4,813 research outputs found
A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.
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 Womenâs Hospital.
Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Womenâs 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
Urinary biomarkers of biofortified beef in healthy women explored by untargeted metabolomics
Background: The prevalence of overweight and non-communicable chronic diseases is
rising all over the globe. The high consumption of energy dense foods on behalf of high
nutrient-dense food leads to lower intake of essential vitamins and minerals, such as
vitamins D, E, K, and selenium. These micronutrients are related with numerous human
vital functions and their deficiency is positively associated with higher risk of chronic
diseases and mortality. Bovine meat is an important source of several micronutrients, with
higher bioavailability compared to other plant-based foods. Meat consumption is expected
to increase worldwide, therefore the biofortification of bullâs feeds can be an innovative
strategy to increase populationâs exposure to nutrients. Metabolomics techniques are
capable to explore if the supplementation will ultimately lead to a higher micronutrientâs
uptake in the body.
Objective: The aim of the present study was to explore the differences on urinary metabolic
fingerprint of women ingesting 300g of beef a day from bulls fed concentrate
supplemented with extra vitamin D, E, K, and selenium compared to the regular composite
feed.
Methodology: A 32 days double-blind randomized cross-over human intervention study
with two intervention periods, each for 6 days, was conducted in 35 healthy women. The
participants were instructed to eat 300g of grinded beef meat as raw weight per day, either
from bulls fed with regular control feed or meat supplemented with vitamin D, E, K and
selenium, combined with their habitual diet. Fasting urine samples were collected in the
morning before and after each intervention period and were analyzed by LC-MS
untargeted metabolomics. Multivariate and univariate analysis were applied do identify
discriminative features between the two interventions.
Results: A total of 7 and 6 metabolites for positive and negative mode, respectively, were
selected as discriminative of the two interventions. Among these, markers of overall meat
intake, as well as markers of animal feed, markers related with the participants diet and
inflammation-related markers were identified as upregulated or downregulated for the
supplemented intervention. No markers specifically related to the biofortification were
observed.
Conclusions: Based on our methodology, the ingestion of biofortified beef did not results
in a higher level of related metabolites when comparing the two interventions. Minor
changes indicate that consequences of biofortification were very small. Further research is
needed to understand if a higher increase of vitamin D, E, K, and selenium on animal´s feed
composite can lead to different outcomes
Endogenous measures for contextualising large-scale social phenomena: a corpus-based method for mediated public discourse
This work presents an interdisciplinary methodology for developing endogenous measures of group membership through analysis of pervasive linguistic patterns in public discourse. Focusing on political discourse, this work critiques the conventional approach to the study of political participation, which is premised on decontextualised, exogenous measures to characterise groups. Considering the theoretical and empirical weaknesses of decontextualised approaches to large-scale social phenomena, this work suggests that contextualisation using endogenous measures might provide a complementary perspective to mitigate such weaknesses.
This work develops a sociomaterial perspective on political participation in mediated discourse as affiliatory action performed through language. While the affiliatory function of language is often performed consciously (such as statements of identity), this work is concerned with unconscious features (such as patterns in lexis and grammar). This work argues that pervasive patterns in such features that emerge through socialisation are resistant to change and manipulation, and thus might serve as endogenous measures of sociopolitical contexts, and thus of groups.
In terms of method, the work takes a corpus-based approach to the analysis of data from the Twitter messaging service whereby patterns in usersâ speech are examined statistically in order to trace potential community membership. The method is applied in the US state of Michigan during the second half of 2018â6 November having been the date of midterm (i.e. non-Presidential) elections in the United States. The corpus is assembled from the original posts of 5,889 users, who are nominally geolocalised to 417 municipalities. These users are clustered according to pervasive language features. Comparing the linguistic clusters according to the municipalities they represent finds that there are regular sociodemographic differentials across clusters. This is understood as an indication of social structure, suggesting that endogenous measures derived from pervasive patterns in language may indeed offer a complementary, contextualised perspective on large-scale social phenomena
PLA Logistics and Sustainment: PLA Conference 2022
The US Army War College Peopleâs Liberation Army Conference (PLA) Conference was held March 31 to April 2, 2022, at Carlisle Barracks, Pennsylvania.
The conference focused on PLA logistics and sustainment. As the PLA continues to build and modernize its combat forces, it is important to examine if the capabilities meant to support combat operations are also being developed.
Specific topics included: 1) Chinaâs national-level logistics, including how China mobilizes national resources for the military and how it provides joint logistics support to the PLA Theater Commands; 2) the logistics capabilities of the different PLA services, especially the Army, Navy, and Air Forces; 3) PLA logistics in Chinaâs remote regions, such as airpower projection in the Western Theater Command along the Indian border; and, 4) the PLAâs ability to sustain overseas operations at its base in Djibouti.
Despite notable potential shortfalls and points of friction, the PLA has successfully sustained counterpiracy maritime operations for many years and conducted noncombatant evacuation operations well-distant from China. It is increasingly able to move forces across the vast distances of China and conduct large training exercises. Far more must be known about PLA sustainment and logistics before the hard questions about PLA operational reach and endurance can be answered.https://press.armywarcollege.edu/monographs/1954/thumbnail.jp
The automatic processing of multiword expressions in Irish
It is well-documented that Multiword Expressions (MWEs) pose a unique challenge
to a variety of NLP tasks such as machine translation, parsing, information retrieval,
and more. For low-resource languages such as Irish, these challenges can be exacerbated by the scarcity of data, and a lack of research in this topic. In order to
improve handling of MWEs in various NLP tasks for Irish, this thesis will address
both the lack of resources specifically targeting MWEs in Irish, and examine how
these resources can be applied to said NLP tasks.
We report on the creation and analysis of a number of lexical resources as part
of this PhD research. Ilfhocail, a lexicon of Irish MWEs, is created through extract-
ing MWEs from other lexical resources such as dictionaries. A corpus annotated
with verbal MWEs in Irish is created for the inclusion of Irish in the PARSEME
Shared Task 1.2. Additionally, MWEs were tagged in a bilingual EN-GA corpus
for inclusion in experiments in machine translation. For the purposes of annotation, a categorisation scheme for nine categories of MWEs in Irish is created, based
on combining linguistic analysis on these types of constructions and cross-lingual
frameworks for defining MWEs.
A case study in applying MWEs to NLP tasks is undertaken, with the exploration of incorporating MWE information while training Neural Machine Translation
systems. Finally, the topic of automatic identification of Irish MWEs is explored,
documenting the training of a system capable of automatically identifying Irish
MWEs from a variety of categories, and the challenges associated with developing
such a system.
This research contributes towards a greater understanding of Irish MWEs and
their applications in NLP, and provides a foundation for future work in exploring
other methods for the automatic discovery and identification of Irish MWEs, and
further developing the MWE resources described above
Biosimilars in Europe
This reprint examines regulatory, pricing and reimbursement issues related to the market access and uptake of off-patent biologics, biosimilars, next-generation biologics and competing innovative medicines in European countries
Nutrient Intake and Physical Exercise as Modulators of Healthy Women
Cumulative evidence demonstrates that healthy nutrient intake and regular physical exercise are both powerful lifestyle strategies that modulate lifelong health through their ability to improve body composition, musculoskeletal health, sex steroid hormones, sleep quality, and physical and cognitive performance, as well as to prevent chronic diseases across the lifespan, especially in women. While the benefits of nutrition and physical exercise are commonly studied separately, the integration of nutrition and physical exercise has the potential to produce greater benefits in women than strategies focusing only on one or the other. Studying the specificities of women in response to interventions is of the utmost importance for providing optimal healthcare and aids the design of guidelines that are better suited for women. A better knowledge regarding nutrient intake and physical exercise and their interaction in women is therefore needed. This Special Issue entitled ânutrient intake and physical exercise as modulators of healthy womenâ will comprise manuscripts that highlight this integrational approach as a potential modulator of lifelong outcomes in women
Liquid Welfare guarantees for No-Regret Learning in Sequential Budgeted Auctions
We study the liquid welfare in repeated first-price auctions with budget
limited buyers. We focus on first-price auctions, which are commonly used in
many settings, and consider liquid welfare, a natural and well-studied
generalization of social welfare for the case of budget-limited buyers. We use
a behavioral model for the buyers, assuming a learning style guarantee: the
resulting utility of each buyer is within a factor (where ) of the utility achievable by shading her value with the same factor at each
iteration. We show a price of anarchy for liquid
welfare assuming buyers have additive valuations. This positive result is in
stark contrast to repeated second-price auctions, where even with ,
the resulting liquid welfare can be arbitrarily smaller than the maximum liquid
welfare. We prove a lower bound of on the liquid welfare loss under
the above assumption in first-price auctions, making our bound asymptotically
tight. For the case when our theorem implies a price of anarchy
upper bound that is about ; we show a lower bound of for that case.
We also give a learning algorithm that the players can use to achieve the
guarantee needed for our liquid welfare result. Our algorithm achieves utility
within a factor of the optimal utility even when a buyer's
values and the bids of the other buyers are chosen adversarially, assuming the
buyer's budget grows linearly with time. The competitiveness guarantee of the
learning algorithm deteriorates somewhat as the budget grows slower than
linearly with time.
Finally, we extend our liquid welfare results for the case where buyers have
submodular valuations over the set of items they win across iterations with a
slightly worse price of anarchy bound of compared to
the guarantee for the additive case
Sport team leadership coaching and captaincy in elite level rugby union football
A wide range of literature exists on coaching but it is concerned predominantly with the high school and college levels, is based upon athlete or coach perceptions, or is confined to observations of training or competition. As leaders of sports teams, coaches and captains have rarely been studied at the highest level of national or international sports competition.
In the present study, the team leadership roles of the coach and captain in elite rugby union football in New Zealand were examined using participant observation and other qualitative research methods. Elite was defined as New Zealand rugbyâs highest internal level of competition: (a) the national provincial championships and (b) international test matches of the national team, the All Blacks.
The study explored the roles of the elite rugby coach and captain in vivo in a wide variety of team situations. It was felt that this could provide first-hand information on particular team leader behaviours, on what a coach and captain actually do, and how they are perceived by those around them. The main objective, however, was to use grounded theory techniques to create a model of elite rugby team leadership that might guide developmental programmes on such leadership.
The research phases undertaken were those of participant observation with a Provincial Team for five matches, a survey of provincial teamsâ coaches and captains on their leadership associated with actual matches, three yearsâ participant observation with the All Blacks (including observation in eight test match weeks), multiple perspectives on elite team leadership from past rugby test players in New Zealand and overseas, and interviews with national team leaders in sports other than rugby.
Participant observation, interviews, questionnaires and document analysis generated data from the research settings. These data were considered in terms of symbolic interactionism and subjected to a grounded theory process. This led to a set of elite rugby team leadership categories and properties which, in turn, generated a comprehensive set of theoretical propositions.
The propositions became the basis for a model of elite rugby team leadership. This model was then considered as the basis for a programme to develop elite rugby team leaders. Significant aspects of the research findings which have not featured in previous research literature included the coachâs vision, team culture, centrality of the game plan, match week build-up, the importance of the captainâs playing example, the coach's ability to utilise teaching precepts, the coachâs personal qualities, and the need to develop and evaluate team leaders. The model, and the developmental programme principles emanating from it, are seen as relevant for developing elite level leaders in team sports other than rugby
Occupational exposure to particles in relation to chronic obstructive pulmonary disease and cardiovascular disease
Objective
The working life is expanding with increased retirement ages as the population is aging, in Sweden but in also other parts of the world. However, workers with poor health might not cope with working in higher ages. Two of the worldâs most common causes of death, chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs) are partly due to exposures from work. Exposure to particles increase the risk of incident COPD and CVD. However, more research is needed on the effect of occupational exposure of particles of different origin, and to which extent they contribute to COPD and different types of CVD, including dose-response relationships. The overall aim of this thesis was to investigate occupational particle exposure in relation to COPD and CVD, investigate effects of different particle types, dose-response relationships, and potential differences in effects in men and women.
Methods
This thesis comprises four studies, two epidemiological studies, one on COPD and one on CVD resulting in two papers, and two field studies on CVD. Study I is a populationbased longitudinal study in which we investigated the smoking-adjusted risk of COPD associated with occupational exposure to 13 particles/groups (inorganic, organic, combustion particles, and welding fumes). We formed a cohort of subjects born in 1965 or earlier who responded to the Stockholm Public Health Survey in 2002, 2006, or 2010 with follow-up surveys in 2007, 2010, and 2014, in total 43,641 subjects. Participants were identified as COPD cases if they had been diagnosed with COPD by a physician during 1990-2014 or were prescribed anticholinergic medication specific for COPD. A job exposure matrix (JEM) was used to estimate occupational particle exposure. Study II and III investigated the association between particle exposure and markers of CVD. They are based on measurements of respirable silica, respirable dust, and dust of PM 0.1-10, and on biological sampling of included participants within construction industry. Study II, based on 65 participants, investigated if occupational particle exposure is affecting common biomarkers for CVD, both cross-sectionally at work and longitudinally before and after vacation. In study III, based on 46 participants, our aim was to study short-term effects on pulse rate and blood pressure associated with rapid varying particle levels at work, but also intermittent noise. Study IV analyzed the association between occupational exposure to 41 different particles and chemicals and first MI adjusted for joint exposures of lack of decision authority, physical workload, noise, and other particles/chemicals. It is based on the Swedish National Cohort on Work and Health (SNOW) and includes all persons who were born between 1930 and 1990 and working in Sweden (6,437,660 subjects), in this study working at any time between 1985-2013. Occupational history was retrieved from the 1980, 1985, and 1990 National censuses and the Occupational register within the Statistic Swedenâs Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA). Cases of first MI were identified from the National Patient Register and the National Cause of Death Register. Other registries and cohorts were matched to add additional information of education, smoking, and body mass index (BMI). Four different JEMs were used to estimate the different occupational exposures.
Results
After adjusting for smoking, men occupationally exposed to any type of inorganic, organic, high levels to any combustion particles, and high levels of welding fumes had increased risk of incident COPD. Specifically, respirable crystalline silica (RCS), gypsum and insulation, diesel exhaust, and high levels of welding fumes were associated with COPD and showed dose-response relationships. There was also a tendency of dose-response relationship among men exposed to particles of asphalt/bitumen. For women there was an increased risk of COPD among those highly exposed to various organic particles from animal, flour, leather, plastic, soil, soot, and textile. The population attributable fractions in all ages were 10 % for men and 3 % for women (study I).
The two field studies showed changed levels of markers of CVD. Low to moderate occupational exposure to all types of the particles included (median levels: respirable silica 0.015 mg/m3, respirable dust 0.259 mg/m3, particulate matter (PM) 0.1-10 0.473 mg/m3) was associated with higher homocysteine levels, lower high-density lipoprotein-levels, and higher resting pulse rate. Also, long-term (years) occupational exposure to particles was associated with changes in low-density lipoprotein and homocysteine levels (study II). Furthermore, PM 0.1-10 in levels above 0.480 mg/m3 was significantly associated with elevated pulse rate within the same minute. A significant positive association with pulse rate was also found for noise exposure, and there was an additive effect on pulse rate if simultaneously exposed to particles and noise (study III).
With regard to first MI, for the whole population of all ages, significant increased risks were observed with cumulative exposure of particles adjusted for joint occupational exposures for the combustion compounds diesel and gasoline engine exhaust, polycyclic aromatic hydrocarbons (PAH) including benzo(a)pyrene (BAP), and sulfur dioxide (SO2), the gases carbon monoxide (CO) and volatile sulfur compounds, and the metals cadmium (Cd), chromium (Cr), iron (Fe) and lead (Pb), as well as for oil mist, benzene, gasoline, pulp or paper dust, and respirable dust. Near significant associations were seen for welding fumes and quartz dust. There were some differences between sexes. Recent exposure was also significantly associated with MI in the whole study population for diesel engine exhaust, PAH including BAP, SO2, CO, volatile sulfur compounds, Cd, Fe, formaldehyde, welding fumes, asbestos, and flour dust, for most exposures with dose-response relationships (study IV).
Conclusions
There are several particle types which are associated with COPD and first MI, respectively. Additionally, some particle types show effect on these two outcomes in two or more of the included studies, i.e., diesel engine exhaust, welding fumes, and respirable particles/silica which all are associated with both COPD and MI, even in levels below the OELs for respirable silica, and respirable inorganic particles. Results from the field studies also indicate changes in markers of CVD if occupationally exposed to respirable particles and particles of PM 0.1-10. Preventing poor health by improving work environment, for example by reducing occupational exposure to particles, will increase the likelihood of people remaining longer at work, and would most likely prevent incident COPD and CVD
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