRG could influence the increase of objectivity of the transcript analysis in qualitative social research. RRG provides new information which in combination with other methods can help us to understand the positions of participants involved into conflicts

  2. IBS SURVEY 2010: DRIVERS, BARRIERS AND CRITICAL SUCCESS FACTORS IN ADOPTING INDUSTRIALISED BUILDING SYSTEM (IBS CONSTRUCTION BY G7 CONTRACTORS IN MALAYSIA

    Directory of Open Access Journals (Sweden)

    KAMARUL ANUAR MOHAMAD KAMAR

    2014-08-01

    Full Text Available The industrialised building system (IBS survey has become an essential tool for ensuring the IBS Roadmap (2003 to 2010 meets its goals and target. As part of the process review survey, it also records the trend achievement of Malaysia in the usage of IBS in the building construction industry. The first and second IBS surveys were published in 2003 and 2005, respectively. Afterward, the IBS Roadmap’s midterm review was conducted. The third and the most recent IBS surveys were conducted in 2008 and 2010, respectively. This paper aims to highlight a part of the IBS survey report in 2010, which has been conducted to measure the drivers, barriers and the critical success factors of G7 contractors in adopting IBS construction. G7 is a Construction Industry Development Board contractor grade that can apply tender without limit. The importance of this paper is that it guides the policy and implementation strategy of IBS by G7 contractors. The survey shows that the acceptance, adoption, and deployment of IBS in the Malaysian construction industry are still low and do not address the persisting problems, such as productivity, dependency on foreign workers and high level of construction wastage.

  3. Identifying critical success factors for designing selection processes into postgraduate specialty training: the case of UK general practice.

    Science.gov (United States)

    Plint, Simon; Patterson, Fiona

    2010-06-01

    The UK national recruitment process into general practice training has been developed over several years, with incremental introduction of stages which have been piloted and validated. Previously independent processes, which encouraged multiple applications and produced inconsistent outcomes, have been replaced by a robust national process which has high reliability and predictive validity, and is perceived to be fair by candidates and allocates applicants equitably across the country. Best selection practice involves a job analysis which identifies required competencies, then designs reliable assessment methods to measure them, and over the long term ensures that the process has predictive validity against future performance. The general practitioner recruitment process introduced machine markable short listing assessments for the first time in the UK postgraduate recruitment context, and also adopted selection centre workplace simulations. The key success factors have been identified as corporate commitment to the goal of a national process, with gradual convergence maintaining locus of control rather than the imposition of change without perceived legitimate authority.

  4. Cellular adhesome screen identifies critical modulators of focal adhesion dynamics, cellular traction forces and cell migration behaviour

    Science.gov (United States)

    Fokkelman, Michiel; Balcıoğlu, Hayri E.; Klip, Janna E.; Yan, Kuan; Verbeek, Fons J.; Danen, Erik H. J.; van de Water, Bob

    2016-01-01

    Cancer cells migrate from the primary tumour into surrounding tissue in order to form metastasis. Cell migration is a highly complex process, which requires continuous remodelling and re-organization of the cytoskeleton and cell-matrix adhesions. Here, we aimed to identify genes controlling aspects of tumour cell migration, including the dynamic organization of cell-matrix adhesions and cellular traction forces. In a siRNA screen targeting most cell adhesion-related genes we identified 200+ genes that regulate size and/or dynamics of cell-matrix adhesions in MCF7 breast cancer cells. In a subsequent secondary screen, the 64 most effective genes were evaluated for growth factor-induced cell migration and validated by tertiary RNAi pool deconvolution experiments. Four validated hits showed significantly enlarged adhesions accompanied by reduced cell migration upon siRNA-mediated knockdown. Furthermore, loss of PPP1R12B, HIPK3 or RAC2 caused cells to exert higher traction forces, as determined by traction force microscopy with elastomeric micropillar post arrays, and led to considerably reduced force turnover. Altogether, we identified genes that co-regulate cell-matrix adhesion dynamics and traction force turnover, thereby modulating overall motility behaviour. PMID:27531518

  5. Electronic problem lists: a thematic analysis of a systematic literature review to identify aspects critical to success.

    Science.gov (United States)

    Hodge, Chad M; Narus, Scott P

    2018-05-01

    Problem list data is a driving force for many beneficial clinical tools, yet these data remain underutilized. We performed a systematic literature review, pulling insights from previous research, aggregating insights into themes, and distilling themes into actionable advice. We sought to learn what changes we could make to existing applications, to the clinical workflow, and to clinicians' perceptions that would improve problem list utilization and increase the prevalence of problems data in the electronic medical record. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to systematically curate a corpus of pertinent articles. We performed a thematic analysis, looking for interesting excerpts and ideas. By aggregating excerpts from many authors, we gained broader, more inclusive insights into what makes a good problem list and what factors are conducive to its success. Analysis led to a list of 7 benefits of using the problem list, 15 aspects critical to problem list success, and knowledge to help inform policy development, such as consensus on what belongs on the problem list, who should maintain the problem list, and when. A list of suggestions is made on ways in which the problem list can be improved to increase utilization by clinicians. There is also a need for standard measurements of the problem list, so that lists can be measured, compared, and discussed with rigor and a common vocabulary.

  6. A lipid E-MAP identifies Ubx2 as a critical regulator of lipid saturation and lipid bilayer stress

    DEFF Research Database (Denmark)

    Surma, Michal A; Klose, Christian; Peng, Debby

    2013-01-01

    Biological membranes are complex, and the mechanisms underlying their homeostasis are incompletely understood. Here, we present a quantitative genetic interaction map (E-MAP) focused on various aspects of lipid biology, including lipid metabolism, sorting, and trafficking. This E-MAP contains ∼250......,000 negative and positive genetic interaction scores and identifies a molecular crosstalk of protein quality control pathways with lipid bilayer homeostasis. Ubx2p, a component of the endoplasmic-reticulum-associated degradation pathway, surfaces as a key upstream regulator of the essential fatty acid (FA...

  7. Identifying ozone-sensitive communities of (semi-)natural vegetation suitable for mapping exceedance of critical levels

    International Nuclear Information System (INIS)

    Mills, G.; Hayes, F.; Jones, M.L.M.; Cinderby, S.

    2007-01-01

    Using published data on the responses of individual species to ozone, 54 EUNIS (European Nature Information System) level 4 communities with six or more ozone-sensitive species (%OS) and c. 20% or more species tested for ozone sensitivity, were identified as potentially ozone-sensitive. The largest number of these communities (23) was associated with Grasslands, with Heathland, scrub and tundra, and Mires, bogs and fens having the next highest representation at 11 and 8 level 4 communities each respectively. Within the grasslands classification, E4 (Alpine and sub-alpine grasslands), E5 (Woodland fringes and clearings) and E1 (Dry grasslands) were the most sensitive with 68.1, 51.6 and 48.6%OS respectively. It is feasible to map the land-cover for these and other communities at level 2, but it may not be currently possible to map the land-cover for all communities identified to be ozone-sensitive at levels 3 and 4. - Grassland communities such as alpine and sub-alpine grasslands have the highest potential sensitivity ozone, based on the responses of their component species

  8. A critical assessment of the photodegradation of pharmaceuticals in aquatic environments: defining our current understanding and identifying knowledge gaps.

    Science.gov (United States)

    Challis, Jonathan K; Hanson, Mark L; Friesen, Ken J; Wong, Charles S

    2014-04-01

    This work presents a critical assessment of the state and quality of knowledge around the aquatic photochemistry of human- and veterinary-use pharmaceuticals from laboratory experiments and field observations. A standardized scoring rubric was used to assess relevant studies within four categories: experimental design, laboratory-based direct and indirect photolysis, and field/solar photolysis. Specific metrics for each category are defined to evaluate various aspects of experimental design (e.g., higher scores are given for more appropriate characterization of light source wavelength distribution). This weight of evidence-style approach allowed for identification of knowledge strengths and gaps covering three areas: first, the general extent of photochemical data for specific pharmaceuticals and classes; second, the overall quality of existing data (i.e., strong versus weak); and finally, trends in the photochemistry research around these specific compounds, e.g. the observation of specific and consistent oversights in experimental design. In general, those drugs that were most studied also had relatively good quality data. The four pharmaceuticals studied experimentally at least ten times in the literature had average total scores (lab and field combined) of ≥29, considered decent quality; carbamazepine (13 studies; average score of 31), diclofenac (12 studies; average score of 31), sulfamethoxazole (11 studies; average score of 34), and propranolol (11 studies; average score of 29). Major oversights and errors in data reporting and/or experimental design included: lack of measurement and reporting of incident light source intensity, lack of appropriate controls, use of organic co-solvents in irradiation solutions, and failure to consider solution pH. Consequently, a number of these experimental parameters were likely a cause of inconsistent measurements of direct photolysis rate constants and quantum yields, two photochemical properties that were highly

  9. Use of a Web-based Delphi for identifying critical components of a professional science master's program in biotechnology

    Science.gov (United States)

    Kantz, Jeannine Wells

    The primary purpose of this research was to develop a model for a professional science master's program combining biotechnology and business. The objectives were to identify stakeholder preferences for various dimensions of a professional science master's program combining biotechnology and business and to identify differences in priorities between subgroups. A secondary purpose was to examine user preferences between Web-based and traditional methods of conducting a Delphi study and the panelist's impressions of its usefulness for program development. Prior to the first round, demographic data were collected on panelists regarding their gender, age, years experience in their current field, position title and education levels. Round 1 started with eight open-ended questions designed to investigate (a) learning objectives, (b) internships, (c) thesis vs. non-thesis degrees, (d) program focus (e) possible entry level positions, (f) roles for the industry advisory board, (g) recommended hours of hands-on experience and (h) other issues of importance. The final round ended with three questions to assess the panelists' perception of the usefulness of the Delphi for program development in higher education. Twenty-four panelists started Round 1 and participation in subsequent rounds varied from 17 in Round 2 to 11 in Round 4. Education level varied and included all levels of education in science and business. Issues emerged early in the study regarding development of different program tracks and the program goals, which were clarified in subsequent rounds. Significant differences occurred between industry and academic subgroups for two tracks, six skills designated for tracks, method of evaluating the internship, and entry-level positions appropriate for new graduates. When analyzed by level of confidence (high confidence vs. low confidence), significant differences occurred for (a) the number of semesters of hands-on experience students should have upon graduation, (b

  10. 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…

  11. 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

  12. Identifying Critical Habitat for Australian Freshwater Turtles in a Large Regulated Floodplain: Implications for Environmental Water Management

    Science.gov (United States)

    Ocock, J. F.; Bino, G.; Wassens, S.; Spencer, J.; Thomas, R. F.; Kingsford, R. T.

    2018-03-01

    Freshwater turtles face many threats, including habitat loss and river regulation reducing occupancy and contributing to population decline. Limited knowledge of hydrological conditions required to maintain viable turtle populations in large floodplain wetlands hinders effective adaptive management of environmental water in regulated rivers. We surveyed three turtle species over 4 years across the Lower Murrumbidgee River floodplain, a large wetland complex with a long history of water resource development. Using site and floodplain metrics and generalized linear models, within a Bayesian Model Averaging framework, we quantified the main drivers affecting turtle abundance. We also used a hierarchical modeling approach, requiring large sample sizes, quantifying possible environmental effects while accounting for detection probabilities of the eastern long-necked turtle ( Chelodina longicollis). The three species varied in their responses to hydrological conditions and connectivity to the main river channel. Broad-shelled turtles ( Chelodina expansa) and Macquarie River turtles ( Emydura macquarii macquarii) had restricted distributions, centered on frequently inundated wetlands close to the river, whereas the eastern long-necked turtles were more widely distributed, indicating an ability to exploit variable habitats. We conclude that turtle communities would benefit from long-term management strategies that maintain a spatiotemporal mosaic of hydrological conditions. More specifically, we identified characteristics of refuge habitats and stress the importance of maintaining their integrity during dry periods. Neighboring habitats can be targeted during increased water availability years to enhance feeding and dispersal opportunities for freshwater turtles.

  13. 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

  14. Genome-wide association study identifies nox3 as a critical gene for susceptibility to noise-induced hearing loss.

    Directory of Open Access Journals (Sweden)

    Joel Lavinsky

    2015-04-01

    Full Text Available In the United States, roughly 10% of the population is exposed daily to hazardous levels of noise in the workplace. Twin studies estimate heritability for noise-induced hearing loss (NIHL of approximately 36%, and strain specific variation in sensitivity has been demonstrated in mice. Based upon the difficulties inherent to the study of NIHL in humans, we have turned to the study of this complex trait in mice. We exposed 5 week-old mice from the Hybrid Mouse Diversity Panel (HMDP to a 10 kHz octave band noise at 108 dB for 2 hours and assessed the permanent threshold shift 2 weeks post exposure using frequency specific stimuli. These data were then used in a genome-wide association study (GWAS using the Efficient Mixed Model Analysis (EMMA to control for population structure. In this manuscript we describe our GWAS, with an emphasis on a significant peak for susceptibility to NIHL on chromosome 17 within a haplotype block containing NADPH oxidase-3 (Nox3. Our peak was detected after an 8 kHz tone burst stimulus. Nox3 mutants and heterozygotes were then tested to validate our GWAS. The mutants and heterozygotes demonstrated a greater susceptibility to NIHL specifically at 8 kHz both on measures of distortion product otoacoustic emissions (DPOAE and on auditory brainstem response (ABR. We demonstrate that this sensitivity resides within the synaptic ribbons of the cochlea in the mutant animals specifically at 8 kHz. Our work is the first GWAS for NIHL in mice and elucidates the power of our approach to identify tonotopic genetic susceptibility to NIHL.

  15. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper.

    Science.gov (United States)

    Aapro, Matti; Astier, Alain; Audisio, Riccardo; Banks, Ian; Bedossa, Pierre; Brain, Etienne; Cameron, David; Casali, Paolo; Chiti, Arturo; De Mattos-Arruda, Leticia; Kelly, Daniel; Lacombe, Denis; Nilsson, Per J; Piccart, Martine; Poortmans, Philip; Riklund, Katrine; Saeter, Gunnar; Schrappe, Martin; Soffietti, Riccardo; Travado, Luzia; van Poppel, Hein; Wait, Suzanne; Naredi, Peter

    2017-09-01

    In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care. Copyright © 2017. Published by Elsevier Ltd.

  16. A critical evaluation of the use of cluster analysis to identify contaminated sediments in the Ria de Vigo

    Energy Technology Data Exchange (ETDEWEB)

    Rubio, B; Nombela, M. A; Vilas, F [Departamento de Geociencias Marinas y Ordenacion del Territorio, Vigo, Espana (Spain)

    2001-06-01

    The indiscriminate use of cluster analysis to distinguish contaminated and non-contaminated sediments has led us to make a comparative evaluation of different cluster analysis procedures as applied to heavy metal concentrations in subtidal sediments from the Ria de Vigo, NW Spain. The use of different clusters algorithms and other transformations from the same departing set of data lead to the formation of different clusters with a clear inconclusive result about the contamination status of the sediments. The results show that this approach is better suited to identifying groups of samples differing in sedimentological characteristics, such as grain size, rather than in the degree of contamination. Our main aim is to call attention to these aspects in cluster analysis and to suggest that researches should be rigorous with this kind of analysis. Finally, the use of discriminate analysis allows us to find a discriminate function that separates the samples into two clearly differentiated groups, which should not be treated jointly. [Spanish] El uso indiscriminado del analisis cluster para distinguir sedimentos contaminados y no contaminados nos ha llevado a realizar una evaluacion comparativa entre los diferentes procedimientos de estos analisis aplicada a la concentracion de metales pesados en sedimentos submareales de la Ria de Vigo, NW de Espana. La utilizacion de distintos algoritmos de cluster, asi como otras transformaciones de la misma matriz de datos conduce a la formacion de diferentes clusters con un resultado inconcluso sobre el estado de contaminacion de los sedimentos. Los resultados muestran que esta aproximacion se ajusta mejor para identificar grupos de muestras que difieren en caracteristicas sedimentologicas, tal como el tamano de grano, mas que el grado de contaminacion. El principal objetivo es llamar la atencion sobre estos aspectos del analisis cluster y sugerir a los investigadores que sean rigurosos con este tipo de analisis. Finalmente el uso

  17. Global Gene-Expression Analysis to Identify Differentially Expressed Genes Critical for the Heat Stress Response in Brassica rapa.

    Directory of Open Access Journals (Sweden)

    Xiangshu Dong

    Full Text Available Genome-wide dissection of the heat stress response (HSR is necessary to overcome problems in crop production caused by global warming. To identify HSR genes, we profiled gene expression in two Chinese cabbage inbred lines with different thermotolerances, Chiifu and Kenshin. Many genes exhibited >2-fold changes in expression upon exposure to 0.5- 4 h at 45°C (high temperature, HT: 5.2% (2,142 genes in Chiifu and 3.7% (1,535 genes in Kenshin. The most enriched GO (Gene Ontology items included 'response to heat', 'response to reactive oxygen species (ROS', 'response to temperature stimulus', 'response to abiotic stimulus', and 'MAPKKK cascade'. In both lines, the genes most highly induced by HT encoded small heat shock proteins (Hsps and heat shock factor (Hsf-like proteins such as HsfB2A (Bra029292, whereas high-molecular weight Hsps were constitutively expressed. Other upstream HSR components were also up-regulated: ROS-scavenging genes like glutathione peroxidase 2 (BrGPX2, Bra022853, protein kinases, and phosphatases. Among heat stress (HS marker genes in Arabidopsis, only exportin 1A (XPO1A (Bra008580, Bra006382 can be applied to B. rapa for basal thermotolerance (BT and short-term acquired thermotolerance (SAT gene. CYP707A3 (Bra025083, Bra021965, which is involved in the dehydration response in Arabidopsis, was associated with membrane leakage in both lines following HS. Although many transcription factors (TF genes, including DREB2A (Bra005852, were involved in HS tolerance in both lines, Bra024224 (MYB41 and Bra021735 (a bZIP/AIR1 [Anthocyanin-Impaired-Response-1] were specific to Kenshin. Several candidate TFs involved in thermotolerance were confirmed as HSR genes by real-time PCR, and these assignments were further supported by promoter analysis. Although some of our findings are similar to those obtained using other plant species, clear differences in Brassica rapa reveal a distinct HSR in this species. Our data could also provide a

  18. 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

  19. Incorporation of Spatial Interactions in Location Networks to Identify Critical Geo-Referenced Routes for Assessing Disease Control Measures on a Large-Scale Campus

    Directory of Open Access Journals (Sweden)

    Tzai-Hung Wen

    2015-04-01

    Full Text Available Respiratory diseases mainly spread through interpersonal contact. Class suspension is the most direct strategy to prevent the spread of disease through elementary or secondary schools by blocking the contact network. However, as university students usually attend courses in different buildings, the daily contact patterns on a university campus are complicated, and once disease clusters have occurred, suspending classes is far from an efficient strategy to control disease spread. The purpose of this study is to propose a methodological framework for generating campus location networks from a routine administration database, analyzing the community structure of the network, and identifying the critical links and nodes for blocking respiratory disease transmission. The data comes from the student enrollment records of a major comprehensive university in Taiwan. We combined the social network analysis and spatial interaction model to establish a geo-referenced community structure among the classroom buildings. We also identified the critical links among the communities that were acting as contact bridges and explored the changes in the location network after the sequential removal of the high-risk buildings. Instead of conducting a questionnaire survey, the study established a standard procedure for constructing a location network on a large-scale campus from a routine curriculum database. We also present how a location network structure at a campus could function to target the high-risk buildings as the bridges connecting communities for blocking disease transmission.

  20. 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

  1. 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...

  2. Information barriers

    International Nuclear Information System (INIS)

    Fuller, J.L.; Wolford, J.

    2001-01-01

    Full text: An information barrier (IB) consists of procedures and technology that prevent the release of sensitive information during a joint inspection of a sensitive nuclear item, and provides confidence that the measurement system into which it has been integrated functions exactly as designed and constructed. Work in the U.S. on radiation detection system information barriers dates back at least to 1990, even though the terminology is more recent. In January 1999 the Joint DoD-DOE Information Barrier Working Group was formed in the United States to help coordinate technical efforts related to information barrier R and D. This paper presents an overview of the efforts of this group, by its Chairs, as well as recommendations for further information barrier R and D. Progress on the demonstration of monitoring systems containing IBs is also provided. From the U.S. perspective, the basic, top-level functional requirements for the information barrier portion of an integrated radiation signature-information barrier inspection system are twofold: The host must be assured that his classified information is protected from disclosure to the inspecting party; and The inspecting party must be confident that the integrated inspection system measures, processes, and presents the radiation-signature-based measurement conclusion in an accurate and reproducible manner. It is the position of the United States that in the absence of any agreement to share classified nuclear weapons design information in the conduct of an inspection regime, the requirement to protect host country classified warhead design information is paramount and admits no tradeoff versus the confidence provided to the inspecting party in the accuracy and reproducibility of the measurements. The U.S. has reached an internal consensus on several critical design elements that define a general standard for radiation signature information barrier design. These criteria have stood the test of time under intense

  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. Integrative systems analysis of diet-induced obesity identified a critical transition in the transcriptomes of the murine liver and epididymal white adipose tissue.

    Science.gov (United States)

    Kim, J; Kwon, E-Y; Park, S; Kim, J-R; Choi, S-W; Choi, M-S; Kim, S-J

    2016-02-01

    It is well known that high-fat diet (HFD) can cause immune system-related pathological alterations after a significant body weight gain. The mechanisms of the delayed pathological alterations during the development of diet-induced obesity (DIO) are not fully understood. To elucidate the mechanisms underlying DIO development, we analyzed time-course microarray data obtained from a previous study. First, differentially expressed genes (DEGs) were identified at each time point by comparing the hepatic transcriptome of mice fed HFD with that of mice fed normal diet. Next, we clustered the union of DEGs and identified annotations related to each cluster. Finally, we constructed an 'integrated obesity-associated gene regulatory network (GRN) in murine liver'. We analyzed the epididymal white adipose tissue (eWAT) transcriptome usig the same procedure. Based on time-course microarray data, we found that the genes associated with immune responses were upregulated with an oscillating expression pattern between weeks 2 and 8, relatively downregulated between weeks 12 and 16, and eventually upregulated after week 20 in the liver of the mice fed HFD. The genes associated with immune responses were also upregulated at late stage, in the eWAT of the mice fed HFD. These results suggested that a critical transition occurred in the immune system-related transcriptomes of the liver and eWAT around week 16 of the DIO development, and this may be associated with the delayed pathological alterations. The GRN analysis suggested that Maff may be a key transcription factor for the immune system-related critical transition thatoccurred at week 16. We found that transcription factors associated with immune responses were centrally located in the integrated obesity-associated GRN in the liver. In this study, systems analysis identified regulatory network modules underlying the delayed immune system-related pathological changes during the development of DIO and could suggest possible

  6. Structure-function relationship of a plant NCS1 member - Homology modeling and mutagenesis identified residues critical for substrate specificity of PLUTO, a nucleobase transporter from arabidopsis

    KAUST Repository

    Witz, Sandra

    2014-03-12

    Plastidic uracil salvage is essential for plant growth and development. So far, PLUTO, the plastidic nucleobase transporter from Arabidopsis thaliana is the only known uracil importer at the inner plastidic membrane which represents the permeability barrier of this organelle. We present the first homology model of PLUTO, the sole plant NCS1 member from Arabidopsis based on the crystal structure of the benzyl hydantoin transporter MHP1 from Microbacterium liquefaciens and validated by molecular dynamics simulations. Polar side chains of residues Glu-227 and backbones of Val-145, Gly-147 and Thr-425 are proposed to form the binding site for the three PLUTO substrates uracil, adenine and guanine. Mutational analysis and competition studies identified Glu-227 as an important residue for uracil and to a lesser extent for guanine transport. A differential response in substrate transport was apparent with PLUTO double mutants E227Q G147Q and E227Q T425A, both of which most strongly affected adenine transport, and in V145A G147Q, which markedly affected guanine transport. These differences could be explained by docking studies, showing that uracil and guanine exhibit a similar binding mode whereas adenine binds deep into the catalytic pocket of PLUTO. Furthermore, competition studies confirmed these results. The present study defines the molecular determinants for PLUTO substrate binding and demonstrates key differences in structure-function relations between PLUTO and other NCS1 family members. 2014 Witz et al.

  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. 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

  9. 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

  10. 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.

  11. Receptor homodimerization plays a critical role in a novel dominant negative P2RY12 variant identified in a family with severe bleeding.

    Science.gov (United States)

    Mundell, S J; Rabbolini, D; Gabrielli, S; Chen, Q; Aungraheeta, R; Hutchinson, J L; Kilo, T; Mackay, J; Ward, C M; Stevenson, W; Morel-Kopp, M-C

    2018-01-01

    Essentials Three dominant variants for the autosomal recessive bleeding disorder type-8 have been described. To date, there has been no phenotype/genotype correlation explaining their dominant transmission. Proline plays an important role in P2Y12R ligand binding and signaling defects. P2Y12R homodimer formation is critical for the receptor function and signaling. Background Although inherited platelet disorders are still underdiagnosed worldwide, advances in molecular techniques are improving disease diagnosis and patient management. Objective To identify and characterize the mechanism underlying the bleeding phenotype in a Caucasian family with an autosomal dominant P2RY12 variant. Methods Full blood counts, platelet aggregometry, flow cytometry and western blotting were performed before next-generation sequencing (NGS). Detailed molecular analysis of the identified variant of the P2Y12 receptor (P2Y12R) was subsequently performed in mammalian cells overexpressing receptor constructs. Results All three referred individuals had markedly impaired ADP-induced platelet aggregation with primary wave only, despite normal total and surface P2Y12R expression. By NGS, a single P2RY12:c.G794C substitution (p.R265P) was identified in all affected individuals, and this was confirmed by Sanger sequencing. Mammalian cell experiments with the R265P-P2Y12R variant showed normal receptor surface expression versus wild-type (WT) P2Y12R. Agonist-stimulated R265P-P2Y12R function (both signaling and surface receptor loss) was reduced versus WT P2Y12R. Critically, R265P-P2Y12R acted in a dominant negative manner, with agonist-stimulated WT P2Y12R activity being reduced by variant coexpression, suggesting dramatic loss of WT homodimers. Importantly, platelet P2RY12 cDNA cloning and sequencing in two affected individuals also revealed three-fold mutant mRNA overexpression, decreasing even further the likelihood of WT homodimer formation. R265 located within extracellular loop 3 (EL3) is

  12. Opportunities and Barriers for Water Co-Governance—A Critical Analysis of Seven Cases of Diffuse Water Pollution from Agriculture in Europe, Australia and North America

    Directory of Open Access Journals (Sweden)

    Morten Graversgaard

    2018-05-01

    Full Text Available Diffuse Water Pollution from Agriculture (DWPA and its governance has received increased attention as a policy concern across the globe. Mitigation of DWPA is a complex problem that requires a mix of policy instruments and a multi-agency, broad societal response. In this paper, opportunities and barriers for developing co-governance, defined as collaborative societal involvement in the functions of government, and its suitability for mitigation of DWPA are reviewed using seven case studies in Europe (Poland, Denmark, Sweden, The Netherlands and UK, Australia (Murray-Darling Basin and North America (State of Minnesota. An analytical framework for assessing opportunities and barriers of co-governance was developed and applied in this review. Results indicated that five key issues constitute both opportunities and barriers, and include: (i pressure for change; (ii connected governance structures and allocation of resources and funding; (iii leadership and establishment of partnerships through capacity building; (iv use and co-production of knowledge; and (v time commitment to develop water co-governance.

  13. 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

  14. Assessment of genetic diversity in the critically endangered Australian corroboree frogs, Pseudophryne corroboree and Pseudophryne pengilleyi, identifies four evolutionarily significant units for conservation.

    Science.gov (United States)

    Morgan, Matthew J; Hunter, David; Pietsch, Rod; Osborne, William; Keogh, J Scott

    2008-08-01

    The iconic and brightly coloured Australian northern corroboree frog, Pseudophryne pengilleyi, and the southern corroboree frog, Pseudophryne corroboree are critically endangered and may be extinct in the wild within 3 years. We have assembled samples that cover the current range of both species and applied hypervariable microsatellite markers and mitochondrial DNA sequences to assess the levels and patterns of genetic variation. The four loci used in the study were highly variable, the total number of alleles observed ranged from 13 to 30 and the average number of alleles per locus was 19. Expected heterozygosity of the four microsatellite loci across all populations was high and varied between 0.830 and 0.935. Bayesian clustering analyses in STRUCTURE strongly supported four genetically distinct populations, which correspond exactly to the four main allopatric geographical regions in which the frogs are currently found. Individual analyses performed on the separate regions showed that breeding sites within these four regions could not be separated into distinct populations. Twelve mtND2 haplotypes were identified from 66 individuals from throughout the four geographical regions. A statistical parsimony network of mtDNA haplotypes shows two distinct groups, which correspond to the two species of corroboree frog, but with most of the haplotype diversity distributed in P. pengilleyi. These results demonstrate an unexpectedly high level of genetic diversity in both species. Our data have important implications for how the genetic diversity is managed in the future. The four evolutionarily significant units must be protected and maintained in captive breeding programmes for as long as it is possible to do.

  15. Estrogenic exposure affects metamorphosis and alters sex ratios in the northern leopard frog (Rana pipiens): identifying critically vulnerable periods of development.

    Science.gov (United States)

    Hogan, Natacha S; Duarte, Paula; Wade, Michael G; Lean, David R S; Trudeau, Vance L

    2008-05-01

    During the transformation from larval tadpole to juvenile frog, there are critical periods of metamorphic development and sex differentiation that may be particularly sensitive to endocrine disruption. The aim of the present study was to identify sensitive developmental periods for estrogenic endocrine disruption in the northern leopard frog (Rana pipiens) using short, targeted exposures to the synthetic estrogen, ethinylestradiol (EE2). Post-hatch tadpoles (Gosner stage 27) were exposed over five distinct periods of metamorphosis: early (stage 27-30), mid (stage 30-36), early and mid (stage 27-36), late (stage 36-42), and the entire metamorphic period (chronic; stage 27-42). For each period, animals were sampled immediately following the EE2 exposure and at metamorphic climax (stage 42). The effects of EE2 on metamorphic development and sex differentiation were assessed through measures of length, weight, developmental stage, days to metamorphosis, sex ratios and incidence of gonadal intersex. Our results show that tadpoles exposed to EE2 during mid-metamorphosis were developmentally delayed immediately following exposure and took 2 weeks longer to reach metamorphic climax. In the unexposed groups, there was low proportion (0.15) of intersex tadpoles at stage 30 and gonads appeared to be morphologically distinct (male and female) in all individuals by stage 36. Tadpoles exposed early in development displayed a strong female-biased sex ratio compared to the controls. Moreover, these effects were also seen at metamorphic climax, approximately 2-3 months after the exposure period, demonstrating that transient early life-stage exposure to estrogen can induce effects on the reproductive organs that persist into the beginning of adult life-stages.

  16. 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.

  17. 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

  18. 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).

  19. Phase space barriers and dividing surfaces in the absence of critical points of the potential energy: Application to roaming in ozone

    Energy Technology Data Exchange (ETDEWEB)

    Mauguière, Frédéric A. L., E-mail: frederic.mauguiere@bristol.ac.uk; Collins, Peter, E-mail: peter.collins@bristol.ac.uk; Wiggins, Stephen, E-mail: stephen.wiggins@mac.com [School of Mathematics, University of Bristol, Bristol BS8 1TW (United Kingdom); Kramer, Zeb C., E-mail: zebcolterkramer@gmail.com; Ezra, Gregory S., E-mail: gse1@cornell.edu [Department of Chemistry and Chemical Biology, Baker Laboratory, Cornell University, Ithaca, New York 14853 (United States); Carpenter, Barry K., E-mail: carpenterb1@cardiff.ac.uk [School of Chemistry, Cardiff University, Cardiff CF10 3AT (United Kingdom); Farantos, Stavros C., E-mail: farantos@iesl.forth.gr [Institute of Electronic Structure and Laser, Foundation for Research and Technology - Hellas, and Department of Chemistry, University of Crete, Iraklion 711 10, Crete (Greece)

    2016-02-07

    We examine the phase space structures that govern reaction dynamics in the absence of critical points on the potential energy surface. We show that in the vicinity of hyperbolic invariant tori, it is possible to define phase space dividing surfaces that are analogous to the dividing surfaces governing transition from reactants to products near a critical point of the potential energy surface. We investigate the problem of capture of an atom by a diatomic molecule and show that a normally hyperbolic invariant manifold exists at large atom-diatom distances, away from any critical points on the potential. This normally hyperbolic invariant manifold is the anchor for the construction of a dividing surface in phase space, which defines the outer or loose transition state governing capture dynamics. We present an algorithm for sampling an approximate capture dividing surface, and apply our methods to the recombination of the ozone molecule. We treat both 2 and 3 degrees of freedom models with zero total angular momentum. We have located the normally hyperbolic invariant manifold from which the orbiting (outer) transition state is constructed. This forms the basis for our analysis of trajectories for ozone in general, but with particular emphasis on the roaming trajectories.

  20. Identificación de territorios críticos en salud materna mediante indicadores Using indicators to identify regions with critical maternal health conditions

    Directory of Open Access Journals (Sweden)

    Marcos Paz Ballivián

    2002-07-01

    Health and Social Welfare of Bolivia brought together a group of experts who, using available information, developed a method that made it possible to identify critical maternal and neonatal health sections of the country and to create a map of the health situation and of the existing health-services capacity in the 112 provinces of Bolivia. The objective of this piece is to describe the method that those experts created and applied. Methods. Two indices were created, one for the health situation and the other for the existing health-services capacity. The steps followed in this process were: 1 identifying the variables included in each index, 2 weighting the variables in each index, 3 creating a mathematical formula for each index, 4 preparing a list with the data from each province for the chosen variables and with the percentage for each province for each index, obtained by using the respective formula, 5 setting three continuous-data categories for each index, and 6 defining the taxonomy that was possible by combining the results of the two indices. Results. Applying this approach, a national map of the maternal health situation and of the existing capacity in each of the 112 Bolivian provinces was developed. This made it possible to choose a small number of provinces where the Ministry of Health and Social Welfare could work with other institutions to carry out joint interventions. The 9 selected provinces have a total of 26 municipalities, which include 17 health districts and which have 29% of the population of the country, 33% of the maternal deaths, and an estimated 35% of the early neonatal deaths. Conclusions. Using available information, this method generated a map of the overall maternal health situation in the 112 provinces of Bolivia and made it possible to identify critical geographical areas for health interventions.

  1. 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

  2. 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

  3. Understanding interdisciplinary health care teams: using simulation design processes from the Air Carrier Advanced Qualification Program to identify and train critical teamwork skills.

    Science.gov (United States)

    Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M

    2010-09-01

    In the report "Five Years After 'To Err is Human' ", it was noted that "the combination of complexity, professional fragmentation, and a tradition of individualism, enhanced by a well-entrenched hierarchical authority structure and diffuse accountability, forms a daunting barrier to creating the habits and beliefs of common purpose, teamwork, and individual accountability for successful interdependence that a safe culture requires". Training physicians, nurses, and other professionals to work in teams is a concept that has been promoted by many patient safety experts. However the model of teamwork in healthcare is diffusely defined, no clear performance metrics have been established, and the use of simulation to train teams has been suboptimal. This paper reports on the first three years of work performed in the Michigan Economic Development Corporation (MEDC) Tri-Corridor life science grant to apply concepts and processes of simulation design that were developed in the air carrier industry to understand and train healthcare teams. This work has been monitored by the American Academy for the Advancement of Science (AAA) and is based on concepts designed in the Advanced Qualification Program (AQP) from the air carrier industry, which trains and assesses teamwork skills in the same manner as technical skills. This grant has formed the foundation for the Center of Excellence for Simulation Education and Research (CESR).

  4. Emory University: MEDICI (Mining Essentiality Data to Identify Critical Interactions) for Cancer Drug Target Discovery and Development | Office of Cancer Genomics

    Science.gov (United States)

    The CTD2 Center at Emory University has developed a computational methodology to combine high-throughput knockdown data with known protein network topologies to infer the importance of protein-protein interactions (PPIs) for the survival of cancer cells.  Applying these data to the Achilles shRNA results, the CCLE cell line characterizations, and known and newly identified PPIs provides novel insights for potential new drug targets for cancer therapies and identifies important PPI hubs.

  5. Safety assessment of discharge chute isolation barrier preparation and installation

    International Nuclear Information System (INIS)

    Meichle, R.H.

    1994-01-01

    This analysis examines activities associated with the installation of isolation barriers in the K Basins at the Hanford Reservation. This revision adds evaluation of barrier drops on stored fuel and basin floor, identifies fuel which will be moved and addresses criticality issues with sludge. The safety assessment is made for the activities for the preparation and installation of the discharge chute isolation barriers. The safety assessment includes a hazard assessment and comparisons of potential accidents/events to those addressed by the current safety basis documentation. No significant hazards were identified. An evaluation against the USQ evaluation questions was made and the determination made that the activities do not represent a USQ. Hazard categorization techniques were used to provide a basis for readiness review classifications

  6. Critical Factors in Mobile Learning: A Quasi-Systematic Review

    Science.gov (United States)

    Rodrigues, Sergio Assis; dos Santos, Rodrigo Pereira; Arnaud, Lucas; de Souza, Jano Moreira

    2013-01-01

    The advance of mobile industry and research has expanded e-learning in order to support an efficient and effective educational process. However, the promised benefits are as much attractive as the existing difficulties and barriers. In this paper, we intend to identify and summarize the critical factors in mobile learning through a…

  7. Introduction to four reviews addressing critical topics identified by the 2015 Nurse Practitioner Research Agenda Roundtable: Priorities for policy, workforce, education, and practice.

    Science.gov (United States)

    Buchholz, Susan W; Klein, Tracy; Cooke, Cindy; Cook, Michelle L; Knestrick, Joyce; Dickins, Kirsten

    2018-05-04

    In 2015, an invitational think tank was convened by the Fellows of the American Association of Nurse Practitioners to update the 2010 Nurse Practitioner (NP) Research Agenda Roundtable. This effort was undertaken to provide guidance for future health care research. The purpose of this article is to introduce the process used for conducting four reviews that address critical topics related to specific research priorities emanating from the 2015 NP Research Agenda Roundtable. The four reviews are published in this issue of Journal of the American Association of Nurse Practitioners (JAANP) to address the state of current research relevant to NP policy, workforce, education, and practice. This introductory article provides an overview of the systematic process used to evaluate the four topical area. The type of review selected, the search strategy, critical appraisal, data extraction, and data synthesis will be further described in the four review articles. Four reviews that examine literature regarding specific aims important to NPs will address strengths as well as gaps in the literature. The knowledge offered by the four reviews has the potential to inform future research, which will benefit NPs and other health care stakeholders.

  8. Critical factors to bioenergy implementation

    International Nuclear Information System (INIS)

    Roos, A.; Hektor, B.; Rakos, C.

    1999-01-01

    Barriers to bioenergy technology implementation have received increased attention in recent years. This paper contributes to the identification and analysis of barriers and drivers behind bioenergy market growth, here labelled c ritical factors . It presents a framework for the analysis of both existing and projected bioenergy market potential, using economic concepts and models from transaction cost theory and industrial organization. The framework can be used for assessments of the potential for market growth of different bioenergy systems by decision makers in administration and industry. The following critical factors are identified: Integration with other economic activity, Scale effects on bioenergy markets, Competition in bioenergy markets, Competition with other business, National policy, Local policy and local opinion. The framework is demonstrated with five cases of real bioenergy markets: Pellet residential heating in USA, bioenergy power in USA, pellet residential heating in Sweden, biomass district heating in Sweden, and biomass district heating in Austria. Different applications of the framework are discussed

  9. Critical Review

    DEFF Research Database (Denmark)

    Rosenbaum, Ralph K.; Olsen, Stig Irving

    2018-01-01

    Manipulation and mistakes in LCA studies are as old as the tool itself, and so is its critical review. Besides preventing misuse and unsupported claims, critical review may also help identifying mistakes and more justifiable assumptions as well as generally improve the quality of a study. It thus...... supports the robustness of an LCA and increases trust in its results and conclusions. The focus of this chapter is on understanding what a critical review is, how the international standards define it, what its main elements are, and what reviewer qualifications are required. It is not the objective...... of this chapter to learn how to conduct a critical review, neither from a reviewer nor from a practitioner perspective. The foundation of this chapter and the basis for any critical review of LCA studies are the International Standards ISO 14040:2006, ISO 14044:2006 and ISO TS 14071:2014....

  10. Critical modeling parameters identified for 3D CFD modeling of rectangular final settling tanks for New York City wastewater treatment plants.

    Science.gov (United States)

    Ramalingam, K; Xanthos, S; Gong, M; Fillos, J; Beckmann, K; Deur, A; McCorquodale, J A

    2012-01-01

    New York City Environmental Protection is in the process of incorporating biological nitrogen removal (BNR) in its wastewater treatment plants (WWTPs) which entails operating the aeration tanks with higher levels of mixed liquor suspended solids (MLSS) than a conventional activated sludge process. The objective of this paper is to discuss two of the important parameters introduced in the 3D CFD model that has been developed by the City College of New York (CCNY) group: (a) the development of the 'discrete particle' measurement technique to carry out the fractionation of the solids in the final settling tank (FST) which has critical implications in the prediction of the effluent quality; and (b) the modification of the floc aggregation (K(A)) and floc break-up (K(B)) coefficients that are found in Parker's flocculation equation (Parker et al. 1970, 1971) used in the CFD model. The dependence of these parameters on the predictions of the CFD model will be illustrated with simulation results on one of the FSTs at the 26th Ward WWTP in Brooklyn, NY.

  11. 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

  12. Proteomics and pathway analysis identifies JNK signaling as critical for high linear energy transfer radiation-induced apoptosis in non-small lung cancer cells.

    Science.gov (United States)

    Ståhl, Sara; Fung, Eva; Adams, Christopher; Lengqvist, Johan; Mörk, Birgitta; Stenerlöw, Bo; Lewensohn, Rolf; Lehtiö, Janne; Zubarev, Roman; Viktorsson, Kristina

    2009-05-01

    During the past decade, we have witnessed an explosive increase in generation of large proteomics data sets, not least in cancer research. There is a growing need to extract and correctly interpret information from such data sets to generate biologically relevant hypotheses. A pathway search engine (PSE) has recently been developed as a novel tool intended to meet these requirements. Ionizing radiation (IR) is an anticancer treatment modality that triggers multiple signal transduction networks. In this work, we show that high linear energy transfer (LET) IR induces apoptosis in a non-small cell lung cancer cell line, U-1810, whereas low LET IR does not. PSE was applied to study changes in pathway status between high and low LET IR to find pathway candidates of importance for high LET-induced apoptosis. Such pathways are potential clinical targets, and they were further validated in vitro. We used an unsupervised shotgun proteomics approach where high resolution mass spectrometry coupled to nanoflow liquid chromatography determined the identity and relative abundance of expressed proteins. Based on the proteomics data, PSE suggested the JNK pathway (p = 6.10(-6)) as a key event in response to high LET IR. In addition, the Fas pathway was found to be activated (p = 3.10(-5)) and the p38 pathway was found to be deactivated (p = 0.001) compared with untreated cells. Antibody-based analyses confirmed that high LET IR caused an increase in phosphorylation of JNK. Moreover pharmacological inhibition of JNK blocked high LET-induced apoptotic signaling. In contrast, neither an activation of p38 nor a role for p38 in high LET IR-induced apoptotic signaling was found. We conclude that, in contrast to conventional low LET IR, high LET IR can trigger activation of the JNK pathway, which in turn is critical for induction of apoptosis in these cells. Thus PSE predictions were largely confirmed, and PSE was proven to be a useful hypothesis-generating tool.

  13. A comparison of pedigree- and DNA-based measures for identifying inbreeding depression in the critically endangered Attwater's Prairie-chicken.

    Science.gov (United States)

    Hammerly, Susan C; Morrow, Michael E; Johnson, Jeff A

    2013-11-01

    The primary goal of captive breeding programmes for endangered species is to prevent extinction, a component of which includes the preservation of genetic diversity and avoidance of inbreeding. This is typically accomplished by minimizing mean kinship in the population, thereby maintaining equal representation of the genetic founders used to initiate the captive population. If errors in the pedigree do exist, such an approach becomes less effective for minimizing inbreeding depression. In this study, both pedigree- and DNA-based methods were used to assess whether inbreeding depression existed in the captive population of the critically endangered Attwater's Prairie-chicken (Tympanuchus cupido attwateri), a subspecies of prairie grouse that has experienced a significant decline in abundance and concurrent reduction in neutral genetic diversity. When examining the captive population for signs of inbreeding, variation in pedigree-based inbreeding coefficients (f(pedigree)) was less than that obtained from DNA-based methods (f(DNA)). Mortality of chicks and adults in captivity were also positively correlated with parental relatedness (r(DNA)) and f(DNA), respectively, while no correlation was observed with pedigree-based measures when controlling for additional variables such as age, breeding facility, gender and captive/release status. Further, individual homozygosity by loci (HL) and parental rDNA values were positively correlated with adult mortality in captivity and the occurrence of a lethal congenital defect in chicks, respectively, suggesting that inbreeding may be a contributing factor increasing the frequency of this condition among Attwater's Prairie-chickens. This study highlights the importance of using DNA-based methods to better inform management decisions when pedigrees are incomplete or errors may exist due to uncertainty in pairings. © 2013 John Wiley & Sons Ltd.

  14. Identification and analysis of reverse logistics barriers using fuzzy Delphi method and AHP

    DEFF Research Database (Denmark)

    Bouzon, Marina; Govindan, Kannan; Rodriguez, Carlos M Taboada

    2016-01-01

    enacted National Policy on solid waste. To bridge this gap, this paper identifies and evaluates the barriers for RL in the Brazilian context. An eleven-step research methodology is proposed. First, literature was thoroughly reviewed. fuzzy Delphi method (FDM) was used to obtain the critical list...... a systematic literature review process, a list of most common RL barriers accepted by Brazilian organizations, and a priority ranking of RL barriers for the electrical-electronic industry sector in Brazil. The "Economic related issues" category of barriers seems to be the first priority. The financial burden...... the reverse flow must be taken. However, most existing research on the barriers for RL implementation is focused on developed countries. Among the most important emerging economies, Brazil, the largest Latin America economy, faces challenges such as a deficient logistics infrastructure and the recently...

  15. Barriers and enablers to academic health leadership.

    Science.gov (United States)

    Bharwani, Aleem; Kline, Theresa; Patterson, Margaret; Craighead, Peter

    2017-02-06

    Purpose This study sought to identify the barriers and enablers to leadership enactment in academic health-care settings. Design/methodology/approach Semi-structured interviews ( n = 77) with programme stakeholders (medical school trainees, university leaders, clinical leaders, medical scientists and directors external to the medical school) were conducted, and the responses content-analysed. Findings Both contextual and individual factors were identified as playing a role in affecting academic health leadership enactment that has an impact on programme development, success and maintenance. Contextual factors included sufficient resources allocated to the programme, opportunities for learners to practise leadership skills, a competent team around the leader once that person is in place, clear expectations for the leader and a culture that fosters open communication. Contextual barriers included highly bureaucratic structures, fear-of-failure and non-trusting cultures and inappropriate performance systems. Programmes were advised to select participants based on self-awareness, strong communication skills and an innovative thinking style. Filling specific knowledge and skill gaps, particularly for those not trained in medical school, was viewed as essential. Ineffective decision-making styles and tendencies to get involved in day-to-day activities were barriers to the development of academic health leaders. Originality/value Programmes designed to develop academic health-care leaders will be most effective if they develop leadership at all levels; ensure that the organisation's culture, structure and processes reinforce positive leadership practices; and recognise the critical role of teams in supporting its leaders.

  16. Proteomics and Pathway Analysis Identifies JNK Signaling as Critical for High Linear Energy Transfer Radiation-induced Apoptosis in Non-small Lung Cancer Cells*S⃞

    Science.gov (United States)

    Ståhl, Sara; Fung, Eva; Adams, Christopher; Lengqvist, Johan; Mörk, Birgitta; Stenerlöw, Bo; Lewensohn, Rolf; Lehtiö, Janne; Zubarev, Roman; Viktorsson, Kristina

    2009-01-01

    During the past decade, we have witnessed an explosive increase in generation of large proteomics data sets, not least in cancer research. There is a growing need to extract and correctly interpret information from such data sets to generate biologically relevant hypotheses. A pathway search engine (PSE) has recently been developed as a novel tool intended to meet these requirements. Ionizing radiation (IR) is an anticancer treatment modality that triggers multiple signal transduction networks. In this work, we show that high linear energy transfer (LET) IR induces apoptosis in a non-small cell lung cancer cell line, U-1810, whereas low LET IR does not. PSE was applied to study changes in pathway status between high and low LET IR to find pathway candidates of importance for high LET-induced apoptosis. Such pathways are potential clinical targets, and they were further validated in vitro. We used an unsupervised shotgun proteomics approach where high resolution mass spectrometry coupled to nanoflow liquid chromatography determined the identity and relative abundance of expressed proteins. Based on the proteomics data, PSE suggested the JNK pathway (p = 6·10−6) as a key event in response to high LET IR. In addition, the Fas pathway was found to be activated (p = 3·10−5) and the p38 pathway was found to be deactivated (p = 0.001) compared with untreated cells. Antibody-based analyses confirmed that high LET IR caused an increase in phosphorylation of JNK. Moreover pharmacological inhibition of JNK blocked high LET-induced apoptotic signaling. In contrast, neither an activation of p38 nor a role for p38 in high LET IR-induced apoptotic signaling was found. We conclude that, in contrast to conventional low LET IR, high LET IR can trigger activation of the JNK pathway, which in turn is critical for induction of apoptosis in these cells. Thus PSE predictions were largely confirmed, and PSE was proven to be a useful hypothesis-generating tool. PMID:19168796

  17. Strategies for Overcoming Barriers to Training and Education for Canadians with Disabilities. Lessons in Learning

    Science.gov (United States)

    Canadian Council on Learning, 2009

    2009-01-01

    If stronger skills and more education are key to greater labour force participation, then it is important to identify critical barriers to education and training for Canadians with disabilities. In 2008, the Canadian Council on Learning's Adult Learning Knowledge Centre funded a "Community Outreach Initiative for Learner's with…

  18. 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

  19. Prototype Hanford Surface Barrier: Design basis document

    International Nuclear Information System (INIS)

    Myers, D.R.; Duranceau, D.A.

    1994-11-01

    The Hanford Site Surface Barrier Development Program (BDP) was organized in 1985 to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site and other arid sites. This document provides the basis of the prototype barrier. Engineers and scientists have momentarily frozen evolving barrier designs and incorporated the latest findings from BDP tasks. The design and construction of the prototype barrier has required that all of the various components of the barrier be brought together into an integrated system. This integration is particularly important because some of the components of the protective barreir have been developed independently of other barreir components. This document serves as the baseline by which future modifications or other barrier designs can be compared. Also, this document contains the minutes of meeting convened during the definitive design process in which critical decisions affecting the prototype barrier's design were made and the construction drawings

  20. 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.

  1. Review of durability of cementitious engineered barriers in repository environments

    International Nuclear Information System (INIS)

    Parrott, L.J.; Lawrence, C.D.

    1992-01-01

    This report is concerned with the durability of cementitious engineered barriers in a repository for low and intermediate level nuclear waste. Following the introduction the second section of the review identifies the environmental conditions associated with a deep, hard rock repository for ILW and LLW that are relevant to the durability of cementitious barriers. Section three examines the microstructure and macrostructure of cementitious materials and considers the physical and chemical processes of radionuclide immobilization. Potential repository applications and compositions of cementitious materials are reviewed in Section four. The main analysis of durability is dealt with in Section five. The different types of cementitious barrier are considered separately and their most probable modes of degradation are analysed. Concluding remarks that highlight critical technical matters are given in Section six. (author)

  2. A critical assessment of marine aquarist biodiversity data and commercial aquaculture: identifying gaps in culture initiatives to inform local fisheries managers.

    Directory of Open Access Journals (Sweden)

    Joanna M Murray

    Full Text Available It is widely accepted that if well managed, the marine aquarium trade could provide socio-economic stability to local communities while incentivising the maintenance of coral reefs. However, the trade has also been implicated as having potentially widespread environmental impacts that has in part driven developments in aquaculture to relieve wild collection pressures. This study investigates the biodiversity in hobbyist aquaria (using an online survey and those species currently available from an aquaculture source (commercial data and hobbyist initiatives in the context of a traffic light system to highlight gaps in aquaculture effort and identify groups that require fisheries assessments. Two hundred and sixty nine species including clown fish, damsels, dotty backs, angelfish, gobies, sea horses and blennies, have reported breeding successes by hobbyists, a pattern mirrored by the European and US commercial organisations. However, there is a mismatch (high demand and low/non-existent aquaculture for a number of groups including tangs, starfish, anemones and hermit crabs, which we recommend are priority candidates for local stock assessments. Hobbyist perception towards the concept of a sustainable aquarium trade is also explored with results demonstrating that only 40% of respondents were in agreement with industry and scientists who believe the trade could be an exemplar of a sustainable use of coral reefs. We believe that a more transparent evidence base, including the publication of the species collected and cultured, will go some way to align the concept of a sustainable trade across industry stakeholders and better inform the hobbyist when purchasing their aquaria stock. We conclude by proposing that a certification scheme established with government support is the most effective way to move towards a self-regulating industry. It would prevent industry "greenwashing" from multiple certification schemes, alleviate conservation concerns

  3. Perceptions of the use of critical thinking teaching methods.

    Science.gov (United States)

    Kowalczyk, Nina; Hackworth, Ruth; Case-Smith, Jane

    2012-01-01

    To identify the perceived level of competence in teaching and assessing critical thinking skills and the difficulties facing radiologic science program directors in implementing student-centered teaching methods. A total of 692 program directors received an invitation to complete an electronic survey soliciting information regarding the importance of critical thinking skills, their confidence in applying teaching methods and assessing student performance, and perceived obstacles. Statistical analysis included descriptive data, correlation coefficients, and ANOVA. Responses were received from 317 participants indicating program directors perceive critical thinking to be an essential element in the education of the student; however, they identified several areas for improvement. A high correlation was identified between the program directors' perceived level of skill and their confidence in critical thinking, and between their perceived level of skill and ability to assess the students' critical thinking. Key barriers to implementing critical thinking teaching strategies were identified. Program directors value the importance of implementing critical thinking teaching methods and perceive a need for professional development in critical thinking educational methods. Regardless of the type of educational institution in which the academic program is located, the level of education held by the program director was a significant factor regarding perceived confidence in the ability to model critical thinking skills and the ability to assess student critical thinking skills.

  4. Confidence in critical care nursing.

    Science.gov (United States)

    Evans, Jeanne; Bell, Jennifer L; Sweeney, Annemarie E; Morgan, Jennifer I; Kelly, Helen M

    2010-10-01

    The purpose of the study was to gain an understanding of the nursing phenomenon, confidence, from the experience of nurses in the nursing subculture of critical care. Leininger's theory of cultural care diversity and universality guided this qualitative descriptive study. Questions derived from the sunrise model were used to elicit nurses' perspectives about cultural and social structures that exist within the critical care nursing subculture and the influence that these factors have on confidence. Twenty-eight critical care nurses from a large Canadian healthcare organization participated in semistructured interviews about confidence. Five themes arose from the descriptions provided by the participants. The three themes, tenuously navigating initiation rituals, deliberately developing holistic supportive relationships, and assimilating clinical decision-making rules were identified as social and cultural factors related to confidence. The remaining two themes, preserving a sense of security despite barriers and accommodating to diverse challenges, were identified as environmental factors related to confidence. Practice and research implications within the culture of critical care nursing are discussed in relation to each of the themes.

  5. 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

  6. 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

  7. 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…

  8. 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…

  9. Barriers in education of indigenous nursing students: a literature review.

    Science.gov (United States)

    Foxall, Donna

    2013-11-01

    The poor health status of indigenous people has been identified internationally as a critical issue. It is now commonly accepted that the ability to address this concern is hindered, in part, by the disproportionately low number of indigenous health professionals, including nurses. This paper reports the findings of a review of literature that aimed to identify key barriers in the education of the indigenous undergraduate nursing students in the tertiary sector, to identify strategies to overcome these, and discuss these elements within the New Zealand context. A number of health-related databases were searched and a total of 16 peer-reviewed articles from Canada, U.S.A., Australia and New Zealand were reviewed. Key barriers to recruitment and retention and strategies to overcome these are presented. Barriers to recruitment included: academic unpreparedness; poor understanding of cultural needs; and conflicting obligations, and financial constraints. Barriers to retention included lack of cultural and academic support, family obligations and financial hardship. Strategies to address recruitment barriers included: addressing pre-entry education requirements; targeted promotion of nursing programmes; indigenous role models in the recruitment process; and streamlining enrolment processes to make programmes attractive and attainable for indigenous students. Strategies to address retention barriers included: cultural relevance within the curriculum; identifying and supporting cultural needs of indigenous students with active participation of indigenous staff; engaging communities and funding support. The crucial development of partnerships between academic institutes and indigenous communities to ensure the provision of a culturally safe, supportive environment for the students was stressed. In New Zealand, while government-level policy exists to promote the success of MBori nursing students, the translation of what is known about the recruitment and retention of

  10. 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

  11. Overcoming ICT Barriers in IBS Management Process in Malaysia Construction Industry

    Directory of Open Access Journals (Sweden)

    Soon Ern Peniel Ang

    2017-01-01

    Full Text Available As the result of government’s initiative and future outlook in uprising the awareness towards the implementation of sustainable elements in construction industries, the Industrialized Building System (IBS is one of the approaches that had been introduced as an alternative to conventional building method and produce the new strategy of reducing the waste of materials in construction. The IBS approach is actively promoted through several strategies and incentives as an alternative to conventional building methods. Extensive uptakes of modern Information Communication Technology (ICT applications are able to support the different IBS processes for effective production. However, it is argued that ICT uptake at the organizational level needs to be regularly improved. Thus, this paper fulfills the need to identify the critical barriers to ICT employment and highlighting the ICT drivers in enhancing the IBS management process. Critical barriers and drivers to ICT uptake were identified through questionnaire survey with industry stakeholders and were analyzed using mean index and critical t-value with the use of SPSS software. The critical drivers are top management support and commitment and improving the availability of the technologies. The critical drivers which were identified are significant in ensuring the enhancement of ICT implementation. Hence, any system in place should avoid the highest ranked barriers or seek to alleviate their impact by focusing on the identified drivers in order to enhance implementation of ICT in IBS process management.

  12. Support or Barrier?

    DEFF Research Database (Denmark)

    Sanden, Guro Refsum; Lønsmann, Dorte

    This study offers a critical look at how corporate-level language management influences front-line language practices among employees in three multinational corporations (MNCs) headquartered in Scandinavia. Based on interview and document data, we examine, firstly, what front-line practices...... employees use to cross language boundaries in their everyday work, and, secondly, how these practices relate to top-down language management in the case companies. Our findings show that employees are often dependent on ad hoc and informal solutions in cross- language situations, which leads us...... to a discussion of how a company’s language policy may be seen as both support and a barrier....

  13. 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.

  14. A Systematic Approach of Employing Quality by Design Principles: Risk Assessment and Design of Experiments to Demonstrate Process Understanding and Identify the Critical Process Parameters for Coating of the Ethylcellulose Pseudolatex Dispersion Using Non-Conventional Fluid Bed Process.

    Science.gov (United States)

    Kothari, Bhaveshkumar H; Fahmy, Raafat; Claycamp, H Gregg; Moore, Christine M V; Chatterjee, Sharmista; Hoag, Stephen W

    2017-05-01

    The goal of this study was to utilize risk assessment techniques and statistical design of experiments (DoE) to gain process understanding and to identify critical process parameters for the manufacture of controlled release multiparticulate beads using a novel disk-jet fluid bed technology. The material attributes and process parameters were systematically assessed using the Ishikawa fish bone diagram and failure mode and effect analysis (FMEA) risk assessment methods. The high risk attributes identified by the FMEA analysis were further explored using resolution V fractional factorial design. To gain an understanding of the processing parameters, a resolution V fractional factorial study was conducted. Using knowledge gained from the resolution V study, a resolution IV fractional factorial study was conducted; the purpose of this IV study was to identify the critical process parameters (CPP) that impact the critical quality attributes and understand the influence of these parameters on film formation. For both studies, the microclimate, atomization pressure, inlet air volume, product temperature (during spraying and curing), curing time, and percent solids in the coating solutions were studied. The responses evaluated were percent agglomeration, percent fines, percent yield, bead aspect ratio, median particle size diameter (d50), assay, and drug release rate. Pyrobuttons® were used to record real-time temperature and humidity changes in the fluid bed. The risk assessment methods and process analytical tools helped to understand the novel disk-jet technology and to systematically develop models of the coating process parameters like process efficiency and the extent of curing during the coating process.

  15. IDENTIFYING THE CRITICAL CAUSES OF CONFLICT IN ...

    African Journals Online (AJOL)

    Completing construction projects entails inputs from various professional disciplines; this makes projects prone to conflicts. It has been acknowledged that management of conflict is crucial to improving project performance. Thus, understanding the causes of conflicts in construction project will ease the process of conflict ...

  16. The Critical Difference: Identifying the Dyslexic.

    Science.gov (United States)

    Burgett, Russell; King, James

    A study compared peripheral vision applied to letter-pair and Dolch word recognition. Subjects, 6 normal readers, 12 Chapter 1 students, and 34 learning disabled (and assumed dyslexic) students from grades one through three enrolled in a parochial school, a public school, and a university summer reading clinic, completed a test designed to…

  17. 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.

  18. Molecular dynamics simulations of Hsp40 J-domain mutants identifies disruption of the critical HPD-motif as the key factor for impaired curing in vivo of the yeast prion [URE3].

    Science.gov (United States)

    Xue, You-Lin; Wang, Hao; Riedy, Michael; Roberts, Brittany-Lee; Sun, Yuna; Song, Yong-Bo; Jones, Gary W; Masison, Daniel C; Song, Youtao

    2018-05-01

    Genetic screens using Saccharomyces cerevisiae have identified an array of Hsp40 (Ydj1p) J-domain mutants that are impaired in the ability to cure the yeast [URE3] prion through disrupting functional interactions with Hsp70. However, biochemical analysis of some of these Hsp40 J-domain mutants has so far failed to provide major insight into the specific functional changes in Hsp40-Hsp70 interactions. To explore the detailed structural and dynamic properties of the Hsp40 J-domain, 20 ns molecular dynamic simulations of 4 mutants (D9A, D36A, A30T, and F45S) and wild-type J-domain were performed, followed by Hsp70 docking simulations. Results demonstrated that although the Hsp70 interaction mechanism of the mutants may vary, the major structural change was targeted to the critical HPD motif of the J-domain. Our computational analysis fits well with previous yeast genetics studies regarding highlighting the importance of J-domain function in prion propagation. During the molecular dynamics simulations several important residues were identified and predicted to play an essential role in J-domain structure. Among these residues, Y26 and F45 were confirmed, using both in silico and in vivo methods, as being critical for Ydj1p function.

  19. Barriers of lean construction implementation in the Moroccan construction industry

    Science.gov (United States)

    Bajjou, Mohamed Saad; Chafi, Anas

    2018-04-01

    Improving the production system performance has become a fundamental pillar that must be taken into consideration in the construction industry. Recent developments in the construction sector have led to renewed interest in new techniques of management. Lean Construction is a very effective approach that has gained a high popularity by its ability to eliminate waste and maximize the value for the customer. Although both developed and developing countries have gained large benefits by implementing Lean Construction approach, several experiences showed many barriers that are hindering its implementation especially in developing countries. This paper aims to assess the critical barriers to the successful implementation in the Moroccan construction industry. Based on a literature review, followed by an analysis of data collected from a questionnaire survey which targeted 330 practitioners in the Moroccan construction field, several barriers were identified as key barriers. The findings of this investigation revealed that there are significant barriers such as Lack of knowledge about Lean Construction concepts, Unskilled Human Resources, and insufficient financial resources.

  20. California Condor Critical Habitat

    Data.gov (United States)

    California Natural Resource Agency — These Data identify (in general) the areas where critical habitat for the California Condor occur. Critical habitat for the species consists of the following 10...

  1. 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

  2. CriticalEd

    DEFF Research Database (Denmark)

    Kjellberg, Caspar Mølholt; Meredith, David

    2014-01-01

    . Since the comments are not input sequentially, with regard to position, but in arbitrary order, this list must be sorted by copy/pasting the rows into place—an error-prone and time-consuming process. Scholars who produce critical editions typically use off-the-shelf music notation software......The best text method is commonly applied among music scholars engaged in producing critical editions. In this method, a comment list is compiled, consisting of variant readings and editorial emendations. This list is maintained by inserting the comments into a document as the changes are made......, consisting of a Sibelius plug-in, a cross-platform application, called CriticalEd, and a REST-based solution, which handles data storage/retrieval. A prototype has been tested at the Danish Centre for Music Publication, and the results suggest that the system could greatly improve the efficiency...

  3. English-as-a-Second Language (ESL) nursing student success: a critical review of the literature.

    Science.gov (United States)

    Olson, Mary Angela

    2012-01-01

    Many English-as-a-Second Language (ESL) nursing students struggle in nursing school for a multitude of reasons. The purpose of this critical review of the literature is to identify barriers and discover bridges to ESL nursing student success. Twenty-five articles were identified for the review. Language barriers were identified as the single most significant obstacle facing the ESL nursing student. Bridges to ESL nursing student success include enhancing language development and acculturation into the American mainstream culture. A broad range of strategies to promote student success are outlined and the role of the nurse educator in ESL nursing student success is also addressed.

  4. 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…

  5. 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.

  6. 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)

  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.

    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

  8. Defining a target population at high risk of long-term foster care: barriers to permanency for families of children with serious emotional disturbances.

    Science.gov (United States)

    Akin, Becci A; Bryson, Stephanie A; McDonald, Tom; Walker, Sheila

    2012-01-01

    Long-term foster care (LTFC) is an enduring problem that lacks evidence of effective strategies for practice or policy. This article describes initial activities of a statewide project of the national Permanency Innovations Initiative. The authors sought to: (1) verify the relevance of children's mental health as a predictor of LTFC, (2) describe critical barriers encountered by parents of children with serious emotional disturbances, and (3) identify systems barriers that hinder permanency for this target population.

  9. Barriers to implementing the World Health Organization's Trauma Care Checklist: A Canadian single-center experience.

    Science.gov (United States)

    Nolan, Brodie; Zakirova, Rimma; Bridge, Jennifer; Nathens, Avery B

    2014-11-01

    Management of trauma patients is difficult because of their complexity and acuity. In an effort to improve patient care and reduce morbidity and mortality, the World Health Organization developed a trauma care checklist. Local stakeholder input led to a modified 16-item version that was subsequently piloted. Our study highlights the barriers and challenges associated with implementing this checklist at our hospital. The checklist was piloted over a 6-month period at St. Michael's Hospital, a Level 1 trauma center in Toronto, Canada. At the end of the pilot phase, individual, semistructured interviews were held with trauma team leaders and nursing staff regarding their experiences with the checklist. Axial coding was used to create a typology of attitudes and barriers toward the checklist, and then, vertical coding was used to further explore each identified barrier. Checklist compliance was assessed for the first 7 months. Checklist compliance throughout the pilot phase was 78%. Eight key barriers to implementing the checklist were identified as follows: perceived lack of time for the use of the checklist in critically ill patients, unclear roles, no memory trigger, no one to enforce completion, not understanding its importance or purpose, difficulty finding physicians at the end of resuscitation, staff/trainee changes, and professional hierarchy. The World Health Organization Trauma Care Checklist was a well-received tool; however, consideration of barriers to the implementation and staff adoption must be done for successful integration, with special attention to its use in critically ill patients. Therapeutic/care management, level V.

  10. Critical success factors for renewable energy projects

    International Nuclear Information System (INIS)

    1995-01-01

    This project highlighted best practice in the planning and assessment of proposals with the aim of: encouraging more successful renewable energy projects and proposals; lowering financial and other barriers; and stimulating a climate for success. Based on the analysis of a number of case studies, data was collected through a series of extensive interviews to identify why certain schemes were considered successful, what might have been done differently and which factors were considered important when entering a market. The Critical Success Factors can be broken down into five groups: Universal CSFs; CSFs for funding bodies; CSFs for managing agencies; CSFs for niche markets; CSFs for individual technologies. (author)

  11. An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking.

    Science.gov (United States)

    Raymond, Christy; Profetto-McGrath, Joanne; Myrick, Florence; Strean, William B

    2017-11-01

    The role of nurse educators in the development of students' critical thinking has been overlooked despite the emphasized need for effective teaching methods. An integrative review was performed to examine both quantitative and qualitative research published from 2000 to 2015 related to nurse educators' critical thinking. Many barriers and facilitators existing on individual, interpersonal, and contextual levels affected nurse educators' critical thinking. Various tools have been used to measure nurse educators' critical thinking. This review also highlighted the continued lack of a consensus definition of critical thinking and the limited presence of conceptual models to guide the use of critical thinking in nursing education. Continued examination of nurse educators' critical thinking is needed, given the limited number of studies that have been completed. Much needs to be explored further, including conceptualizations of critical thinking and confirmation of emerging themes identified in this review. [J Nurs Educ. 2017;56(11):648-654.]. © 2017 Raymond, Profetto-McGrath, Myrick, et al.

  12. 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.

  13. Nurses' knowledge and barriers regarding pain management in intensive care units.

    Science.gov (United States)

    Wang, Hsiang-Ling; Tsai, Yun-Fang

    2010-11-01

    To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.

  14. [Implementation barriers--commentaries from organisational sociology] Implementeringsbarrierer - en organisationssociologisk nuancering

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Thorsen, T.

    2009-01-01

    During the last two decades numerous technologies for improving the quality of care have been introduced in the healthcare sector. The various problems encountered by such endeavours have given rise to a large number of studies attempting to identify the most effective techniques for implementation...... and the most important barriers to change. However, the barrier-centred approach to change has not yet fulfilled the expectations of its promoters and has recently come under criticism from research in organisational change. The article explores the contents and implications of this critique Udgivelsesdato...

  15. Barriers to delirium assessment in the intensive care unit: A literature review.

    Science.gov (United States)

    Rowley-Conwy, Gabby

    2018-02-01

    Delirium is a common syndrome that has both short and long-term negative outcomes for critically ill patients. Many studies over several years have found a knowledge gap and lack of evidence-based practice from critical care personnel, but there has been little exploration of the reasons for this. To identify the perceived barriers to delirium assessment and management among critical care nurses. A literature review of published studies to examine barriers to effective delirium assessment using a comprehensive search strategy. Five relevant studies identified for review. Few studies have investigated barriers to delirium assessment and management, but several themes reoccur throughout the literature. The perceived time consuming nature of the assessment tools is cited by many, as is the lack of medical prioritisation of results. Lack of education on delirium appears to be a significant factor and reinforces some of the stated misconceptions. Many barriers exist to prevent effective assessment and management of delirium, but several of these are due to a lack of understanding or unfamiliarity with the condition and the assessment tools as well as lack of medical prioritisation of the results. Further research is needed on this topic. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Being Critical in Marketing Studies

    DEFF Research Database (Denmark)

    Dholakia, Nikilesh

    2012-01-01

    review the research spaces for critical studies of marketing in various global settings and conclude that United Kingdom and Nordic Europe have the best epistemic climate, and this region needs to take leadership in promoting greater range of macro and critical studies of marketing in the rest......In this article, I argue that an elevated macro-level perspective is imperative for conducting critical studies in the fields of marketing and consumer research. There are epistemic barriers to operating in this manner, and I offer several suggestions for overcoming these barriers. Finally, I...

  17. Barriers and enablers to physical activity participation in patients with COPD: a systematic review.

    Science.gov (United States)

    Thorpe, Olivia; Johnston, Kylie; Kumar, Saravana

    2012-01-01

    Physical activity (PA) has been shown to improve symptoms in people with chronic obstructive pulmonary disease (COPD). Despite the high health and financial costs, the uptake of management strategies, particularly participation in PA and pulmonary rehabilitation (PR), are low. The review objective here was to identify potential barriers and enablers, which people with COPD report being associated with their participation in PA programs, including PR. A systematic search was undertaken to identify studies (published Jan 2000 to Aug 2011) reporting any barriers and enablers experienced by people with COPD regarding participation in PA and PR. Methodological quality of the studies was appraised using McMaster critical appraisal tools. A narrative summary of findings was undertaken reporting on individual study characteristics, country of origin, participants, and potential barriers and enablers. Eleven studies (8 qualitative and 3 quantitative) met the inclusion criteria for this systematic review. Several methodological issues (small sampling, poor description of data collection and analysis, issues with generalizability of the research findings) were common among included studies. Barriers identified included changing health status, personal issues, lack of support, external factors, ongoing smoking, and program-specific barriers. Enablers identified included social support, professional support, personal drivers, personal benefit, control of condition, specific goals, and program-specific enablers. The findings from this review may assist health professionals, patients, care givers and the wider community to develop effective strategies to promote participation in PA and PR among people with COPD.

  18. 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.

  19. 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.

  20. 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 ...

  1. Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level.

    Science.gov (United States)

    O'Connell, Thomas S; Bedford, K Juliet A; Thiede, Michael; McIntyre, Di

    2015-06-09

    A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. To adequately understand access barriers as a

  2. 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.

  3. 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.

  4. Labont? Identifies Key Issues for Health Promoters in the New World Order

    OpenAIRE

    Raphael, Dennis

    2016-01-01

    For over 35 years Ronald Labonté has been critically analyzing the state of health promotion in Canada and the world. In 1981, he identified the shortcomings of the groundbreaking Lalonde Report by warning of the seductive appeal of so-called lifestyle approaches to health. Since then, he has left a trail of critical work identifying the barriers to — and opportunities for —health promotion work. More recently, he has shown how the rise of economic globalization and acceptance of neo-liberal ...

  5. "But I wasn't told to": lack of education and workplace policy as barriers in the provision of family planning information.

    Science.gov (United States)

    Bell, Melissa M

    2015-01-01

    Access to family planning has been identified as critical to public health. Improving the linkage between medical and social services could result in improved access to care for those most at risk of unintended pregnancy. This study used a survey based on Alfred Bandura's social cognitive theory (1986) to increase the understanding of the barriers social workers confront in the provision of family planning information to clients. Although moral disagreement with family planning presented a barrier for some, workplace policy, participation in family planning trainings, and working in an urban setting were of greater value in understanding barriers.

  6. Access to Strong Opioid Analgesics in the Context of Legal and Regulatory Barriers in Eleven Central and Eastern European Countries.

    Science.gov (United States)

    Vranken, Marjolein J M; Mantel-Teeuwisse, Aukje K; Schutjens, Marie-Hélène D B; Scholten, Willem K; Jünger, Saskia; Medic, Dr Rer; Leufkens, Hubert G M

    2018-04-06

    In 2011-2013, >95% of the global opioid analgesics consumption occurred in three regions, accounting for 15% of the world population. Despite abundant literature on barriers to access, little is known on the correlation between actual access to opioid analgesics and barriers to access, including legal and regulatory barriers. This study aimed to evaluate the correlation between access to strong opioid analgesics and barriers to access in national legislation and regulations in 11 central and eastern European countries that participated in the Access to Opioid Medication in Europe (ATOME) project. Two variables were contrasted to assess their correlation: the country level of access to strong opioid analgesics indicated by the Adequacy of Consumption Measure (ACM) and the number of potential legal and regulatory barriers identified by an external review of legislation and regulations. A linear correlation was evaluated using a squared linear correlation coefficient. Evaluation of the correlation between the ACM and the number of potential barriers produces an R 2 value of 0.023 and a correlation plot trend line gradient of -0.075, indicating no correlation between access to strong opioid analgesics and the number of potential barriers in national legislation and regulations in the countries studied. No correlation was found, which indicates that other factors besides potential legal and regulatory barriers play a critical role in withholding prescribers and patients essential pain medication in the studied countries. More research is needed toward better understanding of the complex interplay of factors that determine access to strong opioid analgesics.

  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. Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

    Science.gov (United States)

    AllahBakhshian, Maryam; Alimohammadi, Nasrollah; Taleghani, Fariba; Nik, Ahmadreza Yazdan; Abbasi, Saeed; Gholizadeh, Leila

    The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Suppressing electron turbulence and triggering internal transport barriers with reversed magnetic shear in the National Spherical Torus Experiment

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, J. L. [Lawrence Livermore National Laboratory, Livermore, California 94550 (United States); Bell, R.; Guttenfelder, W.; Hammett, G. W.; Kaye, S. M.; LeBlanc, B.; Mikkelsen, D. R. [Princeton Plasma Physics Laboratory, Princeton University, Princeton, New Jersey 08543 (United States); Candy, J. [General Atomics, San Diego, California 92186 (United States); Smith, D. R. [Department of Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706 (United States); Yuh, H. Y. [Nova Photonics Inc., Princeton, New Jersey 08540 (United States)

    2012-05-15

    The National Spherical Torus Experiment (NSTX) [M. Ono et al., Nucl. Fusion 40, 557 (2000)] can achieve high electron plasma confinement regimes that are super-critically unstable to the electron temperature gradient driven (ETG) instability. These plasmas, dubbed electron internal transport barriers (e-ITBs), occur when the magnetic shear becomes strongly negative. Using the gyrokinetic code GYRO [J. Candy and R. E. Waltz, J. Comput. Phys. 186, 545 (2003)], the first nonlinear ETG simulations of NSTX e-ITB plasmas reinforce this observation. Local simulations identify a strongly upshifted nonlinear critical gradient for thermal transport that depends on magnetic shear. Global simulations show e-ITB formation can occur when the magnetic shear becomes strongly negative. While the ETG-driven thermal flux at the outer edge of the barrier is large enough to be experimentally relevant, the turbulence cannot propagate past the barrier into the plasma interior.

  12. Barriers to women engaging in collective action to overcome sexism.

    Science.gov (United States)

    Radke, Helena R M; Hornsey, Matthew J; Barlow, Fiona Kate

    2016-12-01

    Over centuries women have fought hard to obtain increasing gender equality, but despite these successes absolute equality remains an elusive goal. Theoretically, women's numerical strength makes them well-placed to take effective collective action, and millions of women engage in feminist collective action every day. In this article, however, we argue that women also face barriers to engaging in feminist collective action; barriers that are associated with the social construction and experience of what it means to be a woman. Our review synthesizes sexism research under a contemporary collective action framework to clarify our current understanding of the literature and to offer novel theoretical explanations for why women might be discouraged from engaging in feminist collective action. Using the antecedents of collective action identified by van Zomeren, Postmes, and Spears' (2008) meta-analysis, we critically review the sexism literature to argue that women face challenges when it comes to (a) identifying with other women and feminists, (b) perceiving sexism and expressing group-based anger, and (c) recognizing the efficacy of collective action. We then outline a research agenda with a view to investigating ways of overcoming these barriers. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  13. Evaluation of Erosion Resistance of Advanced Turbine Thermal Barrier Coatings

    Science.gov (United States)

    Zhu, Dongming; Kuczmarski, Maria A.; Miller, Robert A.; Cuy, Michael D.

    2007-01-01

    The erosion resistant turbine thermal barrier coating system is critical to aircraft engine performance and durability. By demonstrating advanced turbine material testing capabilities, we will be able to facilitate the critical turbine coating and subcomponent development and help establish advanced erosion-resistant turbine airfoil thermal barrier coatings design tools. The objective of this work is to determine erosion resistance of advanced thermal barrier coating systems under simulated engine erosion and/or thermal gradient environments, validating advanced turbine airfoil thermal barrier coating systems based on nano-tetragonal phase toughening design approaches.

  14. 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

  15. Modeling approaches for concrete barriers used in low-level waste disposal

    International Nuclear Information System (INIS)

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

    1993-11-01

    A series of three NUREGs and several papers addressing different aspects of modeling performance of concrete barriers for low-level radioactive waste disposal have been prepared previously for the Concrete Barriers Research Project. This document integrates the information from the previous documents into a general summary of models and approaches that can be used in performance assessments of concrete barriers. Models for concrete degradation, flow, and transport through cracked concrete barriers are discussed. The models for flow and transport assume that cracks have occurred and thus should only be used for later times in simulations after fully penetrating cracks are formed. Most of the models have been implemented in a computer code. CEMENT, that was developed concurrently with this document. User documentation for CEMENT is provided separate from this report. To avoid duplication, the reader is referred to the three previous NUREGs for detailed discussions of each of the mathematical models. Some additional information that was not presented in the previous documents is also included. Sections discussing lessons learned from applications to actual performance assessments of low-level waste disposal facilities are provided. Sensitive design parameters are emphasized to identify critical areas of performance for concrete barriers, and potential problems in performance assessments are also identified and discussed

  16. Thinking Critically about Critical Thinking

    Science.gov (United States)

    Mulnix, Jennifer Wilson

    2012-01-01

    As a philosophy professor, one of my central goals is to teach students to think critically. However, one difficulty with determining whether critical thinking can be taught, or even measured, is that there is widespread disagreement over what critical thinking actually is. Here, I reflect on several conceptions of critical thinking, subjecting…

  17. 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

  18. 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.

  19. Challenges confronting female surgical leaders: overcoming the barriers.

    Science.gov (United States)

    Kass, Rena B; Souba, Wiley W; Thorndyke, Luanne E

    2006-05-15

    The number of women reaching top ranks in academic surgery is remarkably low. The purpose of this study was to identify: 1) barriers to becoming a female surgical leader; 2) key attributes that enable advancement and success; and 3) current leadership challenges faced as senior leaders. Semi-structured interviews of ten female surgical leaders queried the following dimensions: attributes for success, lessons learned, mistakes, key career steps, the role of mentoring, gender advantages/disadvantages, and challenges. Perseverance (60%) and drive (50%) were identified as critical success factors, as were good communication skills, a passion for scholarship, a stable home life and a positive outlook. Eighty percent identified discrimination or gender prejudice as a major obstacle in their careers. While 90% percent had mentors, 50% acknowledged that they had not been effectively mentored. Career advice included: develop broad career goals (50%); select a conducive environment (30%); find a mentor (60%); take personal responsibility (40%); organize time and achieve balance (40%); network (30%); create a niche (30%); pursue research (30%); publish (50%); speak in public (30%); and enjoy the process (30%). Being in a minority, being highly visible and being collaborative were identified as advantages. Obtaining buy-in and achieving consensus was the greatest leadership challenge reported. Female academic surgeons face challenges to career advancement. While these barriers are real, they can be overcome by resolve, commitment, and developing strong communication skills. These elements should be taken into consideration in designing career development programs for junior female surgical faculty.

  20. 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

  1. 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

  2. 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....

  3. 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....

  4. Oscillatory shear response of moisture barrier coatings containing clay of different shape factor.

    Science.gov (United States)

    Kugge, C; Vanderhoek, N; Bousfield, D W

    2011-06-01

    Oscillatory shear rheology of barrier coatings based on dispersed styrene-butadiene latex and clay of various shape factors or aspect ratio has been explored. Barrier performance of these coatings when applied to paperboard has been assessed in terms of water vapour transmission rates and the results related to shape factor, dewatering and critical strain. It has been shown that a system based on clay with high shape factor gives a lower critical strain, dewatering and water vapour transmission rate compared with clays of lower shape factor. The dissipated energy, as calculated from an amplitude sweep, indicated no attractive interaction between clay and latex implying a critical strain that appears to be solely dependent on the shape factor at a constant volume fraction. Particle size distribution was shown to have no effect on the critical strain while coatings of high elasticity exhibited high yield strains as expected. The loss modulus demonstrated strain hardening before the elastic to viscous transition. The loss modulus peak was identified by a maximum strain which was significantly lower for a coating based on clay with a high shape factor. The characteristic elastic time was found to vary between 0.6 and 1.3s. The zero shear viscosity of barrier dispersion coatings were estimated from the characteristic elastic time and the characteristic modulus to be of the order of 25-100 Pa s. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. 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.

  6. Differential Rollover Risk in Vehicle-to-Traffic Barrier Collisions

    Science.gov (United States)

    Gabauer, Douglas J.; Gabler, Hampton C.

    2009-01-01

    In the roadside safety community, there has been debate over the influence of vehicle and barrier type on rollover rates in traffic barrier crashes. This study investigated rollover rates between sport utility vehicles (SUVs), pickup trucks, and cars in vehicle-traffic barrier crashes and has examined the effect of barrier type on rollover risk for concrete barrier and metal barrier impacts. The analysis included 955 barrier impact cases that were selected from 11-years of in-depth crash data available through the National Automotive Sampling System (NASS) / Crashworthiness Data System (CDS). In real world tow-away level longitudinal barrier collisions, the most important predictors of vehicle rollover were found to be vehicle type and whether the vehicle was tracking prior to barrier impact. Based on binary logistic regression, SUVs were found to have 8 times the risk of rollover as cars in barrier impacts. Although pickups were found to have an increased risk of rollover compared to cars, the risk was not as pronounced as that found for SUVs. This finding has direct implications for the full scale crash testing of longitudinal barriers as the testing procedures have been predicated on the assumption that the pickup truck provides a critical or worst case impact scenario. In towaway crashes, our study does not support the notion that concrete barriers have a higher risk of vehicle rollover than metal beam barriers. PMID:20184839

  7. 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,…

  8. 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

  9. 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…

  10. 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...

  11. T3 may be a better agent than T4 in the critically ill hypothyroid patient: evaluation of transport across the blood-brain barrier in a primate model

    International Nuclear Information System (INIS)

    Chernow, B.; Burman, K.D.; Johnson, D.L.; McGuire, R.A.; O'Brian, J.T.; Wartofsky, L.; Georges, L.P.

    1983-01-01

    Thyroid hormone transport across the blood brain barrier in hypothyroid patients is clinically important yet poorly understood. To study this question, 200 micrograms of thyroxine (T4), 100 micrograms of 3,5,3'-triiodothyronine (T3) and 100 micrograms of 3,3',5'-triiodothyronine (reverse T3) were administered separately to 3 baboons, first iv and at a later date intrathecally (IT). Six animals were used. Three received the iv injections and three received the IT injections. In each of the 18 experiments, cerebrospinal fluid (CSF) and serum specimens were collected serially for 6 h after injection. Mean maximal elevations from baseline in CSF iodothyronine levels were 100 +/- 10 ng/dl after iv T4, 3921 +/- 293 ng/dl after iv T3 and 31 +/- 17 ng/dl after iv reverse T3. When given IT in the same dosages, the mean maximal increases in serum iodothyronine concentrations were: 1670 +/- 600 ng/dl for T4, 806 +/- 405 ng/dl for T3, and 210 +/- 43 ng/dl for reverse T3. In every animal studied, rapid bidirectional transfer of T3 from serum to CSF and CSF to serum occurred, whereas iv T4 resulted in delayed minimal increments in CSF T4 concentration. Isotopic experiments were also performed and the results analyzed using a kinetic model. When 125 I-T3 was given iv, the equilibrium point in CSF was observed within 90 min with 1.7% of the administered dose/L able to be counted in CSF at any moment in time. When labeled T4 was given iv, only 0.6% of the administered dose/L was counted in CSF and the equilibrium point was not reached until 360 min. These data suggest: T4, T3, and reverse T3 are all capable of bidirectional transfer across the blood brain barrier, T3 may be a better agent than T4 in treating patients with myxedema coma because T3 crosses more rapidly and more completely from serum to CSF

  12. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  13. Implementing system-wide risk stratification approaches: A review of critical success and failure factors.

    Science.gov (United States)

    Huckel Schneider, Carmen; Gillespie, James A; Wilson, Andrew

    2017-05-01

    Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.

  14. 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.

  15. Aluminium oxide barrier films on polymeric web and their conversion for packaging applications

    OpenAIRE

    Struller, CF; Kelly, PJ; Copeland, NJ; Tobin, V; Assender, HE; Holliday, CW; Read, SJ

    2013-01-01

    In recent years, inorganic transparent barrier layers such as aluminium oxide or silicon oxide deposited onto polymer films have emerged as an attractive alternative to polymer based transparent barrier layers for flexible food packaging materials. For this application, barrier properties against water vapour and oxygen are critical. Aluminium oxide coatings can provide good barrier levels at thicknesses in the nanometre range, compared to several micrometres for polymer-based barrier layers....

  16. Double-barrier junction based dc SQUID

    NARCIS (Netherlands)

    Bartolomé, M.E.; Brinkman, Alexander; Flokstra, Jakob; Golubov, Alexandre Avraamovitch; Rogalla, Horst

    2000-01-01

    dc SQUIDs based on double-barrier Nb/Al/AlOx/Al/AlOx/Al/Nb junctions (DBSQs) have been fabricated and tested for the first time. The current–voltage curves have been measured at temperatures down to 1.4 K. The critical current, Ic, dependence on the temperature T is partially described by the

  17. The Status of Industrial Ecology in Australia: Barriers and Enablers

    Directory of Open Access Journals (Sweden)

    Glen D. Corder

    2014-03-01

    Full Text Available Drawing on current international industrial ecology thinking and experiences with Australian initiatives, this article critically overviews the current status of industrial ecology in Australia and examines the barriers and potential strategies to realise greater uptake and application of the concept. The analysis is conducted across three categories: heavy industrial areas (including Kwinana and Gladstone, mixed industrial parks (Wagga Wagga and Port Melbourne, and waste exchange networks, and identifies the past and future significance of seven different types of barriers—regulation, information, community, economic, technical, cooperation and trust, commitment to sustainable development—for each of the three categories. The outcomes from this analysis highlight that regulation, information, and economic barriers for heavy industrial area and mixed industrial parks, and economic and technical barriers for waste exchange networks are the current and future focus for industrial ecology applications in Australia. These findings appear to be consistent with recently published frameworks and learnings. The authors propose key questions that could enhance greater adoption of industrial ecology applications in Australia and acknowledge that international research and experiences, while partly providing answers to these questions, need to be adapted and refined for the Australian context.

  18. Barriers to and drivers for UK bioenergy development

    Energy Technology Data Exchange (ETDEWEB)

    Adams, P.W.; Mezzullo, W.G. [Department of Mechanical Engineering, Faculty of Engineering and Design, University of Bath, Claverton Down, Bath BA2 7AY (United Kingdom); Hammond, G.P.; McManus, M.C. [Department of Mechanical Engineering, Faculty of Engineering and Design, University of Bath, Claverton Down, Bath BA2 7AY (United Kingdom); Institute for Sustainable Energy and Environment (I.SEE), University of Bath, Claverton Down, Bath BA2 7AY (United Kingdom)

    2011-02-15

    Barriers to UK bioenergy development arise from a number of technical, financial, social and other constraints. Likewise, the drivers for using bioenergy are numerous and diverse. A range of these barriers and drivers have been identified through a comprehensive literature and case study review, and then assessed through an online questionnaire, completed by stakeholders from across the UK bioenergy industry: farmers/suppliers, developers/owners of bioenergy projects, primary end-users, and government/policy stakeholders. The results are presented in the form of 'spider web' diagrams. The most critical barriers and drivers relate to economic factors of bioenergy projects. Farmers/suppliers and developers are influenced by production costs and benefits, whilst primary end-users of bioenergy are concerned mainly with the cost of purchasing energy resources. Common drivers for all stakeholders were found to be reducing carbon emissions and the dependency on fossil fuels. In order to satisfy the needs of stakeholders schemes must be both economically attractive and environmentally sustainable for projects to be successful. (author)

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. A novel approach for barriers to industrial energy efficiency

    NARCIS (Netherlands)

    Cagno, E.; Worrell, E.; Trianni, A.; Pugliese, G.

    2013-01-01

    A critical review of the literature highlighted the need for a new taxonomy encompassing the most relevant barriers stemmed from previous studies, and accounting for interactions and independences of the barriers to avoid overlaps and implicit interactions. Based on an extensive literature review

  4. Physiology and immunology of mucosal barriers in catfish (Ictalurus spp.)

    Science.gov (United States)

    The mucosal barriers of catfish (Ictalurus spp.) constitute the first line of defense against pathogen invasion while simultaneously carrying out a diverse array of other critical physiological processes, including nutrient adsorption, osmoregulation, waste excretion, and environmental sensing. Catf...

  5. 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

  6. How Critical Is Critical Thinking?

    Science.gov (United States)

    Shaw, Ryan D.

    2014-01-01

    Recent educational discourse is full of references to the value of critical thinking as a 21st-century skill. In music education, critical thinking has been discussed in relation to problem solving and music listening, and some researchers suggest that training in critical thinking can improve students' responses to music. But what exactly is…

  7. 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

  8. 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.

  9. 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.

  10. 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…

  11. 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

  12. 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.

  13. Health Sector Coordination in Disasters: Barriers & Facilitators

    Directory of Open Access Journals (Sweden)

    Mohammadkarim Bahadori

    2016-07-01

    Full Text Available Background: Coordination is a critical factor in successful organization and appropriate response to disasters. In this regard, a centralized coordination mechanism is the first step towards an effective, efficient, and sustainable response in order to be ensured of the short- and long-term recovery. Thus, this study aimed to identify and prioritize the barriers and facilitators of coordination in disasters. Materials and Methods: This research was a descriptive and cross-sectional study, conducted in 2016. The participants comprised 22 experts in field of disaster. Data collection tool was a researcher-made questionnaire according to the analytical hierarchy process approach. For data analysis, we used Expert Choice software. Results: Based on the results, “dominance of organizational approach instead of national points of view when addressing the health management during disasters,” took the first priority rank, earning the score of 0.344 among the barriers. Furthermore, among the facilitators, “having a processive and organizational view in health management during disasters,” took the first priority rank, earning the score of 0.374. Conclusion: To increase the effective coordination in health area, we should develop infrastructure and structural measures, which include bolstering authorities’ belief about the health system’s role in the response to disasters, reinforcing the national approach rather than organizational approach in the field of health at disasters, implementing the coordination requirements, attending sufficiently and specifically to public participation, reducing the organizational friction in the health field for sharing resources and information, raising the level of readiness with a focus on people and training programs, and finally creating an evolutionary process in the health field at disasters.

  14. Impaired Skin Barrier Due to Sebaceous Gland Atrophy in the Latent Stage of Radiation-Induced Skin Injury: Application of Non-Invasive Diagnostic Methods

    Directory of Open Access Journals (Sweden)

    Hyosun Jang

    2018-01-01

    Full Text Available Radiation-induced skin injury can take the form of serious cutaneous damage and have specific characteristics. Asymptomatic periods are classified as the latent stage. The skin barrier plays a critical role in the modulation of skin permeability and hydration and protects the body against a harsh external environment. However, an analysis on skin barrier dysfunction against radiation exposure in the latent stage has not been conducted. Thus, we investigated whether the skin barrier is impaired by irradiation in the latent stage and aimed to identify the molecules involved in skin barrier dysfunction. We analyzed skin barrier function and its components in SKH1 mice that received 20 and 40 Gy local irradiation. Increased transepidermal water loss and skin pH were observed in the latent stage of the irradiated skin. Skin barrier components, such as structural proteins and lipid synthesis enzymes in keratinocyte, increased in the irradiated group. Interestingly, we noted sebaceous gland atrophy and increased serine protease and inflammatory cytokines in the irradiated skin during the latent period. This finding indicates that the main factor of skin barrier dysfunction in the latent stage of radiation-induced skin injury is sebaceous gland deficiency, which could be an intervention target for skin barrier impairment.

  15. Critical Jostling

    Directory of Open Access Journals (Sweden)

    Pippin Barr

    2016-11-01

    Full Text Available Games can serve a critical function in many different ways, from serious games about real world subjects to self-reflexive commentaries on the nature of games themselves. In this essay we discuss critical possibilities stemming from the area of critical design, and more specifically Carl DiSalvo’s adversarial design and its concept of reconfiguring the remainder. To illustrate such an approach, we present the design and outcomes of two games, Jostle Bastard and Jostle Parent. We show how the games specifically engage with two previous games, Hotline Miami and Octodad: Dadliest Catch, reconfiguring elements of those games to create interactive critical experiences and extensions of the source material. Through the presentation of specific design concerns and decisions, we provide a grounded illustration of a particular critical function of videogames and hope to highlight this form as another valuable approach in the larger area of videogame criticism.

  16. Imaging blood-brain barrier dysfunction as a biomarker for epileptogenesis.

    Science.gov (United States)

    Bar-Klein, Guy; Lublinsky, Svetlana; Kamintsky, Lyn; Noyman, Iris; Veksler, Ronel; Dalipaj, Hotjensa; Senatorov, Vladimir V; Swissa, Evyatar; Rosenbach, Dror; Elazary, Netta; Milikovsky, Dan Z; Milk, Nadav; Kassirer, Michael; Rosman, Yossi; Serlin, Yonatan; Eisenkraft, Arik; Chassidim, Yoash; Parmet, Yisrael; Kaufer, Daniela; Friedman, Alon

    2017-06-01

    A biomarker that will enable the identification of patients at high-risk for developing post-injury epilepsy is critically required. Microvascular pathology and related blood-brain barrier dysfunction and neuroinflammation were shown to be associated with epileptogenesis after injury. Here we used prospective, longitudinal magnetic resonance imaging to quantitatively follow blood-brain barrier pathology in rats following status epilepticus, late electrocorticography to identify epileptic animals and post-mortem immunohistochemistry to confirm blood-brain barrier dysfunction and neuroinflammation. Finally, to test the pharmacodynamic relevance of the proposed biomarker, two anti-epileptogenic interventions were used; isoflurane anaesthesia and losartan. Our results show that early blood-brain barrier pathology in the piriform network is a sensitive and specific predictor (area under the curve of 0.96, P brain barrier pathology as a clinically relevant predictive, diagnostic and pharmaco!dynamics biomarker for acquired epilepsy. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Barriers to implementing evidence-based clinical guidelines: A survey of early adopters

    Science.gov (United States)

    Spallek, Heiko; Song, Mei; Polk, Deborah E; Bekhuis, Tanja; Frantsve-Hawley, Julie; Aravamudhan, Krishna

    2010-01-01

    Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed. PMID:21093800

  18. 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.

  19. Critical Proximity

    OpenAIRE

    Simon, Jane

    2010-01-01

    This essay considers how written language frames visual objects. Drawing on Michel Foucault’s response to Raymond Roussel’s obsessive description, the essay proposes a model of criticism where description might press up against its objects. This critical closeness is then mapped across the conceptual art practice and art criticism of Ian Burn. Burn attends to the differences between seeing and reading, and considers the conditions which frame how we look at images, including how w...

  20. 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.

  1. Criticality Model

    International Nuclear Information System (INIS)

    Alsaed, A.

    2004-01-01

    The ''Disposal Criticality Analysis Methodology Topical Report'' (YMP 2003) presents the methodology for evaluating potential criticality situations in the monitored geologic repository. As stated in the referenced Topical Report, the detailed methodology for performing the disposal criticality analyses will be documented in model reports. Many of the models developed in support of the Topical Report differ from the definition of models as given in the Office of Civilian Radioactive Waste Management procedure AP-SIII.10Q, ''Models'', in that they are procedural, rather than mathematical. These model reports document the detailed methodology necessary to implement the approach presented in the Disposal Criticality Analysis Methodology Topical Report and provide calculations utilizing the methodology. Thus, the governing procedure for this type of report is AP-3.12Q, ''Design Calculations and Analyses''. The ''Criticality Model'' is of this latter type, providing a process evaluating the criticality potential of in-package and external configurations. The purpose of this analysis is to layout the process for calculating the criticality potential for various in-package and external configurations and to calculate lower-bound tolerance limit (LBTL) values and determine range of applicability (ROA) parameters. The LBTL calculations and the ROA determinations are performed using selected benchmark experiments that are applicable to various waste forms and various in-package and external configurations. The waste forms considered in this calculation are pressurized water reactor (PWR), boiling water reactor (BWR), Fast Flux Test Facility (FFTF), Training Research Isotope General Atomic (TRIGA), Enrico Fermi, Shippingport pressurized water reactor, Shippingport light water breeder reactor (LWBR), N-Reactor, Melt and Dilute, and Fort Saint Vrain Reactor spent nuclear fuel (SNF). The scope of this analysis is to document the criticality computational method. The criticality

  2. 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...

  3. 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...

  4. Barriers to teaching ocean science in Greek schools

    Science.gov (United States)

    Papathanassiou, Martha; McHugh, Patricia; Domegan, Christine; Gotensparre, Susan; Fauville, Geraldine; Parr, Jon

    2017-04-01

    Most European citizens are not aware of the full extent of the medical, economic, social, political and environmental importance of the sea to Europe and beyond. Most citizens are not aware of how our day-to-day actions can have a cumulative effect on the health of the ocean - a necessary resource that must be protected for all life on the planet Earth to exist. In other words, European citizens lack a sense of "Ocean Literacy" - an understanding of the ocean's influence on us and our influence on the ocean. Sea Change, a 3.5 million EU-funded project started in March 2015, is designed to bring about a fundamental 'Sea Change' in the way European citizens view their relationship with the sea, by empowering them as 'Ocean Literate' citizens - to take direct and sustainable action towards healthy seas and ocean, healthy communities and ultimately, a healthy planet. The project involves 17 partners from nine countries across Europe and will bring about real actions using behavior change and social engagement methodologies. Building upon the latest research on citizen and stakeholder attitudes, perceptions and values, the Sea Change partnership will design and implement mobilisation activities focused on education, community, government agencies, policy makers and citizens. Eight consultations were held around Europe with regards to barriers to teaching ocean science at schools. All project partners used a Collective Intelligence (CI) methodology to involve target group(s) in active, direct participation for Sea Change. CI is a "barriers and value" structuring methodology, a process of critical learning and reflection followed by action, and then by more critical learning to enable mobilisation, design and development 'with' people rather than on their behalf. In Greece, the consultation was carried out by HCMR, the lead partner for Greece. Participants were recruited through personal contact and existing education networks that the HCMR has previously worked with. In

  5. The Barrier code for predicting long-term concrete performance

    International Nuclear Information System (INIS)

    Shuman, R.; Rogers, V.C.; Shaw, R.A.

    1989-01-01

    There are numerous features incorporated into a LLW disposal facility that deal directly with critical safety objectives required by the NRC in 10 CFR 61. Engineered barriers or structures incorporating concrete are commonly being considered for waste disposal facilities. The Barrier computer code calculates the long-term degradation of concrete structures in LLW disposal facilities. It couples this degradation with water infiltration into the facility, nuclide leaching from the waste, contaminated water release from the facility, and associated doses to members of the critical population group. The concrete degradation methodology of Barrier is described

  6. 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...

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

    Science.gov (United States)

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

    2015-01-01

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

  8. The youth form of the Motivators of and Barriers to Health-Smart Behaviors Inventory.

    Science.gov (United States)

    Tucker, Carolyn M; Rice, Kenneth G; Desmond, Frederic F; Hou, Wei; Kaye, Lillian B; Smith, Tasia M

    2012-06-01

    To develop a youth form of the Motivators of and Barriers to Health-Smart Behaviors Inventory (MB-HSBI-Youth) for use in identifying self-reported motivators of and barriers to the following health-promoting behaviors (called health-smart behaviors): eating a healthy breakfast, eating healthy foods and snacks, drinking healthy drinks, and engaging in physical activity. The MB-HSBI-Youth was developed through several research phases as part of a larger, multisite, and multicomponent study on modifying and preventing obesity in families. A critical aspect of the larger study was to identify the motivators of and barriers to the above-identified health-smart behaviors among African American, Asian American, Hispanic/Latino American, and non-Hispanic White American adults and youth. After preliminary research involving content validity, item analyses, and pilot testing, a pilot version of the MB-HSBI-Youth was administered to a national sample of 567 culturally diverse youth ranging from 9 to 17 years old. Factor analyses and internal consistency results revealed the existence of multiple subscales measuring motivators of and barriers to each of the above-specified health-smart behaviors. Scores on the MB-HSBI-Youth correlated in expected directions with health self-efficacy scores and with ratings of the importance of health-related behavioral goals. The MB-HSBI-Youth may be a useful and novel tool for developing assessment-based, culturally sensitive health promotion programs customized to be responsive to the motivators of and barriers to health-smart behaviors identified in target communities, particularly those communities whose members are mostly racial/ethnic minorities. (c) 2012 APA, all rights reserved

  9. Migration mechanisms and diffusion barriers of vacancies in Ga2O3

    Science.gov (United States)

    Kyrtsos, Alexandros; Matsubara, Masahiko; Bellotti, Enrico

    2017-06-01

    We employ the nudged elastic band and the dimer methods within the standard density functional theory (DFT) formalism to study the migration of the oxygen and gallium vacancies in the monoclinic structure of β -Ga2O3 . We identify all the first nearest neighbor paths and calculate the migration barriers for the diffusion of the oxygen and gallium vacancies. We also identify the metastable sites of the gallium vacancies which are critical for the diffusion of the gallium atoms. The migration barriers for the diffusion of the gallium vacancies are lower than the migration barriers for oxygen vacancies by 1 eV on average, suggesting that the gallium vacancies are mobile at lower temperatures. Using the calculated migration barriers we estimate the annealing temperature of these defects within the harmonic transition state theory formalism, finding excellent agreement with the observed experimental annealing temperatures. Finally, we suggest the existence of percolation paths which enable the migration of the species without utilizing all the migration paths of the crystal.

  10. 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…

  11. [Construction and validation of a short scale of perception of barriers for the physical activity in adolescents].

    Science.gov (United States)

    Cabanas-Sánchez, Verónica; Tejero-González, Carlos M; Veiga, Oscar L

    2012-01-01

    One of the main problems of health in the first world is the increase of physical inactivity. In this respect, adolescence has been identified as a critic period with high decline of physical activity. Therefore, a relevant line of research is the understanding of this social phenomenon. The aim of this study was to design a scale to assess perceived barriers to physical activity on adolescents. A convenience sample of 160 Spanish adolescents (84 girls), between 12 and 18 years old, was recruited for this study. Firstly, there were designed 40 items whose pertinence was evaluated through content validation by experts. Later, the participants were divided in two randomized groups, and Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to define a short scale of 12 items. Cronbach Alfa Coefficent was used to evaluate internal consistence of the instrument. The scale reports four dimensions: incompatibility barriers (2 items), self-concept barriers (4 items), amotivation barriers (4 items) and social barriers (2 items). The scale showed enough construct validity (χ2=60.78; d.f.=48; p=0.100; GFI=0.88; CFI=0.94; RMSEA=0.58) and high internal reliability (α=0.80). Moreover, the scale was able to explain 67% of the data variance. The Short Scale of Perceived Barriers to Physical Activity in Adolescents is a valid and reliable instrument.

  12. Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

    Science.gov (United States)

    Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

    2015-10-01

    Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR system is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive

  13. Nuclear criticality predictability

    International Nuclear Information System (INIS)

    Briggs, J.B.

    1999-01-01

    As a result of lots of efforts, a large portion of the tedious and redundant research and processing of critical experiment data has been eliminated. The necessary step in criticality safety analyses of validating computer codes with benchmark critical data is greatly streamlined, and valuable criticality safety experimental data is preserved. Criticality safety personnel in 31 different countries are now using the 'International Handbook of Evaluated Criticality Safety Benchmark Experiments'. Much has been accomplished by the work of the ICSBEP. However, evaluation and documentation represents only one element of a successful Nuclear Criticality Safety Predictability Program and this element only exists as a separate entity, because this work was not completed in conjunction with the experimentation process. I believe; however, that the work of the ICSBEP has also served to unify the other elements of nuclear criticality predictability. All elements are interrelated, but for a time it seemed that communications between these elements was not adequate. The ICSBEP has highlighted gaps in data, has retrieved lost data, has helped to identify errors in cross section processing codes, and has helped bring the international criticality safety community together in a common cause as true friends and colleagues. It has been a privilege to associate with those who work so diligently to make the project a success. (J.P.N.)

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

    Directory of Open Access Journals (Sweden)

    Natasha Kuruppu

    2015-03-01

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

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

    Science.gov (United States)

    Kuruppu, N.; Willie, R.

    2015-12-01

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

  16. 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

  17. 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...

  18. Using Proteomics to 1) Identify the Bone Marrow Homing Receptors Expressed on Human Hematopoietic Stem Cells and 2) Elucidate Critical Signaling Pathways Responsible for the Blockage of Hematopoietic Differentiation in Leukemia

    KAUST Repository

    Chin, Chee J.

    2011-05-22

    Successful hematopoiesis requires the trafficking of hematopoietic stem/progenitor cells (HSPCs) to their bone marrow (BM) niche, where they can differentiate to produce all blood lineages. Leukemia arises when there is a blockage of differentiation and uncontrolled proliferation in the hematopoietic cells during their development. To refine therapies for leukemia, this study sought to improve the homing of healthy donor HSPCs for better transplantation and to find new candidates for differentiating and blocking proliferation in leukemic cells. Characterizing the molecular effectors mediating cell migration forms the basis for improving clinical transplantation of HSPCs. E-selectin/ligand interactions play a critical role in the homing of HSPCs to the BM, however, the identity of E-selectin ligands remains elusive. We aimed to use mass spectrometry (MS) to fully analyze the E-selectin ligands expressed on HSPCs. Immunoprecipitation studies coupled with MS confirmed the expression of three known E-selectin ligands, the hematopoietic cell E-/L-selectin ligand (HCELL), P-selectin glycoprotein ligand-1 (PSGL-1) and CD43, and revealed the presence of many interesting candidates on HSPCs-like cell line and on primary human BM CD34+ cells. The MS dataset represents a rich resource for further characterization of E-selectin ligands, which will lead to improvement of HSPCs transplantation. 4 Understanding the critical pathways underlying the initiation and maintenance of leukemia plays a key role in treating acute myeloid leukemia (AML). Ligation of the glycoprotein, CD44, using monoclonal antibodies or its natural ligand, hyaluronic acid, drives the differentiation of immature leukemic cells towards mature terminally differentiated cells, inhibits their proliferation and in some case induces their apoptosis. The aim of this study is to characterize the phosphoproteome of AML cells in response to CD44-induced differentiation. This will afford novel insights into the

  19. 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

  20. Nuclear criticality safety: 2-day training course

    Energy Technology Data Exchange (ETDEWEB)

    Schlesser, J.A. [ed.] [comp.

    1997-02-01

    This compilation of notes is presented as a source reference for the criticality safety course. At the completion of this training course, the attendee will: be able to define terms commonly used in nuclear criticality safety; be able to appreciate the fundamentals of nuclear criticality safety; be able to identify factors which affect nuclear criticality safety; be able to identify examples of criticality controls as used as Los Alamos; be able to identify examples of circumstances present during criticality accidents; have participated in conducting two critical experiments; be asked to complete a critique of the nuclear criticality safety training course.

  1. Nuclear criticality safety: 2-day training course

    International Nuclear Information System (INIS)

    Schlesser, J.A.

    1997-02-01

    This compilation of notes is presented as a source reference for the criticality safety course. At the completion of this training course, the attendee will: be able to define terms commonly used in nuclear criticality safety; be able to appreciate the fundamentals of nuclear criticality safety; be able to identify factors which affect nuclear criticality safety; be able to identify examples of criticality controls as used as Los Alamos; be able to identify examples of circumstances present during criticality accidents; have participated in conducting two critical experiments; be asked to complete a critique of the nuclear criticality safety training course

  2. Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review.

    Science.gov (United States)

    Al-Ghareeb, Amal Z; Cooper, Simon J

    2016-01-01

    This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education. In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education. An integrative review adapted a systematic approach. Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied. The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education. Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted. Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator." Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Critical Arts

    African Journals Online (AJOL)

    both formal and informal) in culture and social theory. CRITICAL ARTS aims to challenge and ... Book Review: Brian McNair, An Introduction to Political Communication (3rd edition), London: Routledge, 2003, ISBN 0415307082, 272pp. Phil Joffe ...

  4. Critical Proximity

    Directory of Open Access Journals (Sweden)

    Jane Simon

    2010-09-01

    Full Text Available This essay considers how written language frames visual objects. Drawing on Michel Foucault’s response to Raymond Roussel’s obsessive description, the essay proposes a model of criticism where description might press up against its objects. This critical closeness is then mapped across the conceptual art practice and art criticism of Ian Burn. Burn attends to the differences between seeing and reading, and considers the conditions which frame how we look at images, including how we look at, and through words. The essay goes on to consider Meaghan Morris’s writing on Lynn Silverman’s photographs. Both Morris and Burn offer an alternative to a parasitic model of criticism and enact a patient way of looking across and through visual landscapes.

  5. Critical proximity

    Directory of Open Access Journals (Sweden)

    Simon, Jane

    2010-01-01

    Full Text Available This essay considers how written language frames visual objects. Drawing on Michel Foucault’s response to Raymond Roussel’s obsessive description, the essay proposes a model of criticism where description might press up against its objects. This critical closeness is then mapped across the conceptual art practice and art criticism of Ian Burn. Burn attends to the differences between seeing and reading, and considers the conditions which frame how we look at images, including how we look at, and through words. The essay goes on to consider Meaghan Morris’s writing on Lynn Silverman’s photographs. Both Morris and Burn offer an alternative to a parasitic model of criticism and enact a patient way of looking across and through visual landscapes.

  6. Herbal medicines that benefit epidermal permeability barrier function

    Directory of Open Access Journals (Sweden)

    Lizhi Hu

    2015-06-01

    Full Text Available Epidermal permeability barrier function plays a critical role in regulating cutaneous functions. Hence, researchers have been searching for effective and affordable regimens to enhance epidermal permeability barrier function. In addition to topical stratum corneum lipids, peroxisome proliferator-activated receptor, and liver X receptor ligands, herbal medicines have been proven to benefit epidermal permeability barrier function in both normal and diseased skin, including atopic dermatitis, glucocorticoid-induced skin damage, and UVB-damaged skin. The potential mechanisms by which herbal medicines improve the permeability barrier include stimulation of epidermal differentiation, lipid production, antimicrobial peptide expression, and antioxidation. Therefore, utilization of herbal medicines could be a valuable alternative approach to enhance epidermal permeability barrier function in order to prevent and/or treat skin disorders associated with permeability barrier abnormalities.

  7. Criticality safety

    International Nuclear Information System (INIS)

    Walker, G.

    1983-01-01

    When a sufficient quantity of fissile material is brought together a self-sustaining neutron chain reaction will be started in it and will continue until some change occurs in the fissile material to stop the chain reaction. The quantity of fissile material required is the 'Critical Mass'. This is not a fixed quantity even for a given type of fissile material but varies between quite wide limits depending on a number of factors. In a nuclear reactor the critical mass of fissile material is assembled under well-defined condition to produce a controllable chain reaction. The same materials have to be handled outside the reactor in all stages of fuel element manufacture, storage, transport and irradiated fuel reprocessing. At any stage it is possible (at least in principle) to assemble a critical mass and thus initiate an accidental and uncontrollable chain reaction. Avoiding this is what criticality safety is all about. A system is just critical when the rate of production of neutrons balances the rate of loss either by escape or by absorption. The factors affecting criticality are, therefore, those which effect neutron production and loss. The principal ones are:- type of nuclide and enrichment (or isotopic composition), moderation, reflection, concentration (density), shape and interaction. Each factor is considered in detail. (author)

  8. 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.

  9. 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...

  10. 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

  11. 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)

  12. 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)

  13. 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.

  14. Using the 'Social Marketing Mix Framework' to explore recruitment barriers and facilitators in palliative care randomised controlled trials? A narrative synthesis review.

    Science.gov (United States)

    Dunleavy, Lesley; Walshe, Catherine; Oriani, Anna; Preston, Nancy

    2018-05-01

    Effective recruitment to randomised controlled trials is critically important for a robust, trustworthy evidence base in palliative care. Many trials fail to achieve recruitment targets, but the reasons for this are poorly understood. Understanding barriers and facilitators is a critical step in designing optimal recruitment strategies. To identify, explore and synthesise knowledge about recruitment barriers and facilitators in palliative care trials using the '6 Ps' of the 'Social Marketing Mix Framework'. A systematic review with narrative synthesis. Medline, CINAHL, PsycINFO and Embase databases (from January 1990 to early October 2016) were searched. Papers included the following: interventional and qualitative studies addressing recruitment, palliative care randomised controlled trial papers or reports containing narrative observations about the barriers, facilitators or strategies to increase recruitment. A total of 48 papers met the inclusion criteria. Uninterested participants (Product), burden of illness (Price) and 'identifying eligible participants' were barriers. Careful messaging and the use of scripts/role play (Promotion) were recommended. The need for intensive resources and gatekeeping by professionals were barriers while having research staff on-site and lead clinician support (Working with Partners) was advocated. Most evidence is based on researchers' own reports of experiences of recruiting to trials rather than independent evaluation. The 'Social Marketing Mix Framework' can help guide researchers when planning and implementing their recruitment strategy but suggested strategies need to be tested within embedded clinical trials. The findings of this review are applicable to all palliative care research and not just randomised controlled trials.

  15. 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...

  16. Sub-barrier fusion: An experimental review

    International Nuclear Information System (INIS)

    Betts, R.R.

    1991-01-01

    This paper contains a review of the current status of the experimental study of heavy-ion fusion at sub-barrier energies. Emphasis is placed on the comparison of the experimentally observed quantities with theoretical expectations. Results of measurements of the spin distributions of the composite systems formed following fusion are critically examined with a view to understanding the large discrepancies between theory and experiment which exist for some systems. 20 refs., 14 figs

  17. Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators.

    Science.gov (United States)

    Manspeaker, Sarah; Van Lunen, Bonnie

    2011-01-01

    The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making. To evaluate athletic training educators' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers. Qualitative interviews of emergent design with grounded theory. Undergraduate CAATE-accredited athletic training education programs. Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06. Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness. Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective. Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions' clinical practices and educational standards. Because today's students are tomorrow's clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our

  18. 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

  19. 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...

  20. Critical Vidders

    DEFF Research Database (Denmark)

    Svegaard, Robin Sebastian Kaszmarczyk

    2015-01-01

    This article will introduce and take a look at a specific subset of the fan created remix videos known as vids, namely those that deal with feminist based critique of media. Through examples, it will show how fans construct and present their critique, and finally broach the topic of the critical ...

  1. Nuclear criticality safety: 2-day training course

    International Nuclear Information System (INIS)

    Schlesser, J.A.

    1992-11-01

    This compilation of notes is presented as a source reference for the criticality safety course. At the completion of this training course, the attendee will: (1) be able to define terms commonly used in nuclear criticality safety; (2) be able to appreciate the fundamentals of nuclear criticality safety; (3) be able to identify factors which affect nuclear criticality safety; (4) be able to identify examples of criticality controls as used at Los Alamos; (5) be able to identify examples of circumstances present during criticality accidents; (6) have participated in conducting two critical experiments

  2. Small Business Programs: Benefits, Barriers, Bridges and Critical Success Factors

    Science.gov (United States)

    2009-05-01

    Decreased product development time cycles • Product, process and technology innovation • Joint marketing and advertising • Access to new markets or...Increased Joint Marketing and Advertising Yuva (2005) Increased Penetration into New Markets Yuva (2005); Terrill (2007) Improved Forecasting and Response

  3. Organic food consumption in Poland: Motives and barriers.

    Science.gov (United States)

    Bryła, Paweł

    2016-10-01

    This paper aims to investigate selected aspects of organic food consumption in Poland. We conducted a survey in a representative sample of 1000 consumers. Polish consumers are convinced that organic food is more expensive, healthier, more environmentally friendly, more tasty and more authentic than conventional food. They believe its arouses more trust, has a better quality, is subject to more strict controls, and is produced in a more traditional way. According to Polish consumers, the most important characteristics of organic food are healthiness and high quality. The perceived authenticity of organic food depends on its natural taste, product quality, labelling, in particular having a European quality sign, as well as the retailer type and a separate exposition place in the points of purchase (merchandising). The critical barrier to the development of the organic food market in Poland is the high price, followed by an insufficient consumer awareness, low availability of organic products, short expiry dates and low visibility in the shop. The principal motives of organic food selection in Poland include: healthiness, ecological character of the product, food safety considerations, superior taste, and quality assurance. We identified the motives for and barriers to organic food consumption in Poland. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Near and sub-barrier reactions of 8B

    Directory of Open Access Journals (Sweden)

    Kolata J. J.

    2017-01-01

    Full Text Available Four classes of measurements that are important for achieving a complete understanding of the reactions of exotic nuclei are identified and classified according to their degree of difficulty. Previously reported data for near- and sub-barrier fusion of 8B+58Ni are critically reviewed. The influence of breakup protons on the evaporation proton measurements for this system is shown to be small at all energies except for the lowest one measured, and corrections are made for this process. Model dependencies in the deduced fusion cross sections are assessed using three different evaporation codes. Data sets for targets of 58Ni and 28Si are shown to be consistent with each other, and with fusion enhancement up to energies that are greater than the Coulomb barrier Vb (Ec.m. ≲ Vb + 1.5×ћω. An important difference with the behavior of neutron-halo systems is thereby confirmed. Possible fusion suppression beyond this energy is suggested by the 28Si data. A proposal to measure the 8B+40Ar fusion cross section using an active-target time projection chamber is discussed.

  5. Myocardial Polyploidization Creates a Barrier to Heart Regeneration in Zebrafish.

    Science.gov (United States)

    González-Rosa, Juan Manuel; Sharpe, Michka; Field, Dorothy; Soonpaa, Mark H; Field, Loren J; Burns, Caroline E; Burns, C Geoffrey

    2018-02-26

    Correlative evidence suggests that polyploidization of heart muscle, which occurs naturally in post-natal mammals, creates a barrier to heart regeneration. Here, we move beyond a correlation by demonstrating that experimental polyploidization of zebrafish cardiomyocytes is sufficient to suppress their proliferative potential during regeneration. Initially, we determined that zebrafish myocardium becomes susceptible to polyploidization upon transient cytokinesis inhibition mediated by dominant-negative Ect2. Using a transgenic strategy, we generated adult animals containing mosaic hearts composed of differentially labeled diploid and polyploid-enriched cardiomyocyte populations. Diploid cardiomyocytes outcompeted their polyploid neighbors in producing regenerated heart muscle. Moreover, hearts composed of equivalent proportions of diploid and polyploid cardiomyocytes failed to regenerate altogether, demonstrating that a critical percentage of diploid cardiomyocytes is required to achieve heart regeneration. Our data identify cardiomyocyte polyploidization as a barrier to heart regeneration and suggest that mobilizing rare diploid cardiomyocytes in the human heart will improve its regenerative capacity. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. 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)

  7. 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.

  8. Postpartum nurses' perceptions of barriers to screening for intimate partner violence: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Guillery Margaret E

    2012-02-01

    Full Text Available Abstract Background Intimate partner violence (IPV is a human rights violation that is pervasive worldwide, and is particularly critical for women during the reproductive period. IPV includes physical, sexual and emotional abuse. Nurses on in-patient postpartum units are well-positioned to screen women for IPV, yet low screening rates suggest that barriers to screening exist. The purpose of this study was to (a identify the frequency of screening for IPV, (b the most important barriers to screening, (c the relationship between the barriers to screening and the frequency of screening for types of abuse, and (d to identify other factors that contribute to the frequency of screening for IPV. Methods In 2008, we conducted a cross-sectional survey of 96 nurses from postpartum inpatient units in three Canadian urban hospitals. The survey included the Barriers to Abuse Assessment Tool (BAAT, adapted for postpartum nurses (PPN. Ordinary least squares (OLS regression models were used to predict barriers to screening for each type of IPV. Results The frequency of screening varied by the type of abuse with highest screening rates found for physical and emotional abuse. According to the BAAT-PPN, lack of knowledge was the most important barrier to screening. The BAAT-PPN total score was negatively correlated with screening for physical, sexual, and emotional abuse. Using OLS regression models and after controlling for demographic characteristics, the BAAT-PPN explained 14%, 12%, and 11% of the variance in screening for physical, sexual and emotional abuse, respectively. Fluency in the language of the patient was negatively correlated with screening for each type of abuse. When added as Step 3 to OLS regression models, language fluency was associated with an additional decrease in the likelihood of screening for physical (beta coefficient = -.38, P P = .05, and emotional abuse (beta coefficient = -.48, P Conclusions Our findings support an inverse

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

    Science.gov (United States)

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

    2015-06-01

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

  10. Identification of multi-drug resistant Pseudomonas aeruginosa clinical isolates that are highly disruptive to the intestinal epithelial barrier

    Directory of Open Access Journals (Sweden)

    Shevchenko Olga

    2006-06-01

    Full Text Available Abstract Background Multi-drug resistant Pseudomonas aeruginosa nosocomial infections are increasingly recognized worldwide. In this study, we focused on the virulence of multi-drug resistant clinical strains P. aeruginosa against the intestinal epithelial barrier, since P. aeruginosa can cause lethal sepsis from within the intestinal tract of critically ill and immuno-compromised patients via mechanisms involving disruption of epithelial barrier function. Methods We screened consecutively isolated multi-drug resistant P. aeruginosa clinical strains for their ability to disrupt the integrity of human cultured intestinal epithelial cells (Caco-2 and correlated these finding to related virulence phenotypes such as adhesiveness, motility, biofilm formation, and cytotoxicity. Results Results demonstrated that the majority of the multi-drug resistant P. aeruginosa clinical strains were attenuated in their ability to disrupt the barrier function of cultured intestinal epithelial cells. Three distinct genotypes were found that displayed an extreme epithelial barrier-disrupting phenotype. These strains were characterized and found to harbor the exoU gene and to display high swimming motility and adhesiveness. Conclusion These data suggest that detailed phenotypic analysis of the behavior of multi-drug resistant P. aeruginosa against the intestinal epithelium has the potential to identify strains most likely to place patients at risk for lethal gut-derived sepsis. Surveillance of colonizing strains of P. aeruginosa in critically ill patients beyond antibiotic sensitivity is warranted.

  11. Critical reading and critical thinking Critical reading and critical thinking

    Directory of Open Access Journals (Sweden)

    Loni Kreis Taglieber

    2008-04-01

    Full Text Available The purpose of this paper is to provide, for L1 and L2 reading and writing teachers, a brief overview of the literature about critical reading and higher level thinking skills. The teaching of these skills is still neglected in some language classes in Brazil, be it in L1 or in L2 classes. Thus, this paper may also serve as a resource guide for L1 and/or L2 reading and writing teachers who want to incorporate critical reading and thinking into their classes. In modern society, even in everyday life people frequently need to deal with complicated public and political issues, make decisions, and solve problems. In order to do this efficiently and effectively, citizens must be able to evaluate critically what they see, hear, and read. Also, with the huge amount of printed material available in all areas in this age of “information explosion” it is easy to feel overwhelmed. But often the information piled up on people’s desks and in their minds is of no use due to the enormous amount of it. The purpose of this paper is to provide, for L1 and L2 reading and writing teachers, a brief overview of the literature about critical reading and higher level thinking skills. The teaching of these skills is still neglected in some language classes in Brazil, be it in L1 or in L2 classes. Thus, this paper may also serve as a resource guide for L1 and/or L2 reading and writing teachers who want to incorporate critical reading and thinking into their classes. In modern society, even in everyday life people frequently need to deal with complicated public and political issues, make decisions, and solve problems. In order to do this efficiently and effectively, citizens must be able to evaluate critically what they see, hear, and read. Also, with the huge amount of printed material available in all areas in this age of “information explosion” it is easy to feel overwhelmed. But often the information piled up on people’s desks and in their minds is of

  12. 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…

  13. Barriers to voluntary participation in sport for children: a systematic review.

    Science.gov (United States)

    Somerset, Sarah; Hoare, Derek J

    2018-02-09

    Numerous studies have detailed the physical health benefits of children's participation in sport and a growing body of research also highlights the benefits for mental health. Children who participate in sport have also been shown to be advantaged academically. However, despite the benefits there is evidence that children are leading increasingly sedentary lifestyles and are at greater risk of chronic disease than those with active lifestyles. Sport provides an important means for children to achieve their recommended amount of daily physical activity. This systematic review asks 'what are those barriers to children's participation in sport?' Literature searches were carried out in June 2015 using; EMBASE, Medline, CINAHL and SportDiscus using the search terms barrier*, stop*, prevent*, participat*, taking part, Sports/, sport*, "physical education", PE, child*, young person*, adolescen*. These were supplemented with hand searches. A total of 3434 records were identified of which 22 were suitable for inclusion in the review, two additional studies were identified from Google Scholar in November 2016. Both qualitative and quantitative studies were included. Study's included in the review assessed children up to 18 years of age. Study quality was assessed using Critical Appraisal Skills Programme (CASP) tools. Studies took place in the school environment (n = 14), sports club (n = 1), community setting (n = 8) and adolescent care setting (n = 1). Frequently reported barriers across quantitative studies were 'time' (n = 4), 'cost' (n = 3), 'opportunity/accessibility' (n = 3) and 'friends' (n = 2). Frequently reported barriers across qualitative studies were 'time' (n = 6), 'cost' (n = 5), 'not being good at sport' (n = 6) and 'fear of being judged/embarrassed' (n = 6). Policy makers, parents and teachers should all be aware that 'cost' and 'time' are key barriers to participation in sport. More local sports opportunities are needed where costs are reduced. Schools

  14. 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.

  15. 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

  16. Critical and shielding parametric studies with the Monte Carlo code TRIPOLI to identify the key points to take into account during the transportation of blanket assemblies with high ratio of americium

    International Nuclear Information System (INIS)

    Gosmain, Cecile-Aline

    2011-01-01

    In the framework of French research program on Generation IV sodium cooled fast reactor, one possible option consists in burning minor actinides in this kind of Advanced Sodium Technological Reactor. Two types of transmutation mode are studied in the world : the homogeneous mode of transmutation where actinides are scattered with very low enrichment ratio in fissile assemblies and the heterogeneous mode where fissile core is surrounded by blanket assemblies filled with minor actinides with ratio of incorporated actinides up to 20%. Depending on which element is considered to be burnt and on its content, these minor actinides contents imply constraints on assemblies' transportation between Nuclear Power Plants and fuel cycle facilities. In this study, we present some academic studies in order to identify some key constraints linked to the residual power and neutron/gamma load of such kind of blanket assemblies. To simplify the approach, we considered a modeling of a 'model cask' dedicated to the transportation of a unique irradiated blanket assembly loaded with 20% of Americium and basically inspired from an existent cask designed initially for the damaged fissile Superphenix assembly transport. Thermal calculations performed with EDF-SYRTHES code have shown that due to thermal limitations on cladding temperature, the decay time to be considered before transportation is 20 years. This study is based on explicit 3D representations of the cask and the contained blanket assembly with the Monte Carlo code TRIPOLI/JEFF3.1.1 library and concludes that after such a decay time, the transportation of a unique Americium radial blanket is feasible only if the design of our model cask is modified in order to comply with the dose limitation criterion. (author)

  17. Criticality accident:

    International Nuclear Information System (INIS)

    Canavese, Susana I.

    2000-01-01

    A criticality accident occurred at 10:35 on September 30, 1999. It occurred in a precipitation tank in a Conversion Test Building at the JCO Tokai Works site in Tokaimura (Tokai Village) in the Ibaraki Prefecture of Japan. STA provisionally rated this accident a 4 on the seven-level, logarithmic International Nuclear Event Scale (INES). The September 30, 1999 criticality accident at the JCO Tokai Works Site in Tokaimura, Japan in described in preliminary, technical detail. Information is based on preliminary presentations to technical groups by Japanese scientists and spokespersons, translations by technical and non-technical persons of technical web postings by various nuclear authorities, and English-language non-technical reports from various news media and nuclear-interest groups. (author)

  18. Critical dynamics

    International Nuclear Information System (INIS)

    Dekker, H.

    1980-01-01

    It is shown how to solve the master equation for a Markov process including a critical point by means of successive approximations in terms of a small parameter. A critical point occurs if, by adjusting an externally controlled quantity, the system shows a transition from normal monostable to bistable behaviour. The fundamental idea of the theory is to separate the master equation into its proper irreducible part and a corrective remainder. The irreducible or zeroth order stochastic approximation will be a relatively simple Fokker-Planck equation that contains the essential features of the process. Once the solution of this irreducible equation is known, the higher order corrections in the original master equation can be incorporated in a systematic manner. (Auth.)

  19. Critical scattering

    International Nuclear Information System (INIS)

    Stirling, W.G.; Perry, S.C.

    1996-01-01

    We outline the theoretical and experimental background to neutron scattering studies of critical phenomena at magnetic and structural phase transitions. The displacive phase transition of SrTiO 3 is discussed, along with examples from recent work on magnetic materials from the rare-earth (Ho, Dy) and actinide (NpAs, NpSb, USb) classes. The impact of synchrotron X-ray scattering is discussed in conclusion. (author) 13 figs., 18 refs

  20. 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.

  1. Can We Protect the Gut in Critical Illness: The Role of Growth Factors and Other Novel Approaches

    OpenAIRE

    Dominguez, Jessica A.; Coopersmith, Craig M.

    2010-01-01

    The intestine plays a central role in the pathophysiology of critical illness and is frequently called the “motor” of the systemic inflammatory response. Perturbations to the intestinal barrier can lead to distant organ damage and multiple organ failure. Therefore, identifying ways to preserve intestinal integrity may be of paramount importance. Growth factors and other peptides have emerged as potential tools for modulation of intestinal inflammation and repair due to their roles in cellular...

  2. Barriers to condom use among women at risk of HIV/AIDS: a qualitative study from Iran

    Directory of Open Access Journals (Sweden)

    Lotfi Razieh

    2012-05-01

    Full Text Available Abstract Background The growing trend of women infected with HIV through sexual transmission is alarming. Factors influencing condom use have not yet been fully identified, especially in countries with conservative cultures and backgrounds. The present study aimed to explore the barriers of condom use in Iranian women at risk of HIV. Methods Using the grounded theory methodology, participants’ experiences and their perceptions regarding condom were collected during semi structured in depth interviews. Participants were 22 women, aged 21–49 years, considered to be at risk for HIV, due to their own or their partner’s sexual behaviors. Qualitative analysis of the data was conducted manually and was guided by constant comparative analysis. Results Two main barriers, personal and socio-environmental emerged from data analysis. Lack of perceived threat, absence of protective motivation, inadequate knowledge, perceived lack of control, negative attitudes towards condom and misperception were the major personal barriers, while unsupportive environments and cultural norms were the common socio-environmental barriers to condom use among these at risk women. Conclusions These critical barriers have to be addressed for implementing effective prevention programs against HIV among populations at risk for HIV.

  3. Towards critical aspects of Confucianism

    Directory of Open Access Journals (Sweden)

    Dunaj Ľubomír

    2016-12-01

    Full Text Available This paper consists of two parts. The first deals with the issue of whether it is possible to coherently employ the term ‘critical Confucian’ in general, i.e. whether it is a paradox or oxymoron. It will be argued that Confucianism should not be identified with any particular ideology and, therefore, can be critical. This critical potential, in turn, can be developed by bringing it into dialogue with Critical Theory. As such, the second part indicates, in an introductory way, some possible overlaps between Confucianism and Critical Theory by comparing Heiner Roetz’s and Axel Honneth’s respective interpretations of these traditions.

  4. 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 th