Assessing reported adherence to antiretroviral therapy using the method of verbal recall in children from Kwa-Zulu Natal, South Africa.

Master of Medical Science in Paediatrics and Child Health. University of KwaZulu-Natal. Durban, 2017.Sub-Saharan Africa has the highest number of children living with HIV. HIV is one of the major causes of under-five mortality in Africa. Antiretroviral therapy in the paediatric population has improved mortality, led to a better quality of life, as well as overall health and well-being of children. Adherence is a critical factor in determining treatment outcomes and success. Non-adherence to therapy increases risk of treatment failure, delays immunological recovery and increases opportunistic infections. In the paediatric population, there is a paucity of studies assessing adherence rates, particularly in resource limited settings. Adherence behaviour is found to be more complex in children. A number of factors affect adherence in children. These include socio-economic factors, medication factors as well as healthcare provider dynamics. The purpose of this secondary analysis of a prospective study was to describe adherence in a cohort of children attending a regional hospital in Kwa-Zulu Natal, South Africa, from September 2006 until October 2009. This study also examined factors associated with adherence such as age of the child, gender, as well as the role of the primary caregiver. Since there is no “gold standard” for assessing adherence to antiretroviral therapy, this area of research needs to be explored further. Secondly, assessing factors associated with adherence will assist in looking at ways to improve treatment outcome. In the main study, prospective patients who were treatment naïve and met criteria to commence antiretroviral therapy were identified in outpatients and clinics. Baseline and follow-up questionnaires were used to capture information including adherence details over the preceding week as well as since the last visit to hospital. Adherence was assessed using the method of verbal recall. Missed doses and the reasons for these were recorded and analysed. Additional factors possibly associated with adherence were also recorded and analysed further. This study reported an overall adherence rate of 94 per cent, similar to rates reported in other studies. Adherence rates over the past week as well as since the patient’s last visit were similar. There was a substantial degree of agreement between verbal recall for the preceding week as well as since the last visit (kappa statistic 0.64, p < 0.005). It was found that children older than five years were more likely to be adherent than those under five years (OR 0.871, 95 % CI 0.22-3.376) and males were twice as likely to adhere as females (OR=2.05, 95% CI 0.49 -8.59). The impact of this study is that it will provide information on adherence in children in Kwa-Zulu Natal, South Africa. This could encourage other such studies to be undertaken to improve adherence rates and hence treatment success. By examining factors associated with adherence as well as identifying possible barriers, we may improve treatment success in children. Adherence to antiretroviral therapy is important, especially in the paediatric population as it is shown to increase survival, improve immunity, as well as help prevent the development of opportunistic infections. Sub-optimal adherence is associated with treatment failure and drug resistance. The use of verbal recall as a measure of adherence is useful in a resource limited setting

Impact of Islamophobia on Post-Secondary Muslim Students Attending Ontario Universities

This study investigated the experiences of Muslim Canadian students attending institutions of higher education in the context of increasing Islamophobia. This study utilized qualitative case study methodology to investigate the following questions: (1) What are the experiences of Muslim Canadians attending institutions of higher education in the current context of Islamophobia? (2) How is the rising anti-Muslim sentiment impacting the academic performance of Muslim students? (3) How do Muslim students negotiate or navigate their identities subsequent to recent national and international tragic events (e.g. Paris Attacks, San Bernardino and other terrorist atrocities)? The students’ responses resulted in three major themes that included: (a) Islamophobia on Campus; (b) Strong religious identity, and Resisting and challenging Islamophobic sentiments; (c) Gendered Islamophobia. The findings of this research indicate that Muslim students have more attachment to their religious identity, are at the forefront of advocating for Muslims and are actively working to demystify Islamophobic notions

Deconstructing the Tower of London : resolution, alternatives and executive function

Although widely employed as an executive task, the performance demands of the Tower of London task (TOL) are not well understood. The aim of this Thesis is to determine what TOL measures and seven studies are included that illustrate its performance demands. Much of the work is experimental and TOL is explored via a novel verification paradigm in which participants make speeded judgements about whether a demonstrated move is optimal or suboptimal. The deconstruction of the task to the level of the individual move indicated that the number of moves until a disk was placed in its goal position (resolution) and the number of legal alternative moves there were predicted performance. When the task was reconstructed to its original form where complete problems were issued, these performance demands continued to predict planning time, execution time and accuracy. These demands were characterised as involving a depth search (resolution) and a breadth search (alternatives) of the problem space. Several studies included individual difference measureso r the dual-taskp aradigmt o determinet he cognitive processesth at were involved in performance.It was argued that spatial processes are involved to manipulate disks in memory and it was argued that the resolution demands were closely related to planning and the alternative move demands to inhibition. These performance characteristics are involved in many real world tasks and may elicit the deficits observed in clinical samples. One study was presented in which the performance of older adults was compared to younger adults. It was shown that older adults had a particular deficit in their ability to consider alternative moves; a similar TOL deficit might be observed in other dysexecutive populations. This thesis provides recommendations and guidelines for using TOL in research and stresses the importance of the items used on performance.Economic and Social Research Council

SIMPLE INCREMENTAL APPROACH FOR ANALYSING OPTIMAL NON-PRISMATIC FUNCTIONALLY GRADED BEAMS

This paper presents a simple incremental approach of analysing the static behaviour of functionally graded tapered beams. This approach involves dividing the non-uniform beam into segments with uniform cross-sections, and using two separate finite element models to analyse the structural behavior of slender beams (Euler-Bernoulli model) and deep beams (Timoshenko beam theory). The material properties of the beam vary according to a power law distribution through the thickness, resulting in smooth variations in the mechanical properties. The finite element system of equations is obtained using the principle of virtual work. Detailed information on the shape functions and stiffness matrix of the beam is provided, and the numerical results are evaluated and validated using data from the literature. The comparison demonstrates that the response of the functionally graded tapered beams is accurately assessed by the proposed approach. Additionally, the effects of material distribution, boundary conditions, and tapering parameter on the deflection behavior are presented. Results show that an increase in the power law index increases the flexibility of the functionally graded tapered beams, resulting in higher deflection. Furthermore, lower tapering parameters also result in higher deflection. Compared to other boundary conditions, clamped-clamped boundary conditions demonstrate the best performance in terms of maximum deflection

MODAL BEHAVIOUR OF LONGITUDINALLY PERFORATED NANOBEAMS

Nano-electro-mechanical systems (NEMS) require perforated beams for structural integrity. Hole sizes, hole numbers, and scale effects need to be modelled appropriately in their design. This paper presents a new finite element model to investigate the modal behaviour of longitudinally perforated nanobeams (LPNBs) using the classical Euler–Bernoulli beam theory. A symmetric array of holes arranged parallel to the length direction of the beam with equal spacing was assumed for the perforation. The non-local Eringen’s differential form was used to incorporate the nanoscale sizes. The accuracy of the proposed model was verified by comparing the obtained results with the available analytical solutions for fully filled nanobeams. The effects of aspect ratios, non-local parameters, boundary conditions, and perforation characteristics on the modal behaviour of LPNBs were investigated. The non-local parameter reduced the natural frequency owing to a decrease in the stiffness of the structures. However, the perforation filling ratio led to higher values of the fundamental frequency. Furthermore, compared with other boundary conditions, clamped–clamped boundary conditions demonstrated the best performance in terms of the maximum frequency

A procedure for total knee alignment prosthesis using the ICP algorithm in the aim to implant it in the biomechanical engineering

It isn’t exceptional that in orthopedic surgery, the surgeon observes during his intervention the important deformations in the knee, like a bad leg orientation, collapse of some bone surfaces, shortening or lengthening ligaments etc. That makes it sometimes necessary to make complementary gestures like lengthen a ligament, adapt a bones cut, in order, to have a best knee performance. The join an implant system associated with a revision instrument of total knee prosthesis (PTG) causes the navigation system to produce a perfect alignment, stability and functional results that are both reliable and precise. In this paper, a procedure which uses the ICP (Iterative Closest Point) algorithm for total knee alignment prosthesis is proposed in order to improve the current technique and thus avoid the revision surgery of total knee prostheses