Does "thin client" mean "energy efficient"?

The thick client –a personal computer with integral disk storage and local processing capability, which also has access to data and other resources via a network connection – is accepted as the model for providing computing resource in most office environments. The Further and Higher Education sector is no exception to that, and therefore most academic and administrative offices are equipped with desktop computers of this form to support users in their day to day tasks. This system structure has a number of advantages: there is a reduced reliance on network resources; users access a system appropriate to their needs, and may customise “their” system to meet their own personal requirements and working patterns. However it also has disadvantages: some are outside the scope of this project, but of most relevance to the green IT agenda is the fact that relatively complex and expensive (in first cost and in running cost) desktop systems and servers are underutilised – especially in respect of processing power. While some savings are achieved through use of “sleep” modes and similar power reducing mechanisms, in most configurations only a small portion of the overall total available processor resource is utilised. This realisation has led to the promotion of an alternative paradigm, the thin client. In a thin client system, the desktop is shorn of most of its local processing and data storage capability, and essentially acts as a terminal to the server, which now takes on responsibility for data storage and processing. The energy benefit is derived through resource sharing: the processor of the server does the work, and because that processor is shared by all users, a number of users are supported by a single system. Therefore – according to proponents of thin client – the total energy required to support a user group is reduced, since a shared physical resource is used more efficiently. These claims are widely reported: indeed there are a number of estimation tools which show these savings can be achieved; however there appears to be little or no actual measured data to confirm this. The community does not appear to have access to measured data comparing thin and thick client systems in operation in the same situation, allowing direct comparisons to be drawn. This is the main goal of this project. One specific question relates to the overall power use, while it would seem to be obvious that the thin client would require less electricity, what of the server? Two other variations are also considered: it is not uncommon for thin client deployments to continue to use their existing PCs as thin client workstations, with or without modification. Also, attempts by PC makers to reduce the power requirements of their products have given rise to a further variation: the incorporation of low power features in otherwise standard PC technology, working as thick clients. This project was devised to conduct actual measurements in use in a typical university environment. We identified a test area: a mixed administrative and academic office location which supported a range of users, and we made a direct replacement of the current thick client systems with thin client equivalents; in addition, we exchanged a number of PCs operating in thin and thick client mode with devices specifically branded as “low power” PCs and measured their power requirements in both thin and thick modes. We measured the energy consumption at each desktop for the duration of our experiments, and also measured the energy draw of the server designated to supporting the thin client setup, giving us the opportunity to determine the power per user of each technology. Our results show a significant difference in power use between the various candidate technologies, and that a configuration of low power PC in thick client mode returned the lowest power use during our study. We were also aware of other factors surrounding a change such as this: we have addressed the technical issues of implementation and management, and the non-technical or human factors of acceptance and use: all are reported within this document. Finally, our project is necessarily limited to a set of experiments carried out in a particular situation, therefore we use estimation methods to draw wider conclusions and make general observations which should allow others to select appropriate thick or thin client solutions in their situation

Challenges in saving babies - avoidable factors, missed opportunities and substandard care in perinatal deaths in South Africa

Objective. To identify the most common avoidable factors, missed opportunities and substandard care in perinatal care in South Africa.Setting. Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns, and rural areas.Method. Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa.Result. A total of 8 085 perinatal deaths among babies weighing 1 000 g or more were reported from 232 718 births at the PPIP sentinel sites. Avoidable factors, missed opportunities and substandard care were reported to be patient-related (between 31.5% and 47.5% of deaths), due to administrative problems (between 10.1% and 31.1% of deaths), and due to healthworker-related problems (between 28.4% and 36.0% of deaths) in the metropolitan and rural areas respectively. Figures for cities and towns lay between these ranges. Deaths due to intrapartum asphyxia and birth trauma were thought to be clearly preventable within the health system in 63.1 %, 34.4% and 35.7% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Deaths due to hypertension and antepartum haemorrhage were thought to be clearly preventable within the health system in 18.7%, 15.4% and 20.0% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Far fewer preventable deaths were recorded in the spontaneous preterm labour category.Conclusion. Concentration on the remediable priority problems identified (namely labour management, resuscitation of the asphyxiated neonate, and care of the premature neonate) makes the reduction of perinatalmortality in South Africa feasible and inexpensive

Why babies die - a perinatal care survey of South Africa, 2000 - 2002

Objective. To identify the major causes of perinatal mortality in South Africa.Setting. Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns and rural areas.Method. Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa.Results. A total of 8 085 perinatal deaths among babies weighing 1 000 g or more were reported from 232 718 births at the PPIP user sites. The perinatal mortality rates for the metropolitan, city and town, and rural groupings were 36.2, 38.6 and 26.7/1 000 births, respectively. The neonatal death rate was highest in the city and town group (14.5/1 000 live births) followed by the rural and metropolitan groups (11.3 and 10.0/1 000 live births respectively). The low birth weight rate was highest in the metropolitan group (19.6%), followed by the city and town group (16.5%) and the rural group (13.0%). The most common primary cause of perinatal death in the rural group was intrapartum asphyxia and birth trauma (rate 6.92/1 000 births) followed by spontaneous preterm delivery (5.37/1 000 births). The most common primary cause of death in the city and town group was spontaneous preterm delivery (6.79/1 000 births) followed by intrapartum asphyxia and birth trauma (6.21/1 000 births) and antepartum haemorrhage (5.7/1 000 births). The metropolitan group's most common primary causes were antepartum haemorrhage (7.14/1 000 births), complications of hypertension in pregnancy (5.09/1000 births) and spontaneous preterm labour (4.01/1000 births). Unexplained intrauterine deaths were the most common recorded primary obstetric cause of death in all areas. Complications of prematurity and hypoxia were the most common final causes of neonatal death in all groups.Conclusion. Intrapartum asphyxia, birth trauma, antepartum haemorrhage, complications of hypertension in pregnancy and spontaneous preterm labour account for more than 80% of the primary obstetric causes of death

Uricult trio as a screening test for bacteriurla in pregnancy

Objective. To establish the effectiveness in an indigent urban population of Uricult Trio as a screening test for asymptomatic bacteriuria in pregnancy and in diagnosing urinary tract infections (UTI) in symptomatic pregnant women. likelihood ratios were established for positive and negative Uricult Trio test results.Subjects. Two populations of patients from the Pretoria region were involved: (J) asymptomatic pregnant women attending the antenatal clinic for the first time or presenting in labour; and (iI) pregnant women with symptoms suggestive of UTI.Method. A midstream urine specimen was collected from the two populations of patients, plated onto the Uricult Trio and sent to the laboratory for culture.Results. The prevalence of asymptomatic bacteriuria in this population was 23%, and for women with symptoms suggestive of UTI, 29%. The likelihood ratios for a positive test were 1.8 and 1.5 for asymptomatic and symptomatic patients respectively. The likelihood ratios for a negative test were 0.35 and 0.44 for asymptomatic and symptomatic patients respectively. Escherichia coli was the causative agent . in 36% of cases.Conclusion. Uricult Trio is not effective as a screening test for asymptomatic bacteriuria in pregnancy or for diagnosing UTIs in women with symptoms suggestive of infection

Intrapartum-related birth asphyxia in South Africa lessons From the first national perinatal care survey

Background. The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report.Objectives. To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths.Methods. The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia. Results. There were 123 508 births in the hospitals surveyed, with 4 142 perinatal deaths among infants ≥ 1 000 g, giving a perinatal mortality rate of 33.5/1 000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8/1 000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town and rural areas were 30.0, 39.4 and 30.9/1 000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively

The use of Doppler velocitnetry of the utnbilical artery before 24 weeks' gestation to screen for high-risk pregnancies

Objective. To describe the prevalence and natural history of absent end-diastolic velocities (AEDV) in the mnbilical artery of the fetus between 16 and 24 weeks' gestation, and to evaluate its role as a screening test.Design. Population-based descriptive study.Setting. Tygerberg Hospital, Tygerberg, South Africa. The hospital serves a population from the lower socio-economic bracket.Subjects. Doppler velocimetry was performed at routine ultrasound examinations for confirmation of gestational age in 496 women.Main outcome measures. The occurrence of perinatal death, small-for-gestational-age (SGA) babies and proteinuric hypertension.Results. Forty-four (8,9%) patients had AEDVs at the first examination, but AEDV persisted in only 1. In this case, severe proteinuric hypertension developed unexpectedly at 29 weeks' gestation and the fetus needed delivery because ofpersistent late decelerations of the fetal heart rate pattern. There was a significant association between the group with AEDV at first examination and the development of proteinuric hypertension (P <0,05), but no association with SGA babies. The association with proteinuric hypertension was too weak to be of clinical use.Conclusion. Doppler velocimetry of the mnbilical artery, performed along with routine ultrasound examination to confirm gestational age, is not of use as a screening test for identifYing highrisk pregnancies

Changing priorities in maternal and perinatal health in Gert Sibande District, South Africa

Gert Sibande District is a predominantly rural district in Mpumalanga Province, South Africa (SA), with a population of just over 1.1 million. It has a high prevalence of HIV infection and pregnancy-related hypertensive disease. In 2010 the district was one of the worst-performing health districts in SA, with a maternal mortality ratio of 328.0 per 100 000 births. Various programmes were introduced between 2010 and 2017 to address major causes of maternal and perinatal morbidity and mortality in the district. The focus has been on HIV-related morbidity, the direct obstetric causes of maternal and perinatal morbidity and mortality, and health systems strengthening. During the period 2010 - 2017, there was a steady decline in institutional maternal mortality with a drop of 71% in maternal deaths over a period of 6 years, from 328.0 per 100 000 births to 95.0. However, the ratio levelled off in 2016 and 2017, mainly as a result of a changing disease profile. The stillbirth rate showed a decline of 24.4% over a period of 8 years. With perseverance, rapid response and evidence-based strategies it was possible to more than halve the institutional maternal mortality ratio within 6 years. However, with the changing disease profile, conditions such as hypertensive disease in pregnancy should be prioritised and new strategies developed to further reduce maternal and perinatal mortality and morbidity

The tap test- an accurate First-line test for fetal lung maturity testing

Objective. To determine the accuracy of near-patient and laboratory- based fetal lung maturity tests in predicting the need for neonatal ventilation.Design. A prospective descriptive study. Subjects. One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery.Methods. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation.Results. Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with the greatest accuracy.Conclusion. The tap test is a rapid, easy and accurate predictor of the need for neonatal ventilation. The OD shift at 650 nm is the laboratory-based test with the greatest accuracy in our setting