This study quantified the changes in pedaling mechanics and energy expenditure accompanying a posterior shift in cleat placement during prolonged cycling. Six male competitive cyclists participated. Each subject was asked to complete two separate hour long rides using traditional cleat placement and a novel heel placement, respectively. Expired gasses, kinematics, and EMG from 7 lower limb muscles were collected at three time intervals during each ride. No significant difference in O2 utilization was seen (p=0.905). A significant difference was seen in sagittal plane knee angle (p=0.008) and angular velocity (p=0.003) in the heel condition, demonstrating a more extended knee and lower peaks in angular velocity. Musculo-tendon kinematic data showed no differences. Tibialis anterior (TA) iEMG was higher in the heel condition, and SOL and TA showed differences in timing between conditions. These results demonstrate changes in ankling patterns and knee joint kinematics as adaptations to heel pedaling. / School of Physical Education, Sport, and Exercise Science

Call number: LD2668 .T4 1986 W23 / Master of Arts / Communication Studies

M.Com. (Business Economics) / By paying more attention to the risks associated with funding, banks will be able to fund themselves more effectively. Of especial importance are liquidity and interest rate risk because of the perceived trade-off that exists between them. This complicates the funding of a bank. To manage the liquidity and interest rate risks effectively requires a comprehensive analysis to ensure that they are properly understood. The causes, origins, inter-relationships with other risks and the measurement of risk are investigated thoroughly. The management of these risks is then examined. With regard to risk management, it is especially important not to focus on anyone risk in isolation, but to manage the multiple risk profile bearing in mind their interrelationships. All the risks a bank is exposed to are ultimately reflected in capital risk. Stringent capital requirements are imposed upon banks and these are being phased in over the period to 1995. Consequently capital risk is also investigated. The relationship that exists between liquidity risk and interest rate risk is investigated. Ways and means to separate these two risks are examined to try and manage them separately. In this way each of these two risks can be managed within acceptable norms. To achieve this goal, the use of the traditional funding instruments, modified funding instruments and derivatives are examined. Each of these are investigated and applied to the funding of a bank. The yield curve is investigated as one of the ways to explain the term structure of interest rates. The different types of yield curves and the meaning of each are dealt with. Thereafter the use of yield curve analyses in forecasting interest rates is assessed with a view to formulating an optimal funding strategy. An asset and liability model was used during the analysis of liquidity risk, interest rate risk and the yield curve.

An Intensive Care Unit (ICU) is an extreme technological environment where different t)?es of equipment and devices, intended for the care of critically ill patients, are found. The use of technological equipment has assisted in reduction of morbidity, mortality, and length of hospital stay because the problems are diagnosed earlier. The purpose of the study was to explore the perceptions of nu$es who work in the Intensive Care Units about the effects of the use of technological equipment, with the intention of making recommendations for clinical practice, education of nurses and further research. A quantitative, descriptive, prospective, and non-experimental study design was utilised in this study, as well as a non-probability sampling method. Participants (n:60) were drawn from neurosurgical, cardiothoracic and main ICUs. Data collection was done by use of questionnaire. Descriptive and inferential statistics were used to analyse data.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.

A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, 2011 / Mecklenburg Hospital provides a comprehensive package of promotive, preventive, curative and rehabilitative reproductive health services for women which are not available in primary health care clinics and community health centres. These services require special equipment (such as cardiotochograph machine) and personnel (such as medical doctors) that are not available in these health facilities. The availability of medical equipment is one of the crucial components of effective maternal health services. Specific life saving medical equipment must be available for routine and emergency management of maternal and neonatal complications. This study is undertaken since no formal study has been done to systematically study the availability and related cost of medical equipment in a district Hospital maternity ward.

A Research Report submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2016 / Maintenance of technical systems aims at retaining their reliability and availability, restoring their capability of continuing their operation in case they have failed. A number of reliability and maintenance policies that play a significant role in reducing system failures and in making cost-effective decisions on whether to repair or replace a system will be examined in great detail. This research report places greater emphasis on the total repair cost (TRC) limit policy and compares it with other polices like the economic lifetime (EL) policy. The maintenance cost rate will be used to obtain the optimal parameters. When a system fails, it is replaced with an identical unused one if the total repair cost goes beyond a pre-determined repair cost limit by a preventive replacement if in the time period (0, v) no failure forces a replacement of the system. Else, a repair is carried out. / M T 2016

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Introdução: A existência de uma relação importante entre o uso de produtos para a assistência à saúde e a ocorrência de infecções, torna prioritário estabelecer medidas eficazes de processamento daqueles passíveis de reuso.O Centro de Material e Esterilização (CME) tem como missão fornecer produtos para saúde (PPS) seguramente processados, ou seja, limpos, desinfetados ou esterilizados, livres de biofilmes, de endotoxinas, de proteínas priônicas e de substâncias tóxicas, e ainda funcionalmente efetivos.No Brasil, o CME tem as suas Boas Práticas regulamentadas por legislação federal da Agência Nacional de Vigilância Sanitária desde 15/03/2012 por meio da Resolução da Diretoria Colegiada (RDC) nº 15. Expirado o prazo de 24 (vinte e quatro) meses contados a partir da data de sua publicação para que os CME fizessem as adequações necessárias, pode-se inferir que muitos dos serviços de saúde e das empresas processadoras abrangidos por esta Resolução não conseguiram atender integralmente as exigências legais. Analisando a RDC ANVISA nº 15, nem todos os itens se encaixam no mesmo nível desegurança para os PPS processados,ou seja, numa situação de inspeção sanitária as inconformidades não devem ser consideradas com a mesma gravidade. Apresente análise das inconformidades do Centro de Material e Esterilização com base na RDC ANVISA nº15/2012 para julgamento da gravidade validada por especialistaspoderá subsidiaro gestor do CME na priorização de planos de ação junto à administração do Estabelecimento de Saúde para tornar o serviço conforme com a legislação vigente. Objetivo: Analisar asinconformidades apresentadas pelo CME, com base na RDC ANVISA nº15/2012 para julgamento da gravidade esubmeter a validação por especialistas. Materiais e métodos: Tratou-se deuma pesquisa metodológica, que consistiu na atribuiçãode gravidade para 132 inconformidades em relação ao não cumprimento de 89 itens da RDC ANVISA nº 15/2012. Atribuiu-se gravidadealtapara itens da lei cujo não cumprimento comprometia a segurança do processamento seguro do PPS, ou baixa para itens que permitiam um tempo maior para adequação às exigências legais, sem comprometimento do processamento seguro do PPS.Posteriormente, a atribuição da gravidade foi validada por um grupo de 14 especialistas por meio da técnica Delphi, em duas rodadas.Resultados: Das 132 inconformidades referentes ao não cumprimento dos artigos da RDC ANVISA nº15/2012, julgou-se 108 inconformidades como gravidade alta referentes à infra-estrutura, aos equipamentos, aos processos de limpeza, de inspeção, de preparo, de acondicionamento, de desinfecção, de esterilização, de monitoramento da esterilização e do transporte, que poderiam comprometer a segurança do PPS, 105 validadas pela concordância acima de 70% dos juízes especialistas. Julgou-se como gravidade baixa 24 inconformidades; destas, 13 foram validadas, com consenso de mais de 70%, que se referiram à saúde ocupacional, à climatização, à estrutura física e aos equipamentos e 11 não obtiveram a concordância no percentual necessário para validação. Estes itens não validados referiram-se à climatização, à separação de áreas limpas e sujas, à desinfecção química, à qualidade da água de enxágue de PPS, à atribuição do CPPS e ao CME classe I processando materiais complexos. Conclusão: Para as 132 inconformidades referentes ao não cumprimento de 89 artigos da RDC ANVISA nº15/2012, validou-se 118 inconformidades quanto ao grau de gravidade atribuído 105 como gravidade alta e 13 como gravidade baixa. Das inconformidades elencadas como sendo de gravidade baixa, 11 não obtiveram a concordância no percentual necessário para validação. Evidenciou-se lacunas de conhecimento científico na área de processamento de produtos para saúde, como a influência do diferencial de pressão na área de limpeza de PPS como fator de segurança para os profissionais, e o efeito do desgaste/abrasão do PPS limpo com material abrasivo na facilitação da adesão de biofilmes. / Introduction: The existence of an important relationship between the use of products for health care and the occurrence of infections makes it a priority to establish effective measures for the processing of those that can be reused. The purpose of the Material and Sterilization Center (CME) is to provide safely processed, cleaned, disinfected or sterilized health products (PPS) free from biofilms, endotoxins, prion proteins and toxic substances, and still functionally effective . In Brazil, the CME has its Good Practices regulated by federal legislation of the National Sanitary Surveillance Agency since 03/15/2012 through the Resolution of the Collegiate Board of Directors (RDC) No. 15. The term of twenty-four (24) month, counted from the date of its publication for the CME to make the necessary adjustments, it can be inferred that many of the health services and processing companies covered by this Resolution have not been able to fully meet the legal requirements. Analyzing RDC ANVISA No. 15, not all items fit the same level of safety for the processed PPS, that is, in a sanitary inspection situation, nonconformities should not be considered with the same seriousness. The present analysis of the nonconformities of the Center of Material and Sterilization based on the ANVISA RDC nº15 / 2012 for severity validated by specialists can subsidize the CME manager in the prioritization of action plans with the Administration of the Health Establishment to make the service conform With current legislation. Objective: To analyze the nonconformities presented by CME, based on ANVISA RDC nº15 / 2012, to assess severity and to submit validation by specialists. Materials and methods: This was a methodological research, which consisted in the attribution of seriousness to 132 nonconformities in relation to the non-compliance of 89 items of DRC ANVISA nº 15/2012. High severity was assigned to items of law whose non-compliance compromised the security of PPS\'s secure processing, or lowering to items that allowed longer time to conform to legal requirements without compromising PPS\'s secure processing. Subsequently, the assignment of gravity was validated by a group of 14 specialists using the Delphi technique, in two rounds. Results: Of the 132 nonconformities related to the non-compliance of the articles of DRC ANVISA nº15 / 2012, 108 non-conformities were judged as \"high severity\" regarding infrastructure, equipment, cleaning, inspection, preparation, packaging , Disinfection, sterilization, sterilization and transport monitoring, which could compromise the safety of the PPS, validated by the agreement of more than 70% of the expert judges. It was judged as \"low gravity\" 24 nonconformities; Of these, 13 were validated, with a consensus of more than 70%, referring to occupational health, air conditioning, physical structure and equipment and 11 did not obtain agreement on the percentage required for validation. These items were not validated, they referred to the air conditioning, the separation of clean and dirty areas, the chemical disinfection, the quality of the rinsing water of PPS, the assignment of CPPS and the CME class I processing complex materials. Conclusion: For the 132 nonconformities regarding non-compliance with 89 articles of the ANVISA RDC nº15 / 2012, 118 nonconformities were validated regarding the degree of severity attributed - 105 as high severity and 13 as low severity. Of the nonconformities listed as being of low severity, 11 did not obtain the agreement in the percentage necessary for validation. There was evidence of gaps in scientific knowledge in the area of health products processing, such as the influence of the pressure differential in the PPS cleaning area as a safety factor for professionals, and the wear / abrasion effect of clean PPS with abrasive material In facilitating biofilm adhesion.