Perceived health needs and services gaps for elders on ARV treatment - south east district, Botswana (2014-2015)

A Research Report Submitted in Partial Fulfilment for the Requirements of the Degree Masters in Public Health. November, 2015Background: Health care of older people living with HIV and on ARV treatment has received very little attention in Botswana over the years. The 17.6% national HIV prevalence for Botswana excludes the older people as the Botswana Index AIDS Survey (BIAS) is focused on ages 10-64. This survey is meant to look at current national and district HIV estimations, sexual and preventive trends for each target group, compare HIV rates, behavior, knowledge, attitude, poverty and other factors related to HIV in order to come up with strategies to mitigate and enhance uptake of programs for prevention and control of HIV in Botswana. With little or no information on this group effective and targeted services are not possible hence this study. Objective: To explore perceived health services needs and services gaps for HIV positive older people over 65 years by the older people attending ARV dispensing clinics and HCW in Gaborone and Greater Gaborone, Botswana (2014-2015). Methods: A cross-sectional survey was conducted among 20 older people on ARV treatment and 15 Health Care Workers (nurses and pharmacy technicians) caring for them in Gaborone and Greater Gaborone (2014-2015). An in-depth interview guide was used to explore perceived health needs and services gaps of older people. Respondents were older people of age ranges 65 to 87 years who have been on ARV treatment for an average of 7 years (4 months to 13 years). Results: Older people in Botswana are happy with curative and non-curative services offered as part of their care in ARV clinics. Curative services being ARV treatment, blood tests and consultation are offered consistently to the appreciation of all older people. Counselling services are not consistently done and older people advocate for its strengthening; targeted health education in non-existent, there is limited interaction with medical doctors due to language barrier, poor queue management results in older people waiting for long which is attributed to staff shortage, poor defaulter identification and follow up are also not coordinated. The need for social support increases with their age and medical situation while need for improved nutrition or food ration remains critical for their health and wellbeing restoration. Above all pill burden due to comorbidities is in the increase therefore requiring coordinated patient management to maximise positive outcomes and minimise impact on older people. Conclusion and Recommendations: Need for evidence based care initiatives can never be over emphasised. Despite that older people report high cases of disclosure and adherence, major needs and services gaps that need immediate response are inevitable basing on this study. Their high illiteracy rates impact adherence to services, openness to discuss sensitive issues, limits interaction with English speaking medical doctors and ultimately impact health outcomes. More skilled HCWs should be placed in Botswana ARV clinics to offer comprehensive and high quality services that meet the needs of older people. More longitudinal researches are recommended to better understand the journey of older people living with HIV in the mist of comorbidities. Coordination of services delivery among various professionals remains instrumental if we hope to maximise adherence and benefits of the services offered to older people

FireFly: A Bayesian Approach to Source Finding in Astronomical Data

Efficient and rigorous source finding techniques are needed for the upcoming large data sets from telescopes like MeerKAT, LSST and the SKA. Most of the current source-finding algorithms lack full statistical rigor. Typically these algorithms use some form of thresholding to find sources, which leads to contamination and missed sources. Ideally we would like to use all the available information when performing source detection, including any prior knowledge we may have. Bayesian statistics is the obvious approach as it allows precise statistical interrogations of the data and the inclusion of all available information. In this thesis, we implement nested sampling and Monte Carlo Markov Chain (MCMC) techniques to develop a new Bayesian source finding technique called FireFly. FireFly employs a technique of switching ‘on’ and ‘off’ sources during sampling to deal with the fact that we don’t know how many true sources are present. It therefore tackles one of the critical questions in source finding, which is estimating the number of real sources in the image. We compare FireFly against a Bayesian evidence-based search method and show on simulated astronomical images that FireFly outperforms the evidence-based approach. We further investigate two implementations of FireFly: the first with nested sampling and the second with MCMC. Our results show that MCMC FireFly has better computational scaling than the nested sampling version FireFly but the nested sampling version of FireFly appears to perform somewhat better than MCMC FireFly. Future work should examine how best to quantify FireFly performance and extend the formalism developed here to deal with multiwavelength data

The use of assessment centres as a selection and development tool for executive leaders in the Botswana public service

Organisations worldwide are attempting to identify talent by using various assessment methods to evaluate competencies perceived to be core to the mandate of their organisations. In recent years recruitment and selection of individuals rely on assessment methods deemed to have high validity and reliability. One such assessment method used worldwide to evaluate top management is the assessment centre, commonly referred to as the AC. The main research problem of this study focussed on an evaluation of the extent to which the assessment centre method is effectively used for the selection and development of senior management employees in the public service of Botswana. The main research problem had eight sub-problems which were addressed through the following actions: A comprehensive literature study was conducted to define and establish the purpose of assessment centres. Moreover, the study aimed to establish the international best practice for the administration of the assessment centre as a tool for selection and talent development. Subsequent to the literature study an interview schedule and survey questionnaire were developed based on the literature. The interview schedule was used to obtain information from consultants who provide assessment centre services to the public service. The objective of the questionnaire was to obtain information from the recipients of the service and determine the extent to which that information compares with information obtained from the consultants. The questionnaire was distributed to a randomly selected population. The results of the empirical study were statistically analysed and interpreted and revealed that permanent and deputy permanent secretaries are more aware of the reasons for using the assessment centre method than directors and deputy directors. These senior management employees felt that the assessment centre is an effective tool for selection and development but the results from the assessment centre are not optimally used for development. The study revealed that generally the assessment centre process conducted in the Botswana public service is in line with international best practice of assessment centres. However, there are certain areas that need some improvement for the assessment centre to entirely conform to international best practice. These areas include the implementation of an assessment centre policy and the improvement of feedback and vital information provided to participants prior to the centre. The empirical study also revealed that senior management employees hold the view that many senior officers in the public service do not know the importance of the assessment centre method and are not comfortable to participate in such a centre. The assessment centre method has proven to be an effective tool for evaluating competencies. This is due to its use of multiple techniques, assessors, simulations and exercises. Theory has revealed that the assessment centre has higher validity and reliability than other assessment methods. However, due to the high costs of running assessment centres, some organisations take shortcuts and therefore jeopardise its validity

A framework for effective management of water and sewer infrastructure

Abstract: From a municipal operational and maintenance perspective water and sewer infrastructure systems are complex systems with numerous components leading to recurring water pipe bursts and sewer blockages. This prompted the study to assess, analyze and quantify the characteristics of factors that compromise water distribution and sewer services reliability around Johannesburg (used as a case study). The aim of the study was firstly to investigate water and sewer infrastructure challenges by researching the relationship between operations, maintenance, design and construction. To develop a short-term framework for improving the day to day operations process based on data highlighting common failures. The common trend found in the literature case studies is the use of a water audit as a basis for assessing bursts, blockages, leaks and water losses. The water audit approach enables researchers to discover patterns in big data without formulating hypotheses by using a grading system (Lycett, A., 2013).This study considered various methods of managing water and sewer systems, developing a framework for addressing various types of infrastructure failures related to water and sewer. The study fills a gap by supporting effective project management of water leaks and sewer blockages by implementing quality management systems during construction to prevent recurring burst/blockages and post construction (maintenance plan linked to operations and complaint loggings from residents). In order to simplify understanding a Model Based Systems Engineering (MBSE) approach was used to develop and present a proposed framework. Failure Modes and Effects Analysis (FMEA) was used as a method to identify potential failures of a design, construction operations, maintenance, product and process identified. The FMEA was used as a continuation from the data to create the Framework The initial study focused on developing a short-term framework for improving the day to day operations process based on data findings. This is then to be escalated into a longer term framework over time

Profibus network in the instrumentation and control laboratory

The Instrumentation and Process Control Laboratory is facility that provides Engineering students a way of performing control experiments by using a combination of instrumentation hardware and LabVIEW programs. The Laboratory is based upon three components: - The Experimental Stations - The Master I/O Program - The Basic Experimental Template The Experimental stations are panels where hardware components like valves and measuring devices are connected to. The Master I/O program is a LabVIEW program which acts as an interface between the Experimental Stations and the Basic Experimental Template. The Basic Experimental Template is a LabVIEW program which stundents can modify to suit their designs for process control experiments. The main aim of this project is to integrate the PROFIBUS PA instruments into the Master Input/Output (I/O) program and to produce a guide to assist students in using these instruments. This project involves communication between instruments from different vendors, hence the use of open and vendor independent protocols. Once completed, the project will avail more instruments to be used for process control experiments. The project also avails another infrastructure for students studying Industrial Computer Engineering to use the physical PROFIBUS network when learning about industrial communication systems. Even though PROFIBUS PA instruments are more accurate and fast, their response in controlled by the scan cycle of the Master I/O Program. The communication protocols used in this project are PROFIBUS PA, OLE for Process Control (OPC) and Ethernet. The PROFIBUS protocol is vendor independent and based on the master and slave architecture. The SIEMENS CPU314C-2DP is used as the master, while the slaves are the Siemens DP/PA coupler, Levelflex M FMP40 and Deltbar S PMD70. Communication between the slaves and the master was via the PROFIBUS PA protocol. The configuration and programming of the SIEMENS CPU314C-2DP and PROFIBUS PA devices was done using TIA Portal V13 software. Communication between an OPC server and CPU314C-2DP was via a serial communication port using an MPI cable. The OPC server was configured to read the required data from the iv CPU314C-2DP. The Master I/O program was updated to read data from the OPC server using shared variables and calculate the measured parameters. The OPC server and Master I/O program were running on the same computer. Finally, the experimental template was updated to read data from the Master I/O program using Ethernet as the medium of communication. The communication and programs were tested at the end of each stage to ensure functionality of each segment. In overall, the objectives of this project were achieved as the PROFIBUS PA instruments can now be used in the laboratory, and the guide on how to use them was developed

X-RAY CRYSTALLOGRAPHY OF RECOMBINANT LACTOCCOCUS LACTIS PROLIDASE

Prolidase has potential applications in cheese debittering, organophosphate detoxification and as an enzyme replacement therapy in prolidase-deficient patients. Recombinant Lactococcus lactis prolidases and their catalytic properties have previously been characterized in Dr. Tanaka's research group. Unlike other prolidases, L. lactis prolidase shows allosteric behaviour, metal-dependent substrate specificity and substrate inhibition. The current project focuses on elucidating the three-dimensional structure of L. lactis prolidase using X-ray crystallography. Hexagonal plate-like crystals of wild-type L. lactis prolidase were grown by the hanging drop vapour diffusion method, allowing the crystals to grow to about 50 µm in their longest dimension. The crystallization cocktail in which they grew contained 0.08 M sodium cacodylate (pH 6.5), 0.16 M calcium acetate, 14 % PEG 8000 and 18 % glycerol. Crystal diffraction data was collected at a wavelength of 0.9795 Å on beamline 08ID-1 of the Canadian Macromolecular Crystallography Facility at the Canadian Light Source and was processed using X-ray Detector Software. The crystals belonged to space group C2 and estimated to contain three molecules in an asymmetric unit. The electron density map of this structure was solved by the molecular replacement method and the structure model was refined against 2.25 Å resolution data. Molecule A forms a dimer with molecule B, while molecule C forms a dimer with molecule C', which is located in the neighbouring crystal asymmetric unit. The electron density of molecule A was well-defined and complete. Therefore, all the 362 amino acid residues of L. lactis prolidase were fitted. The other two molecules were incomplete and less defined. Only 360 and 352 residues could be fitted in molecules B and C, respectively. Molecule C, the worst of the three, compromised the overall quality of the refined structure. However, the functional interpretation of the structure was not compromised since the well-defined molecules form a dimer with each other and the biologically-functional form of L. lactis prolidase is a homodimer. The final Rwork and Rfree are 22.39 and 27.77, respectively. Comparison with other known prolidases revealed that Asp 36 and His 38 are unique to L. lactis prolidase. These residues have been shown to be involved in the allosteric behaviour and substrate inhibition of this enzyme, respectively. Therefore, this crystal structure further supports their suggested contribution in L. lactis prolidase's unique catalytic properties

Effects of restrictions to Income Support on health of lone mothers in the UK: a natural experiment study

Background: In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO. Methods: From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12). Findings: The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI −1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (−0·57 to 5·48) compared with control group 1 and by 1·28 (−1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2. Interpretation: Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health. Funding: UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland

Value of a pre-sentence report in determining the suitability of sentences other than imprisonment

In this dissertation the problems surrounding the sentencing stage and factors which influence the sentence are briefly considered. The emphasis is on the use and value of a pre-sentence report in determining suitable sentences other than imprisonment. Historical background in the use of pre-sentence reports in South Africa, England and America is briefly referred to. Relevant concepts, such as individualisation of punishment, are considered in relation to possible sentences such as compensation, fines, community service, and correctional supervision. It is concluded that the provisions of sections 274 and 276A of the Criminal Procedure Act 51 of 1 977 are not enough to regulate the use of pre-sentence reports in South Africa. It is further concluded that legislation is needed in this area, but in the meantime, our courts should work towards developing guidelines based on the provisions of the Criminal Procedure Act 51 of 1 977.Criminal and Procedural LawLL.M (Law

Associations of blood pressure with body composition among Afro-Caribbean children in Barbados

Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9–10 years (2010-2011).The United States normative blood pressure percentiles were used to identify children with high (≥ 95th percentile) or high normal blood pressure (90th – 95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. Major findings: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p< 0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressurewere14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. Principal conclusion: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition

Does psychological capital play a role in the prediction of team altruism?

Abstract: The positive psychological resources that the hope, efficacy, resilience and optimism characteristics of psychological capital (PsyCap) holds, possibly affects altruistic behavior of teams. This quantitative investigation sheds more light on this relationship. Multiple Regression Analysis with PsyCap as independent variable predicts the four factors of team altruism: team goals, collegiality, after hours support and problem solving. Questionnaires were sent to 598 participants in different industries. Indications are that selfefficacy, hope and resilience significantly predict team altruism. This is a further indication of the important role that PsyCap plays in promoting healthy teamwork in business