Unexpected Barrier Research Articles

LOST IN TRANSLATION: PHARMACY TRANSLATION SOFTWARE MOUNTS AN UNEXPECTED BARRIER TO SCHOOL MEDICATIONS

LOST IN TRANSLATION: PHARMACY TRANSLATION SOFTWARE MOUNTS AN UNEXPECTED BARRIER TO SCHOOL MEDICATIONS

Towards a systematic computational framework for modeling multi-agent decision-making at micro level for smart vehicles in a smart world

We propose a multi-agent based computational framework for modeling decision-making and strategic interaction at micro level for smart vehicles in a smart world. The concepts of Markov game and best response dynamics are heavily leveraged. Our aim is to make the framework conceptually sound and computationally practical for a range of realistic applications, including micro path planning for autonomous vehicles. To this end, we first convert the would-be stochastic game problem into a closely related deterministic one by introducing risk premium in the utility function for each individual agent. We show how the sub-game perfect Nash equilibrium of the simplified deterministic game can be solved by an algorithm based on best response dynamics. In order to better model human driving behaviors with bounded rationality, we seek to further simplify the solution concept by replacing the Nash equilibrium condition with a heuristic and adaptive optimization with finite look-ahead anticipation. In addition, the algorithm corresponding to the new solution concept drastically improves the computational efficiency. To demonstrate how our approach can be applied to realistic traffic settings, we conduct a simulation experiment: to derive merging and yielding behaviors on a double-lane highway with an unexpected barrier. Despite assumption differences involved in the two solution concepts, the derived numerical solutions show that the endogenized driving behaviors are very similar. We also briefly comment on how the proposed framework can be further extended in a number of directions in our forthcoming work, such as behavioral calibration using real traffic video data, and computational mechanism design for traffic policy optimization.

Practitioners’ conceptualisations of ‘evidence-based practice’ as a barrier to changing practice

The promotion of evidence-based, healthcare practice is a key concern for healthcare professionals both in the UK and internationally. However, what healthcare professionals understand by the term ‘evidence-based practice’ varies, and this can have implications for changing practice. This discussion piece describes a doctoral research project exploring the implementation of a new Enhanced Recovery Pathway (ERP) in three NHS hospitals. ERPs are evidence-based approaches to streamlining surgery and research demonstrates the positive impacts that their introduction has had for patient hospital stay, morbidity and mortality, post-surgical complications and quality of life. The ERP discussed in this article was designed to address the specific, complex needs of patients with cognitive impairment who fracture their hip. These patients are currently underrepresented in published literature regarding ERP effectiveness. As such, the evidence informing the ERP’s design consolidated current best practice guidelines, expert consultation and guidance from public and patient involvement groups. Staff members who were tasked with coordinating the implementation interpreted this to mean that the ERP was not sufficiently ‘evidence-based’. This presented an unexpected barrier to changing staff behaviour and successful ERP implementation. To promote successful intervention implementation, policy makers need to carefully consider how staff conceptualise ‘evidence-based practice’ and their attitudes towards newly introduced practices.

Langar’s axillary arch; a misguiding finding to the physicians and unexpected barrier to the surgeons

Introduction: Variation in the axillary anatomy is of tremendous practical relevance along almost all operations executed in this area. The aim of this study is to report and discuss a case with the axillary arch of Langer.

Topological ferroelectricity in layered perovskite LaTaO4: A first principles study

Abstract The ferroelectricity in layered perovskite LaTaO 4 is investigated by first-principles calculations. The rather large polarization (about 36 μC/cm 2 ) along -c direction is obtained by the Berry phase approach. Ferroelectric phase can be induced by freezing a soft B 1 u mode from the prototype phase, and this mode involves the rotations of oxygen octahedron and the displacement of La 3+ cations. The topological ferroelectricity is adopted based on the previous work to distinguish from the typical proper ferroelectrics, such as BaTiO 3 . The 0 K stable monoclinic phase can be regarded as an antiferroelectric phase since the polarization of the neighboring layer will be canceled each other. However, the ferroelectric phase is metastable because of the unexpected small barrier between paraelectric and monoclinic phase and narrow energy gap between ferroelectric and monoclinic phase, and this result can explain the previous experimental results. From the present work, the topological ferroelectricity in layered perovskite LaTaO 4 is confirmed, and the rather high polarization makes the present compound as a promising candidate for the lead-free ferroelectric application.

El viaje al Pacífico: los fundamentos geo-históricos del «lago español» = Journey to the Pacific: the geographical and historical foundations of the ‘Spanish lake’

Despite the Christopher Columbus’ inability in understanding that he had bumped into an unexpected barrier, the fact of the existence of a ‘South Sea’ —which was named by Francisco Magallanes as the Pacific Ocean— resulted clear to the Europeans not before about 30 years after the takeover of the Atlantic Ocean. However, the knowledge of Pacific remained very partial on the mid-eighteenth century. The main objective of this text is to reflect about this time lag between the early discovery and its later exploration. It’ll insist here on the various obstacles that slowed the navigation to the Pacific, favouring the settlement of what, at the time, Pierre Chaunu dubbed the ‘Spanish lake’.

Rehabilitation Barriers Recognized in a Geriatric Patient after Cardiac Revascularization Procedure

ABSTRACTThe incidence of coronary heart disease is most prevalent among persons greater than 65 years of age (Fang et al., ). A cardiac catheterization is often required to confirm or evaluate the extent of the disease. Over 1 million inpatient cardiac catheterizations are performed annually in the United States, with approximately half of those patients needing a percutaneous cardiac intervention as a result of the catheterization findings. The use of larger catheters during this procedure may cause complications after removal of the catheter, and vascular access complications are a leading cause of morbidity, cost, and legal ramifications. One method to achieve hemostasis after a catheter is removed from the femoral artery is to mechanically close the puncture site with a femoral artery closure device (FACD) (Hamel, ). This case study describes how the complications of an FACD deployed after a coronary intervention created an impediment to progression of a geriatric patient's rehabilitation course. Opportunities to share lessons learned from this unexpected physiologic barrier are discussed, and consequences related to inadequate information at hand-off between institutions are described.

Increasing uptake of bowel cancer screening.

Uptake of bowel cancer screening uptake at our practice is 32.72%, which is below the national target of 60%, but our cancer prevalence and death rate is higher than our CCG statistical mean. We examined reasons for non-response to bowel cancer screening in our patients and explored ways to promote engagement.From August 2013 to February 2014 we used three interventions in two patient groups: those turning 60 and eligible for screening (rising 60's) and non-responders to screening. Interventions used were; letter encouragement for rising 60's, staff education to increase opportunistic promotion of screening and calling non- responders to identify reasons for non-participation and encourage participation. Calls were made by either a Doctor or a Health Care Assistant (HCA); ethnicity, language spoken, caller and call outcome was recorded.Rising 60's (n=26) had an uptake of 46%, increased from 32.72%. From the non-responders (n = 73) we were unable to contact 38%, 46% was due to an incorrect or no phone number. Of those contacted main reasons for non-participation were not receiving a screening kit (n=19) and not wanting to be screened (n=14). Following calls 66% of non-responders agreed to screening. From this 66% half (50%) completed screening with a negative result. 15 non-responders refused screening following our calls, the main reason given was not wanting to know if they had cancer (n =14). Calls from doctor and HCA had similar rates of screening uptake (39% and 33% respectively).Difficulty contacting patients was an unexpected barrier to screening and will be addressed. Actively encouraging screening appears beneficial with similar responses to Doctor and HCA. There appears to be a place for increased education regarding screening and early detection of malignancy amongst patients.Overall our interventions improved screening uptake at the practice and will be continued in future.

Managing the citizen: privatized public works and the bureaucratic management of citizenship in post-authoritarian Chile, 1990–2005

Chile's transition to democracy in the early 1990s posed a challenge to the country's newly elected governments: how to manage conflicts and contradictions generated by the simultaneous liberalization of the economy and political arena. In the mid-1990s, residents of Chile's capital city, Santiago, emerged as an unexpected barrier to a market-driven model of urban development. Their protests and claims of authoritarian planning shook elected governments, prompting bureaucratic reforms meant to manage the assault on a coveted state program and the definition of (urban) citizenship. This article examines the construction of the concept of urban citizenship in Chile through the lens of the state's response to organized protests at the neighborhood level against highway projects. It focuses on the bureaucracy charged with the daily management of government policies and the political tensions they generated, illustrating the messy, unpredictable translation of macro-state policies into micro-strategies of social management and definition of rights.

The pharmacist’s personal IMPACT

At all of the diverse Project IMPACT: Diabetes sites, pharmacists are having firsthand experience with the effectiveness of personal contact with patients. By encouraging patients to adhere to their medications, helping them navigate the tricky waters of the health care system, or simply listening to their concerns, pharmacists can make a difference just by their presence.

Unintended Consequences: Abortion Training in the Years After Roe v Wade

The US Supreme Court's 1973 Roe v Wade decision had clear implications for American women's reproductive rights and physician ability to carry out patient choices. Its effect on physician abortion training was less apparent. In an effort to increase patient access to abortions after Roe, provision shifted from hospitals to nonhospital clinics. However, these procedures and patients were taken out of the medical education realm, and physicians became vulnerable to intimidation. The consequent provider shortage created an unexpected barrier to abortion access. Medical Students for Choice was founded in 1993 to increase abortion-training opportunities for medical students and residents. Its mission ensures that motivated medical students will learn and a growing number of physicians will commit to comprehensive abortion provision.

Unexpected barrier properties of structurally matched and unmatched polyelectrolyte multilayers

Structurally unmatched hyperthin (14 nm) polyelectrolyte multi-layers (PEMs) formed on poly[1-(trimethylsilyl)-1-propyne] supports exhibit exceptionally high CO(2)/N(2) permeation selectivities, ranging from 100 to 150. Structurally matched PEMs show similar selectivities with significantly higher permeances.

Of Spirit in Shakespeare's Julius Caesar

This essay explores the ways in which Shakespeare dramatizes the question of spirit in Julius Caesar. By closely reading the scenes in which the word spirit appears, it aims to explicate the fundamental nature of spirit. To be more specific, I argue that spirit is power. Caesar is a case in point. Despite physical limitedness and frailties, he lives in such a way as to overcome and transcend them. He even faces death as if he aspires to live forever as a spirit in the minds of Romans. His life, in a sense, can be read as a kind of process toward the birth of spiritual power and spirit as power. However, what is interesting about the nature of spirit is that anyone who possesses as powerful spirit as Caesar may become the source of power as well, thereby creating a new spirit. This is why revolt is structurally possible; spirit brings about anti-spirit. Brutus’s rebellion against Caesar can be understood in this line of thought. Brutus, as well as Cassius, strives to replace the spirit of Caesar that they defined as tyranny with a new spirit based upon peace, freedom, and liberty. They believe that they would herald a new spirit. Yet their ambition faces an unexpected barrier, as Antony redefines the spirit of Caesar as an emblem of sacrifice and successfully instigates plebeians to riot. Antony revives the spirit of Caesar by bringing the plebeians together, demonstrating that the collective power of people animates spirit. As a result, the conflict between the spirit of Caesar and anti-Caesar spirit escalates to the level of war. Shakespeare, in other words, seems to show that the nature of spirit is fundamentally warfare, as best shown in the employment of fire in the play. By associating spirit with a fire, which both literally and symbolically represents warfare. he is seen to confirm that the power of spirit, or spirit as power, is warfare of fire, which simultaneously inflames itself and others although Romans like us fight for ethical assumptions and values.

Assessing technological barriers to telemedicine: technology-management implications

Telemedicine, the use of information technology to deliver health care from one location to another, has the potential to increase the quality and access to health care and to lower costs. This growth of telemedicine installations is occurring even as the utilization rates for installed telemedicine projects are falling well below expectations. Drawing on data collected from three operational telemedicine projects involving different clinical telemedicine applications, we examine how the technological barriers to telemedicine are impacting telemedicine utilization rates. Addressing technological barriers is a necessary but not sufficient condition if telemedicine is to fulfil its promise, and it is predominantly only after such barriers are addressed that the other barriers-professional, legal, and financial-come to the fore. Our findings support end-user and technical training as major barriers but do not support the quality of the video, system reliability, or the perceived inconvenience for physicians to use the equipment as barriers to telemedicine. The mismatch between the sophistication of the technology and end-user requirements for clinical activities and patient confidentiality and privacy issues were supported as barriers, but how they impacted telemedicine utilization was different than expected. Finally, unsatisfactory sound quality of the telemedicine equipment was identified as a frequent and unexpected barrier to telemedicine utilization rates.

Small free energy barrier and postdesorption collisions: The keys towards the understanding of reactive ion etching of silicon.

Reactive ion etching of Si with C${\mathrm{l}}_{2}$ as the reactive gas has been examined with molecular dynamics simulations. The volatility of ${\mathrm{SiCl}}_{x}$ molecules is determined by Gibbs free energy calculations as a function of temperature. The high entropy of activation of the desorbing molecules results in an unexpected low desorption barrier under etching conditions. Etching simulations show that many sputtered molecules undergo one or more collisions with protrusions on the corrugated surface. This results in a redistribution of the kinetic energy and a consistent interpretation of experimental results.

On the difference between internal and external reactions to legitimate and illegitimate frustrations: A demonstration

Although it is commonly assumed that the nature of any given frustration (defined as an unexpected barrier to goal attainment) affects the strength of the resulting instigation to aggression, the present paper argues that the type of frustration, ie, whether it is legitimate or illegitimate, can also influence the strength of an overt attack upon an available target independently of instigation intensity. Two groups of university men were unexpectedly kept from winning a money prize for working on a motor task, and one group was induced to attribute this failure to their partner's misbehavior (illegitimate frustration) while the other men were told the failure was due to the apparatus (legitimate frustration). In comparison to a nonthwarted control group, both frustrated conditions displayed the same level of internal arousal. However, when all subjects had an opportunity to “supervise” a second partner on an unrelated task soon afterwards, only those who had been illegitimately thwarted earlier were now more openly punitive toward this “innocent” individual than the control group. Possible reasons for these results are discussed, but it is emphasized that a distinction must be drawn between the internal and external reactions to a frustration.