Positive health: The passport approach to improving continuity of care for low income South African chronic disease sufferers

Research Problem: The South African health system faces numerous challenges associated with its status as a middle-income developing nation. Wasteful expenditure and poor clinical outcomes arise from inefficient inter-organizational communication of patient information and the lack of a centralized health database. Research question: How does the experience of chronic disease patients with their health information inform the development of future health records in low income population groups? Proposition: Exploration of patient and health care workers experiences of medical records can inform their future development to enhance continuity of care. Objectives, methodology, procedures and outcome: Identification of an appropriate format, technological basis and functional design of a prototype medical record system by means of a phenomenological study conducted through in-depth interviews of patients and doctors in order to improve clinical care. Left and right hermeneutics were used to analyse the data and develop themes. Findings: Health records play a critical role in the clinics workflow processes, document the patients' management and clinical progress. They are an important intermediary in the relationship between the patient and the facility. Inefficiencies in the paper-based system lead to ineffective consultations, loss of continuity of care and discord between practitioners and patients. Improvement of the records format is required to provide ubiquitous access to health and improve patient health literacy

Learning a Physical Activity Classifier for a Low-power Embedded Wrist-located Device

This article presents and evaluates a novel algorithm for learning a physical activity classifier for a low-power embedded wrist-located device. The overall system is designed for real-time execution and it is implemented in the commercial low-power System-on-Chips nRF51 and nRF52. Results were obtained using a database composed of 140 users containing more than 340 hours of labeled raw acceleration data. The final precision achieved for the most important classes, (Rest, Walk, and Run), was of 96%, 94%, and 99% and it generalizes to compound activities such as XC skiing or Housework. We conclude with a benchmarking of the system in terms of memory footprint and power consumption.Comment: Submitted to the 2018 IEEE International Conference on Biomedical and Health Informatic

The rational formula from the runhydrograph

The rational formula is possibly the simplest flood estimation technique available using rainfall-runoff relationships. In spite of the many criticisms regarding its over-simplification of the processes of rainfall conversion into runoff, it remains possibly the most widely used method for estimating peak flood flows for urban drainage systems and small

The Effectiveness Study on Applying Multimedia Element into a Web-Based Academic Grading System

Every institution of higher learning would certainly have the own marking system. This is so because every lecturer will have to assess their students' performance by accumulating the marks earned by the students according to the allocations given. Among the criteria of assessment are coursing work such as quizzes, tests, assignments, and projects, whereas final exams are assessed separately. A web-based academic grading system has been developed for Examination Unit in Kolej Antarabangsa Teknologi dan Profesional, Perlis. These standalone system runs on the unit's to smooth up the daily operation and reduce the time and operation cost as well. Prior to the system development, a study has been done to understand how the system gives the benefit for the college. Questionnaire has been prepared to determine the effectiveness study on applying a multimedia element of the system compared the manual way that will be distributed to system's users. The user will be implemented to take the feedback of the system and understand the system's capability to manage a lot of data from time to time. The programming language used in the development of Web-Based Academic Grading System is used in PHP and MySQL database management

Observation of Fragile-to-Strong Dynamic Crossover in Protein Hydration Water

At low temperatures proteins exist in a glassy state, a state which has no conformational flexibility and shows no biological functions. In a hydrated protein, at and above 220 K, this flexibility is restored and the protein is able to sample more conformational sub-states, thus becomes biologically functional. This 'dynamical' transition of protein is believed to be triggered by its strong coupling with the hydration water, which also shows a similar dynamic transition. Here we demonstrate experimentally that this sudden switch in dynamic behavior of the hydration water on lysozyme occurs precisely at 220 K and can be described as a Fragile-to-Strong dynamic crossover (FSC). At FSC, the structure of hydration water makes a transition from predominantly high-density (more fluid state) to low-density (less fluid state) forms derived from existence of the second critical point at an elevated pressure.Comment: 6 pages (Latex), 4 figures (Postscript

Synthesis and Surface Modification of Inorganic Nanoparticles for Application in Physics and Medicine

The core focus of this cumulative thesis is the synthesis, the characterization, and the polymer coating or the surface modification of different types of inorganic nanoparticles (NPs), e.g., semiconductor, magnetic, plasmonic, and titanium oxide NPs. These NPs are used in the field of physics, biotechnology, and in nanomedicine or life sciences for both diagnosis and therapy. The applications of these NPs depend on their unique properties, which are correlated to their size, shape, and the material composition. The colloidal stability of these nanocrystals or NPs in different media (e.g. organic, water, cell culture media) was achieved by means of capping agents or by wrapping suitable ligands or surfactants around the core of the NPs. The colloidal NPs that were synthesised during this research work were capped with hydrophobic ligands (e.g. oleic acid, oleylamine, etc.) to keep them stable in the organic media, e.g., toluene, chloroform, etc. The phase transfer from organic to aqueous is a mandatory step prior to their use in the few desired applications, especially when these NPs are exposed to aqueous medium or cell media. This is carried out by wrapping the NPs with an amphiphilic polymer, i.e., poly(isobutylene-alt-maleic anhydride) (Mw= 6000 Da) that is grafted with hydrophobic side chains of dodecylamine. The mentioned four types of produced NPs were: (i) Semiconductor NPs which include the hydrophobic cadmium sulfide (CdS) quantum dots (QDs) that are used: for organic scintillation neutrino detection experiments; for PPO (2, 5-diphenyloxazole) styrene based plastic scintillator detectors; for time resolved spectral measurement, and for fluorescence studies with different surface coatings; additionally, water soluble CdS, manganese doped CdS, and zinc sulphide (ZnS) with and without manganese doping were synthesized and engineered to run several experiments on nanomaterials’ (NMs) behavior in environmental media, e.g., river and lake water; (ii) magnetic NPs (MNPs) that include core only (iron oxide, e.g. magnetite) and core shell composite iron oxide magnetic NPs combined with cobalt and manganese ferrites; (iii) plasmonic NPs such as gold and silver NPs that were used in combination with iron-oxide NPs (4 nm each) for toxicity screening and dose determination assays, and (vi) titanium dioxide iv (TiO2) NPs with different sizes and shapes (i.e. cube, rods, plates, and bipyramids), which were used for in vivo experiments: To evaluate the bio-distribution, organ accumulation, biological barrier passage, and potential organ toxicity after a single intravenous administration of TiO2 NPs, and to assess the influence of the TiO2 NPs shape and geometry on the mentioned effects. Furthermore TiO2 NPs were also used to perform few more in vivo studies to investigate: (i) The effect of biological environment (e.g. lung lining liquid, saliva, gastric/intestinal fluids) on NPs’ behaviour and toxicity, using complex co-culture systems for the intestine and alveoli, (ii) the effect of NPs on the activation of the inflammasome, and (iii) the influence of NPs on the maturation and activation of dendritic cells. In addition to above mentioned experiments for synthesis and surface modification another study was carried out with the aim to transfer three different types of NPs (i.e. plasmonic, fluorescent and magnetic) in aqueous phase to be employed in hydrogels, aerogels, and heterogels applications. In this study bimetallic (gold-copper) plasmonic nanocubes, fluorescent (cadmium selenide/CdS) core shell nanorods and magnetic iron oxide (Fe3O4) nanospheres were successfully transferred to the aqueous phase irrespective of their different sizes ranging from 5-40 nm in at least one dimension. All water soluble NPs were cleaned by means of gel electrophoresis or by ultracentrifugation to get rid of micelles (empty polymer) followed by sterilization for all in vivo studies. The qualitative and quantitative analyses all of these NPs were performed by means of different characterization techniques, e.g., ultraviolet-visible spectroscopy, fluorescence spectroscopy, dynamic light scattering, zeta potential measurements gel electrophoresis, transmission electron microscopy, inductively coupled plasma mass spectrometry, and the X-ray diffraction analysis

The impact of species and cell type on the nanosafety profile of iron oxide nanoparticles in neural cells

Background: While nanotechnology is advancing rapidly, nanosafety tends to lag behind since general mechanistic insights into cell-nanoparticle (NP) interactions remain rare. To tackle this issue, standardization of nanosafety assessment is imperative. In this regard, we believe that the cell type selection should not be overlooked since the applicability of cell lines could be questioned given their altered phenotype. Hence, we evaluated the impact of the cell type on in vitro nanosafety evaluations in a human and murine neuroblastoma cell line, neural progenitor cell line and in neural stem cells. Acute toxicity was evaluated for gold, silver and iron oxide (IO) NPs, and the latter were additionally subjected to a multiparametric analysis to assess sublethal effects. Results: The stem cells and murine neuroblastoma cell line respectively showed most and least acute cytotoxicity. Using high content imaging, we observed cell type-and species-specific responses to the IONPs on the level of reactive oxygen species production, calcium homeostasis, mitochondrial integrity and cell morphology, indicating that cellular homeostasis is impaired in distinct ways. Conclusions: Our data reveal cell type-specific toxicity profiles and demonstrate that a single cell line or toxicity end point will not provide sufficient information on in vitro nanosafety. We propose to identify a set of standard cell lines for screening purposes and to select cell types for detailed nanosafety studies based on the intended application and/or expected exposure

A descriptive analysis of the effect of the national COVID-19 lockdown on the workload and case mix of patients presenting to a district-level emergency centre in Cape Town, South Africa

Background. The global COVID-19 pandemic caused many countries to institute nationwide lockdowns to limit the spread of the disease.Objectives. To describe the effect of the national COVID-19 lockdown in South Africa (SA) on the workload and case mix of patients presenting to a district-level emergency centre.Methods. The electronic patient tracking and registration database at Mitchells Plain Hospital, a district-level hospital in Cape Town, was retrospectively analysed. The 5-week lockdown period (27 March - 30 April 2020) was compared with a similar period immediately before the lockdown (21 February - 26 March). A comparison was also made with corresponding time periods during 2018 and 2019. Patient demographics, characteristics, diagnoses and disposition, as well as process times, were compared.Results. A total of 26 164 emergency centre visits were analysed (8 297 in 2020, 9 726 in 2019, 8 141 in 2018). There was a reduction of 15% in overall emergency centre visits from 2019 to 2020 (non-trauma 14%, trauma 20%). A 35% decrease was seen between the 2020 lockdown period and the 5-week period before lockdown (non-trauma 33%, trauma 43%), and the reduced number of visits stayed similar throughout the lockdown period. The median age increased by 5 years during the 2020 lockdown period, along with an 8% decrease in patients aged <12 years. High-acuity patients increased by 6% and the emergency centre mortality rate increased by 1%. All process times were shorter during the lockdown period (time to triage –24%, time to consultation –56%, time to disposition decision –29%, time in the emergency centre –20%).Conclusions. The SA national COVID-19 lockdown resulted in a substantial decrease in the number of patients presenting to the emergency centre. It is yet to be seen how quickly emergency centre volumes will recover as lockdown measures are eased

Evaluation of Wearable Optical Heart Rate Monitoring Sensors

Heart rate monitoring provides valuable information about an individual’s physiological condition. The information obtained from heart rate monitoring can be used for a wide range of purposes such as clinical diagnostics, assessment of the efficiency of training for sports and fitness, or of sleep quality and stress levels in wellbeing applications. Other useful parameters for describing a person’s fitness, such as maximal oxygen uptake and energy expenditure, can also be estimated using heart rate measurement. The traditional ‘gold standard’ for heart rate monitoring is the electrocardiograph, but nowadays there are a number of alternative methods too. Of these, optical sensors provide a relatively simple, lowcost and unobtrusive technology for monitoring heart rate and they are widely accepted by users. There are many factors affecting the measurement of optical signals that have an effect on the accuracy of heart rate estimation. However, there is a lack of standardized and unified methodology for comparing the accuracy of optical heart rate sensors to the ‘gold standard’ methods of measuring heart rate. The widespread use of optical sensors for different purposes has led to a pressing need for a common objective methodology for the evaluation of how accurate these sensors are. This thesis presents a methodology for the objective evaluation of optical heart-rate sensors. The methodology is applied in evaluation studies of four commercially available optical sensors. These evaluations were carried out during both controlled and non-controlled sporting and daily life activities. In addition, evaluation of beat detection accuracy was carried out in non-controlled sleep conditions. The accuracy of wrist-worn optical heart-rate sensors in estimating of maximal oxygen uptake during submaximal exercise and energy expenditure during maximal exercise using heart rate as input parameter were also evaluated. The accuracy of a semi-continuous heart rate estimation algorithm designed to reduce power consumption for long-term monitoring was also evaluated in various conditions. The main findings show that optical heart-rate sensors may be highly accurate during rhythmic sports activities, such as jogging, running, and cycling, including ramp-up running during maximal exercise testing. During non-rhythmic activities, such as intermittent hand movements, the sensors’ accuracy depends on where they are worn. During sleep and motionless conditions, the optical heart-rate sensors’ estimates for beat detection and inter-beat interval showed less than one percent inaccuracy against the values obtained using standard measurement techniques. The sensors were also sufficiently accurate at measuring the interbeat intervals to be used for calculating the heart rate variability parameters. The estimation accuracy of the fitness parameters derived from measured heart rate can be described as follows. An assessment of the maximal oxygen uptake estimation during a sub-maximal outdoor exercise had a precision close to a sport laboratory measurement. The energy expenditure estimation during a maximal exercise was more accurate during higher intensity of exercise above aerobic threshold but the accuracy decreased at lower intensity of exercise below the aerobic threshold, in comparison with the standardized reference measurement. The semi-continuous algorithm was nearly as accurate as continuous heart-rate detection, and there was a significant reduction in the power consumption of the optical chain components up to eighty percent. The results obtained from these studies show that, under certain conditions, optical sensors may be similarly accurate in measuring heart rate as the ‘gold standard’ methods and they can be relied on to monitor heart rate for various purposes during sport, everyday activities, or sleep