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2022 ◽  
Author(s):  
Ijeoma Uchenna Itanyi ◽  
Juliet Iwelunmor ◽  
John Olawepo ◽  
Semiu Gbadamosi ◽  
Alexandra Ezeonu ◽  
...  

Abstract Background Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. Methods Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. Results The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women’s medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the “Baby showers” which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. Conclusion These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.


Author(s):  
Anwar Habeeb Saad ◽  
Ihsan Rabeea ◽  
Haider Salih

  Breast cancer is the most common cancer among women over the world. To reducing reoccurrence and mortality rates, adjuvant hormonal therapy (AHT) is used for a long period. The major barrier to the effectiveness of the treatment is adherence. Adherence to medicines among patients is challenging. Patient beliefs in medications can be positively or negatively correlated to adherence. Objectives: To investigate the extent of adherence and factors affecting adherence, as well as to investigate the association between beliefs and adherence in women with breast cancer taking AHT. Method: A cross-sectional study included 124 Iraqi women with breast cancer recruited from Middle Euphrates Cancer Center. Morisky medication adherence scale (MMAS) and beliefs about medication questionnaires (BMQ) are used to assess adherence and beliefs respectively. Result: 25% of women were fully adherent (MMAS = 8). 83.06% of all women developed side effects from medications received. Side effects and unemployed women were significantly associated with non-adherence. Additionally, there is no significant association between beliefs in medications and adherence. conclusion The enormous percent of poor adherence caused by side effects suggests the need for interventions by educating patients about the importance of their treatment and how to overcome side effects.


2022 ◽  
Vol 12 (2) ◽  
pp. 740
Author(s):  
Matteo Prussi ◽  
Calliope Panoutsou ◽  
David Chiaramonti

Modern economies rely on the efficiency of their transportation sector; however, the environmental impact of the sector remains a growing concern. Among the various proposed solutions, the production and deployment of alternative fuels is a major option. However, concerns exist that the actual availability of sustainable feedstock might lower the current level of ambition. This paper addresses this issue by reviewing recent studies and policy targets, to match forecasts for expected demand and feedstock availability for road, aviation, and maritime sectors in the EU in 2030. The existing literature is fragmented and based on a variety of different approaches, and a consistent assessment of the potential overall demand for transport is still missing. In spite of the challenges posed by the numerous uncertainties, this research provides an estimate of potential European demand for alternative fuels that ranges between 20 and 33 Mtoe. We aimed to answer the question about the availability of sustainable feedstock to cover this potential demand. The analysis confirmed, even under very conservative assumptions, that feedstock may not be the major barrier today. Other issues, such as the feedstock costs, the price volatilities, the existing logistical infrastructures, etc., are relevant aspects contributing to the puzzle. Whilst feedstock is present across European regions, a critical element which requires detailed analysis at the implementation value chain level is the effectiveness of its sustainable mobilisation alongside the synergies and trade-offs that may arise.


2022 ◽  
Vol 14 (2) ◽  
pp. 712
Author(s):  
Emad Abraik ◽  
Maged A. Youssef ◽  
Salah F. El-Fitiany

Reinforced concrete (RC) walls are extensively used in high-rise buildings to resist lateral loads, while ensuring an adequate level of ductility. Durability problems, including corrosion of conventional steel reinforcements, necessitate exploring alternative types of reinforcement. The use of glass fiber reinforced polymer (FRP) bars is a potential solution. However, these bars cannot be used in seismic applications because of their brittleness and inability to dissipate seismic energy. Superelastic shape memory alloy (SMA) is a corrosion-free material with high ductility and unique self-centering ability. Its high cost is a major barrier to use in construction projects. The clear advantage of utilizing both SMA and FRP to achieve durable self-centering structures has motivated the development of a composite SMA-FRP bar. This paper investigates the hybrid use of FRP bars and either SMA bars or composite SMA-FRP in concrete shear walls. An extensive parametric study was conducted to study the effect of different design parameters on the lateral performance of hybrid RC walls. The seismic behavior of the hybrid walls was then examined. The hybrid walls not only solved the durability problem but also significantly improved the seismic performance.


2022 ◽  
pp. rapm-2021-102719
Author(s):  
Lukas D Linde ◽  
Carey M Ogryzlo ◽  
Cassandra M Choles ◽  
Brian E Cairns ◽  
John L K Kramer

Background/importanceCannabinoids are emerging as an alternative pain management option, preliminarily supported by preclinical and clinical studies. Unwanted side effects from oral or inhaled cannabinoids remain, however, a major barrier to widespread use. Peripherally acting cannabinoids (eg, topically applied) may circumvent these side effects while providing localized pain management.ObjectiveOur purpose was to systematically review the literature on the effectiveness of peripherally acting cannabinoids for pain management.Evidence reviewWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, and PubMed databases. Included studies examined the effect of topical/peripherally administered cannabinoids on pain ratings in humans, as well as pain-related outcomes in animals (eg, paw withdrawal). Due to a lack of trials, human studies were summarized in a narrative synthesis. Separate meta-analyses were performed for animal studies using radiant tail flick or paw withdrawal outcomes.FindingsOur search yielded 1182 studies following removal of duplicates, with 46 studies (6 human, 40 animal) included. Human studies (one randomized controlled trial and five case studies/series) reported no adverse events to topical cannabinoids and preliminary evidence of decreased pain ratings. Animal studies reporting tail flick (5) (2.81, 95% CI 1.93 to 3.69, p<0.001) and mechanical withdrawal (11) (2.74, 95% CI 1.82 to 3.67, p<0.001) reported prolonged responses (analgesia) in peripheral cannabinoid groups compared with controls.ConclusionsPreclinical animal studies provided low-quality evidence for peripherally administered cannabinoids to provide regional, antinociceptive effects. The scarcity of high-quality human studies underscores the need to translate preclinical evidence into well-controlled human trials.


2022 ◽  
Vol 46 ◽  
pp. 1-16
Author(s):  
Hirusha Randimal Algewatta ◽  
Priyan Perera

The absence of robust species-specific methods to estimate the number of animals in seizures of pangolin scales is a major barrier to effective law enforcement. Therefore, studies focused on developing methods to establish accurate conversion parameters are a priority. This study proposes improved methods to estimate the number of pangolins in the illegal trade to inform law-enforcing authorities. Based on the observations of 25 specimens, Indian pangolins were on average found to possess 511 scales. Three morph-types of scales were identified: broad rhombic (n=411), elongated kite shape (n=69), and folded scales (n=31). The mean dry weight of the three-scale morph-types was 7.5 g, 4.9 g, and 6.2 g. Based on the average frequency and mean dry weight of each scale morph type, the species-specific dry weight of scales for Indian pangolins was 3.6 kg. Accordingly, we propose new and improved methods based on scale morph-type frequencies and species-specific dry weight of scales to estimate the number of Indian pangolins from quantities of scales. Their accuracy was compared with current methods, and the improved methods were found to be more accurate.


PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262215
Author(s):  
Anna Tupetz ◽  
Loren K. Barcenas ◽  
Ashley J. Phillips ◽  
Joao Ricardo Nickenig Vissoci ◽  
Charles J. Gerardo

Introduction Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal. Objective This study explored physicians’ perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer. Methods We conducted a qualitative study including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed inductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. Findings Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants’ specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients. Conclusions A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost–benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.


2022 ◽  
Vol 11 ◽  
Author(s):  
Akriti G. Jain ◽  
Hany Elmariah

Myelodysplastic syndromes (MDS) are a diverse group of hematological malignancies distinguished by a combination of dysplasia in the bone marrow, cytopenias and the risk of leukemic transformation. The hallmark of MDS is bone marrow failure which occurs due to selective growth of somatically mutated clonal hematopoietic stem cells. Multiple prognostic models have been developed to help predict survival and leukemic transformation, including the international prognostic scoring system (IPSS), revised international prognostic scoring system (IPSS-R), WHO prognostic scoring system (WPSS) and MD Anderson prognostic scoring system (MDAPSS). This risk stratification informs management as low risk (LR)-MDS treatment focuses on improving quality of life and cytopenias, while the treatment of high risk (HR)-MDS focuses on delaying disease progression and improving survival. While therapies such as erythropoiesis stimulating agents (ESAs), erythroid maturation agents (EMAs), immunomodulatory imide drugs (IMIDs), and hypomethylating agents (HMAs) may provide benefit, allogeneic blood or marrow transplant (alloBMT) is the only treatment that can offer cure for MDS. However, this therapy is marred, historically, by high rates of toxicity and transplant related mortality (TRM). Because of this, alloBMT is considered in a minority of MDS patients. With modern techniques, alloBMT has become a suitable option even for patients of advanced age or with significant comorbidities, many of whom who would not have been considered for transplant in prior years. Hence, a formal transplant evaluation to weigh the complex balance of patient and disease related factors and determine the potential benefit of transplant should be considered early in the disease course for most MDS patients. Once alloBMT is recommended, timing is a crucial consideration since delaying transplant can lead to disease progression and development of other comorbidities that may preclude transplant. Despite the success of alloBMT, relapse remains a major barrier to success and novel approaches are necessary to mitigate this risk and improve long term cure rates. This review describes various factors that should be considered when choosing patients with MDS who should pursue transplant, approaches and timing of transplant, and future directions of the field.


2022 ◽  
Vol 11 ◽  
Author(s):  
Weina Yu ◽  
Fengsen Liu ◽  
Qingyang Lei ◽  
Peng Wu ◽  
Li Yang ◽  
...  

Immunotherapy resistance is a major barrier in the application of immune checkpoint inhibitors (ICI) in lung adenocarcinoma (LUAD) patients. Although recent studies have found several mechanisms and potential genes responsible for immunotherapy resistance, ways to solve this problem are still lacking. Tumor immune dysfunction and exclusion (TIDE) algorithm is a newly developed method to calculate potential regulators and indicators of ICI resistance. In this article, we combined TIDE and weighted gene co-expression network analysis (WGCNA) to screen potential modules and hub genes that are highly associated with immunotherapy resistance using the Cancer Genome Atlas (TCGA) dataset of LUAD patients. We identified 45 gene co-expression modules, and the pink module was most correlated with TIDE score and other immunosuppressive features. After considering the potential factors in immunotherapy resistance, we found that the pink module was also highly related to cancer stemness. Further analysis showed enriched immunosuppressive cells in the extracellular matrix (ECM), immunotherapy resistance indicators, and common cancer-related signaling pathways in the pink module. Seven hub genes in the pink module were shown to be significantly upregulated in tumor tissues compared with normal lung tissue, and were related to poor survival of LUAD patients. Among them, THY1 was the gene most associated with TIDE score, a gene highly related to suppressive immune states, and was shown to be strongly expressed in late-stage patients. Immunohistochemistry (IHC) results demonstrated that THY1 level was higher in the progressive disease (PD) group of LUAD patients receiving a PD-1 monoclonal antibody (mAb) and positively correlated with SOX9. Collectively, we identified that THY1 could be a critical biomarker in predicting ICI efficiency and a potential target for avoiding tumor immunotherapy resistance.


2022 ◽  
Vol 5 ◽  
Author(s):  
Mariam Coulibaly ◽  
Guillaume Bodjrenou ◽  
Félicien Akohoue ◽  
Eric Etchikinto Agoyi ◽  
Fustelle Michée Merinosy Francisco ◽  
...  

Kersting's groundnut [Macrotyloma geocarpum (Harms.) Maréchal and Baudet], Fabaceae, is an important source of protein and essential amino acids. As a grain legume species, it also contributes to improving soil fertility through symbiotic nitrogen fixation. However, the crop is characterized by a relatively low yield (≤500 kg/ha), and limited progress has been made so far, toward the development of high-yielding cultivars that can enhance and sustain its productivity. Recently, there was an increased interest in alleviating the burdens related to Kersting's groundnut (KG) cultivation through the development of improved varieties. Preliminary investigations assembled germplasms from various producing countries. In-depth ethnobotanical studies and insightful investigation on the reproductive biology of the species were undertaken alongside morphological, biochemical, and molecular characterizations. Those studies revealed a narrow genetic base for KG. In addition, the self-pollinating nature of its flowers prevents cross-hybridization and represents a major barrier limiting the broadening of the genetic basis. Therefore, the development of a research pipeline to address the bottlenecks specific to KG is a prerequisite for the successful expansion of the crop. In this paper, we offer an overview of the current state of research on KG and pinpoint the knowledge gaps; we defined and discussed the main steps of breeding for KG' cultivars development; this included (i) developing an integrated genebank, inclusive germplasm, and seed system management; (ii) assessing end-users preferences and possibility for industrial exploitation of the crop; (iii) identifying biotic and abiotic stressors and the genetic control of responsive traits to those factors; (iv) overcoming the cross-pollination challenges in KG to propel the development of hybrids; (v) developing new approaches to create variability and setting adequate cultivars and breeding approaches; (vi) karyotyping and draft genome analysis to accelerate cultivars development and increase genetic gains; and (vii) evaluating the adaptability and stability of cultivars across various ecological regions.


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