Background: This mixed-methods dissertation is multi-layered and exploratory in nature. It provides methodological contributions to the fields of evaluation and research methods by demonstrating how the root cause analysis (RCA) method can be utilized to evaluate program improvement and assist in the development of research questions and hypotheses. Additionally, it adds to the literature on reproductive genetics decision-making by contributing to the knowledge of this complex process. Research Aims: This dissertation includes the following three aims: 1) to illustrate how the RCA interview method can be a useful tool to improve programs that have not been implemented with fidelity; 2) to demonstrate how the RCA interview method can be adapted for research by elucidating research questions and hypothesis development processes; and 3) to glean information pertaining to reproductive genetics decision-making knowledge, attitudes, and behaviors among genetic counselors and women who were pregnant and had reproductive genetic counseling. Methods: Mixed-methods research took place over a 13-month period in Arizona and across the U.S. between June 2015 and August 2016 among two separate groups. The qualitative research includes semi-structured, in-depth interviews with genetic counselors (n=22), and RCA interviews (n=9) with genetic counselors sampled from 12 southwestern and western states. The quantitative research comprised of piloting two survey instruments. Survey #1 for genetic counselors (n=22) and Survey #2 for women who had genetic counseling and were pregnant between January 1, 2005 and December 31, 2015 (n=104). Results: The results by manuscript are: 1) RCA is a useful evaluation tool for evaluating program improvement when programs have not been implemented with fidelity; 2) RCA is a beneficial methodological approach for researchers for focusing areas of inquiry, generating research questions, and developing research hypotheses; and 3) Women with a master's degree or higher are more likely to have reproductive genetic testing than women with a bachelor’s degree or under. Women who received reproductive genetic testing had significantly higher genetic testing knowledge scores than women who did not have genetic testing. Women who held a master's degree or higher had significantly higher genetic testing knowledge scores than women with a bachelor’s degree or under. Conclusions: RCA is a flexible and adaptive tool that works well for evaluation and research purposes. Reproductive genetic testing is a complex field that is rapidly changing, and there are significant differences in knowledge among women facing testing decisions calling for tailored interventions around genetic testing literacy. Recommendations: Evaluators and researchers alike should be aware of RCA as a useful methodological tool that they can use to help evaluate program improvement as well as facilitate the process of developing research questions and hypotheses. Genetic literacy interventions and decision-making resources must take into consideration the role education has on genetic testing decisions as well as its part in understanding the appropriateness, benefits, and limitations of specific genetic tests. This research further advocates for women to have access to certified genetic counselors to tailor the information to meet the individuals' needs in order to promote informed, autonomous genetics decision-making.

Master of Science in Veterinary Biomedical Science / Department of Clinical Sciences / Robert L. Larson / The selection of young replacement animals can have a significant impact on beef herd reproductive performance. Replacement heifers can be utilized to improve reproductive performance by replacing mature animals that failed to meet the production with young, cycling heifers that can have the potential of improving the reproductive momentum of a herd. The use of yearling bulls in natural breeding herds has the advantage of shortening the generational interval of the herd and has the potential of reducing the cost per cow exposed as additions to the bull battery. This thesis involves two studies that investigated methods used for the selection of peripubertal replacement animals in beef herds. The first study evaluated the ability of the novel Ready-Intermediate-Problem (RIP) replacement heifer evaluation matrix to classify heifers into groups that allow producers to select for replacements that meet production goals. Beef heifers (n=341) were classified according to the RIP matrix guidelines and then exposed to AI breeding, bull breeding, or a combination of both as per the management plans for each participating herd. Following breeding season the heifers were evaluated to determine pregnancy status, pregnancy status to single AI exposure, days bred, and the number of 21 day cycles needed during breeding season to become pregnant. After breeding season, 298 (87%) of the heifers were pregnant, 204 (68%) of which became pregnant in the first 21 days of the breeding season. Probability of overall pregnancy and pregnancy after single AI exposure was not significantly associated with RIP classification. There was a significant interaction in RIP classification by 21 day cycle. The second study was a retrospective study using BSE result data to determine the proportion of yearling beef bulls that are classified as satisfactory potential breeders when reevaluated after failing their initial breeding soundness evaluation (BSE) and to identify any predictive factors at initial BSE for satisfactory performance at revaluation. The study included 2,805 beef bulls between 11 and 14 months of age at first BSE evaluated at KABSU from 2006 to 2014. Generalized linear mixed models were created to assess potential associations among breed, age, and interaction between breed and age and passing the initial evaluation and identify predictive factors for risk of passing BSE after initial failure. The majority (93%) of the study bulls passed one of up to three BSEs. There was a significant interaction between age and breed of bull at initial BSE. Identification of suitable peripubertal replacement animals that will improve herd reproductive performance remains a challenge for producers. There are several factors that can affect replacement animals’ ability to perform according to expectations at the beginning of the breeding season. Classification of heifers into categories that can predict performance during breeding season with reasonable confidence can assist producers in identifying heifers that complement the reproductive performance goals of the herd. Utilizing BSE to identify bulls that have adequate semen quality as well as other traits important for breeding soundness is similarly important in reducing the risks of using young bulls for breeding.

Philosophiae Doctor - PhD / This study aimed to investigate the effects of commercially available natural (sugar cane molasses, white sugar and brown sugar) and artificial (Canderel, Equal, Natreen, Sweetex, Splenda and Swheet) sweeteners on various physiological systems. The artificial sweeteners tested in this study may be categorised into their respective groups based on their primary ingredient. The brands Canderel and Equal contain aspartame, Natreen and Sweetex consist of saccharin and Splenda and Swheet are composed of sucralose. The inclusion of artificial or natural sweeteners in the human diet has been continually debated and their implication in the development of certain diseases has raised concern regarding their safe use. Therefore, it is necessary that these food products be subjected to a battery of tests to determine adverse effects on human health. / South Africa

The major components of the tracheal system of insects are an extension of the exoskeleton, and the size of the exoskeleton is fixed in the adult stage, so any increase in metabolic demand that may accompany reproduction must be met by a relatively unaltered tracheal system that the female set in place at ecdysis, when entering adulthood. Acute hypoxia tends to elicit an increase in ventilation in insects, and here, I observe increased interburst VCO2 release, and a tendency towards a more continuous gas exchange pattern being preferred over discontinuous gas exchange when Blaptica dubia and Eublaberus posticus are exposed to a descending regime of hypoxia. Additionally, higher temperatures appear to increase sensitivity to hypoxia in these species, an expected result because both species, like most ectothermic animals, display a Q10 effect, increasing metabolic rates as temperature increases. The reproductive mode of B. dubia is considered to be lecithotrophic pseudoviviparity (or type A ovoviviparity), and by the time the embryos are born, they have more than doubles in volume from the time of oviposition. This gain is apparent in the wet mass of the embryo, with no change occurring in dry mass. The egg mass that can be attributed to water begins at 39% at oviposition and increased to nearly 82% at hatching. The metabolic rates of females and embryos increase as embryonic development progresses, but bomb calorimetry reveals that energy content of the embryos does not change. It is possible that these embryos gain some nutrition from the mother during embryonic development, but direct evidence remains to be demonstrated. Blaptica dubia and Eublaberus posticusare both blaberid species that display the same reproductive mode, pseudoviviparity, with incubation occurring in a brood sac. Comparisons between the reproductive traits of B. dubia and E. posticus reveal that the two species have similar reproductive periods, interbirth periods, and clutch sizes to one another, and that both have reproductive cycles and incubation times intermediate to oviparous species and the one species of cockroach that some consider to be truly viviparous (Diploptera punctata). However, whereas adult female E. posticus are larger than female B. dubia (E. posticus non-gravid female mass: 2.91 +/- 0.42 g, 20; B. dubia non-gravid female mass: 2.60 +/- 0.40 g, 20), the offspring of B. dubia are larger than those of E. posticus at the time of birth (B. dubia neonate mass: 24.70 +/- 4.01 mg, 19; E. posticus neonate mass: 22.40 +/- 1.36 mg, 19). Both gravid and non-gravid female B. dubia respond similarly to acute hypoxia exposure, increasing mean total VCO2. However, the reproductive state does not appear to exacerbate, nor dull, the acute response to hypoxia. Gravid and non-gravid female B. dubia were exposed to chronic hypoxia for 30 days and 45 days. Relatively high mortality was observed in nearly all chronic hypoxic treatment groups as compared to controls at 21 kPa O2. Comparing treatment groups to controls maintained at 21 kPa O2, embryo mass was not decreased, nor was embryo VCO2 at day 30. Adult female B. dubia metabolic rates did not show a consistent change in response to chronic hypoxia, but decreased metabolic rate was observed in the non-gravid B. dubia exposed to chronic 4 kPa O2, an observation that is consistent with past studies in insects. Survival rates were lower for both gravid and non-gravid females in 4, 8, and 12 kPa O2, as well as in 15 kPa O2 in gravid females, as compared to 21 kPa O2. Gravid females experiences a decreased survival rate compared with non-gravid females at 12 and 15 kPa O2, but gravid and non-gravid females had similarly low survival rates at 4 and 8 kPa O2. This difference in survival rates suggests there is a cost associated with carrying an ootheca in a brood sac, resulting in an increased sensitivity to hypoxia, at least over a long period of time.

Little is known about the factors that influence people from the Caribbean to seek reproductive health services in the United States. In this paper, I focus on Indo-Caribbean women from Guyana and Trinidad who undertake reproductive journeys to New York. I ask: (1) What influences Indo-Caribbean women to begin their reproductive journeys to Richmond Hill, New York? (2) How do Indo-Caribbean women challenge gender norms during their reproductive journeys? (3) How does women’s class inform their decision making in challenging gendered norms? After conducting 30 in-depth interviews with Indo-Caribbean women from Guyana and Trinidad who seek reproductive health services in New York, I find that Indo-Caribbean women’s reproductive journeys are influenced by sexism experienced within households, communities, and doctors’ offices, lack of proper care, legal restrictions, and unaffordable treatment. Another driver is support from women networks. Social networks helped women challenge gendered norms around motherhood that are present within communities in home countries. As women receive support from their networks, they challenge gender norms varied by their class. Women from middle-income households are more likely to challenge gender norms outwardly. Obtaining reproductive health care abroad becomes a journey with multidimensional experiences of gendered negotiations and constraints.

This dissertation describes the patient experience. In Chapter One, we review the currentstate of patient-centered care with a specific focus on women’s experiences in infertility treatments, highlighting the gaps in our understanding of their experiences. The four independent but complementary aims of the dissertation studies are then introduced, and we identify how they address current gaps to advance our understanding of women’s experiences using reproductive technology. In Chapter One, we also introduce an innovative service design tool, journey mapping, as well as the Burden of Treatment Framework which guided the dissertation. Chapter Two, An Integrative Review of Journey Mapping to Document the Patient Experience, presents an integrative review examining the use of journey mapping in health care services research. In the analysis of these twenty-two studies, we demonstrate how journey mapping has been adapted to describe the patient experience. While the qualitative rigor of the included studies is of good quality, the inconsistent application of design standards in the accompanying visualizations, when present, suggests that further work and guidance is needed in the adaptation of this service design tool for the health research field. In Chapter Three, Journey Mapping the Patient Experience of IVF: A Social Media Analysis, we used posts from the largest infertility subreddit and patient-facing online resources to describe and visually depict the patient experience of IVF in two journey maps representing the experiences of women in their first cycle of infertility treatment and women in repeat cycles. Findings highlighted problems and unmet needs in the infertility treatment experience, including information needs, communication needs, and support needs. Chapter Four, The Burden of Treatment in IVF: An Analysis of Social Media Using a Framework for Chronic Complex Conditions, used qualitative descriptive methodology to guide inductive and deductive content analysis of posts from the same infertility subreddit. Findings suggest that Eton’s framework is applicable to infertility, but can be expanded by the inclusion of three new constructs that we identified. Finally, Chapter Five synthesizes the key findings across these four aims, outlining their strengths and limitations, and discussing implications for future research, policy, and clinical practice.

The significance of reproductive health and rights cannot be overemphasised. Investment in the rights of rural women, specifically their reproductive health rights, is a fundamental determinant of their empowerment and social development. Access to reproductive health services enables rural women to make informed choices in their reproductive lives. This is of paramount significance because the exercise of choice in one domain opens possibilities for choices in others. International and regional human rights treaties recognise the significance of reproductive health rights for women's wellbeing and survival and require that State Parties provide access to reproductive health services. Zimbabwe has ratified the relevant human rights treaties and has domesticated many of their provisions through the Constitution and other laws. Zimbabwe has obligations to respect, protect, promote and fulfil the right to reproductive health. Despite these obligations, rural women face a plethora of challenges in accessing reproductive health services, and their right to reproductive health continues to be infringed. The infringement is in violation of Zimbabwe's international and domestic human rights obligations. The purpose of this study was to examine and establish the challenges confronting rural women when accessing reproductive health care services in Hwange Rural District Zimbabwe. Using a phenomenology qualitative research design, data were gathered through structured face-to-face interviews with 20 women of reproductive age and five health care providers. Data from the field were bolstered with reviews of extant literature. Collected field data were thematically analysed and presented. The research findings revealed that although most of Zimbabwe's legislative, policy and institutional frameworks have provisions that comply with international obligations, the frameworks also contain restrictive provisions which perpetuate the challenges women face in accessing reproductive health care services. Furthermore, the human-rights compliant legislative and policy frameworks are often not properly implemented, thus leading to a violation of the right to reproductive health in practice. The study's empirical research revealed that in Hwange Rural District, women's capabilities to exercise their reproductive rights are limited by factors such as physical barriers like distance to the nearest health facility, availability of services, quality of care given at health facilities, poverty, religion and patriarchal tradition. A major challenge unearthed by the study was that rural women in Hwange District are not aware of their reproductive health rights. This lack of knowledge is disempowering because women who do not know their rights are not knowledgeable enough to demand their rights or defend them when violated. To redress the challenges faced by rural women, the study found that women can use judicial and extra judicial mechanisms ─ including the courts, human rights institutions, nongovernmental organisations, and civil society organisations ─ for litigation, exertion of political pressure, awareness raising and grassroots mobilisation. Such strategies are essential for ensuring that women hold the State accountable for violations of their reproductive rights. The study concludes that there is need to raise awareness on the right to reproductive health and the enacted laws and policies so as to equip women with the necessary information that will allow them to exercise their rights. It recommends that intensive human rights education programmes for both the formal and informal sector should be prioritised. It recommends the provision of adequate resourcing of various state institutions responsible for women's rights issues. Further, there should be a situational analysis of challenges faced by rural women in Zimbabwe based on the intricate factors of location within rural areas, religion, gender, human rights knowledge, culture and tradition. After such situational analysis, there is need to enact laws and policies that respond directly to the unique challenges faced by rural women, without using a ‘one size fits all' approach.

'Leaving no one behind' is the slogan for strategies and action plans. Goal 3 of the Agenda aims to "Ensure healthy lives and promote being for all at all ages" which includes sexual and reproductive health. However, it leads ther the policy frameworks are leading to the goal of 'leaving no one behind'. In order to answer the question, migrants' rights is one of them. The construction of the inequalities in the discourse will be

Introduction: Unintended pregnancies are associated with poor health and economic outcomes. The use of modern contraceptive methods has been proven to be effective in reducing unintended pregnancy. Historical barriers in access to care experienced by rural communities suggest that rural women may also experience barriers in accessing reproductive health services. However, little is known about geographic variation in reproductive health services. The primary aim of this study is to examine rural and urban differences in access to and utilization of contraceptive methods among publicly funded clinics in South Carolina. Methods: A cross-sectional study of all Federally Qualified Health Center (FQHC) and Department of Health & Environmental Control (DHEC) family planning clinics in South Carolina offering reproductive health services in 2017 was used to examine access to and utilization of contraceptive methods. Administrators or organizational representatives with knowledge of clinic operations were asked to complete a survey specific to the provision of contraceptive services. Two outcomes from the survey were of primary interest. Access to a full range of contraceptive methods was operationalized as a dichotomous variable reflecting whether or not an individual method was directly available on-site. Utilization was defined as the percent of women using individual methods, relative to the overall distribution of women receiving contraceptive services. The Rural-Urban Continuum Codes (RUCC) were used to categorize clinic as rural or urban. RUCC codes 1, 2 and 3 were classified as urban, while codes 4 through 8 were classified as rural. Contraceptive methods were examined individually and aggregated into 3 groups: highly effective reversible methods, moderately effective methods and least effective methods. Bivariate relationships between the two-level RUCC variable and provision of contraceptive methods were examined using a Chi-square test for independence. An independent t-test was also used to examine differences in contraceptive utilization based on rural or urban clinic designation. Results: The study population consisted of 105 clinics, with 60% of clinics in urban areas and 40% in rural areas. Across the state of South Carolina, 75% of clinics offer highly effective contraceptive methods without having to schedule a follow-up visit to receive the method. Although not statistically significant, among clinics that offered highly effective reversible contraceptives on site, 79% of such methods are available in urban communities compared to 74% in rural and communities (p=0.49). About 12% of women at urban clinics utilized highly effective reversible methods compared to 7% of women at rural clinics (p=0.02). This appears to be driven by less access to and utilization of hormonal implants (9% among urban clinics compared to 5% among rural). Conclusion: Access to highly effective methods through publicly funded providers is similar in rural and urban communities; however, rural/urban differences in the utilization of highly effective methods, specifically implants, was noted. Given historical disparities in access and transportation barriers among rural population, decreased access and utilization of methods that allow for longer durations between provider visits could be problematic. These findings suggest that increased efforts ensuring access to long acting reversible contraception in rural clinics is warranted.

Bibliography: leaves 47-53. / The "new" reproductive technologies (NRTs) have gathered substantial momentum in recent years. 'Psychological' discourse on these techniques has tended towards uncritical preoccupation with intra-individual, constitutional factors, and has ignored the sociocultural, political and economic contexts of these practices. Within an inter-disciplinary, social-constructionist framework, this study presents a feminist critique of the NRTs in which they are argued to be biopsychosocially noxious to women. Modern biomedicine's appropriation and ownership of infertility as "disease" is argued to be consistent with the agendas of capitalism and patriarchy. Results of fieldwork within a particular medical setting are presented to develop a hermeneutic of the discursive interface between medical gatekeepers and the applicant 'patients' with whom they negotiate treatment. In a concluding section a dominant theme in gatekeepers' talk, "the well-being of the child", is ideologically analyzed; women-centered strategies are briefly discussed; and implications for the interface between psychology and reproductive technology are drawn.