MMed, Psychiatry, University of the Witwatersrand, Faculty of Health Sciences / Introduction Antipsychotics are used for the treatment of psychotic disorders, most commonly schizophrenia, as well as mood disorders e.g. bipolar mood d isorder. The efficacy of the newer second generation (atypical) antipsychotics is equivalent to first generation antipsychotics. The apparent advantage of the second generation antipsychotics is related to their purported reduced side effect profile, thus making them more desirable due to improved compliance and relapse prevention. The limiting factor with this class of drugs, especially in the state sector in South Africa, has been the cost. However, reports of treatment-emergent adverse events such as diabetes mellitus, diabetic ketoacidosis, hyperglycaemia and dyslipidaemia in patients receiving second generation antipsychotics have increased in recent times. This has lead to growing concern about the link between metabolic complications and their use, with consequent reconsideration of the implications of prescribing. Aims The study aimed to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients who have been prescribed olanzapine, a second generation antipsychotic. Specifically the extent to which the American Diabetes Association Consensus Conference monitoring protocols were being implemented in a specialist psychiatric South African setting i.e.: at Tara: The H. Moross Centre’s outpatient department. Objectives The study objectives were to describe the demographic profile, clinical diagnosis and risk factors for metabolic complications in a sample of patients receiving olanzapine. Further, to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients prescribed olanzapine as well as to what extent the patients’s demographics, diagnosis and metabolic risk factors influenced the treating doctor’s adherence to screening guidelines. Method This study was undertaken at Tara: The H. Moross Centre (outpatient department). A convenience sample of patients prescribed olanzapine were selected as the study group. The study involved a review of case records. It was a retrospective descriptive study. Relevant data was entered on a data sheet, designed for the study in accordance with the objectives and adapted from the American Diabetes Association Consensus Development Conference on Antipsychotic Drugs, Obesity and Diabetes. The data sheet is based on an existing protocol for monitoring metabolic status. v Frequencies for the presence or absence of evidence of screening or monitoring for metabolic complications were established, as per American Diabetes Association monitoring protocol requirements. Although the study involved outpatients, not all patients were intiated on olanzapine as outpatients i.e. some of the prescribing was inpatient initiated. Results The sample comprised of 19 females and 20 males. 48.72% female and 51.28% male. The mean age of females in the sample was 52.38 years (SD=16.20) and the mean age of males was 41.28 (SD=17.05) years. The sample were predominantly single ( 61.54% n=24 ) with the majority being white (79.49% n=31 ); most had either tertiarty (43% n=17 ) or secondary (53.85% n =21 ) level of education. Only 2.56% (n=1) had only primary level education. With regards to the diagnoses of patients in the sample, 17,95% (n=7) were diagnosed with bipolar 1 disorder, 7.69% (n=3) with major depressive disorder with psychosis, 20,51% (n=8) schizoaffective disorder and 53,84% (n=21) with schizophrenia. The percentage of screening for all the parameters was generally less than 20% and it continued to decline to less than 20% until 4 months. The exception was weight, where frequency increased slightly over time. Comparing inpatient vesus outpatient initiated treatment there were apparent differences in the extent of screening i.e. greater for inpatient initiated treatment, specifically with respect to weight and blood pressure. Conclusion The current study was conducted in a very specific setting, but the findings demonstrated an area requiring attention i.e. adherence to acceptable clinical guidelines. Whilst one can only speculate on the basis for non-adherence, having established the status quo, there is a requirement for an appropriate strategy to address the deficit, given the implications of inadequate monitoring.

PROEFSKRIF VOORGELe TER VERVULLING VAN DIE VEREISTES VIR DIE GRAAD PHlLOSOPHIAE DOCTOR IN AFRIKAANS EN NEDERLANDS IN DIE FAKULTEIT VAN LETTERE AAN DIE UNlVERSITEIT VAN DIE WlTWATERSRAND / The aim of this study is to investigate marked linguistic phenomena in the spoken language of a group of (elderly) white Afrikaans-speaking men and women who were economically active in Johannesburg and surrounding areas between 1920 and 1940. For this purpose, tape recordings of twelve male railway workers and twelve female factory workers who fall into a lower socio-economic group were transcribed and analysed as faithfully as possible. Tape recordings of five white male and five white female Afrikaans-speaking teachers of more or less the same age as the first group, but belonging to a higher socio-economic category, were also analysed and transcribed as a basis for comparison. Distinct phonological, syntactical and lexical phenomena indicating signs of language contact were observed in the language of the speakers in the various groups under investigation. Significant differences may also be observed in the language of the men and women in the different socio-economic groups, with the language of the men and women in the lower socio-economic group and that of those in the higher socio-economic group clearly exhibiting gradual differences. Contrary to what was initially expected, men do not necessarily adhere more strictly to standardised language in speech than do women, and few significant characteristics typify the language of men and women in this period. The original expectation of finding relics of spoken Afrikaans from the pre-standardisation phase amongst the speakers selected was not fulfilled since the linguistic phenomena recorded are generally still heard in colloquial Afrikaans today. Furthermore, no traces of Dutchification were to be found in the case of the speakers selected. Dutchification apparently did not take place at lower socio-economic levels. From this study it is clear that the interaction between social stratification and language variation plays an important role, as do the problems surrounding language norms and social norms. In this study of variation, attention is also paid to language normalisation and standardisation, and to language variation and social stratification prior to a discussion of the language of men and women. / Andrew Chakane 2018

MSc (Med), Child Health Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand / Objective: To identify determinants for the utilisation of delivery services by pregnant women in Rwanda, considering individual and demographic, socioeconomic and health service factors. Design: A secondary data analysis of the third (2005) Rwandan Demographic Health Survey (RDHS III) was conducted. Women who had at least one live birth during the fiveyear period prior to the survey were included in the analysis. Bivariate and multivariate analyses were undertaken. Results: A total of 5235 participants fulfilled the study eligibility criteria and were included in the analysis. Although more than 90% of participants attended an antenatal service, only 30% delivered at a health facility. The predictors of a home delivery were higher parity (OR=5.01, 95% CI: 4.11-6.31 for parity of 6 or more), place of residence (OR=1.86, 95% CI: 1.55-2.23 for rural women), lower household wealth (OR=4.37, 95% CI: 3.43-5.56 for the poorest quintile), lower education level (OR=3.61, 95% CI: 2.73-4.76 for no education), none or one antenatal care visit (OR=3.62, 95% CI: 2.76-4.74 for one antenatal care visit) and the lack of antenatal counselling about pregnancy complications (OR=1.83, 95% CI:1.40-2.40). Conclusion Utilisation of maternal health services, particularly health facility delivery services, remains low in Rwanda. The promotion of at least four standard antenatal care visits, as well as efforts targeting specific risk groups, such as higher parity, rural and less educated women living in poorer households are critical if the country wishes to reduce maternal and neonatal mortality and morbidity.

Government initiatives called for electronic health records for each individual healthcare consumer by 2014. the purpose of the initiatives is to provide for the common exchange of clinical information between healthcare consumers, healthcare providers, third-party payers and public healthcare officials.This exchange of healthcare information will impact the healthcare industry and enable more effective and efficient application of healthcare so that there may be a decrease in medical errors, increase in access to quality of care tools, and enhancement of decision making abilities by healthcare consumers, healthcare providers and government health agencies. an electronic personal health record (ePHR) created, managed and accessed by healthcare consumers may be the answer to fulfilling the national initiative. However, since healthcare consumers potentially are in control of their own ePHR, the healthcare consumer’s concern for privacy may be a barrier for the effective implementation of a nationwide network of ePHR. a technology acceptance model, an information boundary theory model and a trust model were integrated to analyze usage intentions of healthcare consumers of ePHR. Results indicate that healthcare consumers feel there is a perceived usefulness of ePHR; however they may not see ePHR as easy to use. Results also indicate that the perceived usefulness of utilizing ePHR does not overcome the low perceived ease of use to the extent that healthcare consumers intend to utilize ePHR. in addition, healthcare consumers may not understand the different components of usage: access, management, sharing and facilitating third-party ePHR. Also, demographics, computer self-efficacy, personal innovativeness, healthcare need and healthcare literacy impact a healthcare consumer’s privacy concerns and trusting intentions in the context of ePHR and intent to utilize ePHR. Finally, this research indicates that healthcare consumers may need a better understanding of the Health Insurance and Portability and Accountability Act of 1996 (HIPAA) regulations of ePHR as well as a better understanding of the impact HIPAA has on websites that may facilitate ePHR.

Deng, Hongbo. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 156-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Electronic commerce servers have a significant presence in today's Internet. Corporations want to maintain high availability, sufficient capacity, and satisfactory performance for their E-commerce Web systems, and want to provide satisfactory services to customers. Workload characterization and the analysis of customers' interactions with Web sites are the bases upon which to analyze server performance, plan system capacity, manage system resources, and personalize services at the Web site. To date, little empirical evidence has been discovered that identifies the characteristics for Web workloads of E-commerce systems and the behaviours of customers. This thesis analyzes the Web access logs at public Web sites for three organizations: a car rental company, an IT company, and the Computer Science department of the University of Saskatchewan. In these case studies, the characteristics of Web workloads are explored at the request level, functionlevel, resource level, and session level; customers' interactions with Web sites are analyzed by identifying and characterizing session groups. The main E-commerce Web workload characteristics and performance implications are: i) The requests for dynamic Web objects are an important part of the workload. These requests should be characterized separately since the system processes them differently; ii) Some popular image files, which are embedded in the same Web page, are always requested together. If these files are requested and sent in a bundle, a system will greatly reduce the overheads in processing requests for these files; iii) The percentage of requests for each Web page category tends to be stable in the workload when the time scale is large enough. This observation is helpful in forecasting workload composition; iv) the Secure Socket Layer protocol (SSL) is heavily used and most Web objects are either requested primarily through SSL or primarily not through SSL; and v) Session groups of different characteristics are identified for all logs. The analysis of session groups may be helpful in improving system performance, maximizing revenue throughput of the system, providing better services to customers, and managing and planning system resources. A hybrid clustering algorithm, which is a combination of the minimum spanning tree method and k-means clustering algorithm, is proposed to identify session clusters. Session clusters obtained using the three session representations Pages Requested, Navigation Pattern, and Resource Usage are similar enough so that it is possible to use different session representations interchangeably to produce similar groupings. The grouping based on one session representation is believed to be sufficient to answer questions in server performance, resource management, capacity planning and Web site personalization, which previously would have required multiple different groupings. Grouping by Pages Requested is recommended since it is the simplest and data on Web pages requested is relatively easy to obtain in HTTP logs.

Electronic commerce servers have a significant presence in today's Internet. Corporations want to maintain high availability, sufficient capacity, and satisfactory performance for their E-commerce Web systems, and want to provide satisfactory services to customers. Workload characterization and the analysis of customers' interactions with Web sites are the bases upon which to analyze server performance, plan system capacity, manage system resources, and personalize services at the Web site. To date, little empirical evidence has been discovered that identifies the characteristics for Web workloads of E-commerce systems and the behaviours of customers. This thesis analyzes the Web access logs at public Web sites for three organizations: a car rental company, an IT company, and the Computer Science department of the University of Saskatchewan. In these case studies, the characteristics of Web workloads are explored at the request level, functionlevel, resource level, and session level; customers' interactions with Web sites are analyzed by identifying and characterizing session groups. The main E-commerce Web workload characteristics and performance implications are: i) The requests for dynamic Web objects are an important part of the workload. These requests should be characterized separately since the system processes them differently; ii) Some popular image files, which are embedded in the same Web page, are always requested together. If these files are requested and sent in a bundle, a system will greatly reduce the overheads in processing requests for these files; iii) The percentage of requests for each Web page category tends to be stable in the workload when the time scale is large enough. This observation is helpful in forecasting workload composition; iv) the Secure Socket Layer protocol (SSL) is heavily used and most Web objects are either requested primarily through SSL or primarily not through SSL; and v) Session groups of different characteristics are identified for all logs. The analysis of session groups may be helpful in improving system performance, maximizing revenue throughput of the system, providing better services to customers, and managing and planning system resources. A hybrid clustering algorithm, which is a combination of the minimum spanning tree method and k-means clustering algorithm, is proposed to identify session clusters. Session clusters obtained using the three session representations Pages Requested, Navigation Pattern, and Resource Usage are similar enough so that it is possible to use different session representations interchangeably to produce similar groupings. The grouping based on one session representation is believed to be sufficient to answer questions in server performance, resource management, capacity planning and Web site personalization, which previously would have required multiple different groupings. Grouping by Pages Requested is recommended since it is the simplest and data on Web pages requested is relatively easy to obtain in HTTP logs.

There are two purposes for employees to use working computers and internet: for work-related activities and nonwork-related activities. As to work-related activities, they are purchasing, customer services, marketing, recruitment, sales, management, work-related communication and information-acquiring. Otherwise, nonwork-related activities comprise of social/communicative purposes (using internet to communicate with friends and co-workers inside and outside companies) and Entertainment/informational purposes (acquiring information about weather, entertainment, news etc.). Through literature research, there are evidences suggesting that different purposes of internet usage has a significant effect on job playfulness, while performance will increase, with accompanying job playfulness enhanced. The relationship between purposes of internet usage and performance will be discussed in the study. Furthermore, there are other antecedent factors affecting purposes of internet usage, such as job stress, job characteristics and attitudes towards job and monitoring. This is one of the discussions on how these antecedent factors influencing purposes of internet usage positively or negatively. The survey data from 233 employees is analyzed by CFA abd SEM. Following are the results: 1. There is a positive relationship between the purposes of internet usage and job playfulness, and job playfulness serves as the mediator to affect the performance. 2. Job stress, job characteristics, attitudes towards job and monitoring have significant effect on the purposes of internet usage. 3. Age, Seniority and Marriage will reduce the usage of social/communicative and entertainment/informational purposes.The demography of respondents¡¥ profiles makes difference on purposes of internet usage, job stress, job characteristics and attitudes towards job and monitoring.

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The fast rise of Internet broadens students¡¦ ways of learning and their views; however, there is possibility that improper Internet use will result in problems of Internet addiction. Reviewing the literature about Internet addiction, we can find that many studies were carried quantitatively by using a questionnaire survey to examine and explain the relationships among related variables and their intensity and then apply regression analysis and characteristic equation to find out the forecast of Internet addiction. These studies truly not only helped the academia understand the factors involved in Internet addiction but also offered reference materials for preventing and improving the problems. Nevertheless, there were some limits in these quantitative studies. For example, it is hard to understand the causal relationship among the factors. Also, one-way linear inference ignored the feedback behaviors from Internet addiction toward related factors and fell into one-way think mode. Internet addiction is indeed a mental problem and involves complicated and obscure factors, which usually could be cause and effect of each other. This study aimed to compensate for the loss of dynamic complexity in all kinds of Internet addiction modes in the literature by reviewing important literature, inducing and generalizing dangerous factors and effects, employing system dynamics to construct the dynamic mode of Internet addiction, and applying the picture of causal feedback and the mode of math to see through the structure of movement behind and the interaction among the factors. This study showed five main findings. First, hiding oneself in the Internet world, which could not reduce pressure, only helped obtain a temporary sense of achievement but resulted in severe outcomes, such as the problem of time management and a vicious circle of interpersonal relationship and schoolwork pressure produced by Internet addiction. Second, ¡§withdrawal symptoms¡¨ and ¡§a sense of achievement obtained on the Internet¡¨ were leading indicators for Internet addiction. Third, limiting the amount of time of surfing on the Internet and slackening withdrawal symptoms were temporary solutions to the problem at a later period. Moreover, there was a certain correlation among the critical points of value of withdrawal symptoms, limiting the amount of time of surfing on the Internet, and improving the timing. Fourth, only facing the problem was the ultimate solution to Internet addiction. Finally, the problem of Internet addiction was actually a transformed version of archetype brought up in the book ¡§The Fifth Discipline.¡¨