318 research outputs found
A hybrid methodology to study stakeholder cooperation in circular economy waste management of cities
Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases.
The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks
ACTwatch 2009 Supply Chain Survey Results, DRC
In the DRC, as in many lowâincome countries, private commercial providers play an important role in
the treatment of malaria.  To design effective interventions for improved access to accurate
diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and
identify the factors that influence their stocking and pricing decisions.  Private commercial retailers
are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are
likely to have an important influence on the price and quality of malaria treatment that consumers
can access.  However, there is limited rigorous evidence on the structure and operation of the
distribution chain for antimalarial drugs that serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this
gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the
ACTwatch countries (the Democratic Republic of Congo, Cambodia, Benin, Madagascar, Nigeria,
Uganda and Zambia).  Other elements of ACTwatch include Retail Outlet and Household Surveys led
by Population Services International (PSI).  This report presents the results of a crossâsectional
survey of antimalarial drug wholesalers conducted in the DRC between January and March 2010
Unobtrusive inference of affective states in virtual rehabilitation from upper limb motions: a feasibility study
Virtual rehabilitation environments may afford greater patient personalization if they could harness the patient's affective state. Four states: anxiety, pain, engagement and tiredness (either physical or psychological), were hypothesized to be inferable from observable metrics of hand location and gripping strength -relevant for rehabilitation-. Contributions are; (a) multiresolution classifier built from Semi-NaĂŻve Bayesian classifiers, and (b) establishing predictive relations for the considered states from the motor proxies capitalizing on the proposed classifier with recognition levels sufficient for exploitation. 3D hand locations and gripping strength streams were recorded from 5 post-stroke patients whilst undergoing motor rehabilitation therapy administered through virtual rehabilitation along 10 sessions over 4 weeks. Features from the streams characterized the motor dynamics, while spontaneous manifestations of the states were labelled from concomitant videos by experts for supervised classification. The new classifier was compared against baseline support vector machine (SVM) and random forest (RF) with all three exhibiting comparable performances. Inference of the aforementioned states departing from chosen motor surrogates appears feasible, expediting increased personalization of virtual motor neurorehabilitation therapies
Multi-label and multimodal classifier for affectve states recognition in virtual rehabilitation
Computational systems that process multiple affective states may benefit from explicitly considering the interaction between
the states to enhance their recognition performance. This work proposes the combination of a multi-label classifier, Circular Classifier
Chain (CCC), with a multimodal classifier, Fusion using a Semi-Naive Bayesian classifier (FSNBC), to include explicitly the
dependencies between multiple affective states during the automatic recognition process. This combination of classifiers is applied to a
virtual rehabilitation context of post-stroke patients. We collected data from post-stroke patients, which include finger pressure, hand
movements, and facial expressions during ten longitudinal sessions. Videos of the sessions were labelled by clinicians to recognize
four states: tiredness, anxiety, pain, and engagement. Each state was modelled by the FSNBC receiving the information of finger
pressure, hand movements, and facial expressions. The four FSNBCs were linked in the CCC to exploit the dependency relationships
between the states. The convergence of CCC was reached by 5 iterations at most for all the patients. Results (ROC AUC) of CCC with
the FSNBC are over 0.940 ± 0.045 (mean ± std. deviation) for the four states. Relationships of mutual exclusion between engagement
and all the other states and co-occurrences between pain and anxiety were detected and discussed
A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in the Democratic Republic of Congo, 2010
In Democratic Republic of Congo (DRC), as in many low-income countries, private commercial providers play
an important role in the treatment of malaria. To design effective interventions for improved access to
accurate diagnosis and effective malaria treatment, there is a need to understand retailers' behaviour and
identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the
last link in a chain of manufacturers, importers and wholesalers, and their supply sources are likely to have
an important influence on the price and quality of malaria treatment that consumers can access. However,
there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial
drugs that serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by
conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch
countries (Benin, Cambodia, DRC, Madagascar, Nigeria, Uganda and Zambia). This report presents the results
from qualitative interviews with antimalarial drug wholesalers, retailers and other key stakeholders
conducted in DRC between January and March 2010. To provide a complete description of the supply chain
for antimalarial drugs, this report should be read in conjunction with the report on the results of the
quantitative supply chain survey also conducted as part of this study, available at www.actwatch.info
âDoingâ hypertension: Experiential knowledge and practice in the self-management of âhigh bloodâ in the Philippines
Patientsâ embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals âdoâ hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Molâs work on the notion of âmultiplicityâ of disease, our analysis was informed by a commitment to privileging patientsâ embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their own embodied knowledge to define their illnessâ nature (e.g., diagnosis), experience (e.g., frequency of symptoms and non-chronicity) and praxis (e.g., self-care practices). We show how this knowledge gained from having embodied experiences of living with the disease interacts in various ways with biomedical knowledge, other diagnostic labels and clinical practices, to shape how hypertension manifests and is managed by patients. Beyond interrogating the relationship between what counts as a âdiseaseâ and what is considered a âsymptomâ, our findings underscore the need to pay attention instead to the mutually co-constitutive processes of embodied experiences and disease categories in co-producing patient knowledge
Nasa dugo (âItâs in the bloodâ): lay conceptions of hypertension in the Philippines
Introduction: Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management. Methods: This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines. Results: Four prominent perceived causes were identifiedâgenetics, heat, stress and dietâfor what patients refer to as âhigh bloodâ. We propose a âfolk physiologyâ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected. Conclusions: By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patientâs beliefs and thus adherence to treatment
Strengths and Weaknesses of Digital Diaries as a Means to Study Patient Pathways: Experiences With a Study of Hypertension in the Philippines
The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patientsâ experience of non-communicable diseases. This study explores the opportunities and challenges in employing âdigital diariesâ via mobile phones to track the lived experiences of people with hypertension in the Philippines. Following in-depth interviews, 40 hypertensive adults were invited to submit digital diaries over 12 months. Mobile phones were found to be an efficient way of reaching participants, although it was difficult to collect in-depth narratives about their experiences using the medium beyond nominal responses about symptoms and treatment. Possible explanations include the asymptomatic nature of hypertension, which limited the participantsâ experiences of the illness, as well as the platform itself, which our mostly-elderly, low-income participants may not be comfortable with. Despite these challenges, âdigital diariesâ hold potential for the study of other chronic conditions, provided that researchers engage in extensive co-production with participants to understand their preferences. Researchers also need more training in the use of these methods appropriately as part of a suite of methods for capturing the experience of people living with chronic illness
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