Prospective study of the barriers to nutritional support in a paediatric intensive care unit : P16

Introduction and aim: Children hospitalised in a paediatric intensive care unit (PICU) are mainly fed by nutritional support (NS) which may often be interrupted. The aims of the study were to verify the relationship between prescribed (PEI) and actual energy intake (AEI) and to identify the reasons for NS interruption. Methods: Prospective study in a PICU. PEI and AEI from day 1 to 15, type of NS (enteral, parenteral, mixed), position of the feeding tube, interruptions in NS and reasons for these were noted. Inter - ruptions were classified in categories of barriers and their frequency and duration were analysed. Results: Fifteen children (24 ± 25.2 months) were studied for 84 days. The NS was exclusively enteral (69%) or mixed (31%). PEI were significantly higher than AEI (54.7 ± 32.9 vs 49.2 ± 33.6 kcal/kg, p = 0.0011). AEI represented 93% of the PEI. Ninety-eight interruptions were noted and lasted 189 h, i.e. 9.4% of the evaluated time. The most frequent barriers were nursing procedures, respiratory physiotherapy and unavailability of intravenous access. The longest were caused by the necessity to stop NS for surgery or diagnostic studies, to treat burns or to carry out medical procedures. Conclusion: AEI in PICU were inferior by 7% to PEI, considerably lower than in adult studies. Making these results available to medical staff for greater anticipation and compensation could reduce NS interruptions. Starving protocols should be reconsidered.

Iowa's Barriers to Prenatal Care Project, July 2015

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal to request their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, frequencies by income, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2014 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that, because percentages were rounded, total values may not equal 100%. Data presented are based upon 2014 questionnaires received to date (n = 24,696). All analyses reflect unweighted percentages of those responding.

From Full stopping to transparency in a holographic model of heavy ion collisions

We numerically simulate planar shock wave collisions in anti-de Sitter space as a model for heavy ion collisions of large nuclei. We uncover a crossover between two different dynamical regimes as a function of the collision energy. At low energies the shocks first stop and then explode in a manner approximately described by hydrodynamics, in close similarity with the Landau model. At high energies the receding fragments move outwards at the speed of light, with a region of negative energy density and negative longitudinal pressure trailing behind them. The rapidity distribution of the energy density at late times around midrapidity is not approximately boost invariant but Gaussian, albeit with a width that increases with the collision energy.

Perceived Barriers to Physical Activity and Related Factors in Spanish University Students

Objective: The purpose of this study was to identify the influence of readiness of change for physical activity (PA), sociodemographic factors, lifestyle and physical activity status (PAS) on perceived barriers among Spanish university students. Participants: Seven hundred and seventy two (n = 772) men and women ages 17 - 39 at a north-west regional university in Spain participated in the study. Methods: The International Physical Activity Questionnaire, the States of Change for Physical Activity Behaviour Questionnaire and the Self-perceived Barriers for Physical Activity Questionnaire were used. Description, correlation and multiple regression analyses were completed. Results: Participants self-perceived low average-score barriers (2.6 ± 1.4 over 10.0). The 3-higher scores barriers corresponded to “too much work”; “lack of time for exercise” and “laziness”. Gender, PAS and self-perceived health were shown to be associated with perceived barriers. Conclusions: University institutions should consider those factors that predict barriers to PA to develop effective intervention programs.

Barriers to Service-sector SME Internationalization in the EU Business Environment

The service sector in the global world is constantly growing: in Europe, they account currently approximately for 70 per cent of the total economy. Yet service internationalization is rather a new phenomenon: services have been traditionally seen as local entities, which also explains why research on service internationalization has properly begun only few decades ago. Even though the Single European Market allows free service movement between Member States, services do not move as actively as desired: approximately only one fifth of services are involved in cross-border trade. Therefore, the main purpose of this thesis is to analyze the barriers to service-sector SME internationalization in the EU business environment. To address the research purpose, the internationalization of service-sector SMEs in the EU area is first described and thereafter, the barriers to service-sector SME internationalization in the European context are mapped and analyzed from intra- and extra-firm perspectives. In order to understand the topic area and the phenomenon, a short glance is first taken into Europe as a business environment for service industries: the market characteristics and benefits of the common free trade area for service industries are described. Also earlier literature on service internationalization and barriers to international service trade are discussed. Due to low previous research activity on barriers specifically to international service trade, the discussion is improved by presenting general findings of barriers to SME internationalization. This research is conducted with qualitative methods: there is only a limited amount of previous research and qualitative methods provide a way of gathering in-depth information and reaching understanding from respondents’ perspectives. The evidence presented in the study was collected through six semi-structured interviews with six different small or medium sized international service firm representatives that all had the first-hand knowledge regarding their company’s process of delivering services from home market to other European countries. The results of the study provide a detailed description and analysis of intra- and extra-firm barriers to service-sector SME internationalization in the context of EU and indicate that in general, internal firm-specific barriers have a greater impact in determining firm’s possibilities to be engaged in cross-border service trade – external barriers played a smaller role. What might explain these results is that first of all, the study has full focus on service firms of smaller size and internal barriers tend to be particularly effective to SMEs as their resources, skills and capabilities are often limited, which limits internationalization possibilities. Second, the results may indicate that EU’s internal market and the free trade concept function quite well from service firms’ perspective, and the low service movement rate may be rather caused by firm’s own competences and resource-related difficulties than directly by flaws in the market. The results complete earlier literature and provide new and more detailed knowledge of barriers to cross-border service trade in the context of Europe. They also indicate that service internationalization should be observed separately from internationalization of traditional manufacturing firms due to unique service-specific characteristics. The findings of this study are particularly beneficial for small or medium sized service firm managers as it provides knowledge of delivering services across borders in Europe and of barriers that relate to that process.

An in-depth analysis of real and perceived barriers to speech and language program participation for children with speech and language delays : a question of barriers to service?

The current study investigated the effects that barriers (both real and perceived) had on participation and completion of speech and language programs for preschool children with communication delays. I compared 36 families of preschool children with an identified communication delay that have completed services (completers) to 13 families that have not completed services (non-completers) prescribed by Speech and Language professionals. Data findings reported were drawn from an interview with the mother, a speech and language assessment of the child, and an extensive package of measures completed by the mother. Children ranged in age from 32 to 71 mos. These data were collected as part of a project funded by the Canadian Language and Literacy Research Networks of Centres of Excellence. Findings suggest that completers and non-completers shared commonalities in a number of parenting characteristics but differed significantly in two areas. Mothers in the noncompleting group were more permissive and had lower maternal education than mothers in the completing families. From a systemic standpoint, families also differed in the number of perceived barriers to treatment experienced during their time with Speech Services Niagara. Mothers in the non-completing group experienced more perceived barriers to treatment than completing mothers. Specifically, these mothers perceived more stressors and obstacles that competed with treatment, perceived more treatment demands and they perceived the relevance of treatment as less important than the completing group. Despite this, the findings suggest that non-completing families were 100% satisfied with services. Contrary to predictions, there were no significant differences in child characterisfics and economic characteristics between completers and non-completers. The findings in this study are considered exploratory and tentative due to the small sample size.

An inquiry into the barriers to participation within the fitness industry for people living with mobility challenges

This qualitative study was designed to inquire about the barriers to participation within the fitness industry for people living with mobility challenges. i\n examination of the insights, stolies~ and experiences with barriers through interviews gi ven by 4 people living with mobility challenges (PMC) formed the core of the research. An analysis of the interviews from the 4 PMC informants was performed at t\\/O levels. First, a content analysis served to identify general and specific categories related to barrier issues within various fitness environments. Secondly, in-depth thematic analyses of the entries related to the insights and stories from the 4 informants which emerged from the content analysis of the data gave rise to fi ve thematic statements. From the thematic statements a fitness industry awareness protocol was created in the fonn of a statement response questionnaire. The protocol, which was given to 4 fitness assessors/trainers, \vas used to provide a snapshot of the fitness industry's readiness to work vvith disability. Throughout the process, the four PNIC informants formed a collaborati vely involved group of coresearchers, adding their voices to the narrative of the fitness-barrier experience. The result of the study suggests that barriers to participation within the fitness industry for PMC exist in various forms and levels of severity. The results also suggest that the fitness industry needs to better prepare their people and environment for working with people with physical disabilities, such as PMC, and provide a more open and positi ve environment for participation. Within the context of any fitness-related environment, recognizing that barriers to participation do exist, and acknowledging and accepting people with disabilities for who they are as indi viduals, will serve to develop a relationship where fitness practitioners and people with disabilities can work towards creating an inviting, inclusive, accessible, and barrier-free fitness environment for all.

Clinician-Perceived Bridges and Barriers to Parental Implementation of Picture Exchange Communication System (PECS): An evaluation.

Picture Exchange Communication System (PECS) is an augmentative and alternative communicative system that improves communication and decreases problem behaviors in children with Developmental Disabilities and Autism. The mediator model is a validated approach that clinicians use to train parents to perform evidence-based interventions. Parental non-adherence to treatment recommendations is a documented problem. This qualitative study investigated clinician-perceived factors that influence parental adherence to PECS recommendations. Three focus groups (n=8) were conducted with Speech Language Pathologists and Behavior Therapists experienced in providing parents with PECS recommendations. Constant comparison analysis was used. In general, clinicians believed that PECS was complex to implement. Thirty-one bridges were identified to overcome complexity. Twenty-two barriers and 6 other factors also impacted parental adherence. Strategies to address these factors were proposed based on a review of the literature. Future research will be performed to validate these findings using parents and a larger sample size.

Retrospective Exploration of the 3Rs Education Program: Systemic Facilitators and Barriers to Implementation

Individuals with intellectual disabilities (ID) have historically been denied basic rights and thus have been subjected to abuse. The 3Rs: Rights, Respect and Responsibility Human Rights Education Program was implemented and researched through a partnership with Community Living Welland Pelham and Brock University initially and then cascade training on the program was provided to five developmental service sector agencies from across the Niagara Region. This research evaluated the role of the 3Rs education program on the shift to a rights-based service agenda across those five agencies. Interviews were conducted with the Executive Director and Liaison staff from each of the agencies and a thematic analysis was used to describe factors that facilitated organizational changes and a cultural shift. Systemic barriers to the change were also explored. The results indicated that the 3Rs education program provides the catalyst necessary for the shift to a rights-based service agenda and that the resultant changes in practices now embedded in the organizations are reflective of a shift to a rights-based service agenda.

Registered Nurses' Perceptions about Facilitators and Barriers to Maternal Skin to Skin Contact in the Operating Room

Abstract It is recommended that all new mothers experience skin-to-skin contact (SSC) with their newborns immediately after birth. However, SSC is not commonly practiced after cesarean deliveries. To understand facilitators and barriers regarding SSC in the operating room (OR), a descriptive online and paper survey was conducted with 68 Registered Nurses from four hospitals in Ontario. The theory of planned behavior framed the study. Nurses had positive attitudes, and believed most health care team members supported SSC in the OR, but were uncertain about their control over the behavior. Nurses who had practiced the behavior in the past had more positive attitudinal and normative beliefs, and perceived some barriers as less difficult. Attitude and past behavior were the only significant multivariate predictors of intention to practice SSC in the future. Results suggest that shifting attitude and supporting more experience with the practice may increase nurses’ implementation of SSC in the OR.

The status and barriers to the implementation and continuation of the school gardening projects in Germany, Nigeria and the United States of America

In drawing a conclusion for this study, care must be taken in generalizing findings since the population of students and teachers investigated were limited to certain levels in the different schools and countries. This study recognized some complexity of the factors underlying the status of school gardening instruction and activities in Germany, Nigeria and the U.S. as inadequate time for decision-making in the process of gardening, motivation of teachers and students. This was seen as the major impediments that influenced the status of gardening in the three countries. However, these factors were considered to have affected students’ mode of participation in the school gardening projects. This research finding suggests that the promotion and encouragement of students in gardening activities will promote vegetable production and increasing the numbers of practical farmers. Gardening has the potential to create opportunities for learning in an environment where children are able to experience nature first hand and to use the shared experience for communication (Bowker & Tearle, 2007). Therefore, the need for students to be encouraged to participate in gardening programs as the benefit will not only reduce the rate of obesity currently spreading among youths, but will contribute to the improve knowledge on science subjects. To build a network between community, parents and schools, a parent’s community approach should be used as the curriculum. The community approach will tighten the link between schools; community members, parents, teachers and students. This will help facilitate a better gardening projects implementation. Through a close collaboration, teachers and students will be able to identify issues affecting communities and undertake action learning in collaboration with community organizations to assess community needs and plan the implementation strategies as parents are part of the community. The sense of efficacy is a central factor in motivational and learning processes that govern educational improvement, standard and performance on complex tasks of both teachers and students. Dedication and willingness are the major stimulator and achievement of a project. Through a stimulator and provision of incentives and facilities, schools can achieve the best in project development. Teachers and principals should be aware that students are the lever for achieving the set goals in schools. Failure to understand what students need will result in achieving zero result. Therefore, it is advised that schools focus more on how to lure students to work through proper collaboration with the parents and community members. Principals and teachers should identify areas where students need to be corrected, helping them to correct the problem will enable them be committed in the schools’ programs.

Propiedades psicométricas de la versión al español del cuestionario “Barriers to Being Active Quiz”, entre estudiantes universitarios de Colombia

Objetivo: El cuestionario Barriers to Being Active Quiz (BBAQ), indaga las barreras para ser físicamente activo. El cuestionario fue traducido al español por el mismo equipo que desarrolló la versión inglésa original, pero carece de estudios de validez en la versión española. El objetivo de esta investigación fue evaluar las propiedades psicométricas del BBAQ (en la versión completa de 21 ítems), centrándose en la fiabilidad y validez. Material y métodos: Un total de 2.634 (1.462 mujeres y 1.172 varones; 18-30 años de edad) estudiantes universitarios completaron el cuestionario BBAQ-21. El alfa de Crombach se estimó como indicador de consistencia interna. El coeficiente de correlación intra-clase (CCI) y el grado de acuerdo se calcularon para evaluar la estabilidad temporal con un periodo de 7 días entre ambas administraciones como estimadores de la reproducibilidad. Se aplicó un análisis factorial exploratorio (AFE) y confirmatorio (AFC) para analizar la validez del BBAQ-21 ítems. Resultados: El BBAQ-21 mostró valores de un alfa de Cronbach entre 0,812 y 0,844 y un CCI entre el 0,46 y 0,87. El porcentaje de acuerdo por todos los conceptos individuales varió de 45 a 80%. El AFE determinó cuatro factores que explicaron el 52,90% de la varianza y el AFC mostró moderadas cargas factoriales. Conclusiones: Los resultados obtenidos en este cuestionario avalan la utilización de este instrumento con este tipo de muestra, desde el punto de vista de la fiabilidad y validez. El BBAQ-21 está disponible para evaluar las barreras para la actividad física en América Latina.

Spelling, hadwriting and dyslexia: overcoming barriers to learning.

La dislexia es considerada un 'problema de la lectura', pero en realidad afecta a todos los aspectos del aprendizaje. Este manual explica cómo y por qué se puede limitar la capacidad de un niño disléxico para acceder a un currículo más amplio. Revisa las políticas educativas y explica muchas de las intervenciones y programas alternativos que se ofrecen para corregir la dislexia. Sostiene que la ortografía y la escritura deben recibir más atención en la enseñanza y en la recuperación, especialmente si los alumnos son disléxicos. Ayuda a los profesores y a los estudiantes de pedagogía a entender la valiosa contribución de la escritura y la ortografía en el desarrollo de la alfabetización en las escuelas primaria y secundaria, y les muestra la manera de superar las barreras existentes para el aprendizaje.

Drivers and barriers to digital television adoption in Portugal: the perspectives of the TV viewers and other main stakeholders

To understand what are the most significant factors for digital TV adoption by the Portuguese population in the switchover context is the main goal of the research project here presented. In April 26, 2012, the analogue terrestrial television switchoff is planned to occur in Portugal, according to the schedule published by the national telecommunication regulator Anacom. Digital terrestrial TV was launched in the country in April 2009, making Portugal one of the countries with a more ambitious schedule – or risky, depending on the perspective - for the full transition from analogue to digital terrestrial television. In this paper we will start by presenting the research project’s objectives, theoretical framework and research design. Next, we will present first results of the project focused on the barriers and drivers to digital TV adoption from two of the empirical studies which integrate it, namely, the quantitative inquiry administered to a representative sample of the Portuguese population and interviews with main stakeholders in the area of digital TV in Portugal. The perspectives of the television viewers are compared with other main stakeholders in this process. The paper will be concluded with a brief discussion of these results and a brief enumeration of next steps for the project.