Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains xii, 162 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 139-150).

Background Adherence to HAART is key to any successful HAART programme. In Madzikane KaZulu Memorial Hospital ARV Clinic, there is an increasing number of patients on HAART and an increasing number of patients still awaiting HAART initiation. With the paucity of healthcare personnel in this rural district hospital, suboptimal patient’s preparation for HAART often occurs, and the HAART defaulter rate is on the increase. This is may be attributed to an interplay of factors affecting HAART adherence. Aim and Objectives The aim of this research was to determine the prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the Madzikane KaZulu Memorial Hospital (MKMH) ARV clinic. The objectives were: • To conduct an audit on all case files of patients on HAART over the study period. • To explore the behavioural aspects of poor HAART adherence in a focused group discussion. • To describe the factors associated with good HAART adherence Methods Study design: A cross-sectional descriptive study which focused on determining the prevalence of established factors( patient-related, therapy-related and facility-related factors) affecting HAART adherence at the ARV clinic was carried out among identified HAART non-adhering patients. Patients that were not adhering with HAART between the period of January 2009 and December 2010 were selected for the study. These patients were 19 years or more and had been on HAART for at least two months. The study was carried out between November and December 2010. The result of the focused group discussion was utilized to refine the development of the questionnaire. Setting: The study was conducted at the Madzikane KaZulu Memorial Hospital ARV clinic. This is a modern 269 bed district hospital in the Mount Frere, Alfred Nzo district, Eastern Cape Province of South Africa. This is a predominantly rural region. Results: Data for analysis was provided by 215 patients that fulfilled the inclusion criteria. The prevalence rate of the factors affecting HAART adherence at the hospitals ARV clinic was 24%. A total of 60% of the patients were females. Majority of the patients (86.1%) had treatment supporters, and more than half of the patients (57.2%) were unemployed and not on disability grant. A total of 62.8% of the patients prefer to take their ARV at a clinic near them, and the majority of these patients (96.3%) want to start taking their ARV in a nearby clinic within 6months. The female gender, unemployment not on disability grant, longer period on HAART, Regimen 1A ARV( stavudine or tenofovir plus lamivudine and efavirenz according to the National ART guideline 2004 and its modified version of April 2010) single marital status and probably poorly selected unprepared treatment supporters, are associated with poor HAART adherence at this ARV clinic. Conclusion The study revealed that the prevalence rate of the factors affecting HAART adherence at the Madzikane KaZulu Hospital ARV clinic was 24% amongst HAART non-adhering patients. These patients had the prevalence rate of patient-related factors (12.4%) more than double of the prevalence rates of therapy related factors (5.8%), and facility related factors (5.7%). Topmost amongst the associated factors for not adhering to HAART were: not belonging to a support group, the pills making the patient feel unwell, and the ARV clinic being too far from where the patients live. Efforts should be targeted at enrolling the patients in support groups, encouraging the use of HAART regimens that have good tolerability profiles, and establishing the down referral.

Active sound control (ASC) based on surface potentials is one of two methods of noise control using potential-based method. The method does not require detailed knowledge of the noise source parameters, boundary conditions, characteristics of the acoustic medium or the transmission path. It allows significant volumetric noise cancellation inside the shielded region using only the knowledge of the total acoustic field which includes the wanted sound at the boundary of the shielded region(s) to obtain additional secondary sound sources known as controls which are distributed at the boundary of the shielded region. It allows the presence of a wanted sound inside the shielded region, which it preserves while canceling the noise. In contrast, other methods require various detailed knowledge. In many cases, they do not allow the wanted sound to be generated inside the protected region. The aim of this thesis is to implement numerically the ASC method in 3D bounded regions and confirm its theoretical predictions. The theoretical framework for the method has already been established in previous related literature. Experimental work in this area is mostly limited to laboratory experiments in one dimensional settings. The algorithm was tested in 3D numerical test cases in the frequency domain involving single and composite regions. The Helmholtz equation was used to model the wave propagation. In both single and composite regions, volumetric noise cancellation of over 20 dB was achieved at most areas of the shielded regions. Outside the shielded region, the field remained practically unchanged during noise cancellation. On the other hand, in test cases involving wanted sound, the noise inside the shielded region was canceled while the wanted sound was preserved. However, outside the shielded region, the field was amplified. Moreover in composite regions, the selective cancellation/propagation of the wanted sound was demonstrated successfully in regions having two and three sub-regions by allowing the wanted sound to propagate to one region but not to the other. To enforce selective propagation of the wanted sound, additional steps are required to obtain the separate field of the wanted sound in addition to the total field. A study on the effect of the number of controls on noise cancellation showed that in both single and composite regions, as the number of controls fell there was a corresponding decrease in the level of noise cancellation. A doubling of the number of controls yields about ~3 dB of noise cancellation, and vice versa. The independence of the operation of the algorithm on characteristics or number of noise sources, shape, size or position of shielded region is also demonstrated via further test cases. In all test cases considered, the results confirmed the theoretical predictions. However, at resonance modes the method did not provide noise cancellation, though at near-resonance modes a lower level of noise cancellation was obtained. Although this work considered only monochromatic waves, the method is applicable to broadband noise. In real-time application of the method, the assumption in the thesis that only the field of the noise source(s) is known does not hold and therefore its implementation is more complicated.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-05-11T19:49:56Z No. of bitstreams: 2 Dissertação - Paulo Freire Sobrinho - 2017.pdf: 10088390 bytes, checksum: 93cbaefd8f5c2dc974201729c2e859f7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-15T11:30:14Z (GMT) No. of bitstreams: 2 Dissertação - Paulo Freire Sobrinho - 2017.pdf: 10088390 bytes, checksum: 93cbaefd8f5c2dc974201729c2e859f7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-05-15T11:30:14Z (GMT). No. of bitstreams: 2 Dissertação - Paulo Freire Sobrinho - 2017.pdf: 10088390 bytes, checksum: 93cbaefd8f5c2dc974201729c2e859f7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-04-13 / Contextualization: Technologies like CAD systems, become ideal as a second opinion, that is, to work in partnership with the doctor. For example, PneumoCAD can be used to perform a diagnosis of absence or absence of pneumonia in children 1 to <5 years of age using X-ray radiographs. Problems: However, the use of PneumoCAD requires a region of interest, referring to the lungs, manually. Based on difficulty and difficulty, we sought a solution that was not found in any research, applied to radiographs, involving PneumoCAD, through the active model, having as a patient children between the ages of 1 and <5 years. Proposal: It is then proposed the use of the active model, associated with the technique developed and called nsAlterar in improvement to segmentation based on ns . Materials and Methods: Fifty-six “padrão ouro” radiographs were submitted to MATLAB, in 8 steps, through modified and improved algorithms, as well as implemented support tools, such as: As well as measures of similarity to investigate quantitatively , On an efficiency of all resources employed for the same purpose. Results: With this question, we obtained, after an analysis of the experiments, a taxon of hits for the right of spraying 75.61% and for the left one in 63.41%, in which nsAlterar promoted the improvement in the distributions, even if They were not segmented correctly, through approximations properly. Conclusions: Based on the active model associated with nsAlterar and other resources, it was possible to complement a functionality of the PneumoCAD system, through the use of segmentation in reais, thus contributing to a higher efficiency and better results. / Contextualização: As tecnologias como sistemas CAD, tornam-se ideais como segunda opinião, ou seja, para trabalhar em parceria com o médico. Por exemplo, o PneumoCAD pode ser utilizado para realização do diagnóstico de ausência ou não de pneumonia em crianças de 1 e < 5 anos de idade, através das radiografias de raios-X. Problemática: Entretanto, a utilização do PneumoCAD exige que uma região de interesse, referente aos pulmões, sejam determinadas manualmente. Baseado nesta exigência e dificuldade buscou-se alguma solução que não foi encontrada em nenhuma pesquisa, aplicada a radiografias, envolvendo o PneumoCAD, através do Active Shape Model, tendo como paciente crianças com idade entre 1 e < 5 anos. Proposta: É, então, proposto o uso do Active Shape Model, associado à técnica desenvolvida e denominada nsAlterar em melhora à segmentação baseada no ns . Materiais e Métodos: Foram submetidas, no MATLAB, 56 amostras de radiografias do “padrão-ouro”, em 8 etapas, através de algoritmos modificados e aperfei- çoados, além de ferramentas implementadas de apoio, como: para o treinamento a partir de exemplos; assim como as medidas de similaridades para buscar investigar, de maneira quantitativa, sobre a eficiência de todos os recursos empregados para o mesmo propósito. Resultados: Com isto, foi obtida, após a análise dos experimentos, a taxa de acertos para o pulmão direito em 75,61% e para o esquerdo em 63,41%, em que o nsAlterar promoveu o melhoramento nas distribuições, mesmo as que não foram segmentadas corretamente, através de aproximações de maneira adequada. Conclusões: A partir do Active Shape Model associado ao nsAlterar e demais recursos, foi possível complementar a funcionalidade do sistema PneumoCAD, através do uso da segmentação em situações reais, contribuindo, assim, para a obtenção de maior eficiência e de melhores resultados.

South African public schools in disadvantaged areas are experiencing serious levels of under resourcing which negatively impact the educational experiences of learners. Attempts to lessen such negative impact include involving alumni who know the school‟s context, history and ethos. Unfortunately, the concept of alumni support in terms of mentoring and motivating learners is not the norm in many under resourced schools. This research focuses on fostering partnerships with alumni using participatory action research (PAR), because it is holistic, relationally driven and inclusive. Embedded in complexity theory that views the school community as a nonlinear system of different interacting parts functioning to improve the school context, the research follows actionreflection cycles of a group of ten past pupils and five educators from various backgrounds, levels of education and expertise collaborating with and mobilizing other alumni. Data were generated using drawings, photo voice and interviews. Thematic data analysis was used to build patterns and form categories. The following themes emerged namely, the importance of establishing a collective vision for sustained alumni engagement for alumni‟s personal and professional aspirations to serve the vision of the school, the importance of creating an alumni culture that reinforces the concept of „paying it forward‟. Lastly, establishing a sustainable alumni association through sustained actions and interactions and by creating an organisation of excellence The newly developed alumni structure as a „resource fountain‟ generating and cascading energy around the school emerged as an anchor for sustainability. The cascaded energy evolved into a structured „Alumni Week‟ providing ongoing motivation for current learners to sustain alumni engagement.

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No description available.

Inactivity and sedentary behavioural patterns among children contribute greatly to a wide range of diseases including obesity, cancer, cardiovascular disease, and diabetes. It is also associated with other important health effects like mental health issues, anxiety, and depression. In order to reduce these trends, we need to focus on the highest contributing factor, which is lack of physical activity in children’s daily lives. 'Exergames' are believed to be a very good solution in promoting physical activity in children. Such games encourage children to engage in physical activity for long periods of time while enjoying their gaming experience. The purpose of this thesis is to provide means of directing child behaviour in a healthy direction by using gaming enhancements that encourage physical exertion. We believe that the combination of both exercising and learning modalities in an attractive gaming environment could be more beneficial for the child's well-being. In order to achieve this, we present an adaptive exergaming system, the "ExerLearn Bike", which combines physical, gaming, and educational features. The main idea of the system is to have children learn about new objects, new language, practice their math skills, and improve their cognitive ability through enticing games and effective exercise. Three games have been incorporated to provide children with various educational benefits. The system has personalized features that allow guardians to customize the learning content, skill level, and required physical activity to meet their child’s needs. A stationary bike is used as a gaming controller to encourage children to undertake daily aerobic exercise. A modular design approach was adopted so that it is possible to use any stationary bicycle as an input interface by simply attaching a number of devices to it. This thesis provides detailed information about the design requirements, the design model, the proposed system and its related hardware components, the design and development of the gaming software, and the qualitative and quantitative evaluation of the system’s performance.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Science in Epidemiology and Biostatistics. Johannesburg, November 2017. / Introduction Viral load is the most reliable indicator of poor adherence to anti-retroviral therapy (ART). However, this assay is difficult to implement in resource-limited settings due to financial and technical constraints. Laboratory markers, combined with the patient’s demographic and clinical details, have been described as better proxies of adherence than the current self-reported adherence measures. However, the real diagnostic value of these biomarkers remains unknown. Therefore, the aim of this study was to assess the usefulness of a composite marker to identify poor adherence to ART defined as a detectable plasma viral load in HIV-positive patients on first-line regimen at Themba Lethu Clinic (TLC) in Johannesburg, South Africa Materials and Methods: This study was retrospective cohort analysis of data collected on HIV-positive ART naïve adults initiating first line antiretroviral regimen at TLC following the 2010 South African antiretroviral treatment guidelines. The data collection was carried out as part of the low-cost monitoring (LCM) study at Themba Lethu Clinic in Johannesburg from February 2012 to 2014. The LCM cohort which aims to look at low cost monitoring of HIV treatment in resource limited settings was initiated in 2009 in Johannesburg, South Africa. The study or treatment outcome was failure to suppress viral load (VL ≥ 400 copies/ml) at 6 and at 12 months. Adherence to antiretroviral treatment was assessed using four (4) self-reported adherence (SRA) measures namely: a self-reporting questionnaire, a Visual Analogue Scale (VAS), a pill identification test (PIT) and the Simplified Medication Adherence Questionnaire (SMAQ). The result of each self-reported measure was classified as either positive or negative given a conventional threshold. In our study three (3) self-reported adherence (SRA) measures were combined into a multi-method approach tool which included self-reports combined with VAS and the pill identification test (PIT). Continuous variables were summarized by median with interquartile range. Categorical variables were summarized by giving their frequencies. To compare continuous variables, we used an unpaired t-test if the variable was normally distributed. When continuous variables were compared from baseline to the previous 6 months, a paired t-test was done. In the case of skewed distribution, we used a non-parametric variant of the t-test such as the Mann-Whitney U-test. To compare categorical variables, we used cross-tables with corresponding chi-square test or Fisher exact test. A Modified Poisson Generalized Linear Model (GLM) with robust variance was used to estimate adjusted relative risks (aRR) of failing to suppress viral load at 6 and at 12 months adjusting for age age, gender, self-reported adherence measures, changes in laboratory markers and missed appointments at 6 and 12 months after ART initiation. As there was missing values in the covariatess and the outcome, we performed a multiple imputation technique under missing at random (MAR) assumption in order to compare the robustness of the estimations between the complete case analysis and the imputation model under MAR after imputing missing values. with the imputed dataset. Additionally, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each self-reported adherence measure using viral load as the reference standard. Thus, we derived two diagnostic risk scores from rounding and adding together the adjusted regression coefficients used to estimate adjusted relative risk and following the Spiegelhalter and Knill-Jones approach, at 6 and at 12 months. The Receiver Operating characteristic (ROC) curves were computed to see the overall discriminative value of each continuous risk score. To assess the clinical usefulness of the continuous riskscores we dichotomized them from 2 ≥ vs < 1 to 5 ≥ vs < 5 and calculated the sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) at each cut-off, taking detectable viral load as a gold standard. Results: There were 353 HIV-positive patients initiated on first line ART at TLC for the LCM cohort study. Of these, 80.7% did not suppress viral load after 6 months while 30.1% did not suppress viral load at 12 months. The proportion of patients classified as being highly adherent was 86.7% but this proportion decreased to 60% at 12 months. By 6 months, after adjusting for gender and age, the variables that were significantly associated with detectable viral load included: having missed at least two ARV visits by ≥ 7 days (aRR: 2.35 95% CI: 1.08 -5.11); platelet count < 150 cells/mm3 (aRR: 2.73 95% CI: 1.04 -7.18) and VAS ≤ 95% (aRR: 1.65. 95% CI: 1.01-2.71). At 12 months, the estimates showed a positive relationship only with age group and unemployment. There were no similarities in the results found using complete case analysis and analysis with imputed datasets. However, the largest standard errors were obtained from the complete case analysis. At 6 months, the AUC ROC curve was calculated as 0.63 (95% CI, 0.53 - 0.72) while, for the visual analogue scale, the AUC decreased to 0.55 (95% CI, 0.49 - 0.62); for the Simplified Medication Adherence Questionnaire (SMAQ), the AUC decreased to 0.52 (95%CI, 0.45 - 0.60), while for the multi-method approach, it decreased to 0.53 (95% CI, 0.46 - 0.58). The optimal diagnostic accuracy was obtained with the score 5 (≥5 vs <5 Se: 64% and a Sp: 50.0%) followed by a risk score of 4 (Se of 76.0%, Sp of 34.7%). At 12 months, the AUC of the diagnostic risk score was calculated as 0.44 (95%CI, 0.40 - 0.60) while for the three self-reported adherence methods, it decreased to 0.48 (95% CI, 0.40 - 0.60), 0.51 (95%CI, 0.40 - 0.60) and 0.50 (95%CI, 0.41 - 0.59) respectively for the visual analogue scale, the SMAQ and the multi-method approach method respectively. Conclusion. This study shows that after ART initiation, the 6-month’s adherence can be better diagnosed using laboratory markers combined with patient’s information and traditional self-reported adherence measures at Themba Lethu Clinic. The advantage of this proposed method is that it is based on routine and accessible informations collected during HIV-positive patient visits, thus incurring no additional cost for its implementation. An external validation of this diagnostic risk score is needed for its translation into clinical practice in resource-limited settings. / LG2018

Research report submitted in fulfilment of the degree of Master of Public Health (MPH) at the University of Witwatersrand July 2015 / Introduction: Swaziland is facing a very high HIV prevalence and critical human resources for health (HRH) crisis. The Nurse Initiated and Managed Anti-Retroviral Treatment (NIMART), a task shifting program to capacitate nurses to offer ART services, was introduced in 2009 by the government of Swaziland to address the human resources for health (HRH) challenges in the country. Although the country has attained 80% coverage in ART provision amongst adults, the ART coverage in children below 15 years of age is 9% which falls way below the WHO stipulated proportion of 15% in that age group. In addition, ever since the NIMART was introduced there have been limited studies done in Swaziland to explore the perceptions of health workers with regards to its implementation. This study explored providers’ perceptions on the facilitators and barriers to the NIMART implementation in Manzini Region. Materials and Methods: An exploratory qualitative study was used to explore providers’ perceptions of the facilitators and barriers to the implementation of NIMART services in Manzini Region, Swaziland. A semi-structured interview guide was used to interviews with nurses, clinic managers and medical doctors who were purposively selected from five urban and three rural clinics offering NIMART services in Manzini Region, Swaziland. Thematic content analysis was used to analyse data guided by the Donabedian conceptual framework. Results: The findings showed that two weeks training was offered to the professional nurses before they were certified as NIMART nurses. The first week of training was mainly theory classes while the second week was on-site practical training. The NIMART program was perceived as vital by the providers interviewed as it improved access to ART, reduced patient waiting times, empowered nurses and was a cost effective program to address the shortages of doctors in the country. Structural factors like availability of health facilities, professional nurses, antiretroviral drugs and antiretroviral treatment guidelines at the facilities visited were reported by most respondents as facilitators of the implementation of the program. Process factors like the training of NIMART nurses in some facilities, the partnership between the Ministry of Health and various nongovernmental organisations, the health workers commitment and team work greatly facilitated NIMART implementation. Structural barriers like limited paediatric antiretroviral regimen choices and limitations in paediatric ART policy and legislation were mentioned to negatively affect ART uptake in children. Other barriers like children’s dependency on adult caregivers for their health issues and poor socioeconomic circumstances in communities were mentioned to be hampering ART uptake in children. Process factors like inadequate training of the NIMART nurses in some clinics, parents’ and caregivers’ myths and misconceptions around HIV, AIDS and ART, high HIV and AIDS stigma and poor access to health services were also raised. Conclusion and Recommendations: Even though there were facilitating factors of the NIMART program like availability of ART drugs and ART treatment guidelines which have been seen to have played a major role in ART uptake in adults, there are still many barriers to the implementation of NIMART as evidenced by the poor ART uptake in children. The inadequate training of NIMART nurses on paediatric ART, children’s total dependency on adults for their health needs and parents’ and caregivers’ misconceptions around HIV and AIDS negatively impacted the paediatric ART program. Other barriers included poor socioeconomic status and paediatric ART policy and legislation limitations. As a result, the recommendations are that the NIMART training program for nurses be improved with particular emphasis on paediatric ART. There is need to incorporate NIMART training into the nursing curriculum to ensure that more nurses are trained in ART provision. Community awareness needs be raised to address the issues around stigma, myths and misconceptions of HIV and AIDS through educational programs. There is also a need to increase the recruitment of nurses and improve motivation of nurses through provision of incentives.