The Human Immunodeficiency Virus (HIV) epidemic remains a major global public health problem, with sub-Saharan Africa (SSA) at its epicentre. Despite the use of antiretroviral therapy (ART) to reduce new infections and deaths, SSA reports the highest HIV incidence, constituting two-thirds of global new infections. Cameroon is one of SSA countries where HIV care decentralization is enforced as a national policy but follow up of people living with HIV (PLWH) is provider-oriented, with limited patient involvement in clinical monitoring. The purpose of this dissertation was to explore predominant barriers and facilitators influencing ART adherence and identify effective interventions enhancing ART adherence across SSA. Furthermore, we sought to assess the prevalence and predictors of ART non-adherence among PLWH, and factors influencing non-adherence among PLWH who have experienced ART non-adherence in Cameroon. We conducted a comprehensive systematic review and meta-analysis on studies examining barriers to ART adherence and interventions boosting adherence. Forty-five studies were selected (30 for narrative synthesis and 15 for meta-analysis). Identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Adherence-enhancing interventions encompassed counselling, incentives, mobile phone short message service, peer delivered behavioral intervention, community ART delivery, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between intervention and control groups (pooled OR=1.56, 95%CI:1.35 - 1.80, p=<0.01). Using a cross-sectional study of adult PLWH in HIV treatment centres in Cameroon, we explored the prevalence and predictors of ART non-adherence. A total of 451 participants with mean age 43.42 years (SD: 10.42), were enrolled. Overall, ART non-adherence was 37.78%. Reasons for missing ART include forgetfulness, business and traveling without drugs. Significant factors associated with ART non-adherence include age, education, and alcohol consumption. In a qualitative study of 43 adult PLWH who had experienced ART non-adherence, adherence barriers included those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. Adherence facilitators included social support, aligning treatment with patient’s daily routines, use of reminders, health sector/caregiver support, and awareness of HIV status/ART knowledge. To harness full potential of ART and mitigate HIV burden in SSA countries, stakeholders engaged in HIV management must recognize and integrate barriers, facilitators, and adherence-enhancing interventions when formulating policies or crafting treatment strategies. Continuous information provision and unflinching support both from patients’ families and caregivers are needed to improve adherence. Future studies focusing on specific underrepresented demographics - HIV-infected children, adolescents, and pregnant women in SSA are needed to uncover appropriate barriers, facilitators and interventions tailored to each group’s unique needs. Other studies focusing on assessing long-term non-adherence trends and determinants using larger samples of PLWH in many regions are necessary. Also, studies using both in-depth and focused group discussions, and quantitative approaches are required to uncover the ART non-adherence-related burden.

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This article reports on the findings of questionnaires completed by fifty-seven social work students studying at four universities in northern England and the English midlands. The questionnaires surveyed students' views about the extent to which issues of religion and belief had been discussed in practice settings over a twelve-month period. A range of factors are identified that either encourage or discourage them from considering or exploring religion and belief in their work, in relation to the attitudes of colleagues and service users, themselves and their agencies. Their responses suggest that individual perspectives on and experiences of religion together with the informal views of colleagues determine whether and how religion and belief are acknowledged as significant and relevant. Students reported that few agencies promoted any opportunity for staff development and training in respect of this area, perhaps because issues of religion and belief are not considered important or are given less priority amongst other issues and responsibilities.

Over the past several years, many state Cooperative Extension Services have taken inventory of their engagement with international issues, including barriers (real and perceived) to active participation in globalizing programs as well as staff needs for effective communication with diverse audiences. While Virginia Cooperative Extension (VCE) has actively involved 4-H youth in international exchange programs, they have not engaged in a coherent and proactive effort to globalize all program areas. The study purpose was to assess attitudes of VCE faculty toward globalizing their programming efforts. Also examined were information related to VCE faculty's current involvement in globally-focused activities and barriers to globalizing programming efforts. The survey instrument combined various sections of two surveys developed and employed by Barbara Ludwig in studies on Ohio Cooperative Extension. The web-based survey included four sections: 1) Employee Profile, 2) Involvement in International Activities, 3) Perception towards Global Issues, and 4) Perceived Barriers to Globalizing Extension Programs. The target audience included all VCE faculty members (N = 332). Two hundred six faculty members completed the on-line survey. This represents a return rate of 62%. Data revealed that 92% of the respondents were involved in international efforts within the past five years. On a scale of one to four, with four representing the highest level of engagement, campus administrators (mean = 2.66) and specialists (mean = 2.13) were the most involved in international programming effort; the least involved were the district directors (mean = 1.21). "Exchanged ideas with colleagues from other countries" and "hosted an international visitor" were the top two activities performed by faculty. Data also revealed an attitude mean score of 2.9 on a scale from one to four, with four being the most positive. Campus administrators (mean = 3) were the most positive of the four position categories; agents were the least positive (mean = 2.86). Furthermore, the top two barriers to globalizing VCE programs, as identified by respondents, were "lack of financial support" and "not a programming priority". Respondents also selected "Lack of time" as a major barrier. / Ph. D.

This study utilized a nationwide survey of collegiate female athletic directors in the three NCAA divisions to ask about their perceptions about organizational barriers, pathways, and mentorship. The following research questions guided the thesis, with a feminist Standpoint Theory focus: (1) What are some of the organizational barriers that keep women from becoming ADs? (2)What are some of the pathways that women take to become an AD? (3)What are the roles of mentoring in advancing through collegiate athletic administration? The 93 respondents provided responses suggesting that women seeking leadership positions are still outsiders within athletic administrations. They still have to push through the glass ceiling and maneuver through the old boys' club in order to have success. Women are the outsiders within the athletic director role and are working together through mentoring to gain access to the position. / Master of Arts

Permeable reactive barrier (PRB) technology is increasingly considered for in situ treatment of contaminated groundwater; however, current design formulas for PRBs are limited and do not properly account for all major physical and attenuation processes driving remediation. This study focused on developing a simple methodology to design PRBs that is easy to implement while improving accuracy and being more conservative than the available design methodologies. An empirical design equation and a simple analytical design equation were obtained to calculate the thickness of a PRB capable of degrading a contaminant from a source contaminant concentration to a maximum contaminant level at a Point of compliance . Both equations integrate the fundamental components that drive the natural attenuation process of the aquifer and the reactive capacity of the PRB.The empirical design equation was derived from a dataset of random hypothetical cases that used the solutions of the PRB conceptual model (Solution I). The analytical design equation was derived from particular solutions of the model (Solution II) which the study showed fit the complex solutions of the model well. Using the hypothetical cases, the analytical equation has shown that it gives an estimated thickness of the PRB just 15 % lower or higher than the real thickness of the PRB 95 percent of the time. To calculate the design thickness of a PRB, Natural attenuation capacity of the aquifer can be estimated from the observed contaminant concentration changes along aquifer flowpaths prior to the installation of a PRB. Bench-scale or pilot testing can provide good estimates of the required residence times ( Gavaskar et al. 2000) , which will provide the reactive capacity of the PRB needed for the calculation. The results of this study suggest also that the installation location downgradient from the source of contaminant is flexible. If a PRB is installed in two different locations, it will achieve the same remediation goals. This important finding gives engineers and scientists the choice to adjust the location of their PRBs so that the overall project can be the most feasible and cost effective. / Master of Science

The Center for High Performance Learning Environments (CHPLE) at Virginia Tech aims to provide guidance on various issues associated with high performance learning environments, using information gained through the various studies undertaken at the College of Architecture and Urban Studies. One such study is presented in this thesis. Leadership in Energy and Environmental Design (LEED), an environmental rating system for buildings, introduced in 1998, is still in the process of development. The USGBC conducted research and introduced various LEED manuals for different building types. For each building type, in order to achieve environmental credits under LEED, evidence must be provided in terms of various documents. The process of collecting and submitting these documents is perceived to be difficult and this study tries to find the barriers to the documentation process as required during LEED certification. Currently, while documenting the credits under LEED, the design team must assume many important responsibilities. Hence this research sought participation from this group of professionals, who are proactive in promoting LEED and also have experience in school design. To understand the design professionals perception about LEED, a semi-structured interview method was adopted to obtain data for this study. Out of a total of 175 invitations, 15 agreed to participate. A questionnaire was developed and the participants were asked to respond. All interviews were recorded, providing the main source of data. IRB approval was obtained prior to the interviews and all the prescribed ethical concerns were addressed during the interviews. The responses to the questionnaire, were categorized as, 1.Barriers for documentation and2.Recommendations from participants for improving the LEED documentation process. The identified barriers were sequenced to understand the interrelationships between different barriers. The recommendations are interpretations and derivations of the participant recommendations. These recommendations could be adopted by the USGBC to improve the process of documentation in LEED. This study may also initiate other studies to help further understand the opinions of school authorities and other project members with respect to LEED documentation. / Master of Science