5,424 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 empirical investigation of the relationship between integration, dynamic capabilities and performance in supply chains

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    This research aimed to develop an empirical understanding of the relationships between integration, dynamic capabilities and performance in the supply chain domain, based on which, two conceptual frameworks were constructed to advance the field. The core motivation for the research was that, at the stage of writing the thesis, the combined relationship between the three concepts had not yet been examined, although their interrelationships have been studied individually. To achieve this aim, deductive and inductive reasoning logics were utilised to guide the qualitative study, which was undertaken via multiple case studies to investigate lines of enquiry that would address the research questions formulated. This is consistent with the author’s philosophical adoption of the ontology of relativism and the epistemology of constructionism, which was considered appropriate to address the research questions. Empirical data and evidence were collected, and various triangulation techniques were employed to ensure their credibility. Some key features of grounded theory coding techniques were drawn upon for data coding and analysis, generating two levels of findings. These revealed that whilst integration and dynamic capabilities were crucial in improving performance, the performance also informed the former. This reflects a cyclical and iterative approach rather than one purely based on linearity. Adopting a holistic approach towards the relationship was key in producing complementary strategies that can deliver sustainable supply chain performance. The research makes theoretical, methodological and practical contributions to the field of supply chain management. The theoretical contribution includes the development of two emerging conceptual frameworks at the micro and macro levels. The former provides greater specificity, as it allows meta-analytic evaluation of the three concepts and their dimensions, providing a detailed insight into their correlations. The latter gives a holistic view of their relationships and how they are connected, reflecting a middle-range theory that bridges theory and practice. The methodological contribution lies in presenting models that address gaps associated with the inconsistent use of terminologies in philosophical assumptions, and lack of rigor in deploying case study research methods. In terms of its practical contribution, this research offers insights that practitioners could adopt to enhance their performance. They can do so without necessarily having to forgo certain desired outcomes using targeted integrative strategies and drawing on their dynamic capabilities

    The ethics and politics of deportation in Europe

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    Defence date: 19 February 2019Examining Board: Professor Rainer Bauböck, European University Institute (Supervisor); Professor Matthew Gibney, University of Oxford; Professor Iseult Honohan, University College Dublin; Professor Jennifer Welsh, McGill University (formerly European University Institute)This thesis explores key empirical and normative questions prompted by deportation policies and practices in the contemporary European context. The core empirical research question the thesis seeks to address is: what explains the shape of deportation regimes in European liberal democracies? The core normative research question is: how should we evaluate these deportation regimes morally? The two parts of the thesis address each of these questions in turn. To explain contemporary European deportation regimes, the four chapters of the first part of the thesis investigate them from a historical and multilevel perspective. (“Expulsion Old and New”) starts by comparing contemporary deportation practices to earlier forms of forced removal such as criminal banishment, political exile, poor law expulsion, and collective expulsions on a religious or ethnic basis, highlighting how contemporary deportation echoes some of the purposes of these earlier forms of expulsion. (“Divergences in Deportation”) looks at some major differences between European countries in how, and how much, deportation is used as a policy instrument today, concluding that they can be roughly grouped into four regime types, namely lenient, selective, symbolically strict and coercively strict. The next two chapters investigate how non-national levels of government are involved in shaping deportation in the European context. (“Europeanising Expulsion”) traces how the institutions of the European Union have come to both restrain and facilitate or incentivise member states’ deportation practices in fundamental ways. (“Localities of Belonging”) describes how provincial and municipal governments are increasingly assertive in frustrating deportations, effectively shielding individuals or entire categories of people from the reach of national deportation efforts, while in other cases local governments pressure the national level into instigating deportation proceedings against unwanted residents. The chapters argue that such efforts on both the supranational and local levels must be explained with reference to supranational and local conceptions of membership that are part of a multilevel citizenship structure yet can, and often do, come apart from the national conception of belonging. The second part of the thesis addresses the second research question by discussing the normative issues deportation gives rise to. (“Deportability, Domicile and the Human Right to Stay”) argues that a moral and legal status of non-deportability should be extended beyond citizenship to all those who have established effective domicile, or long-term and permanent residence, in the national territory. (“Deportation without Domination?”) argues that deportation can and should be applied in a way that does not dominate those it subjects by ensuring its non-arbitrary application through a limiting of executive discretion and by establishing proportionality testing in deportation procedures. (“Resisting Unjust Deportation”) investigates what can and should be done in the face of unjust national deportation regimes, proposing that a normative framework for morally justified antideportation resistance must start by differentiating between the various individual and institutional agents of resistance before specifying how their right or duty to resist a particular deportation depends on motivational, epistemic and relational conditions

    The regulation of digital platforms: the case of pagoPA

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    How can EU regulation affect innovation. Digital revolution: How big data have changed the world and the legal landscape. The regulation of digital platforms in Europe. Digital revolution: How distributed ledger technologies are changing the world and the legal landscape. Regulation of digital payments: the case of pagopa

    Complexity Science in Human Change

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    This reprint encompasses fourteen contributions that offer avenues towards a better understanding of complex systems in human behavior. The phenomena studied here are generally pattern formation processes that originate in social interaction and psychotherapy. Several accounts are also given of the coordination in body movements and in physiological, neuronal and linguistic processes. A common denominator of such pattern formation is that complexity and entropy of the respective systems become reduced spontaneously, which is the hallmark of self-organization. The various methodological approaches of how to model such processes are presented in some detail. Results from the various methods are systematically compared and discussed. Among these approaches are algorithms for the quantification of synchrony by cross-correlational statistics, surrogate control procedures, recurrence mapping and network models.This volume offers an informative and sophisticated resource for scholars of human change, and as well for students at advanced levels, from graduate to post-doctoral. The reprint is multidisciplinary in nature, binding together the fields of medicine, psychology, physics, and neuroscience

    The Forward Physics Facility at the High-Luminosity LHC

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    Geoarchaeological Approaches to Pictish Settlement Sites: Assessing Heritage at Risk

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    Due to the poor preservation of Pictish period buildings and the occupation deposits within them, very little is known of daily life in early medieval Scotland. In lowland and coastal areas, Pictish buildings are generally truncated by deep ploughing, coastal erosion, or urban development, while those uncovered in upland areas seem to have no preserved floor deposits for reasons that remain poorly understood. Geoarchaeological techniques are particularly effective in clarifying site formation processes and understanding post-depositional transformations. They are also a powerful research tool for identifying floor deposits, distinguishing their composition, and linking this to daily activities. However, archaeologists are often reluctant to apply geoarchaeological methods if they suspect preservation is poor or stratigraphy is not visible in the field. This study therefore employs an innovative suite of geoarchaeological techniques to evaluate the preservation of Pictish period buildings and the potential that fragmentary buildings have to reconstruct daily life in early medieval Scotland. Alongside literature analysis and a desk-based comparison with national soil datasets, over 400 sediment samples from three key settlement sites were subjected to integrated soil micromorphology, x-ray fluorescence, magnetic susceptibility, loss-on-ignition, pH, electrical conductivity and microrefuse analysis. The combined data were successful in generating new information about the depositional and post-depositional history of the sites, preservation conditions of the occupation deposits, and activity areas within domestic dwellings. Most significantly, the integrated approach demonstrated that ephemeral and fragmented occupation surfaces retain surviving characteristics of the use of space, even if floors are not preserved well enough to be clearly defined in the field or in thin-section. A partnership with Historic Environment Scotland has channelled this work into research-led guidelines aimed at communicating geoarchaeological methods and principles to a wider audience
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