5,894 research outputs found

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    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

    Influences on Expert Intelligibility Judgments of School-age Children's Speech

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    Speech-language pathologists (SLPs) make impressionistic intelligibility judgments as part of an evaluation of children for speech sound disorders. Despite the lack of formalization, it is an important measure of choice for SLPs, going beyond single-word standardized measures by using spontaneous speech to assess functional communication. However, spontaneous speech introduces sources of error and bias in the listener. This dissertation argues that impressionistic intelligibility judgments are influenced by listener-dependent factors due to their subjectivity. To identify potential sources of error and bias, speech data were collected from four school-aged child groups: typically developing monolingual, children with speech sound disorder, typically developing Spanish-English bilingual (i.e., an accent familiar to the study’s listeners), and typically developing Mam-English bilingual (i.e., an accent unfamiliar to the study’s listeners), in two school-age groups. Perceiver data were collected from two listener groups (i.e., expert [SLP] and lay). Listeners provided baseline measurements of lab-based intelligibility scores and comprehensibility ratings by orthographically transcribing and rating audio recordings of experimentally controlled utterances. Listeners also made impressionistic global intelligibility assessments after viewing video recordings of children’s spontaneous speech. Findings showed differences between expert’s and lay listener’s global intelligibility assessments however experts were no better than lay listeners at discerning between age and speaker groups. Of the four speaker groups, there was a significant effect of the Mam-English bilingual speaker group on global intelligibility assessments. Relationships were found between global intelligibility assessments and both the lab-based intelligibility measure and the comprehensibility rating, indicating impressionistic judgments tap into both speech signal features and the understandability of speech. Surprisingly, the age and linguistic ability of the child speakers were not significant factors on global intelligibility assessments, so perhaps listeners were making accommodations for these differences in their assessments. These findings indicate the need for increased training of SLPs to reduce error and bias in their speech intelligibility judgments, as well as the need for further research to improve its objectivity

    Quality of Life and Prognostic Factors That Aid Treatment Decision Making in Curatively Treated Colorectal Cancer Patients

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    Kolorektaalisyöpä on kolmanneksi yleisin syöpä Suomessa ja aiheuttaa toiseksi eniten syöpäkuolemia. Kehittyneen seulonnan, parantuneiden hoitomenetelmien ja väestön ikääntymisen myötä kolorektaalisyöpään sairastuneiden määrä on noussut. Ainut parantava hoito kolorektaalisyövässä on kirurginen. Riippuen TNM- luokituksen perusteella tehtävästä uusimisriskiarviosta, osa potilaista ohjataan liitännäishoitoon ja osa suoraan seurantaan. Potilaita seurataan käyttäen kolonoskopiaa, tietokonetomografiaa ja CEA-merkkiainetta. Kolorektaalisyöpä kuitenkin uusiutuu n. 25 % niistä potilaista, joilla taudin arvioitiin alun perin olevan paikallinen. Tämä osoittaa, että nykyisillä seurantamenetelmillä ei kyetä tunnistamaan mahdollista jäännöstautia. Nykyisillä menetelmillä ei tunnisteta niitäkään potilaita, joiden uusimisriski jää edelleen koholle liitännäishoidon päätyttyä eikä toisaalta niitäkään, joilla uusiutuminen on epätodennäköistä. Potilailla, joilla tauti uusiutuu, pyritään parantavaan hoitotavoitteiseen, mikäli etäpesäkkeet voidaan leikata joko suoraan tai neoadjuvanttihoidon jälkeen. Mikäli etäpesäkkeet eivät ole leikattavissa, hoidon tavoite on etenemistä jarruttava ja sairaus johtaa kuolemaan. Kolorektaalisyöpä ja siihen kohdistuvat hoidot vaikuttavat potilaiden elämänlaatuun paitsi hoitojen aikana, myös niiden jälkeen, mikäli potilas parantuu. Ensimmäisessä osatyössä analysoitiin elämänlaatu poikittaistutkimuksena 444 levinnyttä suolistosyöpää sairastavalta potilaalta, jotka osallistuivat RAXO- tutkimuksen alatutkimukseen. Elämänlaatua mitattiin neljällä mittarilla: 15D, EQ- 5D-3L, QLQ-C30 ja QLQ-CR29. Elämänlaatu laski ohimenevästi etäpesäkekirurgiaan liittyen mutta oli korkealla tasolla kuratiivistavoitteisten hoitojen jälkeen ja oli samaa tasoa kuin ikä- ja sukupuolivakioidulla vertailuväestöllä. Elämänlaatu pysyi kohtuullisen hyvänä myös tautia jarruttavan systeemisen syöpälääkehoidon aikana ja putosi selvästi vasta oireenmukaisen hoidon vaiheessa. Merkittävimmät potilaiden elämänlaatuun vaikuttavat oireet olivat seksuaalisuuteen liittyvät tekijät, tihentynyt virtaamistarve, väsymys, ahdistuneisuus ja unettomuus. Toisessa ja kolmannessa osatyössä aineisto koostui 147 stage II-IV kolorektaalisyöpäpotilaasta, joita hoidettiin parantavalla hoitotavoitteella. Tutkimme seeruminäytteistä CRP, IL-6, ja YKL-40 jälkikäteen ja CEA ja CA19-9 osana rutiinihoitoa. Toisessa osatyössä kaikki 147 potilasta olivat mukana analyysissa, jossa tutkittiin kunkin merkkiaineen kohdalla sitä aikaa, joka kului merkkiaineen pitoisuuden noususta viirerajan yli taudin uusiutumisen toteamiseen. CEA:lla tämä aika oli 7.8 kuukautta, muilla tutkittavilla merkkiaineilla 10–53 kuukautta ja 27 kuukautta tutkittaessa, kun yksi tai useampi merkkiaine viidestä nousi yli viiterajan. Jatkoanalyysista poissuljettiin ne 12 potilasta, joilla syöpä uusiutui liitännäishoidon aikana. 135 potilasta oli mukana analyysissa, jossa todettiin, että liitännäishoidon jälkeen CEA, IL-6 ja CRP olivat merkitsevästi yhteydessä lyhentyneeseen tautivapaaseen elossaoloaikaan ja IL-6 ja CRP lisäksi kokonaiselossaoloaikaan. Niillä potilailla, joilla CEA pysyi viiterajan sisällä liitännäishoidon jälkeen mitattuna, koholla oleva IL-6 ainoana merkkiaineena oli monimuuttuja-analyysissa merkitsevä tekijä arvioitaessa tautivapaata elossaoloaikaa sekä kokonaiselinaikaa. Kolmannessa osatyössä tutkittiin samoilla potilailla edellä mainittujen merkkiaineiden kinetiikkaa liitännäishoidon aikana. Työssä todettiin, että niillä potilailla, joilla CEA nousi ohimenevästi liitännäishoidon aikana tai pysyi muuttumattomana, oli suotuisa ennuste verrattuna niihin potilaisiin, joilla CEA nousi jatkuvasti. Myös CA19-9:n ja YKL-40:n ohimenevillä nousuilla vaikutti olevan yhteyttä suotuisampaan ennusteeseen. Neljännessä osatyössä kuvattiin yhden potilaan syövän käyttäytymistä. Potilas rekrytoitiin tutkimukseen yhdessä 82 muun potilaan kanssa, jossa tutkittiin jäännöstaudin esiintyvyyttä parantavalla tavoitteella tehdyn primaarileikkauksen tai etäpesäkekirurgian jälkeen. Potilaan näytteistä tutkittiin syövän klonaalista heterogeenisyyttä, testattiin kiertävän kasvain-DNA:n soveltuvuutta monitoroimaan jäännöstaudin esiintyvyyttä sekä arvioitiin lääkeaineiden sensitiivisyys- ja resistenssitestausta viljeltyjen syöpäsolujen mallissa. Potilaalla todettiin MEK/MAPK signaalireitin aktivaatiota, mutta eri mutaatiot toimivat ajureina primaarinäytteessä ja etäpesäkkeissä. Kiertävä kasvain DNA-menetelmä osoitti potilaan veressä harvinaisen BRAFL597Q-mutaation, joka ennusti kliinisesti aggressiivisen metastaattisen taudin. Soluviljelmässä BRAFL597Q-mutatoituneet solut reagoivat MEK-/MAPK targetoiville syöpälääkehoidoille. Yhteenvetona voidaan todeta, että parantavalla hoitotavoitteella hoidettujen potilaiden elämänlaatu säilyy hyvänä aggressiivisesta hoitostrategiasta huolimatta myös etäpesäkekirurgian jälkeen. Yhdistelemällä useampia merkkiaineita, voidaan pidentää sitä aikaa, jonka avulla uusiutuma voidaan havaita primaarileikkauksen jälkeen jo selvästi ennen kuvantamista. Lisäksi liitännäishoidon jälkeinen koholla oleva IL-6 auttaa tunnistamaan potilaita, joilla on kohonnut uusiutumisriski ja toisaalta ohimenevä CEA-arvon nousu liitännäishoidon aikana ei ole merkki huonontuneesta, vaan ennemminkin paremmasta ennusteesta. Lisäksi totesimme, että BRAFL597Q-mutaation-mutaatio saattaa liittyä kolorektaalisyövässä kasvaintaudin aggressiiviseen käyttäytymiseen.Colorectal cancer (CRC) is the third most common cancer and ranks second in mortality. Early detection, improved treatments, and increases in the age of the population have led to a rising prevalence of patients living with a diagnosis of CRC in the Western world. The only curative treatment for CRC is surgery. According to recurrence risk based on tumour, node, metastasis (TNM) classification, CRC patients resected with curative intent are referred for follow-up or adjuvant chemotherapy. Follow-up is accomplished via colonoscopy, computed tomography (CT), and measuring of carcinoembryonic antigen (CEA) in the patient´s blood. About 25% of patients with local disease will have a recurrence within 5 years, indicating misdetection of residual disease. Some patients with high-risk disease will have a recurrence despite adjuvant therapy and there is still no method in clinical use for detection of residual disease associated with primary resistance to therapy or in those patients with a low risk for recurrence. Patients with recurrent disease are treated with curative intent, whenever possible, with metastasectomy with or without neoadjuvant treatment. Patients with unresectable disease are treated with non- curative systemic treatment. The cancer and its treatments affect the patient’s health- related quality of life (HRQoL) during the treatment trajectory and in the remission phase if the patient is cured. Study I included 444 patients with metastatic CRC (mCRC) participating in the RAXO substudy. The study evaluated HRQoL cross-sectionally using four validated measures: 15D, EQ-5D-3L, QLQ-C30, and QLQ-CR29. HRQoL declined transiently in conjunction with metastasectomy but was high after curative treatment, similar to that seen in the general population. HRQoL was also high during non-curative treatment phases from first- to later-line treatments but clearly declined in the best supportive care (BSC) phase. The most frequent symptoms during treatment trajectory included sexual aspects, urinary frequency, fatigue, distress, and insomnia. Studies II and III included patients from the LIPSYT study with 147 CRC patients treated with curative intent. We measured CEA, carbohydrate antigen 19-9 (CA19-9), and C-reactive protein (CRP) as part of clinical routine, and interleukin 6 (IL-6), and YKL-40 post hoc. All patients were included in lead-time analysis between the elevated biomarker and radiological relapse. CEA had a lead time of 7.8 months, other markers investigated had lead times from 10 to 53 months and the lead time for all five markers combined was 27 months. In further analysis, 12 patients relapsing during adjuvant treatment were excluded. A total of 135 patients were included in an analysis that showed that elevated post-adjuvant CEA, IL-6, and CRP were associated with impaired disease-free survival (DFS), and IL-6 and CRP were also associated with impaired overall survival (OS). Elevated post-adjuvant IL-6 associated significantly with outcome in a multivariate analysis investigating patients with normal CEA values. The same LIPSYT study population was used to investigate the kinetics of the abovementioned five biomarkers during adjuvant treatment. An association between a transient increase in CEA level during adjuvant treatment and improved outcome was noted compared to those patients with constantly increasing CEA levels. Patients with a transient increase in CEA had roughly similar DFS and OS when compared to patients with stable CEA levels. Similar trends were observed with CA19-9 and YKL-40. Study IV described a patient history from the FINCRC study that recruited 82 CRC patients to investigate molecular residual disease after primary tumour resection or metastasectomy. Repeated circulating tumour DNA (ctDNA) measurements demonstrated clonal heterogeneity in tumour samples and revealed residual disease resistant to administered therapy. Drug sensitivity and resistance testing (DSRT) was used in a patient-derived organoid model to evaluate possible treatments. Patient samples exhibited MEK/MAPK signal cascade activation but differing driver mutations in the primary tumour and in metastases. A rise in a rare BRAFL597Q ctDNA in blood samples heralded a rise in a clinically aggressive recurrence during adjuvant treatment. In the organoid model, BRAFL597Q-mutated cells were sensitive to MEK/MAPK-targeted therapies. In conclusion, HRQoL remains high during and after aggressive treatment strategy in mCRC patients treated with metastasectomy. By combining several biomarkers, the lead time before recurrence revealed by a biomarker increase can be clearly prolonged before radiological relapse. Elevated IL-6 after adjuvant treatment helps in identification of the elevated risk of relapse and, in turn, a transient increase in CEA level is a sign of improved prognosis. We also found that BRAFL597Q-mutated CRC may be related to aggressive disease

    Cyberbullying in educational context

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    Kustenmacher and Seiwert (2004) explain a man’s inclination to resort to technology in his interaction with the environment and society. Thus, the solution to the negative consequences of Cyberbullying in a technologically dominated society is represented by technology as part of the technological paradox (Tugui, 2009), in which man has a dual role, both slave and master, in the interaction with it. In this respect, it is noted that, notably after 2010, there have been many attempts to involve artificial intelligence (AI) to recognize, identify, limit or avoid the manifestation of aggressive behaviours of the CBB type. For an overview of the use of artificial intelligence in solving various problems related to CBB, we extracted works from the Scopus database that respond to the criterion of the existence of the words “cyberbullying” and “artificial intelligence” in the Title, Keywords and Abstract. These articles were the subject of the content analysis of the title and, subsequently, only those that are identified as a solution in the process of recognizing, identifying, limiting or avoiding the manifestation of CBB were kept in the following Table where we have these data synthesized and organized by years

    Still, We Thrive: Understanding How Gay, Bisexual, Transgender, and Other Men Who Have Sex with Men (GBTMSM) Experience Structural Barriers & Facilitators to Wellness

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    Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, little is known about the relevance of 2SLGBTQIA+ affirming systems and policies for the wellbeing of GBTMSM. As such, this study seeks to expand on the scarce qualitative literature exploring how systems and policies may act as structural barriers and facilitators to wellness for GBTMSM. 30 GBTMSM with diverse ethnoracial identities, gender identities, HIV statuses and ages from across Southwestern Ontario (five per region) were purposively sampled through local AIDS service organizations (ASOs), other agencies and services who serve GBTMSM, and through social media platforms, including Instagram and Facebook. Semi-structured/narrative blended interviews were implemented to characterize how systems and policies serve as barriers and facilitators to wellness. Particular questions tended to favour a structural-level analysis, asking participants to reflect on their experiences with heteronormativity and/or cisnormativity, racism, healthcare access, sexual health education, and community cohesion. An inductive latent thematic approach following Braun & Clark’s Six Phases was employed to develop a coding grid, where a final set of themes were identified. Knowledge produced through this project will be used to identify tangible points for systems change, where greater 2LGBTQ+ affirming policies and services can be introduced

    Land Use and Land Cover Mapping in a Changing World

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    It is increasingly being recognized that land use and land cover changes driven by anthropogenic pressures are impacting terrestrial and aquatic ecosystems and their services, human society, and human livelihoods and well-being. This Special Issue contains 12 original papers covering various issues related to land use and land use changes in various parts of the world (see references), with the purpose of providing a forum to exchange ideas and progress in related areas. Research topics include land use targets, dynamic modelling and mapping using satellite images, pressures from energy production, deforestation, impacts on ecosystem services, aboveground biomass evaluation, and investigations on libraries of legends and classification systems
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