8,057 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

    “Oh my god, how did I spend all that money?”: Lived experiences in two commodified fandom communities

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    This research explores the role of commodification in participation in celebrity-centric fandom communities, applying a leisure studies framework to understand the constraints fans face in their quest to participate and the negotiations they engage in to overcome these constraints. In fan studies scholarship, there is a propensity to focus on the ways fans oppose commodified industry structures; however, this ignores the many fans who happily participate within them. Using the fandoms for the pop star Taylor Swift and the television series Supernatural as case studies, this project uses a mixed-methodological approach to speak directly to fans via surveys and semistructured interviews to develop an understanding of fans’ lived experiences based on their own words. By focusing on celebrity-centric fandom communities rather than on the more frequently studied textual fandoms, this thesis turns to the role of the celebrity in fans’ ongoing desire to participate in commodified spaces. I argue that fans are motivated to continue spending money to participate within their chosen fandom when this form of participation is tied to the opportunity for engagement with the celebrity. While many fans seek community from their fandom participation, this research finds that for others, social ties are a secondary outcome of their overall desire for celebrity attention, which becomes a hobby in which they build a “leisure career” (Stebbins 2014). When fans successfully gain attention from their celebrity object of fandom, they gain status within their community, creating intra-fandom hierarchies based largely on financial resources and on freedom from structural constraints related to education, employment, and caring. Ultimately, this thesis argues that the broad neglect of celebrity fandom practices means we have overlooked the experiences of many fans, necessitating a much broader future scope for the field

    Lift EVERY Voice and Sing: An Intersectional Qualitative Study Examining the Experiences of Lesbian, Gay, Bisexual, and Queer Faculty and Administrators at Historically Black Colleges and Universities

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    While there is minimal literature that address the experiences of lesbian, gay, bisexual, and trans* identified students at Historically Black Colleges and Universities (HBCUs), the experiences of Black, queer faculty and administrators at HBCUs has not been studied. This intersectional qualitative research study focused on the experiences of lesbian, gay, bisexual, and queer identified faculty and administrators who work at HBCUs. By investigating the intersections of religion, race, gender, and sexuality within a predominantly Black institution, this study aims to enhance diversity, equity, and inclusion efforts at HBCUs by sharing the experiences of the LGBQ faculty and administrators that previously or currently work at an HBCU as a full-time employee. The research questions that guided this study were 1) How have LGBQ faculty and staff negotiated/navigated their careers at HBCUs? and 2) How do LGBQ faculty and staff at HBCUs influence cultural (relating to LGBQ inclusion) change at the organizational level? The main theoretical framework used was intersectionality and it shaped the chosen methodology and methods. The Politics of Respectability was the second theoretical framework used to describe the intra-racial tensions within the Black/African American community. The study included 60-120 minute interviews with 12 participants. Using intersectionality as a guide, the data were coded and utilized for thematic analysis. Then, an ethnodramatic performance engages readers. The goals of this study were to encourage policy changes, promote inclusivity for LGBQ employees at HBCUs, and provide an expansion to the body of literature in the field pertaining to the experiences of LGBQ faculty and administrators in higher education

    Unlocking the potential for thermal energy storage in the UK

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    Rapid and deep energy system decarbonisation is essential to a safe future. Thermal energy storage may hold the key to significant carbon reduction of the heating, cooling and electricity sectors, but the UK remains largely locked in to a fossil-fuel based heating regime. Global urbanisation trends mean cities are crucial to the net-zero transition. This thesis provides a sociotechnical analysis of current and future thermal storage deployment, recognising that fundamental change is complex and involves individuals and companies, supply chains, infrastructures, markets, policy and regulation, norms and traditions. I explore this through the overarching research question: How can cities unlock the potential for thermal energy storage to support the UK’s net-zero transition? The work is presented through three empirical chapters. A pilot study used a survey, thematic analysis, and pre-existing sociotechnical frameworks to explore the current state of UK thermal storage deployment and how sociotechnical characteristics are shaping current and future deployment prospects. A case study of a particular storage approach known as geoexchange analyses the results of interviews with geoexchange practitioners using sociotechnical frameworks, and proposes a new critical success factors framework. Finally, a comparative case study of two UK cities explores the specific role of local authorities to use powers at their disposal within a common planning framework to support the deployment of urban shared ground heat exchange in residential and mixed-use developments. Based on this study, a framework for local policy, support and enforcement activities is proposed. Applied contributions are provided through new knowledge on sociotechnical factors shaping the prospects for TES to support the net-zero transition, the first sociotechnical analysis of UK geoexchange deployment, and policy and practice proposals to support city-based shared ground heat exchange. Theory is advanced through application, testing and development of several existing frameworks for understanding sociotechnical change. Based on empirical evidence, two novel frameworks are proposed to support deployment of geoexchange and shared ground heat exchange

    Selected Papers from the 6th FĂĄbos Conference on Landscape and Greenway Planning

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    This book contains five research articles and one review article derived from the 6th Fabos Conference on Greenway Planning held at the University of Massachusetts, Amherst, in April of 2019. Specific topics covered include greenway planning and analysis for urban morphology, typology, climate change impact and recreational and health usage, in addition to historic greenway restoration. All the articles illustrate multidisciplinary approaches for analyzing urban greenway functions within expanding and contracting cities

    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

    Perspectives on Public Policy in Societal-Environmental Crises

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    This is an open access book. Histories we tell never emerge in a vacuum, and history as an academic discipline that studies the past is highly sensitive to the concerns of the present and the heated debates that can divide entire societies. But does the study of the past also have something to teach us about the future? Can history help us in coping with the planetary crisis we are now facing? By analyzing historical societies as complex adaptive systems, we contribute to contemporary thinking about societal-environmental interactions in policy and planning and consider how environmental and climatic changes, whether sudden high impact events or more subtle gradual changes, impacted human responses in the past. We ask how societal perceptions of such changes affect behavioral patterns and explanatory rationalities in premodernity, and whether a better historical understanding of these relationships can inform our response to contemporary problems of similar nature and magnitude, such as adapting to climate change

    Resource Recovery from Water

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    Throughout history, the first and foremost role of urban water management has been the protection of human health and the local aquatic environment. To this end, the practice of (waste-)water treatment has maintained a central focus on the removal of pollutants through dissipative pathways. Approaches like – in the case of wastewater treatment – the activated sludge process, which makes ‘hazardous things’ disappear, have benefitted our society tremendously by safeguarding human and environmental health. While conventional (waste-)water treatment is regarded as one of the greatest engineering achievements of the 20th century, these dissipative approaches will not suffice in the 21st century as we enter the era of the circular economy. A key challenge for the future of urban water management is the need to re-envision the role of water infrastructure, still holding paramount the safeguard of human and environmental health while also becoming a more proactive force for sustainable development through the recovery of resources embedded in urban water. This book aims (i) to explain the basic principles governing resource recovery from water (how much is there, really); (ii) to provide a comprehensive overview and critical assessment of the established and emerging technologies for resource recovery from water; and (iii) to put resource recovery from water in a legal, economic (including the economy of scale of recovered products), social (consumer's point of view), and environmental sustainability framework. This book serves as a powerful teaching tool at the graduate entry master level with an aim to help develop the next generation of engineers and experts and is also highly relevant for seasoned water professionals and practicing engineers
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