Multiple Potential Barriers Research Articles

Recognition, Description, and Variability of Spasticity in Individuals With Multiple Sclerosis and Potential Barriers to Clinician-Patient Dialogue: Results From SEEN-MSS, a Large-Scale, Self-Reported Survey.

The experience with spasticity varies among individuals with multiple sclerosis and spasticity (MSS), as they may not recognize it as spasticity or have the language to describe their symptoms. This can lead to potential delays in diagnosis and treatment. Symptoms and Emotions Exploration Needed in Multiple Sclerosis Spasticity was an online survey completed by 1177 individuals with MSS in 2021. It sought to capture symptoms of spasticity, variability of symptoms, specific spasticity triggers, and how conversations with physicians were initiated. The mean age of the cohort was 56.8 years and it was 78% women. Prior to spasticity onset, 65% of respondents felt minimally prepared or unprepared for possibly developing spasticity and were unaware that spasticity manifests as part of MS. Eighty percent experienced spasticity daily, which was variable in severity and duration. Spasticity was triggered by a range of factors and 90% of those surveyed were unable to predict when it would occur or its severity. Day-to-day variability of spasticity prevented 65% of respondents from doing things they wished to do. Sixty percent were confused by their symptoms, not recognizing them as spasticity. Although 91% reported experiencing muscle spasms, only 69% used "muscle spasms" to describe their symptoms. Other descriptors included "muscle tightness," "stiffness," "cramping," and "pain." After recognizing spasticity, 78% proactively initiated discussions with their physicians, 52% wished they had done so sooner, and 42% delayed the conversation by up to or more than a year. Results emphasize the variable nature of spasticity and the lack of a common language to describe symptoms, underscoring the importance of education, earlier recognition, and customized treatments tailored to the severity and duration of spasticity symptoms.

Reaction dynamics of P(4S) + O2(X3Σ−g) → O(3P) + PO(X2Π) on a global CHIPR potential energy surface of PO2(X2A1): implications for atmospheric modelling

Abstract. The reaction dynamics of P(4S) + O2(X3Σg-) → O(3P) + PO(X2Π) are thought to be important in atmospheric and interstellar chemistry. Based on the state-of-the-art ab initio energy points, we analytically constructed a global potential energy surface (PES) for the ground-state PO2(X2A1) using the combined-hyperbolic-inverse-power-representation (CHIPR) method. A total of 6471 energy points were computed by the multireference configuration interaction method with the Davidson correction and aug-cc-pV5Z basis set. The analytical CHIPR PES reproduces ab initio energies accurately with a root-mean-square deviation of 91.5 cm−1 (or 0.262 kcal mol−1). The strongly bound valence region of the PES has complicated topographical features with multiple potential wells and barriers. The attributes of the important intermediates are carefully validated with our geometry optimization results, as well as previous experimental and computational results. Finally, the reaction probability, integral cross sections, and rate constants for P(4S) + O2(X3Σg-) → O(3P) + PO(X2Π) are calculated using the quasi-classical trajectory and time-dependent wave packet methods. The trends of probability and integral cross section versus the collision energy can be divided into three stages, which are governed by the entrance barriers or exothermicity of the reaction. The rate constant demonstrates strong Arrhenius linear behaviour at relatively low temperatures but deviates from this pattern at high temperatures. The calculated cross sections and rate constants are helpful for modelling the phosphorus chemistry in atmospheric and interstellar media.

Characterizing Persons With HIV/HCV Coinfection Who Remain Untreated for Hepatitis C at Four HIV Clinics in Connecticut (CT): Role of Multiple Overlapping Barriers at the Individual and Clinic System Levels.

Introduction. Direct-acting antiviral medications have made hepatitis C virus (HCV) cure possible for >95% of persons with chronic HCV infection, including those coinfected with HIV. Achieving strategic HCV elimination targets requires an understanding of system, provider, and patient-level barriers to treatment. We explored such barriers among persons with HIV/HCV coinfection who remained untreated for HCV. Methods. Among four primary care HIV clinics in CT with high rates of HCV cure, 25 patients with HIV/HCV coinfection were eligible (no HCV treatment as of March 31, 2021). We conducted retrospective chart reviews of demographics, clinical practice patterns, patient-specific issues such as housing, transportation, food security, and presence of mental health and substance use problems. Results. Among untreated patients, 13 (51%) were female; 17 (68%) were Black; median age was 62 years old. The majority (84%) had injecting drug use (IDU) as HIV transmission risk factor; 14 (56%) were prescribed medication-assisted treatment. Median time since HIV and HCV diagnosis was 25 and 19 years, respectively. Clinic-level barriers were noted in 19 (76%) and included lack of evaluation, treatment not recommended or implemented. Concomitant structural barriers included unstable housing for 11 (44%) and lack of transportation for eight (32%). Most patients had history of illicit substance use (84%) and mental health issues (68%). Many (76%) had multiple potential barriers. Conclusions. Multiple overlapping barriers spanning clinic and patient level domains including social determinants of health were the norm in persons with long-standing HIV/HCV coinfection who have not received HCV treatment. Interventions will require innovative, multi-disciplinary and personalized approaches.

Barriers and confidence among colorectal and prostate cancer survivors participating in two behavioral intervention studies.

Exercise and healthy diet are key components of cancer survivorship. We sought to explore perceived barriers to engaging in healthy diet and exercise, and whether these barriers change throughout remote-based behavioral interventions. Smart Pace (SP) and Prostate 8 (P8) were two 12-week pilot randomized controlled trials (RCTs) among 42 colorectal cancer (CRC) survivors and 76 prostate cancer (PC) survivors, respectively, that encouraged participants to implement exercise (both) and healthy diet (P8 only) through text messaging and wearable fitness monitors; P8 also included web materials. Participants completed surveys on perceived barriers and confidence in their ability to implement healthy behaviors at enrollment and 12 weeks; P8 also included a 52-week assessment. At enrollment, CRC survivors commonly reported a lack of discipline/willpower (36%), time (33%), and energy (31%); PC survivors often reported a lack of knowledge about healthy dietary behaviors (26%). Not having anyone with whom to exercise with was a common barrier among both groups (21% in CRC, 20% in PC). Among the intervention groups in both studies, various enrollment barriers (overall, functional/psychological disability, aversiveness, excuses, and inconveniences) were associated with change in behavior over time. Among CRC and PC survivors, there are multiple potential barriers related to motivation, time, social support, and lack of knowledge, that can be addressed and overcome to improve healthy behaviors. Tailoring lifestyle interventions to participants' individual barriers and confidence is needed to promote and sustain behavior change long-term.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Abortion and contraception for incarcerated people: A scoping review.

Women experiencing incarceration have higher rates of unmet contraceptive needs and rates of abortion than the public. Incarceration presents multiple potential barriers to accessing abortion and contraception care, including prison security protocols, prison locations, lack of access to care providers, stigma, and low health literacy. The objective of this scoping review is to understand the extent and type of evidence in relation to contraception and abortion access for people experiencing criminalization and incarceration. We used the Joanna Briggs Institute methodology for scoping reviews and include empirical research with people experiencing criminalization or incarceration and/or with prison staff; with respect to prescription contraception or abortion access, while in custody or after having experienced incarceration/criminalization. Databases searched include CINAHL, APA PsycInfo, Gender Studies, Medline (Ovid), Embase, Sociological Abstracts, and Social Services Abstracts. The search yielded 6096 titles of which 43 were included in the review. Our search yielded 43 studies published between 2001 and 2021 across six countries. The studies included qualitative, quantitative, and mixed methods designs. The main outcomes of interest included contraceptive use; attitudes towards abortion, contraception, and pregnancy; and barriers to care. Barriers identified included lack of onsite access to options, contraceptive coercion by providers, financial costs, and disruptions to medical coverage and insurance status which incarcerated. Evidence indicates that people in prison face significant barriers to maintaining continuity of contraceptive methods, abortion access, and reproductive health guidance. Some studies articulated participants felt judged when discussing contraception with prison-based health care providers. Geographic location, out-of-pocket payments, and trust in health care providers were reported as barriers to access. Incarceration presents considerable challenges to the access of contraception and abortion care. Future research should examine the interaction between institutional security policies and procedures on care seeking, the experiences of underserved and hyper-incarcerated groups, and the impact of being denied access to contraception and abortion and experiences of criminalization.

Spin-polarised wave-packets transport through one-dimensional nonlinear multiple barriers: Rashba and Dresselhaus Spin–Orbit interactions

ABSTRACT The time evolution of a Gaussian wave packet travelling through a one- dimensional semiconductor based on multiple potential barriers has been explored in order to obtain the spin-based transmission, reflection, and trapping coefficients. We have used a split-step finite difference method to solve the resulting nonlinear coupled Schrodinger equations. The related behaviour of scattering properties of the system as a function of Rashba and Dresselhaus Spin–Orbit interactions, wave-packet velocity, the geometry of the barriers, and the number of neighbouring barriers have been discussed. Based on the results, it is found that by tuning the Rashba and the Dresselhaus coupling strengths, and the characteristics of the system, one can control the spin polarisation of the wave-packet and its propagation coefficients.

HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study

BackgroundPeople who exchange sex for money, favors, goods or services, combat higher risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Understanding barriers to STD and HIV related healthcare from the perspective of this stigmatized and marginalized community may improve access to sexual health services including pre-exposure prophylaxis (PrEP). MethodsWe used community-partnered participatory and qualitative methods to conduct anonymous one-on-one interviews with people who exchange sex to understand their perspectives and experiences related to pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We conducted twenty-two interviews and coded them to perform thematic analysis. ResultsWe identified five themes: (1) Appreciation of HIV risk and prevention strategies grew from information accumulated over time. (2) PrEP information came from a variety of sources with mixed messages and uncertain credibility. (3) Decision-making about use of PrEP was relative to other behavioral decisions regarding exchange sex. (4) The multi-step process of obtaining PrEP presented multiple potential barriers. (5) Healthcare providers were seen as powerful facilitators to PrEP utilization.ConclusionsOur findings suggest that PrEP education and care needs to be made more relevant and accessible to individuals who exchange sex.

Particle escape problem in semi-open system

<sec>We investigated the tunneling properties of a particle in a semi-open system. Starting initially from the eigenstate of the particle in the one-dimensional infinite well, we quench the infinitely high barrier on the right into a series of <inline-formula><tex-math id="M2">\begin{document}$\delta$\end{document}</tex-math><alternatives><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M2.jpg"/><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M2.png"/></alternatives></inline-formula> barriers to observe the survival probability which is defined as the fidelity to the initial state. This constitutes a semi-Dirac comb model consisting of an infinitely high wall and multiple equally spaced <inline-formula><tex-math id="M3">\begin{document}$\delta$\end{document}</tex-math><alternatives><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M3.jpg"/><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M3.png"/></alternatives></inline-formula>-potential barriers. We first solve the exact analytical solution of this model and obtain the closed analytic form of the eigen function expressed by a recursive relation. For a single barrier, multiple potential barriers, the disordered potential barriers, the closed-form expression of the survival probability i.e., the initial state fidelity, is given for any evolution time and it is used to reveal the mechanism of the particle escape process. The dependence of survival probability on the strength of barrier, number of barriers, and disorder strength is calculated numerically based on fast Fourier transform method. The relevant parameters are used to control and suppress the particle escape problem. We found that for a single <inline-formula><tex-math id="M4">\begin{document}$\delta$\end{document}</tex-math><alternatives><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M4.jpg"/><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="16-20220450_M4.png"/></alternatives></inline-formula>-potential barrier, the survival probability of the particle follows different trends in different decay time ranges. The particle in the ground state or excited states decays exponentially in a short time. After some time, the decay of the excited state will proceed with the same decay constant as that of the ground state. Finally, the survival probability follows a long-time inverse power law. The curve changes abruptly at different decay time intervals and is accompanied by significant oscillations. These oscillations in the transition region are caused by the interference of the exponential rate and the inverse power-law term, while the long-time non-exponential decay is due to the fact that the system energy spectrum has a lower bound. Increasing the barrier strength will greatly increase the probability of particles remaining in the well.</sec><sec>For multiple potential barriers, the reflection and transmission of particles between the potential barriers interfere with each other. When the strength of the potential barrier is small, the particle still decays exponentially. For a larger potential barrier strength, the probability of particle reflection increases, and the particles that tunnel out may be bounced back. The survival probability oscillates sharply, reaching higher fidelity at certain moments. The oscillatory maximum of the survival probability decreases linearly with the number of barriers, while the moment corresponding to the oscillatory maximum shows a parabolic increase with the number of barriers. The introduction of a series disordered barriers can significantly improve the survival probability and greatly suppress its oscillations over time.</sec><sec>Our calculation is expected to find applications in quantum control of particle escape problem in the disordered system.</sec>

Stakeholder Perceptions of Barriers to Diverse Acute Myeloid Leukemia Clinical Trial Enrollment at Comprehensive Cancer Centers

IntroductionDisparities in clinical trial enrollment have the potential to bias findings, limit generalizability, misdirect drug development, and reduce equitable access to novel therapy. Given the unique care delivery and clinical trial patterns of acute leukemia (AML), barriers to trial enrollment for underrepresented groups at the Comprehensive Cancer Centers (CCCs), where patients are often treated, may be distinct. Characterization of these barriers has been limited, preventing the development of interventions to overcome this disparity for AML.MethodsWe conducted an exploratory qualitative project to characterize barriers to trial enrollment and facilitators to overcome them through a series of focus groups and individual interviews. Participants were persons with AML who identified from one or more underrepresented groups and AML physicians, nurse practitioners, and physician assistants at three Dana-Farber/Harvard Cancer Center hospitals. A moderator guide was developed based on literature review and iteratively revised by study investigators. The questions enabled an open-ended multi-level (patient, provider, trial, institution, societal) exploration of five main domains, including familiarity and experience with clinical trials, factors influencing participation, participant concerns and enrollment supports, and facilitators to address enrollment barriers and disparities. Focus groups and interviews occurred through video conference or phone and were audio recorded and professionally transcribed. The interdisciplinary research team conducted a multi-step thematic analysis guided by framework analysis, and included prefigured and emergent codes. The team-based analysis synthesized data within and across participant types and focused on the identification of key patterns and prevalent themes related to barriers to clinical trial enrollment. Coding and analysis were assisted by NVivo 12 software. Results presented below highlight barriers that were considered relevant to the unique care delivery patterns of AML and clinically significant.Results37 participants (19 patients; 18 providers) were recruited to focus groups (30) or interviews (7) between 5/6-6/28/2021. Participant characteristics are shown in Table 1. Patient participants were generally familiar with clinical trials. Despite limited explicit expression of enrollment hesitancy, both patients and providers noted multiple potential barriers to clinical trial enrollment specific to AML, including the rapidity from diagnosis to treatment; the inpatient setting of therapy; a lack of knowledge regarding incidence and enrollment demographics and their differences; restrictive trial design factors (e.g., hospital stays, mutation specificity); and concerns over the appropriateness and efficacy of a given trial relative to individual disease risk. Key enrollment barriers reported by participants are shown in Figure 1. Participant-identified facilitators to address these barriers are shown in Figure 2. Facilitators to overcome barriers specific to AML that were considered potentially impactful included: peri-enrollment peer support for patients, continuance of telehealth visits during trial participation, feedback and training to increase provider awareness and understanding of disparities and diverse communities, trial design augmentation to minimize restrictive barriers (centralized laboratory draws, multiple hospitalizations, white blood cell count and organ function criteria) and increase inclusivity (multiple language and culturally competent consent), and bolstering inter-institutional AML program partnerships to increase diverse patient referral.ConclusionsStakeholder-reported barriers to diverse AML clinical trial enrollment at CCCs include multiple disease-specific characteristics that reflect the unique care pattern of AML, such as concerns about restrictive trial design characteristics, the need to be inpatient, and the requirement to make decisions quickly after diagnosis. Several barriers and potential interventions at each level were considered impactful by both providers and patients. These formative data suggest a novel multi-level approach for overcoming AML enrollment disparities at CCCs is needed. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Interprofessional simulation: The challenges of teamwork training

Introductionsimulation can be a powerful tool to improve interprofessional teamwork and improve patient outcomes. This manuscript aims to describe a simulation intervention and explore its potential benefits and barriers to its successful implementation to inform future work. Methodsthis is a prospective observational study. We conducted 22 in situ simulation sessions in the operating room within a General Surgery division. Observations of surgical teams were conducted before the simulation, on the day of the simulation, and 3 to 4 months after the simulation. Team performance was measured using the NOTECHS scale, an instrument designed to assess the non-technical skills of interprofessional teams. Direct observation was used to assess teamwork, and variation in scores was assessed using ANOVA. Qualitative semi-structured interviews were conducted with participants to explore benefits and barriers of the intervention, and analyzed using content analysis. Resultsno change in team performance was observed using the NOTECHS scale. Participants described not being prepared enough to benefit from the sessions, voiced concerns regarding unequal role of participants in the simulation, and reported a fear of being judged by other team members during the sessions. Conclusionoverall, we identified multiple potential barriers to implementation of in situ simulation as interprofessional teamwork training. The challenges identified here can inform the design and implementation of future teamwork training interventions.

Core-shell nanostructures introduce multiple potential barriers to enhance energy filtering for the improvement of the thermoelectric properties of SnTe.

Using dispersed nanostructures to induce an energy filtering effect is an easy and effective mechanism to optimize the performance of bulk thermoelectric materials. Compared with other nanostructures, core-shell nanostructures possess more interfaces and multiple potential barriers, which would lead to a significant impact on the thermal and electrical properties of materials. In this paper, after BiCuSeO alloy doping into SnTe, SnO2 layers were formed at the interfaces and the BiCuSeO nanoparticles were wrapped in the SnO2 shell during the following high temperature solid state reaction. The formation of SnO2 layers could be observed and confirmed by X-ray diffraction (XRD) and scanning electron microscopy (SEM). BiCuSeO@SnO2 core-shell nanostructures can introduce multiple potential barriers to enhance the energy filtering effect. Once the BiCuSeO doping concentration was over 3%, the carrier concentration could decrease to about 10% while the mobility increases to 350% compared to the values of the undoped sample at room temperature. Meanwhile, the Seebeck coefficients were improved to 176.05 μV K-1 at 835 K. Additionally, due to the scattering of core-shell nanostructures for the phonons, a lower thermal conductivity is achieved with a value of 1.04 W m-1 K-1 at 835 K in Sn1.03Te-5% BiCuSeO. Combined with the improvement of thermal and electrical properties by the BiCuSeO@SnO2 core-shell, a high ZT value of ∼1.21 was achieved for Sn1.03Te-5% BiCuSeO at 835 K, which was enhanced by 190% compared to pristine SnTe.

Room temperature gas nanosensors based on individual and multiple networked Au-modified ZnO nanowires

In this work, we investigated performances of individual and multiple networked Au nanoparticles (NPs)-functionalized ZnO nanowires (NWs) integrated into nanosensor devices using dual beam focused ion beam/scanning electron microscopy (FIB/SEM) and tested them as gas sensors at room temperature. Such important parameters as diameter and relative humidity (RH) on the gas sensing properties were investigated in detail. The presented results demonstrate that thin Au/ZnO NWs (radius of 60 nm) have a gas response of Igas/Iair of about 7.5–100 ppm of H2 gas which is higher compared to Igas/Iair of about 1.2 for NWs with a radius of 140 nm. They have a low dependence of electrical parameters on water vapors presence in environment, which is very important for practical and real time applications in ambient atmosphere. Also, the devices based on multiple networked Au/ZnO NWs demonstrated a higher gas response of Igas/Iair about 40 and a lower theoretical detection limit below 1 ppm compared to devices based on an individual NW due to the presence of multiple potential barriers between the NWs. The corresponding gas sensing mechanisms are tentatively proposed. The proposed concept and models of nanosensors are essential for further understanding the role of noble metal nanoclusters on semiconducting oxide nanowires and contribute for a design of new room-temperature gas sensors.

Should mentoring be routinely introduced into general dental practice to reduce the risk of occupational stress?

Introduction Occupational stress within general dental practice can potentially have an adverse impact on a practitioner's wellbeing and the quality of healthcare provided by that individual. Mentoring has routinely been utilised in other professions for stress management, however, there is little in the dental literature discussing the benefits of mentorship on the reduction of occupational stress for dental practitioners.Aim The aim of this study was to explore the perceptions of experienced foundation dental trainers within the Health Education, Kent, Surrey and Sussex postgraduate deanery as to the usefulness of routine mentoring as a tool to reduce occupational stress.Methods Using a qualitative approach, six individual semi-structured interviews were undertaken. Recorded interviews were transcribed and transcriptions were analysed using thematic coding to identify overarching themes.Results Both similarities and differences with the existing literature on routine mentoring within professional settings were identified. Foundation dental trainers were positive towards the concept of routine mentoring, although there was also a degree of scepticism regarding the potential uptake among colleagues. There was a perception that mentoring might more practically be used as a reactionary tool. Multiple potential barriers to routine mentoring were identified, included funding, scheduling and a lack of training.Conclusions The analysis identified that currently, experienced foundation dental practitioners do not consider routine mentoring as a practical option in the prevention of occupational stress. The results would suggest that further education is required as to the benefits of routine mentoring as a strategy for occupational stress management. However, with additional resources buying time, a hybrid model of mentoring and coaching has significant potential in general dental practice.

The effect of morphology and functionalization on UV detection properties of ZnO networked tetrapods and single nanowires

Rapid detection and fast response of nanoelectronic devices based on semiconducting oxides is nowadays a modern and stringent subject of research. Device performances depend mainly on the morphologies of the metal oxide nanostructures. In the scope of this work, the influence of the structural morphology of three-dimensional (3-D) ZnO nano- and microstructured networks on the room temperature UV detection properties is studied in detail. We show that the formation of multiple potential barriers between the nanostructures, as well as the diameter of the nanostructures, which is in the same order of magnitude as the Debye length, strongly influence the UV sensing properties. Consequently, 3-D ZnO networks consisting of interconnected ultra-long wire-like tips (up to 10 μm) and with small wire diameters of 50–150 nm, demonstrated the highest UV sensing performances (UV response ratio of ∼3100 at 5 V applied bias voltage). Furthermore, we demonstrate the possibility of substantially increasing the UV sensing performances of individual ZnO nanowire (NW) (diameter of ∼50 nm) by surface functionalization with carbon nanotubes (CNTs), showing high response ratio (∼60–50 mW/cm2), as well as fast response (∼1 s) and recovery (∼1 s) times. The obtained results thus provide a platform with respect to the next generation of portable UV radiation detectors based on semiconducting oxide networks.

Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings

BackgroundInappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB). Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices.MethodsWe conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. We used iterative categorization (directed content analysis followed by summative content analysis) to code and analyze the data both deductively (using SEIPS domains) and inductively (emerging themes).ResultsFactors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues.ConclusionsWe identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.

Anisotropic transport of normal metal-barrier-normal metal junctions in monolayer phosphorene

We study transport properties of a phosphorene monolayer in the presence of single and multiple potential barriers of height U0 and width d, using both continuum and microscopic lattice models, and show that the nature of electron transport along its armchair edge (x direction) is qualitatively different from its counterpart in both conventional two-dimensional electron gas with Schrödinger-like quasiparticles and graphene or surfaces of topological insulators hosting massless Dirac quasiparticles. We show that the transport, mediated by massive Dirac electrons, allows one to achieve collimated quasiparticle motion along x and thus makes monolayer phosphorene an ideal experimental platform for studying Klein paradox in the context of gapped Dirac materials. We study the dependence of the tunneling conductance as a function of d and U0, and demonstrate that for a given applied voltage V its behavior changes from oscillatory to decaying function of d for a range of U0 with finite non-zero upper and lower bounds, and provide analytical expression for these bounds within which G decays with d. We contrast such behavior of G with that of massless Dirac electrons in graphene and also with that along the zigzag edge (y direction) in phosphorene where the quasiparticles obey an effective Schrödinger equation at low energy. We also study transport through multiple barriers along x and demonstrate that these properties hold for transport through multiple barriers as well. Finally, we suggest concrete experiments which may verify our theoretical predictions.

Perinatal Depression and Anxiety — Implementing Screening and Response Protocols [6N

INTRODUCTION: Perinatal mood and anxiety disorders are the most common pregnancy complications, and are associated with adverse maternal, infant and child outcomes. Recognizing this, the Council on Patient Safety in Women's Healthcare developed an evidence-based safety bundle to establish a standard of care for these disorders that is relevant to every woman in every clinical setting. Its objective was to outline how to implement current recommendations at the practice level. METHODS: To promote safety bundle dissemination, the American College of Obstetricians and Gynecologists invited 20 nationally representative obstetric and behavioral health providers to engage in a journey mapping process. The journey map followed the safety bundle format and addressed implementation steps needed to screen for and respond to perinatal mood and anxiety disorders. Opportunities to ease implementation were also assessed. RESULTS: The journey map focused on the process of addressing these disorders and identified multiple potential barriers. Each step of implementation must consider an ever changing obstetric practice environment, and the absence of related direct reimbursement. It is critical to focus on implementation until consensus is reached regarding outcomes measures to assess screening and treatment. CONCLUSION: As the implications of untreated perinatal mood and anxiety disorders are better understood, it is critical to develop and disseminate implementation processes to help obstetric practices screen for and address this issue. Implementation protocols need to be customized to each unique care setting. Further efforts are required to establish meaningful outcome measures.

Can community-based adaptation increase resilience?

A central claim of community-based adaptation (CBA) is that it increases resilience. Yet, the concept of resilience is treated inconsistently in CBA, obscuring discussion of the limitations and benefits of resilience thinking and undermining evaluation of resilience outcomes in target communities. This paper examines different participatory assessment activities carried out as part of CBA case studies in Timor-Leste and Solomon Islands. The activities and their outputs were assessed against 10 characteristics of resilience previously identified in a systematic review. The findings offer support to the claim that CBA can build resilience in target communities, revealing the inherent strengths of CBA in relation to resilience. However, it is necessary for CBA assessments to simultaneously incorporate activities that consider cultural, political, economic and ecological factors influencing resilience within and between communities. This may demand multiple staff with different skills. The findings also highlight the importance of politics and power in shaping adaptive capacity. In particular, addressing the highly context specific nature of social, cultural and political relations demands an approach that is situated in and responsive to local realities. Overall, our case studies suggest that using the 10 characteristics as an analytical framework offers support to practitioners looking to develop, implement or evaluate CBA assessment activities. Yet within this, it is critical that a focus on increasing resilience through CBA does not preclude transformation in social relations. Realising the potential to support resilience and transformation requires CBA practitioners to acknowledge the multifaceted nature of resilience, whilst also paying close attention to multiple potential barriers to equitable adaptation.

Access to Care in Vermont: Factors Linked With Time to Chemotherapy for Women With Breast Cancer-A Retrospective Cohort Study.

In the rural United States, there are multiple potential barriers to the timely initiation of chemotherapy. The goal of this study was to identify factors associated with delays in the time from initial diagnosis to first systemic therapy (TTC) among women with breast cancer in Vermont. Using data from the Vermont Cancer Registry, we explored TTC for 702 female Vermont residents diagnosed with stage I to III breast cancer between 2006 and 2010 who received adjuvant chemotherapy. Multivariable linear regression was used to evaluate the associations between TTC and patient, tumor, treatment, and geographic variables. Mean TTC was 10.2 weeks. Longer drive time (P < .001), more invasive surgery (P = .01), and breast reconstruction (P < .001) were each associated with longer TTC. Each additional 15 minutes of drive time was associated with a 0.34-week (95% CI, 0.22 to 0.46 weeks) increase in TTC. Participants age younger than 65 years whose primary payer was Medicare (n = 27) had significantly longer average TTC, by 2.37 weeks (P = .001), compared with those with private or military insurance. There was also substantial variation in TTC across hospitals (P < .001). Most female patients with stage I to III breast cancer in Vermont are receiving adjuvant chemotherapy within the National Comprehensive Cancer Network-recommended timeframe; however, improvements remain needed for certain subgroups. Novel approaches for women with long drive times need to be developed and evaluated in the community. Variation in TTC by hospital, even after adjusting for patient, tumor, and treatment factors, also suggests opportunities for process improvement.