A study of the differences among African -American, Hispanic, and Anglo women on the perceived barriers and strategies to career advancement in public school administration

Women have been traditionally excluded from the ranks of principals and district administrators in public school systems throughout the country. Traditionally, Anglo women have been more successful than African American and Hispanic women in breaking down the barriers that impede their ascension to the top. The purpose of this study was to ascertain how African American, Hispanic, and Anglo higher-level female administrators perceive the barriers that hinder their progress, the effects of the barriers, and the strategies to overcome the barriers. ^ Two hundred, sixty female administrators employed with Miami-Dade County Public Schools and serving in the role of principal or higher were mailed a questionnaire consisting of 49 questions centering on personal and professional characteristics, perceptions of barriers, perceived effects of barriers, and strategies to overcome the barriers. One hundred, seventy-five questionnaires were returned. To analyze the respondents' personal and professional characteristics, cross tabulations were conducted on the demographic information and on the strategies. ANOVA was conducted on the barriers and the effects of the barriers by ethnic groups. Tukey's test for post-hoc comparisons was utilized to identify groups with means significantly divergent from those of other ethnicities. ^ The data revealed that Hispanic female higher-level administrators who returned the questionnaire were more likely to be married and have children as compared to Anglo and African American female administrators. When addressing the barriers to career success, African American females had a higher mean score on 14 of the 17 barriers to career success as compared to the other ethnic groups. Hispanic female administrators proved to be more successful in utilizing the strategies to overcome career barriers. The strategy, forming a “New Girl Network,” was the least utilized with 79 of the respondents reporting that they had never used it. ^ It is concluded that there is strong need for female administrators to network, mentor, and support one another. Also, it is imperative that the success of particular groups in certain areas is shared with others. ^

Exploring the stages of change and perceived barriers to treatment models within the context of parental adherence to an early intervention program

Parent-mediated early intervention programs depend on the willingness and ability of parents to complete prescribed activities with their children. In other contexts, internal factors, such as stages of change, and external factors, such as barriers to treatment, have been shown to correlate with adherence to service. This researcher modified the Stages of Change Questionnaire as well as the Barriers to Treatment Participation Scale (BTPS) to use with this population. Despite initial interest, twenty-three parent participants were referred to the researcher over the course of three years, with only five parents taking part in the study. A population base ten times that of the current sample would be required recruit enough participants (fifty-one) to provide sufficient power. This feasibility study discusses the results of the five parent participants. Findings suggest that the modified Stages of Change Questionnaire may not be sensitive enough for use with the current sample, while the modified BTPS may yield useful information for service providers.

The first time delivery of the first link learning series using Skype and YouTube

Introduction: This case study documented the experiences of informal and service providers who participated in the first time delivery of the First Link Learning Series from May–August 2013 in Newfoundland and Labrador. The aim of this study was to understand how informal caregivers of people with dementia experience this Internet mediated health resource, and how Skype and YouTube can be used as tools for the Alzheimer Society of Newfoundland and Labrador to effectively deliver the First Link Learning Series. Methods: Sources of data included key informant interviews (n=3), pre- study and post-study interviews with informal dementia caregivers (n=2), institutional documentation, field notes, and YouTube analytics. Framework Analysis was used to make meaning of the qualitative data, and descriptive statistics were used to report on quantitative outcomes. Findings: Between 3% and 17% of registered First Link clients attended the learning series sessions, however only two caregivers participated using Skype or YouTube. Framework Analysis revealed three shared themes: access, connection and privacy. Discussion: The themes helped to begin building theory about barriers and facilitators to Internet mediated health resources for informal dementia caregivers. Experiences of service providers using the Internet to support clients served to begin building a case for the appropriateness of these media. A modified version of Dansky et al.’s (2006) theoretical framework for evaluating E-Health research that situates the person/user in the model, helped guide discussion and propose future directions for the study of Internet based health resources for informal dementia caregivers.

Perceived barriers towards healthy eating and their association with fruit and vegetable consumption

Acknowledgements The authors would like to thank the anonymous reviewer, staff at the Health Economics Research Unit and the Rowett Institute of Nutrition and Health for helpful comments on the manuscript. Funding This work was supported by the Scottish Government Rural and Environment Science and Analytical Services (RESAS) division.

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

The Relationship Between Support Systems and Disease Burden for Families Coping with Sickle Cell Disease in South Africa and Cameroon

Background: Sickle cell disease (SCD) is a debilitating genetic blood disorder that seriously impacts the quality of life of affected individuals and their families. With 85% of cases occurring in sub-Saharan Africa, it is essential to identify the barriers and facilitators of optimal outcomes for people with SCD in this setting. This study focuses on understanding the relationship between support systems and disease outcomes for SCD patients and their families in Cameroon and South Africa.

Methods: This mixed-methods study utilizes surveys and semi-structured interviews to assess the experiences of 29 SCD patients and 28 caregivers of people with SCD across three cities in two African countries: Cape Town, South Africa; Yaoundé, Cameroon; and Limbe, Cameroon.

Results: Patients in Cameroon had less treatment options, a higher frequency of pain crises, and a higher incidence of malaria than patients in South Africa. Social support networks in Cameroon consisted of both family and friends and provided emotional, financial, and physical assistance during pain crises and hospital admissions. In South Africa, patients relied on a strong medical support system and social support primarily from close family members; they were also diagnosed later in life than those in Cameroon.

Conclusions: The strength of medical support systems influences the reliance of SCD patients and their caregivers on social support systems. In Cameroon the health care system does not adequately address all factors of SCD treatment and social networks of family and friends are used to complement the care received. In South Africa, strong medical and social support systems positively affect SCD disease burden for patients and their caregivers. SCD awareness campaigns are necessary to reduce the incidence of SCD and create stronger social support networks through increased community understanding and decreased stigma.

Irish dental practitioners perceived barriers to the care of patients with special healthcare needs and the effect of postgraduate training

Inequalities in oral healthcare service provision to people with special health needs have been reported in the Republic of Ireland. These include higher unmet dental treatment needs and longer waiting period to access routine dental treatment than the general population. Aim: The aims of this study were to determine the groups of patients with special needs which pose a challenge to manage in the dental surgery and to examine perceived barriers to the care of these patients. We aimed to determine whether postgraduate training in the management of these patients increases the practitioners’ frequency of treatment and their desire for further training in this area. Methods: A questionnaire was used to survey 326 randomly selected dentists from the Dental Council’s register of dentists. Questionnaire and information sheets explaining the purpose of the survey, confidentiality and anonymity of the responses were posted to the dentists. Results: The results showed that children with intellectual disability posed the biggest challenge for dentists to manage in the dental surgery. Behaviour management issues and the degree of disability were perceived by many dentists as factors that would have high effects on their willingness to treat patients with special needs. Dentists who have postgraduate training in the management of patients with special needs were significantly more willing to treat these patients and to seek additional training in the future. Conclusion: There are links between the training and the willingness of practitioners to undertake dental treatment or patients with special healthcare needs.

Convergence and translation: attitudes to inter-professional learning and teaching of creative problem-solving among medical and engineering students and staff

Background: Healthcare worldwide needs translation of basic ideas from engineering into the clinic. Consequently, there is increasing demand for graduates equipped with the knowledge and skills to apply interdisciplinary medicine/engineering approaches to the development of novel solutions for healthcare. The literature provides little guidance regarding barriers to, and facilitators of, effective interdisciplinary learning for engineering and medical students in a team-based project context. Methods: A quantitative survey was distributed to engineering and medical students and staff in two universities, one in Ireland and one in Belgium, to chart knowledge and practice in interdisciplinary learning and teaching, and of the teaching of innovation. Results: We report important differences for staff and students between the disciplines regarding attitudes towards, and perceptions of, the relevance of interdisciplinary learning opportunities, and the role of creativity and innovation. There was agreement across groups concerning preferred learning, instructional styles, and module content. Medical students showed greater resistance to the use of structured creativity tools and interdisciplinary teams. Conclusions: The results of this international survey will help to define the optimal learning conditions under which undergraduate engineering and medicine students can learn to consider the diverse factors which determine the success or failure of a healthcare engineering solution.

CHARACTERIZATION AND THERMAL-HYDRAULIC MODELING OF ENGINEERED BARRIERS FOR A CANADIAN DEEP GEOLOGICAL REPOSITORY FOR USED NUCLEAR FUEL

Within Canada there are more than 2.5 million bundles of spent nuclear fuel with another approximately 2 million bundles to be generated in the future. Canada, and every country around the world that has taken a decision on management of spent nuclear fuel, has decided on long-term containment and isolation of the fuel within a deep geological repository. At depth, a deep geological repository consists of a network of placement rooms where the bundles will be located within a multi-layered system that incorporates engineered and natural barriers. The barriers will be placed in a complex thermal-hydraulic-mechanical-chemical-biological (THMCB) environment. A large database of material properties for all components in the repository are required to construct representative models. Within the repository, the sealing materials will experience elevated temperatures due to the thermal gradient produced by radioactive decay heat from the waste inside the container. Furthermore, high porewater pressure due to the depth of repository along with possibility of elevated salinity of groundwater would cause the bentonite-based materials to be under transient hydraulic conditions. Therefore it is crucial to characterize the sealing materials over a wide range of thermal-hydraulic conditions. A comprehensive experimental program has been conducted to measure properties (mainly focused on thermal properties) of all sealing materials involved in Mark II concept at plausible thermal-hydraulic conditions. The thermal response of Canada’s concept for a deep geological repository has been modelled using experimentally measured thermal properties. Plausible scenarios are defined and the effects of these scenarios are examined on the container surface temperature as well as the surrounding geosphere to assess whether they meet design criteria for the cases studied. The thermal response shows that if all the materials even being at dried condition, repository still performs acceptably as long as sealing materials remain in contact.

Making personalised nutrition the easy choice: Creating policies to break down the barriers and reap the benefits

Personalised diets based on people’s existing food choices, and/or phenotypic, and/or genetic information hold potential to improve public dietary-related health. The aim of this analysis, therefore, has been to examine the degree to which factors which determine uptake of personalised nutrition vary between EU countries to better target policies to encourage uptake, and optimise the health benefits of personalised nutrition technology. A questionnaire developed from previous qualitative research was used to survey nationally representative samples from 9 EU countries (N = 9381). Perceived barriers to the uptake of personalised nutrition comprised three factors (data protection; the eating context; and, societal acceptance). Trust in sources of information comprised four factors (commerce and media; practitioners; government; family and, friends). Benefits comprised a single factor. Analysis of Variance (ANOVA) was employed to compare differences in responses between the United Kingdom; Ireland; Portugal; Poland; Norway; the Netherlands; Germany; and, Spain. The results indicated that respondents in Greece, Poland, Ireland, Portugal and Spain, rated the benefits of personalised nutrition highest, suggesting a particular readiness in these countries to adopt personalised nutrition interventions. Greek participants were more likely to perceive the social context of eating as a barrier to adoption of personalised nutrition, implying a need for support in negotiating social situations while on a prescribed diet. Those in Spain, Germany, Portugal and Poland scored highest on perceived barriers related to data protection. Government was more trusted than commerce to deliver and provide information on personalised nutrition overall. This was particularly the case in Ireland, Portugal and Greece, indicating an imperative to build trust, particularly in the ability of commercial service providers to deliver personalised dietary regimes effectively in these countries. These findings, obtained from a nationally representative sample of EU citizens, imply that a parallel, integrated, public-private delivery system would capture the needs of most potential consumers.

Peptide Therapeutics and the Pharmaceutical Industry: Barriers Encountered Translating from the Laboratory to Patients

Peptides are receiving increasing interest as clinical therapeutics. These highly tunable molecules can be tailored to biocompatibility and biodegradability with simultaneously selective and potent therapeutic effects. Despite challenges regarding up-scaling and licensing of peptide products, their vast clinical potential is reflected in the 60 plus peptide-based therapeutics already on the market, and the further 500 derivatives currently in developmental stages. Peptides are proving effective for a multitude of disease states including: type 2 diabetes (controlled using the licensed glucagon-like peptide-1 receptor liraglutide); irritable bowel syndrome managed with linaclotide (currently at approval stages); acromegaly (treated with octapeptide somostatin analogues lanreotide and octreotide); selective or broad spectrum microbicidal agents such as the Gram-positive selective PTP-7 and antifungal heliomicin; anticancer agents including goserelin used as either adjuvant or for prostate and breast cancer,and the first marketed peptide derived vaccine against prostate cancer, sipuleucel-T. Research is also focusing on improving the biostability of peptides. This is achieved through a number of mechanisms ranging from replacement of naturally occurring L-amino acid enantiomers with D-amino acid forms, lipidation, peptidomimetics, N-methylation, cyclization and exploitation of carrier systems. The development of self-assembling peptides are paving the way for sustained release peptide formulations and already two such licensed examples exist, lanreotide and octreotide. The versatility and tunability of peptide-based products is resulting in increased translation of peptide therapies, however significant challenges remain with regard to their wider implementation. This review highlights some of the notable peptide therapeutics discovered to date and the difficulties encountered by the pharmaceutica lindustry in translating these molecules to the clinical setting for patient benefit, providing some possible solutions to the most challenging barriers. 

Delivery of nucleic acids for cancer gene therapy: overcoming extra- and intra-cellular barriers

The therapeutic potential of cancer gene therapy has been limited by the difficulty of delivering genetic material to target sites. Various biological and molecular barriers exist which need to be overcome before effective nonviral delivery systems can be applied successfully in oncology. Herein, various barriers are described and strategies to circumvent such obstacles are discussed, considering both the extracellular and intracellular setting. Development of multifunctional delivery systems holds much promise for the progression of gene delivery, and a growing body of evidence supports this approach involving rational design of vectors, with a unique molecular architecture. In addition, the potential application of composite gene delivery platforms is highlighted which may provide an alternative delivery strategy to traditional systemic administration.