5,777 research outputs found

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    An exploration of adherence and persistence in overactive bladder and other long-term conditions

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    Background and aims Overactive bladder is a common, bothersome, and chronic condition associated with symptoms of urinary urgency, incontinence, increased daytime micturition frequency and nocturia. Despite exerting a significant burden on quality of life, adherence, and persistence behaviours with OAB are particularly poor in comparison with other long-term conditions. The aims of the present work were to explore themes relating to medicine-taking behaviours in OAB and other long-term conditions and to suggest ways to improve them. Methods A systematic literature review was undertaken to understand the current landscape of qualitative work exploring adherence and persistence with OAB patients. A qualitative study involving 1:1 semi-structured interviews was conducted with OAB patients to explore the context and drivers for adherence and persistence behaviours using thematic analysis. A comparative analysis was then undertaken with qualitative papers exploring medicinetaking behaviours in a chronic bowel condition, type II diabetes, and multimorbidity to explore the themes identified in the OAB study for convergence and divergence in other conditions and to contextualise the learnings from the former study. Results The systematic literature review revealed a gap in the literature of qualitative exploration of adherence and persistence behaviours in OAB patients. The OAB study found a range of drivers for non-adherent behaviours including a perceived lack of treatment efficacy, side effects, unclear instructions, and drug and condition hierarchies, as well as the rich context within which these themes sit. The comparative analysis study supported the findings of the OAB study demonstrating evidence of key themes transcending across conditions, including a perceived lack of treatment efficacy and side effects, as well as nuances associated with the OAB experience. Conclusions The present work has identified key drivers for non-adherent behaviours in OAB patients and sets out a number of recommendations categorised within the World Health Organisation’s 5 dimensions of adherence. These include addressing the poor understanding and illness perception of OAB by patients and others, by improving the provision and availability of information, as well as the work of patient support groups; scrutiny on the support within primary care to OAB patients before and after diagnosis; and the encouragement of realistic expectations of the condition and treatment with mindful use of prescriber’s language at the point of prescribing. The present work has further highlighted the utility of conceptual models of adherence such as COM-B and the NCF in understanding medicine-taking behaviours in the context of OAB

    The Metaverse: Survey, Trends, Novel Pipeline Ecosystem & Future Directions

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    The Metaverse offers a second world beyond reality, where boundaries are non-existent, and possibilities are endless through engagement and immersive experiences using the virtual reality (VR) technology. Many disciplines can benefit from the advancement of the Metaverse when accurately developed, including the fields of technology, gaming, education, art, and culture. Nevertheless, developing the Metaverse environment to its full potential is an ambiguous task that needs proper guidance and directions. Existing surveys on the Metaverse focus only on a specific aspect and discipline of the Metaverse and lack a holistic view of the entire process. To this end, a more holistic, multi-disciplinary, in-depth, and academic and industry-oriented review is required to provide a thorough study of the Metaverse development pipeline. To address these issues, we present in this survey a novel multi-layered pipeline ecosystem composed of (1) the Metaverse computing, networking, communications and hardware infrastructure, (2) environment digitization, and (3) user interactions. For every layer, we discuss the components that detail the steps of its development. Also, for each of these components, we examine the impact of a set of enabling technologies and empowering domains (e.g., Artificial Intelligence, Security & Privacy, Blockchain, Business, Ethics, and Social) on its advancement. In addition, we explain the importance of these technologies to support decentralization, interoperability, user experiences, interactions, and monetization. Our presented study highlights the existing challenges for each component, followed by research directions and potential solutions. To the best of our knowledge, this survey is the most comprehensive and allows users, scholars, and entrepreneurs to get an in-depth understanding of the Metaverse ecosystem to find their opportunities and potentials for contribution

    COVID-19 Outbreak and Beyond

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    The COVID-19 pandemic drastically changed our lifestyle when, on 30 January 2020, the World Health Organization declared the coronavirus disease outbreak a public health emergency of international concern. Since then, many governments have introduced unprecedented containment measures, hoping to slow the spread of the virus. International research suggests that both the pandemic and the related protective measures, such as lockdown, curfews, and social distancing, are having a profound impact on the mental health of the population. Among the most commonly observed psychological effects, there are high levels of stress, anxiety, depression, and post-traumatic symptoms, along with boredom and frustration. At the same time, the behavioral response of the population is of paramount importance to successfully contain the outbreak, creating a vicious circle in which the psychological distress impacts the willingness to comply with the protective measures, which, in turn, if prolonged, could exacerbate the population’s distress. This book includes: i) original studies on the worldwide psychological and behavioral impact of COVID-19 on targeted individuals (e.g., parents, social workers, patients affected by physical and mental disorders); ii) studies exploring the effect of COVID-19 using advanced statistical and methodological techniques (e.g., machine learning technologies); iii) research on practical applications that could help identify persons at risk, mitigate the negative effects of this situation, and offer insights to policymakers to manage the pandemic are also highly welcomed

    Covid-19 and Capitalism

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    This open access book provides a comprehensive analysis of the socioeconomic determinants of Covid-19. From the end of 2019 until presently, the world has been ravaged by the Covid-19 pandemic. Although the cause of this is (obviously) a virus, the extent to which this virus spread, and therefore the number of infections and deaths, was largely determined by socio-economic factors. From this, it follows that the course of the pandemic varies greatly from one country to another. This observation applies both to countries’ resilience to such a pandemic (which is mainly rooted in the period preceding the outbreak of the virus) and to the way in which countries have reacted to the virus (including the political choices on how to respond). Meanwhile, research has made it clear that the nature of this response (e.g., elimination policy, mitigation policy, and proceeding herd immunity) was, on the one hand, strongly determined by political and ideological factors and, on the other hand, was highly influential in the factors of success or failure in combating the pandemic. The book focuses on the situation in a number of Western regions (notably the USA, the UK, and the EU and its Member States). The author addresses the reasons why in many Western countries both pandemic prevention and response policies to Covid-19 have failed. The book concludes with recommendations concerning the rearrangement of the socio-economic order that could increase the resilience of (Western) societies against such pandemics

    Advances in Forensic Genetics

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    The book has 25 articles about the status and new directions in forensic genetics. Approximately half of the articles are invited reviews, and the remaining articles deal with new forensic genetic methods. The articles cover aspects such as sampling DNA evidence at the scene of a crime; DNA transfer when handling evidence material and how to avoid DNA contamination of items, laboratory, etc.; identification of body fluids and tissues with RNA; forensic microbiome analysis with molecular biology methods as a supplement to the examination of human DNA; forensic DNA phenotyping for predicting visible traits such as eye, hair, and skin colour; new ancestry informative DNA markers for estimating ethnic origin; new genetic genealogy methods for identifying distant relatives that cannot be identified with conventional forensic DNA typing; sensitive DNA methods, including single-cell DNA analysis and other highly specialised and sensitive methods to examine ancient DNA from unidentified victims of war; forensic animal genetics; genetics of visible traits in dogs; statistical tools for interpreting forensic DNA analyses, including the most used IT tools for forensic STR-typing and DNA sequencing; haploid markers (Y-chromosome and mitochondria DNA); inference of ethnic origin; a comprehensive logical framework for the interpretation of forensic genetic DNA data; and an overview of the ethical aspects of modern forensic genetics
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