Barriers and facilitators to HPV vaccination in primary care practices: A mixed methods study using the Consolidated Framework for Implementation Research

Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation

Possibility to realize spin-orbit-induced correlated physics in iridium fluorides

Recent theoretical predictions of "unprecedented proximity" of the electronic ground state of iridium fluorides to the SU(2) symmetric $j_{\mathrm{eff}}=1/2$ limit, relevant for superconductivity in iridates, motivated us to investigate their crystal and electronic structure. To this aim, we performed high-resolution x-ray powder diffraction, Ir L$_3$-edge resonant inelastic x-ray scattering, and quantum chemical calculations on Rb$_2$[IrF$_6$] and other iridium fluorides. Our results are consistent with the Mott insulating scenario predicted by Birol and Haule [Phys. Rev. Lett. 114, 096403 (2015)], but we observe a sizable deviation of the $j_{\mathrm{eff}}=1/2$ state from the SU(2) symmetric limit. Interactions beyond the first coordination shell of iridium are negligible, hence the iridium fluorides do not show any magnetic ordering down to at least 20 K. A larger spin-orbit coupling in iridium fluorides compared to oxides is ascribed to a reduction of the degree of covalency, with consequences on the possibility to realize spin-orbit-induced strongly correlated physics in iridium fluorides

A method of eta' decay product selection to study partial chiral symmetry restoration

In case of chiral U_A(1) symmetry restoration the mass of the eta' boson (the ninth, would-be Goldstone boson) is decreased, thus its production cross section is heavily enhanced. The eta' decays (through one of its decay channels) into five pions. These pions will not be correlated in terms of Bose-Einsten correlations, thus the production enhancement changes the strength of two-pion correlation functions at low momentum. Preliminary results strongly support the mass decrease of the eta' boson. In this paper we propose a method to select pions coming from eta' decays. We investigate the efficiency of the proposed kinematical cut in several collision systems and energies with several simulators. We prove that our method can be used in all investigeted collision systems.Comment: Talk at the VI Workshop on Particle Correlations and Femtoscopy, Kiev, September 14-18, 2010. 6 pages, 3 figures. This work was supported by the OTKA grant NK73143 and M. Csanad's Bolyai scholarshi

Reaction-Diffusion System in a Vesicle with Semi-Permeable Membrane

We study the Schloegl model in a vesicle with semi-permeable membrane. The diffusion constant takes a smaller value in the membrane region, which prevents the outflow of self-catalytic product. A nonequilibrium state is stably maintained inside of the vesicle. Nutrients are absorbed and waste materials are exhausted through the membrane by diffusion. It is interpreted as a model of primitive metabolism in a cell.Comment: 8 pages, 6 figure