Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

OBJECTIVE: To understand facilitators and barriers to participation in a peer support intervention for self-management of chronic pain. METHODS: After completing a pilot intervention study, peer coaches and their veteran patients took part in a qualitative, semistructured interview to explore their experiences with the intervention. Data were analyzed using an immersion/crystallization approach. RESULTS: Three facilitators and 2 barriers to patient participation in a peer support intervention for veterans with chronic pain emerged. Facilitators were (1) having a shared identity as veterans, (2) being partnered with a person who also has chronic pain, and (3) support from the study staff. Barriers were (1) logistical challenges, and (2) challenges to motivation and engagement in the intervention. DISCUSSION: Awareness of facilitators and barriers to participation in a peer-supported self-management program for chronic pain, as well as strategies to capitalize on facilitators and mitigate barriers, are essential for further study and ultimate clinical implementation of such a program

Etude biostratigraphique du cretace inferieur (Barremien Superieur-Albien) du haut atlas occidental (Maroc)

The lower Cretaceous (mainly Upper Barremian and Albian) of the Westem High Atlas of Morocco displays a diversified fauna constitued by Ammonite, Ostracoda, and foraminifera. The analysis of the microfauna, especially the planctonic foraminifera, allowed the characterization of various lithologic units, and their subdivision and datation. We have identified different biozona with planctonic foraminifera typical of the Tethysian realm characterising the Upper Barremian to the Albian. These biozona are described and their limits are discussed.Les affleurements du Crétacé inférieur, et principalement le Barrémien supérieur- Albien du Haut Atlas occidental marocain, ont fourni une faune diversifiée constituée par des ammonites, des ostracodes et des foraminifkres. L'analyse détaillée de la microfaune et principalement les foraminifkres planctoniques a permis de caractériser diverses unités lithologiques, de les subdiviser et de les dater. Nous avons identifié différentes biozones a foraminifkres planctoniques reconnues a l'échelle de la Téthys et caracténsant le Barrémien supérieur-Albien. Ces différentes biozones ont été décrites et leurs limites ont été discutées

Systematic review on human resources for health interventions to improve maternal health outcomes: Evidence from low- and middle-income countries

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health

Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas. The literature search revealed ten studies that described MNH service delivery platforms. The results from the systematic review showed that with utilisation of community outreach services, the greatest impacts were observed in skilled birth attendance and antenatal consultation rates. Facility level services, on the other hand, showed that labour room services for an internally displaced population (IDP) improved antenatal care coverage, contraceptive prevalence rate and maternal mortality. Consultative meetings and discussions conducted in Quetta and Peshawar (capitals of conflict affected provinces) with relevant stakeholders revealed that no systematic models of MNH service delivery, especially tailored for conflict areas, are available. During conflict, even previously available services and infrastructure suffered due to various barriers specific to times of conflict and unrest. A number of barriers that hinder MNH services were discussed. Suggestions for improving MNH services in conflict areas were also laid down by participants. The review identified some important steps that can be undertaken to mitigate the effects of conflict on MNH services, which include: improve provision and access to infrastructure and equipment; development and training of healthcare providers; and advocacy at different levels for free access to healthcare services and for the introduction of the programme model in existing healthcare system. The obligation is enormous, however, for a sustainable programme, it is important to work closely with both the IDP and host community, and collaborating with the government and non-government organisations

Luminescence studies on green emitting InGaN/GaN MQWs implanted with nitrogen

We studied the optical properties of metalorganic chemical vapour deposited (MOCVD) InGaN/GaN multiple quantum wells (MQW) subjected to nitrogen (N) implantation and post-growth annealing treatments. The optical characterization was carried out by means of temperature and excitation density-dependent steady state photoluminescence (PL) spectroscopy, supplemented by room temperatura PL excitation (PLE) and PL lifetime (PLL) measurements. The as-grown and as-implanted samples were found to exhibit a single green emission band attributed to localized excitons in the QW, although the N implantation leads to a strong reduction of the PL intensity. The green band was found to be surprisingly stable on annealing up to 14006C. A broad blue band dominates the low temperature PL after termal annealing in both samples. This band is more intense for the implanted sample, suggesting that defects generated by N implantation, likely related to the diffusion/segregation of indium (In), have been optically activated by the thermal treatmentThe authors acknowledge FCT for the final funding from PEst-C/CTM/LA0025/2013-14, PTDC/CTM-NAN/2156/2012, PTDC/FIS-NAN/0973/2012 and RECI/FIS-NAN/0183/ 2012 (FCOMP-01-0124-FEDER-027494) projects. J. Rodrigues thanks FCT for her PhD grant, SFRH/BD/76300/2011. ARC acknowledges financial support under the ‘Juan de la Cierva’ program (MECO, Spain) through grant JCI-2012-14509

Influence of initial pressure on hydrogen/air flame acceleration during severe accident in NPP

International audienc

Post-Transplant Lymphoproliferative Disorder in Liver Transplant Recipients: Characteristics, Management and Outcome from a Single-Centre Experience with >1000 Liver Transplantations

BACKGROUND: The literature regarding post-transplant lymphoproliferative disorder (PTLD) in liver transplant recipients (LTRs) is limited