127 research outputs found

    Neuroprotective therapies in the NICU in term infants: present and future

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    Mindsets required for implementing a virtual workplace

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    The research centres on the theme that, even though there are various drivers for a more virtual workplace, ranging from organisational, workforce and technology to environmental issues, it seems that progress in adopting virtual work on both individual and organisational level, is still low. The purpose of the research is to determine if there are specific mindsets required to make the implementation of a virtual workplace more successful, with the aim of making recommendations to organisations, managers, teams and individuals for improved implementation strategies. The research defined the target population as a large South African Information and Communication Technology (ICT) company, and its customers. A combination of quantitative and qualitative methods was used. Data relating to needs, perceptions, practicality and readiness concerning the virtual workplace was collected on three levels, namely individual, team and organisational level. The quantitative research covered the objectives relating to the individual level through questionnaires which were sent out in the form of online surveys. The qualitative research covered the organisational level research through individual interviews with the IT/HR managers, while the team level research was covered through focus group interviews. The study found that various mindsets and needs do exist, and on an individual level the mindsets and needs are not restricted to specific generations. This could be of significance to HR and IT managers in general, who may need to take a wider target group into consideration when designing policies and standards for the organisation. Secondly the organisation itself emerged as an entity with a mindset or culture that transcends the individuals working for the organisation. To implement a virtual workplace would, therefore, require an overarching strategy and organisational change interventions to ensure that all the facets of a virtual workplace are addressed in a balanced way.Dissertation (MBA)--University of Pretoria, 2010.Gordon Institute of Business Science (GIBS)unrestricte

    A managerial framework for the enablement of the performance of virtual knowledge workers

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    With the increasing use of mobile technologies in modern organisations, managers are facing the dilemma of having to manage the performance of individuals who are removed from their direct sphere of control, while using performance management principles that have not necessarily been adapted to accommodate this. The study investigated, analysed and described the management and measurement of the performance of these virtual knowledge workers from the perspective of the manager, with the aim of proposing a new conceptual framework to assist managers in this task. In addition, the study identified the organisational context and individual contribution required to support such a framework. The study used a constructivist grounded theory framework, with the aim of building theory through an inductive approach rather than testing existing theory. An embedded, multiple-case study research design was used to execute the study, comprising five companies in the Information and Communications Technology and related sectors in South Africa. Quantitative and qualitative data were collected at the organisational, team and individual levels. In total, 39 interviews were qualitatively analysed using content analysis aided by ATLAS.ti. The 163 questionnaires were quantitatively analysed using descriptive statistical methods. Thereafter, within-case and cross-case analyses were performed to extract themes and to propose a conceptual framework for the enablement of the performance of virtual knowledge workers. The research uncovered four key findings. The first finding was that the concept of "virtual" in the term virtual worker is often misunderstood, and that the definition should be applied on a continuum of virtuality, leading to the concept of perceived and true virtuality. The second finding was that true virtuality influences how performance is perceived, and how deliverables and metrics contribute to perceived, actual and true performance. The third finding was that parameters affecting virtual performance include organisational, contextual, and customer factors, as well as the managerial approach itself. The manager needs to become the mediator for these parameters, thereby fulfilling the role of enabler of virtual performance. The fourth finding was that the visual or face-to-face element still remains important when managing the performance of virtual knowledge workers. The study makes a significant contribution on a theoretical level by extending existing theoretical models regarding virtual distance and the management of dispersed teams into a much more comprehensive model. This concentric performance enablement model for virtual knowledge workers shows how the manager acts as enabler for the true performance of the virtual knowledge workers. On a methodological level, the research demonstrates how an embedded, multiple-case study, executed on three levels of analysis, and based on a grounded theory approach, can be executed to develop theoretical insights into the complex phenomenon of enabling the performance of virtual knowledge workers; and lastly the study has also made a contribution on the level of practice, by giving managers a conceptual framework and practical recommendations on how to manage and enable the performance of virtual knowledge workers.Thesis (PhD)--University of Pretoria, 2012.Human Resource Managementunrestricte

    The impact of a sepsis quality improvement project on neurodisability rates in very low birthweight infants

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    Objective Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants. Design Cohort study. Setting Level 3 regional NICU in the South West of England. Patients VLBW infants born between 2002 and 2011. Interventions A sepsis reduction care bundle implemented between July 2006 and December 2007. Main outcome measures The primary outcome was risk of coagulase-negative Staphylococcus (CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders. Results In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively. Conclusions There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings

    Treatment for Post-hemorrhagic Ventricular Dilatation:A Multiple-Treatment Meta-Analysis

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    Objective: To perform a systematic review and multiple-treatment meta-analysis for the treatment of premature infants with post-hemorrhagic ventricular dilatation (PHVD), to prevent death or long-term neuro-disability. Design/Method: Asystematicreviewwasperformedusing PubMed, EMBASE, andthe Cochrane Library. A free-word search was performed to identify likely relevant literature intervention trials of PHVD in preterm infants. Initially, network mapping was performed followed by performing a Bayesian random-effects model using the Markov chain Monte Carlo method. Areas under the cumulative ranking curve (SUCRA) were calculated as a measure of the probability that each intervention was likely to be the 1st, 2nd, 3rd, etc. best therapy. Primary outcome measure was death or moderate or severe neurodevelopmental outcome at or beyond 12 months of corrected age. Results: Ten different trials were identified, enrolling 700 individuals (449 for the primary outcome). Seven intervention categories were identified, and of the 15 possible pair comparisons, 6 have been studied directly. In the multiple-treatment meta-analysis, no comparison reached conventional levels of statistical significance. Drainage Irrigation and Fibrinolytic Therapy (DRIFT) had the highest probability of being the best treatment for the primary outcome (82.1%), followed by CSF removal (10.8%), conservative management (6.7%), and then diuretic therapy (0.4%). Conclusions: PHVD is a significant cause of death and disability in developed countries, yet few therapeutic options have so far been trialed. While new therapies are urgently needed for these infants, at present, NMA shows that DRIFT appears to be the most likely candidate to improve outcomes after sIVH. Keywords: premature birth, brain injury, preterm, intraventricular hemorrhage, post-hemorrhagic ventricular dilatatio

    Association between neonatal resuscitation and a single nucleotide polymorphism rs1835740

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    © 2016 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd. Aim The aim of this work was to test whether three single nucleotide polymorphisms (SNPs) implicated in glutamate homoeostasis or signalling and cellular survival are associated with birth condition. Methods This study is drawn from the Avon Longitudinal Study of Parents and Children. A total of 7611 term infants were genotyped and patient outcome data retrieved from routine medical records. Exposure measures were the presence of one or more minor alleles in one of 3 SNPs (rs2284411, rs2498804, rs1835740). The primary outcome was the need for resuscitation at birth. Results For SNP rs1835740, infants homozygous for the minor allele compared to wild type were more likely to need resuscitation (9.2% vs. 7.0%, p = 0.041), while the odds ratio for resuscitation was associated with each increasing minor allele [OR 1.17 (1.01-1.35)]. Population attributable risk fraction was 6.5%. There was no evidence that the other two SNPs investigated were associated with birth condition. Conclusion We have tested three candidate SNPs to measure any association with birth condition. The study revealed that the rs1835740 was associated with the need for resuscitation and Apgar scores, with a substantial population impact

    Child suicide rates during the COVID-19 pandemic in England

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    BACKGROUND: There is concern about the impact of COVID-19, and the control measures to prevent the spread, on children's mental health. The aim of this work was to identify if there had been a rise of childhood suicide during the COVID pandemic. METHOD: Using data from England's National Child Mortality Database (NCMD) the characteristics and rates of children dying of suicide between April to December 2020 were compared with those in 2019. In a subset (1(st) January to 17(th) May 2020) further characteristics and possible contributing factors were obtained. RESULTS: A total of 193 likely childhood deaths by suicide were reported. There was no evidence overall suicide deaths were higher in 2020 than 2019 (RR 1.09 (0.80-1.48), p=0.584) but weak evidence that the rate in the first lockdown period (April to May 2020) was higher than the corresponding period in 2019 (RR 1.56 (0.86-2.81), p=0.144). Characteristics of individuals were similar between periods. Social restrictions (e.g. to education), disruption to care and support services, tensions at home and isolation appeared to be contributing factors. LIMITATIONS: As child suicides are fortunately rare, the analysis is based on small numbers of deaths with limited statistical power to detect anything but major increases in incidence. CONCLUSION: We found no consistent evidence that child suicide deaths increased during the COVID-19 pandemic although there was a possibility that they may have increased during the first UK lockdown. A similar peak was not seen during the following months, or the second lockdown

    The improved prognosis of hypoplastic left heart:A Population-Based Register Study of 343 Cases in England and Wales

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    Background: Hypoplastic Left Heart Syndrome (HLHS) is a severe congenital heart defect (CHD) characterised by the underdevelopment of the left side of the heart with varying levels of hypoplasia of the left atrium, mitral valve, left ventricle, aortic valve and aortic arch. In the UK, age 12 survival for cases born between 1991 and 1993 was 21%. UK survival estimates corresponding to cases born between 2000 and 2015 were improved at 56%, but survival was examined up to age five only. Contemporary long-term survival estimates play a crucial role in counselling parents following diagnosis. The aim of this study was to report survival estimates up to age 15 for children born with HLHS or hypoplastic left ventricle with additional CHD in England and Wales between 1998 and 2012. Methods: Cases of HLHS notified to four congenital anomaly registers in England and Wales during 1998–2012, matched to Office for National Statistics mortality information, were included. Kaplan-Meier survival estimates to age 15 were reported. Cox regression models were fitted to examine risk factors for mortality. Results: There were 244 cases of HLHS and 99 cases of hypoplastic left ventricle co-occurring with other CHD, with traced survival status. Kaplan-Meier survival estimates for HLHS were 84.4% at age 1 week, 76.2% at 1 month, 63.5% at age 1 year, 58.6% at age 5 years, 54.6% at age 10 years, and 32.6% to age 15 years. The Kaplan-Meier survival estimates for cases of hypoplastic left ventricle co-occurring with additional CHD were 90.9% at age 1 week, 84.9% at 1 month, 73.7% at age 1 year, 67.7% to age 5 years, 59.2% to age 10 years, and 40.3% to age 15 years. Preterm birth (p = 0.007), low birth weight (p = 0.005), and female sex (p = 0.01) were associated with mortality. Conclusions: We have shown that prognosis associated with HLHS in the twenty first century exceeds that of many previous population-based studies, likely due to improvements in intensive care technologies and advances in surgical techniques over the last few decades
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