Background and need: Burn injuries are a major cause of hospital admission in low-income countries such as Zimbabwe and often lead to secondary complications such as disfigurements, contractures, and scar formations. The study aimed to establish “Guidelines for Rehabilitation of Musculoskeletal Impairments and Functional Limitations for Zimbabwe for Patients with Burns” based on the best evidence available. There were three good candidates for use as the source guideline, but ultimately, the Agency for Clinical Innovation (ACI) of New South Wales in Australia guidelines1 was chosen. The contextualisation of these guidelines for the Zimbabwean situation was informed by the outcomes of five sub-studies. A summary of the methodologies applied and the key results follow. Methods and Results: The Epidemiology of Burns in Zimbabwe: The characteristics of patients with burns in Zimbabwe was established through a retrospective record review (descriptive review) to characterise patients admitted with burns to the two central hospitals in Harare over fifteen months. The sample consisted of 926 admission records and 435 full patient folders were retrieved and analysed. Unfortunately, 425 full folders of children were missing and 85 folders of adults. There was a clear difference in presentation between children and adults, with children constituting over threequarters of all admissions, but with less severe injuries. Post-discharge follow-up: Access to rehabilitation and impact on Health-Related Quality of Life (HRQoL): The second study investigated the utilisation of post-discharge care, regarding referral after discharge and home programme. This was a study with a small sample, 14 adult and 23 child respondents. Despite referrals having been made to local rehabilitation departments, there was practically no further post-discharge contact with rehabilitation and only a single person received post-discharge rehabilitation. Both Health-Related Quality of Life (HRQoL) instruments used by the adult respondents indicated less impact on physical domains of functioning with the greatest impact in pain and emotional well-being. In the absence of trained counsellors, rehabilitation therapists might need to step into this role. Systematic review: The broad objective of this review was to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. The review, which included 19 papers, established that exercises (either resistance or aerobic), are effective and generally have a positive effect on muscle strength and aerobic capacity. However, there was a risk of bias in many of the papers and the evidence is not of high quality. As most of the research enrolled paediatric patients older than seven years and no adverse effects were reported, it can be concluded that resistance exercise is safe for this group of patients. However, as most children admitted with burns are younger than seven years, exercise needs to be carefully monitored in this group as safety and efficacy have not been proven for younger children. iii The results from this support the use of aerobic and resistance as an important component of a burn rehabilitation program as they have shown to improve muscle strength aerobic capacity and functional status even after hospital discharge, especially in patients with severe burns. Documentation of the current rehabilitation practice: This phase documented clinical interventions used to treat musculoskeletal problems by observation of seven rehabilitation workers (not only physiotherapists), based in the five central hospitals, one provincial and one district hospital. The treatments of five adults and five paediatric patients were observed at each hospital, a total of 70 treatments in all. The most significant finding was that the management of patients with burns was offered by a single rehabilitation worker a Physiotherapists (PT), Occupational Therapists (OT) or Rehabilitation Technician (RT), working in Burns' Units without any specialised training or additional courses. The management of burns across all hospitals was similar, and information saturation was reached with the planned number of observations. Passive and active movements were used almost universally, and the patients received a ward programme, which included positioning. Sitting and standing were included in some patients and patients were monitored for any adverse effects. A major weakness observed was the lack of baseline assessment or treatment progress during treatment. No compression bandages were applied and no scar tissue massage was done. Identification and adaptation of the suitable guidelines: Following a literature search and examination of different guidelines by two independent reviewers, the Agency for Clinical Innovation of New South Wales, Australia1 was chosen as a candidate for amendment. The guidelines were amended based on the results of the previous studies and subjected to a Delphi process with four to six Zimbabwean rehabilitation therapists who were experienced in the field of burn management. A credible set of guidelines for Zimbabwe for the rehabilitation of musculoskeletal impairments and functional limitations was thus produced. Conclusion: The current study adds to the body of knowledge through the development of guidelines for the physiotherapy rehabilitation of musculoskeletal impairments and functional limitations for patients with burns in low- and middle-income countries. The thesis has provided an evidence-based framework for patients, rehabilitation workers and policymakers to inform the provision of effective management of patients with burns. The Zimbabwe Guidelines should be regarded as a first attempt rather than the final version and hopefully will be subjected to further review as they are tried out in practice.

Software quality is one of success factors in software development. Usability and user experience (U&UX) as a part of software quality is becoming more and more important. Although, there has been successful attempts to formalize specific parts of U&UX there is still a need for a systematic framework of U&UX evaluation. This thesis is aimed to study the state of the art in U&UX evaluation in order to develop a single framework that comprises existing knowledge on the topic. Furthermore, the U&UX evaluation framework is aimed to support product development in industry and provide a versatile guide for U&UX practitioners. The study is based on reference based systematic review. The literature review covers both scientific publications and industrial grade papers. The papers to be reviewed were selected by their relevance to the study goals and credibility of the source. The result of this is three layer U&UX evaluation framework. First layer of the Model features breakdown structure of usability and user experience. Total number of usability and context of use attributes is 217. Second layer of the model contains guidelines of how to perform usability evaluation. Third layer features validation strategies and guidelines on how to expand the Model. In order to enable practical use of the Model both static and dynamic validation should take place. There are many models in place attempting to formalize U&UX evaluation. However, most of them focuses on particular branch of usability or are too broad to be applied practically without adaption. Furthermore, there are many resources offering practical usability and user experience checklists or guidelines. However, most of them lack connection with industry standards such as ISO/IEC 9126. The Model presented in this thesis attempts to fill the gap between high level industry standards and cook book style U&UX guidelines.

Red blood cells are commonly administered during the perioperative period, however our understanding of available guidance informing transfusion decisions as well as appropriateness of current practice is not well understood. Blood transfusions are associated with post-operative morbidity and possibly worse long-term outcomes. Furthermore, they are a costly and limited resource. They should therefore be used sparingly. The objective of this thesis was to further our understanding of guidance available for administration of intraoperative red blood blood cell transfusion, as well as conduct an audit of the appropriateness of transfusions administered during the perioperative period. This thesis is composed of both a systematic review as well as a retrospective review of a prospectively maintained database. The systematic review of identified 10 guidelines published between 1992-2018 that included indications for intraoperative transfusions. Six provided objective clearly defined criteria for transfusion based on hemoglobin triggers (range 60-100g/L) or hematocrit (<30%); one stated a specific clinical situation for which transfusion would be appropriate (ST changes). The evidence supporting intraoperative recommendations was extrapolated primarily from the non-operative setting. Retrospective review of a single centre revealed 19% of patients underging liver resection were transfused a mean of 2.6 units during the perioperative period. A total of 22% to 63% of transfusions administered during the intraoperative period were considered inappropriate based on the application of three different instruments. In contrast, 38% to 67% of transfusions administered during the postoperative period were considered inappropriate. Patients considered to have been inappropriately transfused during the intraoperative period were at increased risk of developing a major postoperative adverse event (Clavien-Dindograde 3) compared to those who did not receive a transfusion (OR 4.2; 95% CI 1.1-15.6). In conclusion, this thesis demonstrates evidence-based, practitioner oriented, intraoperative transfusion guidance for clinicians is lacking. Furthermore, a significant proportion of patients continue to be exposed to unnecessary transfusion. Further work in this area is warranted to clarify indications for intraoperative transfusion and subsequently minimize the administration of unnecessary transfusion.

The Coexistence Approach was established by Mosbrugger and Utescher (1997) as a plant-based method to reconstruct palaeoclimate by considering recent climatic distribution ranges of the nearest living relatives of each fossil taxon. During its existence for over more than 15. years, its basics have been tested and reviewed in comparison with other terrestrial and marine climate reconstruction techniques and climate modelling data. However, some controversies remain about its underlying data or its applicability in general.In view of these controversies this paper discusses the power and limitations of the Coexistence Approach by summarising past results and new developments. We give insights into the details and problems of each step of the application from the assignment of the fossil plant to the most suitable nearest living relative, the crucial consideration of the usefulness of specific taxa towards their climatic values and the correct interpretation of the software-based suggested palaeoclimatic intervals. Furthermore, we reflect on the fundamental data integrated in the Coexistence Approach by explaining different concepts and usages of plant distribution information and the advantages and disadvantages of modern climatic maps. Additionally, we elaborate on the importance of continually updating the information incorporated in the database due to new findings in e.g., (palaeo-)botany, meteorology and computer technology.Finally, for a transparent and appropriate use, we give certain guidelines for future applications and emphasize to users how to carefully consider and discuss their results. We show the Coexistence Approach to be an adaptive method capable of yielding palaeoclimatic and palaeoenvironmental information through time and space.

Philosophiae Doctor - PhD / The health benefits associated with physically active lifestyles are well known and the World Health Organisation has acknowledged its significance in preventative and rehabilitative health care. It is recommended by the World Health Organisation that children, aged 6 to 17 years, should participate in 60 minutes of moderate-to-vigorous physical activity on a daily basis

People are seeking health information from a wide variety of sources. The comprehensive information in clinical practice guidelines (CPGs) represents an excellent source of evidence based information which should be communicated to this audience. Currently, there is little research about how to write a version of a CPG that would be easily accessible to people and more information is needed to identify barriers and supports, and potential solutions to disseminate CPGs to this audience (i.e. patients and the public). This thesis represents a body of research consisting of four scientific papers with an overarching objective to understand and explore how CPGs and recommendations primarily developed and written for health care professionals can be disseminated to patients and the public. A CPG was developed using the rigorous methods of the GRADE approach; a randomised controlled trial was conducted to evaluate a format to disseminate synthesised evidence to patients and the public; a systematic review of the literature with a thematic and narrative synthesis of patient and public attitudes towards and awareness of CPGs was performed; and a qualitative description and content analysis of a sample of patients versions of CPGs was conducted. The studies found that people are interested in patient versions of CPGs for a variety of purposes, such as for decision making, as a tool to prepare for consultations with health care providers, and as advice for self-care management. However, barriers to their use may include lack of personalisation of information, negative attitudes towards guidelines as ways to restrict and control access to care, and lack of understanding of the recommendations and the evidence. A format to disseminate the evidence from a guideline is proposed, but future research should focus on strategies to personalise the information, to overcome the negative attitudes towards guidelines, and to communicate the recommendations and the evidence informing the recommendations. / Thesis / Doctor of Philosophy (PhD)

No description available.

Background and need: Burn injuries are a major cause of hospital admission in low-income countries such as Zimbabwe and often lead to secondary complications such as disfigurements, contractures, and scar formations. The study aimed to establish “Guidelines for Rehabilitation of Musculoskeletal Impairments and Functional Limitations for Zimbabwe for Patients with Burns” based on the best evidence available. There were three good candidates for use as the source guideline, but ultimately, the Agency for Clinical Innovation (ACI) of New South Wales in Australia guidelines1 was chosen. The contextualisation of these guidelines for the Zimbabwean situation was informed by the outcomes of five sub-studies. A summary of the methodologies applied and the key results follow. Methods and Results: The Epidemiology of Burns in Zimbabwe: The characteristics of patients with burns in Zimbabwe was established through a retrospective record review (descriptive review) to characterise patients admitted with burns to the two central hospitals in Harare over fifteen months. The sample consisted of 926 admission records and 435 full patient folders were retrieved and analysed. Unfortunately, 425 full folders of children were missing and 85 folders of adults. There was a clear difference in presentation between children and adults, with children constituting over threequarters of all admissions, but with less severe injuries. Post-discharge follow-up: Access to rehabilitation and impact on Health-Related Quality of Life (HRQoL): The second study investigated the utilisation of post-discharge care, regarding referral after discharge and home programme. This was a study with a small sample, 14 adult and 23 child respondents. Despite referrals having been made to local rehabilitation departments, there was practically no further post-discharge contact with rehabilitation and only a single person received post-discharge rehabilitation. Both Health-Related Quality of Life (HRQoL) instruments used by the adult respondents indicated less impact on physical domains of functioning with the greatest impact in pain and emotional well-being. In the absence of trained counsellors, rehabilitation therapists might need to step into this role. Systematic review: The broad objective of this review was to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. The review, which included 19 papers, established that exercises (either resistance or aerobic), are effective and generally have a positive effect on muscle strength and aerobic capacity. However, there was a risk of bias in many of the papers and the evidence is not of high quality. As most of the research enrolled paediatric patients older than seven years and no adverse effects were reported, it can be concluded that resistance exercise is safe for this group of patients. However, as most children admitted with burns are younger than seven years, exercise needs to be carefully monitored in this group as safety and efficacy have not been proven for younger children. The results from this support the use of aerobic and resistance as an important component of a burn rehabilitation program as they have shown to improve muscle strength aerobic capacity and functional status even after hospital discharge, especially in patients with severe burns. Documentation of the current rehabilitation practice: This phase documented clinical interventions used to treat musculoskeletal problems by observation of seven rehabilitation workers (not only physiotherapists), based in the five central hospitals, one provincial and one district hospital. The treatments of five adults and five paediatric patients were observed at each hospital, a total of 70 treatments in all. The most significant finding was that the management of patients with burns was offered by a single rehabilitation worker a Physiotherapists (PT), Occupational Therapists (OT) or Rehabilitation Technician (RT), working in Burns' Units without any specialised training or additional courses. The management of burns across all hospitals was similar, and information saturation was reached with the planned number of observations. Passive and active movements were used almost universally, and the patients received a ward programme, which included positioning. Sitting and standing were included in some patients and patients were monitored for any adverse effects. A major weakness observed was the lack of baseline assessment or treatment progress during treatment. No compression bandages were applied and no scar tissue massage was done. Identification and adaptation of the suitable guidelines: Following a literature search and examination of different guidelines by two independent reviewers, the Agency for Clinical Innovation of New South Wales, Australia1 was chosen as a candidate for amendment. The guidelines were amended based on the results of the previous studies and subjected to a Delphi process with four to six Zimbabwean rehabilitation therapists who were experienced in the field of burn management. A credible set of guidelines for Zimbabwe for the rehabilitation of musculoskeletal impairments and functional limitations was thus produced. Conclusion: The current study adds to the body of knowledge through the development of guidelines for the physiotherapy rehabilitation of musculoskeletal impairments and functional limitations for patients with burns in low- and middle-income countries. The thesis has provided an evidence-based framework for patients, rehabilitation workers and policymakers to inform the provision of effective management of patients with burns. The Zimbabwe Guidelines should be regarded as a first attempt rather than the final version and hopefully will be subjected to further review as they are tried out in practice.

Essential Medicine Lists (EMLs) are important for the prioritization and availability of medicines around the world. Since the first Model List of Essential Medicines (MLEM) from the World Health Organization in 1977, the list has expanded from 208 to 479 medicines. The availability of essential medicines is a key priority under the World Health Organization’s Universal Health Coverage agenda & the United Nation’s Sustainable Development Goals (in particular goal 3.8 Coverage of Essential Health Services). EMLs are an important tool to inform health decisions at a country-level and at least 137 countries now have their own national EML. Despite this, there is wide variability in the methods used to develop them, and the certainty of evidence of medicines included on WHO’s MLEM and national EMLs. Additionally, a lack of coordination may result in time delays in updating EMLs or unnecessary duplication of efforts between EMLs and other evidence synthesis and health decision-making paradigms, such as health guidelines. In this thesis, we seek to understand the decision-making process for EMLs with particular focus on WHO’s MLEM, and to identify and advance opportunities to coordinate their development with health guidelines. This is accomplished through three papers, which build upon each other in this sandwich thesis. Paper 1 is a qualitative interview study with EML and guideline stakeholders to better understand decision-criteria and processes in EMLs. Paper 2 evaluates, using user-experience testing, a framework for the connection of guidelines and EMLs using an Evidence-to-Decision (EtD) framework for EMLs. Paper 3 presents a stakeholder-driven Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group concept paper exploring the conceptual challenges and opportunities of linking guidelines and EMLs using case studies on real-world implementation of this connection. / Thesis / Doctor of Philosophy (PhD) / Medicines are important for treating health conditions, and the most important medicines are called essential medicines. Essential Medicine Lists (EMLs) are created to determine what should be considered an essential medicine around the world, and also to ensure people have access to them. The number of medicines on the World Health Organization’s Model List of Essential Medicines (MLEM) has grown since it was first released, but these medicines aren’t always available to treat people who need them. Sometimes medicines that are not the most important are included on national essential medicine lists. The way that the WHO EML and national EMLs are made has been under review and criticized. Health guidelines tell people how medicines should be used, however, the connection between EMLs and health guidelines is not always consistent. Sometimes they may say different things about the same medicine. Additionally, there are differences in how EMLs and guidelines are established, and those involved do not always work with each other. In this thesis, I try to understand how decisions about which medicines are included in EMLs are made, and how they connect to health guidelines. Chapter 1 is an introduction to the topic. Chapter 2 asks experts about the decision-making process for EMLs. In chapter 3, we change a tool for guidelines to help connect guideline and EML decisions and ask for feedback regarding improvements. Chapter 4 presents the work with a group of guideline experts to present problems and suggest ways to overcome them to make EMLs and health guidelines better connected.

For this thesis, I created a guideline for socially assistive robots (SARs), and used it to evaluate a reading comprehension based social robot. To create the guideline I extracted relevant details from published standards about toy safety, radio equipment, electromagnetic compatibility, internet of things security, ethical considerations for human-computer interaction, and data privacy. I then sent a summarized version to experts in the field for feedback. I received seven responses, five of whom were from researchers in academia. The sample size was too small for statistical analysis. Survey responses identified additional areas, such as interactivity and aesthetics, for the guideline. I evaluated a reading comprehension based social robot called HAPI the Librarian with my newly created guidelines. Using HAPI, I found that the guidelines worked, but needed improvement. Improvements suggested for the next iteration of the guide- line are to provide better directives for intangible concepts such as ethics and data privacy. Additionally, the guidelines should help to identify characteristics that raise ethical or data privacy concerns. Overall, these guidelines can be applied to socially assistive robots designed from scratch or purchased off-the-shelf.