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Several Barriers (several + barrier)
Selected AbstractsToward Adaptive Community Forest Management: Integrating Local Forest Knowledge with Scientific Forestry,ECONOMIC GEOGRAPHY, Issue 1 2002Daniel James Klooster Abstract: This case study of indigenous communities in highland Michoacán, Mexico, examines data on forest change, woodcutting practices, social history, and a recent forest inventory and management plan prepared by a professional forester. It assesses the social and environmental fit of both local knowledge and scientific forestry and considers their abilities to contribute to sustainable forest management. Both bodies of knowledge are limited in their ability to inform the social practice of environmental management. The local forest knowledge system is particularly hampered by a limited ability to monitor the forest's response to woodcutting, while scientific forestry lacks the institutional flexibility to ensure the just and effective implementation of restrictions and prescriptions. This article recommends cross-learning between scientific resource managers and woodcutters, participatory environmental monitoring to assess the results of different cutting techniques, and explicit management experiments to facilitate institutional learning at the community level. This kind of adaptive management approach permits the flexible integration of local knowledge, scientific forestry, and appropriate institutional parameters to modulate human needs and goals with the discordant harmonies of inhabited and heavily used forests in a constant state of flux under processes of succession, disturbance, and spatial variation. Several barriers to this kind of institutional innovation exist, but outside intervention has the potential to change the dynamics of institutional evolution. [source] Parents, siblings and grandparents in the Neonatal Intensive Care Unit A survey of policies in eight European countriesACTA PAEDIATRICA, Issue 11 2009Gorm Greisen Abstract Objective:, To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier. Methods:, A questionnaire on early developmental care practices was mailed to 362 units in eight European countries (Sweden, Denmark, the UK, the Netherlands, Belgium, France, Spain and Italy). Of them 78% responded, and among those responded, 175 reported caring for at least 50 very low birth weight infants every year and their responses were analysed further. Results:, A majority of all units allowed access at any time for both parents. This was almost universal in northern Europe and the UK, whereas it was the policy of less than one-third of NICU in Spain and Italy, with France in an intermediate position. Restrictions on visiting of grandparents, siblings and friends, as well as restricting parents' presence during medical rounds and procedures followed the same pattern. A composite visiting score was computed using all the variables related to family visiting. Lower median values and larger variability were obtained for the southern countries, indicating more restrictive attitudes and lack of national policy. Conclusions:, The presence of parents and other family members in European NICUs has improved over a 10-year period. Several barriers, however, are still in place, particularly in the South European countries. [source] Issues related to the diagnosis and treatment of autism spectrum disorders,DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2007Paul T. Shattuck Abstract This paper explores issues and implications for diagnosis and treatment, stemming from the growing number of children identified with autism spectrum disorders (ASDs). Recent developments and innovations in special education and Medicaid programs are emphasized. Eligibility determination policies, innovations in diagnostic practices, the cost and financing of assessment, variability among programs in diagnostic criteria, and racial/ethnic disparities in the timing of diagnosis all influence the capacity of service systems to provide diagnoses in a timely, coordinated, accurate, economical, and equitable manner. There are several barriers to the more widespread provision of intensive intervention for children with ASDs, including lack of strong evidence of effectiveness in scaled-up public programs, uncertainty about the extent of obligations to provide services under the Individuals with Disabilities Education Act, high cost of intervention, and variability among states in their willingness to fund intensive intervention via Medicaid. Innovative policy experiments with respect to financing intensive intervention through schools and Medicaid are being conducted in a number of states. © 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:129,135. [source] Oral insulin , a review of current statusDIABETES OBESITY & METABOLISM, Issue 3 2010Harish Iyer Oral insulin is one of the most exciting areas of development in the treatment of diabetes because of its potential benefit in patient convenience, rapid insulinization of liver, adequate insulin delivery avoiding peripheral hyperinsulinaemia while potentially avoiding adverse effects of weight gain and hypoglycaemia. Growing evidence that earlier initiation of intensive insulin therapy produces sustained tight glycaemic control resulting in substantial delay in complications makes an effective oral insulin product even more vital for the management of patients with diabetes. Despite knowledge of this unmet medical need, oral delivery of insulin has been unsuccessful because of several barriers. For several decades, researchers have tried to develop oral insulin using various technologies without much clinical or commercial success. This review summarizes the development status of oral insulins which are publicly reported to be undergoing clinical studies. Currently, two oral insulin products are in an advanced stage of clinical development and first data from long-term therapy are expected to be available in the second half of 2010. [source] A pilot study comparing a type 1 nurse-led diabetes clinic with a conventional doctor-led diabetes clinicEUROPEAN DIABETES NURSING, Issue 1 2004J Charlton Diabetes Nurse Specialist Abstract A prospective comparative pilot study was designed to assess and compare care delivered by a diabetes specialist nurse (DSN) and standard doctor-led care for patients with type 1 diabetes. The philosophy was to provide an individualised, patient-centred, lifestyle-based approach. In all, 60 patients with type 1 diabetes were randomised to either the nurse-led clinic (NLC) or a conventional clinic. NLC patients received medical input during their annual screening appointment. In the nurse-led system patients prioritised relevant issues with the aid of a ,Waiting Area Menu'. The menu consisted of pertinent topics relevant to living with diabetes. Care interventions were then agreed and targets discussed. To date the results of DSN intervention include: 60% of patients changing to a more appropriate insulin regimen; 36% changing equipment following update from the DSN; 20% needing initiation of cardiovascular medication; and 26% being referred to other health care professionals. The mean HbA1c changed by -0.25% in the NLC group and by -0.06% in the control group (ns). During the pilot there were several barriers which we had not anticipated. These included staffing resources, and organisational and time management issues. However, feedback from patient questionnaires demonstrated that the majority of patients preferred the NLC. Copyright © 2004 FEND. [source] A collaborative approach to embedding graduate primary care mental health workers in the UK National Health ServiceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2008Janine Fletcher MSc Abstract The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised ,collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS. [source] Toward a consilient science of psychologyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2005Kevin L. Rand From its inception, psychology has been characterized by conceptual fragmentation and slow scientific progress (Henriques, 2004; Meehl, 1978). In contrast, the natural sciences have achieved in recent decades a remarkable degree of consilience,the linking of fact, theory, and method across disciplines (and subdisciplines) and across nested levels of informational complexity (Wilson, 1998). Although such consilience serves as a potent catalyst of scientific discovery, there exists several barriers to the emergence of a consilient science of psychology (e.g., the persistent influence of dualism, longstanding internecine discord, resistance to perceived reductionism, etc.). We discuss the manner in which the development of metatheoretical frameworks (including Henriques' Tree of Knowledge model) may play an important role in addressing such barriers. Likewise, we describe the hybrid interdisciplinary domain of cognitive neuroscience, which provides an empirically testable metatheory and a promising consilient bridge between psychology and the natural sciences. © 2004 Wiley Periodicals, Inc. J Clin Psychol. [source] A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing roleOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2008Justin J. Needle Abstract Purpose:, Recent changes in medicines legislation in the UK have broadened the opportunities for optometrists to use and supply therapeutic drugs. We set out to investigate the current therapeutic practice of UK optometrists and to elicit their views on an extended prescribing role. Methods:, Members of the College of Optometrists were invited via email to take part in an online survey. The survey questions covered four areas: mode of practice, proximity and relationship to other providers of eye care, scope of current therapeutic practice and future plans regarding prescriber training. Results:, Of the 1288 responses received (response rate 24%), over 90% were from optometrists working in community practice. Common, non-sight-threatening conditions were managed frequently or occasionally by between 69 and 96% of respondents. Blepharitis and dry eye were the most common (managed routinely by >70%). In terms of therapeutic agents used, large numbers of optometrists reported that they commonly supplied or recommended over-the-counter (non-prescription) drugs, particularly lubricants and anti-allergic agents. However, fewer respondents supplied antibiotics (only 14% supplying chloramphenicol or fusidic acid frequently). Overall, relatively few respondents (14%) expressed no interest in undertaking further training for extended prescribing, although several barriers were identified, including cost and time taken for training, lack of remuneration and fear of litigation. Conclusion:, Significant numbers of community optometrists are currently managing a range of common ocular conditions using a limited formulary. Enabling optometrists to train as independent prescribers will further develop this role, allowing greater use of their skills and providing patients with quicker access to medicines. [source] The present and future state of blended learning in workplace learning settings in the United StatesPERFORMANCE IMPROVEMENT, Issue 8 2008Kyong-Jee Kim This article reports a survey about blended learning in workplace learning settings. The survey found that blended learning gained popularity in many organizations but also that several barriers exist in implementing it. This survey also includes predictions on instructional strategies, emerging technologies, and evaluation techniques for blended learning. [source] Equitable access to dental care for an at-risk group: a review of services for Australian refugeesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2007Natasha Davidson Objective: Despite the poor dental health of refugees, few specific services are available. This review maps public dental services for refugees across Australian jurisdictions, identifies gaps in provision, identifies barriers to accessing dental care, and provides recommendations for improving access and oral health promotion for this group. Methods: Data were sought from the State and Territory services for: a) the survivors of torture; b) oral health care units; and c) auditors-general reports of dental services. Eligibility criteria and estimated waiting times for general dental services, criteria for access to emergency care and availability of interpreter services were reviewed. Results: Marked variation exists across Australian jurisdictions in available dental services and criteria for access to public dental care for refugees. There is limited priority access to general dental services for refugees. Waiting times for public dental treatment in most, if not all, jurisdictions are unacceptably long (range 13,58 months). Few interpreter services exist for refugees seeking to access dental services. Conclusions: Access to dental services for refugees across Australia remains fragmented and limited, particularly in rural and regional areas. Refugees are not using services because of several barriers, including long waiting times, variation in assessment criteria, different eligibility criteria and limited interpreter services. Consequently, their pattern of service use does not accurately reflect their needs. Implications: Australia needs better co-ordinated, more extensive dental services that are easily accessible for this very high risk group. Identification of refugees as a special needs group and provision of targeted interventions addressing barriers to care are needed to establish adequate dental care. [source] Can human rights discourse improve the health of Indigenous Australians?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2006Natalie Gray Objective:Recognition of the poor health outcomes of Indigenous Australians has led to an interest in using human rights discourse as a framework for arguing that the Australian Government has an international obligation to improve Indigenous health. Method:This paper explores two potential directions for human rights discourse in this context. The first is the development and elaboration of an asserted ,human right to health'. The second focuses on developing an understanding of the interactions between health and human rights, particularly the underlying social determinants of health, and thereby creating an advocacy framework that could be used to promote the inclusion of human rights considerations into the policy-making agenda. Results:This paper argues that despite the symbolic force of human rights discourse, its capacity to improve the health of Indigenous Australians through international law is limited. This is so irrespective of whether recourse is made to a legal or moral imperative. Conclusion and Implications:The ,human right to health' is limited primarily by several barriers to its implementation, some of which are perpetuated by the current Australian Government itself. Although the potential advocacy capacity of human rights discourse is similarly limited by the hostility of the Government towards the notion of incorporating human rights considerations into its public policy decision making, it does provide a sustainable intellectual framework in which to consider the social and structural determinants of health and maintain these issues on the political agenda. [source] Non-viral vectors for cancer therapyCANCER SCIENCE, Issue 5 2006Yasufumi Kaneda Cancers are diverse and often resistant to therapeutic strategies. Gene therapy has yet to meet the promise of a breakthrough in cancer therapy. There are several barriers to overcome in cancer gene therapy. One of the biggest challenges is the design of appropriate vectors. Numerous viral and non-viral methods for gene transfer have been developed for human gene therapy, but both viral and non-viral vectors have limitations and advantages. In this review article, recent improvements in the development of non-viral vectors for delivering gene therapy for the treatment of cancer will be discussed. (Cancer Sci 2006; 97: 348 ,354) [source] | |||||||||||||