Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape

Objective There has been considerable debate about the extent to which social cognitive models of health behaviour apply in developing countries. The purpose of this paper was to determine the applicability of the Theory of Planned Behaviour (TPB) in predicting dietary and fluid adherence among a sample of haemodialysis patients attending public sector hospitals in the Western Cape. Design and methods A sample of 62 historically disadvantaged patients undergoing haemodialysis completed a battery of psychometric instruments measuring attitudes, subjective norms, perceived behavioural control regarding dietary and fluid adherence, health literacy, perceived social support, and self-reported dietary and fluid adherence. Interdialytic weight gain (IDWG), predialytic serum potassium levels, and predialytic serum phosphate levels served as biochemical indicators of dietary and fluid adherence. Results Regression analyses indicated that the linear combination of attitudes and perceived behavioural control significantly accounted for 15.5% of the variance in self-reported adherence (a medium-effect size) and 11.4% of the variance in IDWG (a modest-effect size). No significant predictors were identified for predialytic serum potassium and predialytic serum phosphate levels. Interpretation and conclusions The results indicate that, while the TPB may not function in the same manner as it does in Western samples, it may have some nuanced applicability among haemodialysis patients attending public sector hospitals in the Western Cape. SAJCN Vol. 21 (2) 2008: pp. 7-1

Preparing healthcare facilities to operate safely and effectively during the COVID-19 pandemic: The missing piece in the puzzle

The stated objective of the COVID-19 lockdown was to allow time to prepare healthcare facilities. Preparation must include administrative and environmental measures, which when combined with personal protective equipment, minimise the risk of the spread of infection to patients and healthcare workers (HCWs) in facilities, allowing HCWs to safely provide essential services during the pandemic and limit the indirect effects of COVID-19 caused by healthcare disruption. We present our model for facility preparation based on colour-coded zones, social distancing, hand hygiene, rapid triage and separate management of symptomatic patients, and attention to infection transmission prevention between HCWs in communal staff areas. This model specifically addresses the challenges in preparing a facility for COVID-19 in a low-resource setting and in rural areas. In addition, we include links to resources to allow workers in low-resource settings to prepare their facilities adequately

An investigation on permethrin-treated military uniforms against diurnal mosquitoes under field conditions

Background: Military forces are exposed to mosquito bites because of their duties. In addition to the nuisance caused by mosquito bites, they are the vector of some vector-borne diseases in many countries of the world. Impregnation of military uniforms with permethrin is one of the most effective methods of protecting military personnel. The purpose of this study was to evaluate the effect of permethrin-impregnated uniforms against diurnal mosquitoes under field conditions. Methods: In this study, one of the most common uniforms used in the Iranian military was treated by permethrin (0.125 mg. permethrin ai/cm(2)) and evaluated against the natural population of day-biting mosquitoes, in the rural area with Eight participants, three of them put on the treated uniforms and the other one of them wore the untreated uniforms and Four officers were also appointed as collectors. Results: The average number of bites in those who wore untreated uniforms (control) was 1.8/min/person (107.8/hr), while it was 0.16 (9.83/hr) for treated uniforms. The protection of treated uniforms was about 91. The knockdown rate for Culex and Aedes mosquitoes was 95.92 and 94.44, respectively. The mortality rate in Culex was 98.59 and 98.61 in Aedes mosquitoes when exposed to treated uniforms. Conclusion: In this study, military uniforms impregnated with permethrin showed significant protection against the bites of Culex and Aedes mosquitoes. This intervention can be used to protect military personnel from the bites of Culex and Aedes these mosquitoes and to reduce the diseases transmitted by these mosquitoes

Not All Fabrics Are Created Equal: Exploring eFPGA Parameters for IP Redaction

Semiconductor design houses rely on third-party foundries to manufacture their integrated circuits (ICs). While this trend allows them to tackle fabrication costs, it introduces security concerns as external (and potentially malicious) parties can access critical parts of the designs and steal or modify the intellectual property (IP). Embedded field-programmable gate array (eFPGA) redaction is a promising technique to protect critical IPs of an ASIC by redacting (i.e., removing) critical parts and mapping them onto a custom reconfigurable fabric. Only trusted parties will receive the correct bitstream to restore the redacted functionality. While previous studies imply that using an eFPGA is a sufficient condition to provide security against IP threats like reverse-engineering, whether this truly holds for all eFPGA architectures is unclear, thus motivating the study in this article. We examine the security of eFPGA fabrics generated by varying different FPGA design parameters. We characterize the power, performance, and area (PPA) characteristics and evaluate each fabric’s resistance to Boolean satisfiability (SAT)-based bitstream recovery. Our results encourage designers to work with custom eFPGA fabrics rather than off-the-shelf commercial FPGAs and reveals that only considering a redaction fabric’s bitstream size is inadequate for gauging security

A nurse-led intervention to improve management of virological failure in public sector HIV clinics in Durban, South Africa: A pre- and post-implementation evaluation

Background. Identification of patients on antiretroviral therapy (ART) with virological failure (VF) and the response in the public health sector remain significant challenges. We previously reported improvement in routine viral load (VL) monitoring after ART commencement through a health system-strengthening, nurse-led ‘VL champion’ programme as part of a multidisciplinary team in three public sector clinics in Durban, South Africa.Objectives. To report on the impact of the VL champion model adapted to identify, support and co-ordinate the management of individuals with VF on first-line ART in a setting with limited electronic-based record capacity.Methods. We evaluated the VL champion model using a controlled before-after study design. A paper-based tool, the ‘high VL register’, was piloted under the supervision of the VL champion to improve data management, monitoring of counselling support, and enacting of clinical decisions. We abstracted chart and electronic data (TIER.net) for eligible individuals with VF in the year before and after implementation of the programme, and compared outcomes for individuals during these periods. Our primary outcome was successful completion of the VF pathway, defined as a repeat VL <1 000 copies/mL or a change to second-line ART within 6 months of VF. In a secondary analysis, we assessed the completion of each step in the pathway.Results. We identified 60 and 56 individuals in the pre-intervention and post-intervention periods, respectively, with VF who met the inclusion criteria. Sociodemographic and clinical characteristics were similar between the periods. Repeat VL testing was completed in 61.7% and 57.8% of individuals in these two groups, respectively. We found no difference in the proportion achieving our primary outcome in the pre- and post-intervention periods: 11/60 (18.3%; 95% confidence interval (CI) 9 - 28) and 15/56 (22.8%; 95% CI 15 - 38), respectively (p=0.28). In multivariable logistic regression models adjusted for potential confounding factors, individuals in the post-intervention period had a non-significant doubling of the odds of achieving the primary outcome (adjusted odds ratio 2.07; 95% CI 0.75 - 5.72). However, there was no difference in the rates of completion of each step along the first-line VF cascade of care.Conclusions. This enhanced intervention to improve VF in the public sector using a paper-based data management system failed to achieve significant improvements in first-line VF management over the standard of care. In addition to interventions that better address patient-centred factors that contribute to VF, we believe that there are substantial limitations to and staffing requirements involved in the ongoing utilisation of a paper-based tool. A prioritisation is needed to further expand and upgrade the electronic medical record system with capabilities for prompting staff regarding patients with missed visits and critical laboratory results demonstrating VF

ALICE: An Automatic Design Flow for eFPGA Redaction

Fabricating an integrated circuit is becoming unaffordable for many semiconductor design houses. Outsourcing the fabrication to a third-party foundry requires methods to protect the intellectual property of the hardware designs. Designers can rely on embedded reconfigurable devices to completely hide the real functionality of selected design portions unless the configuration string (bitstream) is provided. However, selecting such portions and creating the corresponding reconfigurable fabrics are still open problems. We propose ALICE, a design flow that addresses the EDA challenges of this problem. ALICE partitions the RTL modules between one or more reconfigurable fabrics and the rest of the circuit, automating the generation of the corresponding redacted design

Important causes of chronic kidney disease in South Africa

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD ispresent, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especiallylimitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefullymonitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin IIreceptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitoredand, where possible, home BP-measuring devices are recommended for optimal control.Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients withstages 4 - 5 CKD.There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-basedisturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV

DOA estimation using multiple measurement vector model with sparse solutions in linear array scenarios

A novel algorithm is presented based on sparse multiple measurement vector (MMV) model for direction of arrival (DOA) estimation of far-field narrowband sources. The algorithm exploits singular value decomposition denoising to enhance the reconstruction process. The proposed multiple nature of MMV model enables the simultaneous processing of several data snapshots to obtain greater accuracy in the DOA estimation. The DOA problem is addressed in both uniform linear array (ULA) and nonuniform linear array (NLA) scenarios. Superior performance is demonstrated in terms of root mean square error and running time of the proposed method when compared with conventional compressed sensing methods such as simultaneous orthogonal matching pursuit (S-OMP), l_2,1 minimization, and root-MUISC

Early Clinical and Subclinical Visual Evoked Potential and Humphrey's Visual Field Defects in Cryptococcal Meningitis.

Cryptococcal induced visual loss is a devastating complication in survivors of cryptococcal meningitis (CM). Early detection is paramount in prevention and treatment. Subclinical optic nerve dysfunction in CM has not hitherto been investigated by electrophysiological means. We undertook a prospective study on 90 HIV sero-positive patients with culture confirmed CM. Seventy-four patients underwent visual evoked potential (VEP) testing and 47 patients underwent Humphrey's visual field (HVF) testing. Decreased best corrected visual acuity (BCVA) was detected in 46.5% of patients. VEP was abnormal in 51/74 (68.9%) right eyes and 50/74 (67.6%) left eyes. VEP P100 latency was the main abnormality with mean latency values of 118.9 (±16.5) ms and 119.8 (±15.7) ms for the right and left eyes respectively, mildly prolonged when compared to our laboratory references of 104 (±10) ms (p<0.001). Subclinical VEP abnormality was detected in 56.5% of normal eyes and constituted mostly latency abnormality. VEP amplitude was also significantly reduced in this cohort but minimally so in the visually unimpaired. HVF was abnormal in 36/47 (76.6%) right eyes and 32/45 (71.1%) left eyes. The predominant field defect was peripheral constriction with an enlarged blind spot suggesting the greater impact by raised intracranial pressure over that of optic neuritis. Whether this was due to papilloedema or a compartment syndrome is open to further investigation. Subclinical HVF abnormalities were minimal and therefore a poor screening test for early optic nerve dysfunction. However, early optic nerve dysfunction can be detected by testing of VEP P100 latency, which may precede the onset of visual loss in CM