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Space-time separation during obstacle-avoidance learning in monkeys.

Is the movement duration time known before we move? To answer this question, a new experimental paradigm is introduced that for the first time monitors the acquisition of a new motor skill in rhesus monkeys. Straight reaches were interleaved with reaches around physical obstacles that elicited a different path geometry. Curved and longer spatial paths were immediately resolved and consistent over months of training. A new temporal strategy separately evolved over repetitions from multiple to a single velocity peak. We propose that the obstacle-avoidance spatial paths were resolved before motion execution and used as reference in the computation of the new dynamics. Path conservation from the first trial occurred both at the hand and at the joint angle levels, whereas the speed profile dramatically changed over time. The spatial solution required no learning and was anticipated by the spontaneous repositioning of the initial arm posture. The learning was in the temporal domain, involving the adjustment of the speed during the motion's first impulse. Within the movement initiation, the partial distance traveled by the hand up to the first velocity peak was finely tuned under a constant time. For a given space location, the time of the first impulse remained robust to learning, but significantly shifted for different targets and obstacle configurations. Differences in the temporal-related parameters across time provided a clear distinction between learning and automatic behavior.

Algorithms↗

Obstacles to utilization of prepaid mental health care.

The coverage of out-of-hospital expenses for mental health care through prepayment and insurance programs has been a major advance in removing the economic barriers to early detection, diagnosis, and treatment of mental disorders. However, obstacles to obtaining treatment block many eligible people from receiving help. The authors conducted a study among members of the United Auto Workers union to identify these roadblocks. Among the obstacles were differences in perceptions of need for treatment and in attitudes toward treatment, and lack of awareness of eligibility for benefits among three key groups - consumers, referral agents, and providers. The authors urge psychiatry to help in removing these obstacles.

Attitude of Health Personnel↗

Is the Oedipus complex still the cornerstone of psychoanalysis? Three obstacles to answering the question.

Current controversies about the centrality of the Oedipus complex in psychoanalysis are difficult to resolve unless we address three obstacles in the way of rational examination. The first is that the Oedipus complex, Freud's "shibboleth" of psychoanalysis, is politically controversial. Second is the great difficulty in agreeing upon the definition and boundaries of the Oedipus complex, especially the necessary complexities introduced with the negative Oedipus complex, female sexuality, the nature of the preoedipal, and counteroedipal fantasies and actions. The third obstacle involves basic questions of psychoanalytic epistemology: our criteria for evidence to prove or disprove any particular proposition. I conclude that the awareness of these difficulties signifies a certain maturation in our thinking and that the complexity introduced by these obstacles can in time provide the groundwork for a set of formulations that is richer and closer to the complexities and ambiguities of the clinical situation.

Ego↗

Obstacles to conducting program evaluations: implications for public health evaluators.

This article presents a number of obstacles to conducting program evaluations which include: the "word" evaluation itself, the politics of evaluation, inadequate resources, the tendency of organizations to resist change, and a lack of understanding of the context of program evaluations. Underpinning these obstacles is the longstanding definitional dilemma between program evaluation and social science research. Although the article's implications are directed toward public health evaluators, they are generalizable to other evaluators in other disciplines. These obstacles highlight the fact that a major role of any evaluator is to confront and negotiate successfully around them.

Health Services Research↗

Design and evaluation of a prototype rear obstacle detection and driver warning system.

This study, concerned with the development of driver interface criteria for a rear obstacle detection system, assessed the appropriateness of alternative warning timing algorithms and evaluated various interface approaches for presenting warning information to drivers. Interface testing used a minivan and a passenger sedan equipped with a prototype rear obstacle detection system. Two different warning timing algorithms and four different interface conditions were examined. The appropriateness of the warning timing algorithms was tested using an alerted backing procedure wherein drivers backed to known obstacles and braked in response to the warning. A surprise event scenario was also included in order to examine driver reaction to the warning under unexpected conditions. Alerted backing results suggest that although both timing algorithms led to few target strikes, one algorithm led to more acceptable ratings, fewer target strikes and close calls, and less urgent braking. None of the interface warning conditions reliably induced avoidance braking under the surprise event condition. Actual or potential applications of this work include the appropriate design of effective backing warning systems.

Accidents, Traffic↗

Obstacles to needle exchange participation in Rhode Island.

OBJECTIVE: This study explores obstacles to participation in needle exchange programs (NEPs) among injection drug users (IDUs) in the state of Rhode Island, U.S.A. METHODS: A written questionnaire was administered at two Rhode Island drug detoxification sites in 1998. RESULTS: 488 self-administered surveys were completed, 226 (46.3%) respondents had injected drugs in the past 6 months. 62.1% reported sharing syringes in the past 6 months, and each syringe was used a mean of 10.7 times. Major obstacles to NEP participation were a lack of awareness of the program (25.6%), inconvenient location or hours (15.9%), and fear of identification and/or police harassment (12.2%). Non-white race was a significant predictor of being unaware of the NEP (p = .01) and not participating in the NEP (p = .03). 13.1% of IDUs who used the NEP were referred to the detoxification program by the NEP. Among all IDUs surveyed, 51.0% had participated in a NEP. CONCLUSIONS: NEPs are important in reducing the spread of bloodborne pathogens among IDUs and are effective referral sources for drug treatment. Surveys of IDUs at sites other than NEPs, such as detoxification facilities, can identify obstacles to the use of NEPs.

Acquired Immunodeficiency Syndrome↗

Oncopolitical issues: obstacles and options for success in a comprehensive breast center.

Over the last 20 years of breast center development, it has been found that for every obstacle there is an option for resolution. The solutions are not uniform in each setting, but rather they are a reflection of the medical staff politics, interests, and strengths, the resources and commitment of the institution, and the needs of the community. The most important message of this article is to validate local medical staff issues as legitimate concerns. The crucial obstacle is the lack of cooperation among the medical specialties and the lack of trust between the medical staff and management. The obstacles need to be appropriately addressed by the creation of an effective organizational structure that is successful in the local environment and by the programmatic development that reflects the medical staff's interests and strengths. This will ensure comprehensive breast center success in the local political environment and ultimately translates into enhanced expertise, pride, and higher quality patient care.

Biopsy, Needle↗

[Development of child mental health services in Lithuania: achievements and obstacles].

In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including disabled children and dysfunctional families; lack of evidence-based decision making in the process of health care reform and reform of social infrastructure.

Age Factors↗

[Difficulties and obstacles during medical treatment of epilepsies].

MULTIPLE OBSTACLES: There are many and various difficulties and obstacles during the medical treatment of epilepsy. They may create major stumbling blocks and largely jeopardize the control of this type of disease. POOR COMPLIANCE: Particularly frequent (30 to 50% of epileptics), it is one of the principle causes of pseudo-pharmaco-resistance. THE SIDE EFFECTS OF DRUGS: These are also frequent (15 to 30% of cases). Whatever their severity, they may be an important obstacle to the success of the treatment. Some of these effects are idiosyncratic, dose-independent, whereas others, non-idiosyncratic, are dose and time-dependent. THE AGGRAVATION OF EPILEPSY WITH ANTIEPILEPTIC AGENTS: This is possible and is usually due to an error in diagnosis, either in the type of seizure or the type of epilepsy in cause and which leads the physician to select an inappropriate treatment. Pregnancy may aggravate the progression of epilepsy in around a quarter of cases. Strict monitoring of the treatment is required. Intercurrent diseases and/or their treatment may have an impact on the epilepsy and its treatment. The diseases may be common affections or bacterial infections, psychiatric problems, lupus erythematosus or HIV infection. Likewise, the possible impact of commonly prescribed drugs such as those for gastric ulcers, asthma, cardiovascular diseases or even immunosuppressor treatments should be known. Renal failure and hepatic diseases often have a negative impact on antiepileptic treatments.

Anticonvulsants↗

Evidence-based cardiovascular care. Family physicians' views of obstacles and opportunities.

OBJECTIVE: To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recommendations on chronic ischemic heart disease. DESIGN: Qualitative study. SETTING: Rural, town, and city settings in Nova Scotia. PARTICIPANTS: Fifty family physicians caring for patients with cardiovascular (CV) disease. METHOD: Nine focus groups were conducted, audiotaped, and transcribed. Seven recommendations had been selected for discussion based on their relevance to primary care, strength, and class of supporting evidence. Analysis was guided by grounded-theory methodology. MAIN FINDINGS: "Ischemic events" can be powerful motivators for change, whereas the asymptomatic nature of CV risks and distant outcomes can form obstacles. Trust built through previous experiences and the opportunity to repeat important messages can facilitate application of evidence, but patient-physician relationships can also pose obstacles. CONCLUSION: Physicians can take steps to improve care, but success at reducing CV risks depends upon active involvement of many health professionals and community resources. Future guideline implementation should focus on patient-oriented issues, such as comorbidity and treatment preferences.

Attitude of Health Personnel↗

Obstacles to employment among mothers of children in foster care.

This article reports on a study of obstacles to employment among mothers with children in foster care. The study relies on standardized measures, has a cross-sectional design, and includes a sample of 158 mothers. The analysis shows a high prevalence of obstacles; identifies three co-occurring obstacles, each involving substance abuse, that are related to a low probability of employment (p < or = .05); and reveals that employment and access to transportation are related to higher income relative to mothers' needs (p < or = .05).

Adult↗

Obstacles to the implementation of directly observed treatment in Ouagadougou, Burkina Faso.

SETTING: Five tuberculosis (TB) diagnosis and treatment centres in Ouagadougou, Burkina Faso. OBJECTIVE: To identify obstacles to the direct observation of anti-tuberculosis treatment (DOT) so that it can be adapted to local contexts. DESIGN: A cross-sectional study conducted between August and September 2002 among new and retreatment TB cases in the initial phase of treatment. Information and suggestions were collected on obstacles encountered in DOT. RESULTS: Among 74 patients interviewed, the main difficulties were the lack of assiduity among health personnel, the daily travel, the long distances, the high transportation costs and the high number of tablets. The main suggestions were a reduction in the number of tablets taken at a time, decentralisation of places where tablets are to be taken and weekly provision of drugs. CONCLUSION: Obstacles to DOT should be addressed to optimise the effectiveness of anti-tuberculosis treatment.

Adolescent↗

Identifying and overcoming obstacles to point-of-care data collection for eye care professionals.

Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors. To support free text entry, we arrived at an approach that captures an image of a free text note and associates this image with related data elements in an encounter note. The detailed diagrams included a color pallet that allowed changing pen color with a single stroke and also captured the diagrams as an image associated with related data elements. During observed sessions with simulated patients, these approaches satisfied the clinicians' documentation needs by capturing the full range of clinical complexity that arises in practice.

Attitude to Computers↗

Problems and obstacles in implementation of nosocomial infection control in Thailand.

OBJECTIVES: To study the problems in implementation of nosocomial infection (NI) control in Thailand and strategies to overcome the obstacles. MATERIAL AND METHOD: Interviewing administrators, chair-persons of infection control committee and doctors. RESULTS: During June 2002 and August 2003, 255 persons were interviewed by infection control nurses using a set of questionnaires. Administrators, chair-persons of infection control committee, doctors in 32 hospitals across the country were enrolled by stratified random sampling. Policy on NI control was known to 95.3% and implementation to 81.2% of subjects. The main obstacles of NI control was the lack of incentive (66.7%) and support from administrators (30.2%). Hospital administrators set NI control at high priority, in only 40.9%, they could be motivated by regular presentation of NI data. Infection control nurses (ICN) should ideally work full-time (88.6%) but in reality, only 20.8% did so. The main problem for NI control was the shortage of ICN posts in most hospitals. This resulted in no career ladder and incentive for ICN. To overcome these problems, support from administrators, more education programs in NI control and provision of posts for ICN, are needed. CONCLUSION: The main problems and obstacles an implementation of NI control were the lack of support from administrators and the lack of the ICN post.

Cross Infection↗

The path towards eHealth: obstacles along the way.

OBJECTIVES: The two authors of this article share both a strong interest in, and deep concerns about, the use of eHealth (electronic information and communication technologies for improving or maintaining health). In this article, we identify some unanticipated obstacles to effective use of eHealth. METHODS: We reflected upon the potential of information and communication technologies to transform the health system and its failure to achieve that potential. RESULTS: We chose seven obstacles: the insufficient emphasis on health in eHealth, the lack of time for reflection, the development of a fortress mentality, poor evaluation of efforts, lack of involvement of youth, inequity, and a parochial attitude that precludes economies of scale. Whenever possible, we provided examples of innovative initiatives that illustrate potential ways to meet our current challenges. CONCLUSION: We believe that the obstacles we describe in this article can be overcome. The impediments are not only technological, but also cognitive, financial and political. To succeed will require a major shift from our ethic of competition to one of generosity, commitment, and collaboration; enlightened, as opposed to narrow, self-interest.

Internet↗

Obstacles and solutions to maintenance of advanced procedural skills for rural and remote medical practitioners in Australia.

INTRODUCTION: Most rural communities are too small and remote to sustain specialist services, and therefore some rural and remote doctors in Australia practice advanced procedural skills as part of their comprehensive care to underserved rural communities. The declining number of rural and remote procedural non-specialist doctors poses a problem in Australia. There is, at present, no comprehensive delineation of the obstacles Australian rural doctors face in trying to maintain their skills in the procedural areas of obstetrics, anaesthetics and surgery, nor of the solutions that may overcome the problems. This literature review addresses these two needs. METHODS: We interrogated the MEDLINE database to find articles about rural and remote medical education, with a specific focus on procedural skills. Other sources, including Google Scholar, were used to find relevant project and conference reports. RESULTS: The barriers to the maintenance of advanced procedural skills for rural and remote medical practitioners include: lack of opportunity; expense associated with remaining skilled in advanced procedural areas; lack of access to locum relief to attend educational sessions; lack of flexible options for education; lack of access to advanced procedural training; time constraints; multiple credentialing requirements from state health departments and joint consultative committees; family obstacles; and perceived medico-legal problems. Retention of rural doctors and the difficulties faced by them in maintaining advanced procedural skills are related. There is evidence that both these problems can be addressed, at least in part, by increased support for flexible continuing medical education and professional development such as specific skills rural training programs, the availability of group practice opportunities, improved hospital facilities, reasonable workloads, financial incentives, locum assistance, improved housing quality, and better educational support for families. We also noted a positive association between dedicated rural training programs and the recruitment of rural doctors. Factors associated with these successful training programs include: rural fellowships, explicit rural mission, rural location, rural program directors, and procedural orientation. CONCLUSION: The authors investigated the obstacles rural and remote doctors currently face in obtaining and remaining skilled in procedural medicine. The article describes the main barriers and presents some solutions from the literature. It also highlights the areas where work is being done and highlights the need for more quality research in this area.

Australia↗

[Prevention of athletic injuries by changing the regulations. Experiences with a military obstacle track].

During a period of 12 months of military conscription, all of the injuries occurring on the obstacle track at the Antvorskov Barracks in Slagelse were registered. During the period of investigation, the regulations for employing the track were altered so that the heights of jumping down from obstacles were considerably reduced. The object of this investigation was to demonstrate any possible effect on the pattern of injuries. During the period, a total of 26 injuries were registered (3.78 injuries/conscript/1,000 hours activity). As compared with previous investigations, the frequency of injuries was reduced and practically all of the serious injuries were prevented. The proposed alterations in the techniques are recommended in future when conscripts employ the military obstacle track.

Adult↗

[Activity of neurons of the motor-sensory cortex of the cat during natural locomotion while stepping over obstacles].

During locomotion on flat surface and while walking with stepping over obstacles the activity of 68 motor cortex neurons in cat (there were 12 pyramidal tract neurons (PTN) among them) was modulated in the rhythm of steps, i.e. it increased in one phase of a step and decreased in the other. The results of complication of locomotion task by the necessity to swing of the limbs over obstacles were as follows: an increase of average activity of 34 neurons by 75 +/- 15% and a decrease of the activity of 20 neurons by 30 +/- 4%; growth of modulation depth of 40 neurons (9 PTN) by 35 +/- 5% on the average for non-PTN and by 67 +/- 32% on the average for PTN; temporary distribution of the activity of 81 neurons in the step cycle while walking with stepping over obstacles was that of walking on the flat surface.

Animals↗