Diversity Of Barriers Research Articles

Good agricultural practices (GAP) adoption intensity and production constraints in apple orchards of western Nepal

The declaration of ‘Fruits Decade 2016/17–2026/27’ and the enaction of the ‘NepalGAP Scheme’ by the Government of Nepal has redirected increased public investments to promote apple production and marketability in the western high hills of Nepal. This study explores major good agricultural practices (GAP) related to orchard management, factors influencing their adoption intensity, and key underlying constraints to production using cross-sectional survey data from apple growers in Dolpa district, Nepal. The results showed that farmers mostly adopted GAP such as frequent weeding, intercropping, and nutrient management in apple orchards. Based on the negative binomial regression estimates, household characteristics such as gender of the orchard owner, experience, and number of literate household members were found influential in determining the GAP adoption intensity. The analysis of the problem severity index implied that apple production is mostly constrained by limited access to production inputs and transportation. The findings provide useful insights to the farmers and policymakers regarding the current scenario of GAP adoption along with the diversity of barriers that severely limits the realization of apple production potential in western Nepal.

International Genetic Testing and Counseling Practices for Parkinson's Disease.

There is growing clinical and research utilization of genetic testing in Parkinson's disease (PD), including direct-to-consumer testing. The aim is to determine the international landscape of genetic testing in PD to inform future worldwide recommendations. A web-based survey assessing current practices, concerns, and barriers to genetic testing and counseling was administered to the International Parkinson and Movement Disorders Society membership. Common hurdles across sites included cost and access to genetic testing, and counseling, as well as education on genetic counseling. Region-dependent differences in access to and availability of testing and counseling were most notable in Africa. High-income countries also demonstrated heterogeneity, with European nations more likely to have genetic testing covered through insurance than Pan-American and Asian countries. This survey highlights not only diversity of barriers in different regions but also the shared and highly actionable needs for improved education and access to genetic counseling and testing for PD worldwide. © 2023 International Parkinson and Movement Disorder Society.

Diversity, tolerance, and the social contract

Philosophers and social scientists have recently turned to game theory and agent-based models to better understand social contract formation. The stag hunt game is an idealization of social contract formation. Using the stag hunt game, we attempt to determine what, if any, barrier diversity is to the formation of an efficient social contract. We uncover a deep connection between tolerance, diversity, and the social contract. We investigate a simple model in which individuals possess salient traits and behave cooperatively when the difference between their trait and the trait of their counterpart is less than their ‘tolerance level’. If traits are fixed and correspond to permanent or semipermanent features of the individual, such as religion or race, social contract formation is a remote possibility. If traits are malleable, social contract formation is possible but comes at the steep cost of diversity and tolerance, that is, individuals are unwilling to cooperate with those much different from themselves. Yet homogeneity and intolerance are not a long-term feature of the population. Over time mutations allow for increasingly tolerant agents to prosper, thereby ushering in trait diversity. In the end, all reap the benefits of cooperation.

Why don't patients and physicians talk about end-of-life care? Barriers to communication for patients with acquired immunodeficiency syndrome and their primary care clinicians.

Patients with chronic and terminal disease frequently do not talk to their physicians about end-of-life care. Interventions to improve this communication have generally been unsuccessful, suggesting that important barriers to this communication must exist. To determine the barriers to and facilitators of patient-clinician communication about end-of-life care and to identify barriers and facilitators that are more common among those patients who are least likely to discuss end-of-life care: minorities and injection drug users. We conducted a prospective study of 57 patients with advanced acquired immunodeficiency syndrome and their primary care clinicians who were recruited from university and private clinics. Barriers to and facilitators of end-of-life communication were identified from a prior qualitative study and assessed for frequency and importance and for an association with the occurrence and quality of end-of-life communication. Clinicians identified more barriers than patients. Barriers identified by patients and clinicians fell into 3 categories of potential interventions: education about end-of-life care, counseling to help address end-of-life concerns, and health care system changes to facilitate patient-clinician communication. Although none of the patient-identified barriers was associated with the occurrence of communication, 2 clinician-identified barriers were associated with less communication: "the patient has not been very sick yet" and "the patient isn't ready to talk about end-of-life care." Nonwhite patients were more likely to identify the following 2 barriers than white patients: "I feel that if I talk about death, it could bring death closer" and "I don't like to talk about the care I want if I get very sick." The diversity of barriers and facilitators relevant to patients with acquired immunodeficiency syndrome and their clinicians suggests that interventions to improve communication about end-of-life care must be focused on individual needs and must involve counseling interventions and health system changes in addition to education. Clinician barriers are more common and more strongly associated with the occurrence of end-of-life communication than patient barriers, suggesting that clinicians are an important target group for improving this communication.