Selection of a computerized maintenance management system for mechanical and industrial lab equipment of University of South Africa

The research on which this article is based, sought a suitable computerized maintenance management system (CMMS) for use in the Mechanical and Industrial Engineering laboratories and workshop at the University of South Africa. The university plans to implement such a computerized maintenance management system, to keep track of past repairs, schedule future maintenance, and maintain a ready list of vendors or sources of parts. Currently, the department does not have a maintenance strategy or equipment history. The price of a product is an important factor when selecting a CMMS program. The recommended software will not place to great a stress on the departmental budget, is user friendly and can be used by two to five users.Mechanical and Industrial Engineerin

A Study on Clinical Profile and Reversible Risk Factors Associated with Poor Outcome in Acute Kidney Injury

INTRODUCTION: Acute Kidney Injury (AKI), the new term heralds a paradigm shift for our conceptualization of the syndrome which is previously called “acute renal failure.” AKI retains one word, substitutes a synonym for another, but supplants “failure” with “injury.” This substitution may very well redefine the epidemiology of the syndrome. Acute renal failure (ARF), now increasingly referred to as “acute kidney injury” or AKI, which is characterized by a abrupt (ie., hours to days) impairment of kidney function. The current perception of AKI has evolved along with developments in pathology and clinical biochemistry that have permitted clinicopathologic correlations and early diagnosis3. Initial delineation of AKI from the early 20th century centered around specific conditions such as war nephritis5 , crush injuries4,and falciparum malaria6.In 1912, Sir William Osler7 described several recognizable causes of AKI under the heading of “acute Bright’s disease,” including toxins, burns, pregnancy, and sepsis. AKI is now inferred to be an increasingly common and potentially disastrous complication in hospitalized patients. AIM OF STUDY: This study aims at finding out the clinical profile and reversible(modifiable) risk factors associated with poor outcome in children with acute kidney injury seen in this part of the country in a referral pediatric centre at Chennai. DISCUSSION: In our study, the maximum number of cases of acute kidney injury were under 1 year age group accounting 37% of total children. This is because of increased incidence of sepsis in this age group. Next major group was noted in 4-8 years age group with 28% of total children. With regard to the sex distribution, the females are predominantly affected when compared to males. This fact of female predominance is consistent with ICH scenario of ARF cases in the year 2008 (male : female ratio 1:2).Whereas the study conducted by Gallego et al., showed that there is no sex predilection among the ARF cases and also contrary to the observation by Arora et al., which showed male predominance . A.K.I can occur due to number of causes. Significant portion being acute glomerulonephritis, acute tubular necrosis following diarrhoeal dehydration ,posterior urethral valves, Post surgical etc., In our study ,sepsis is the leading cause of A.K.I. It differs from the study conducted by B.V. Singh et al., His study showed that Acute glomerulo nephritis is commonest. Our study showed that next to sepsis, diarrholeal dehydration and A.G.N were common. In study conducted by Arora et al., showed haemolytic uremic syndrome as the commonest cause of A.K.I. Patrick Niaudet et al., also showed that haemolytic uremic syndrome as the commonest cause of A.R.F. which he attributed mostly due to the precipitating factor like diarrhoea and high incidence of H.U.S may be probably due to poor socio economic conditions and poor sanitary facilities, leading on to diarrhoea . H.U.S is a cause of A.K.I only in less than 5% of cases in our study. This is because of recognition of complication earlier and efficient treatment of acute watery diarrhoea .Besides that delayed referral increases the mortality rate. H.U.S was found to be a bad prognosticator by R.S Trompeter , he gave a mortality of 30% .In our study one child expired out of three children affected with haemolytic uremic syndrome. CONCLUSION: 1.Acute kidney injury is one of the important causes of morbidity and mortality in children. 2.Female predominance with a male : female ratio 1:1.4 is observed. 3.Sepsis is the commonest cause of acute kidney injury in children. Other common causes of acute kidney injury in children are acute gastro enteritis, acute glomrulonephritis. 4.Overall mortality rate of acute kidney injury in children aged between 1 month to 12 years noted was 43%.In male children mortality rate was 45.3%and in female children it was 41.4%. 5.Non oliguric AKI is usually diagnosed by high index suspicion and by periodic biochemical monitoring. 6.Mortality among non oliguric AKI patients was due to septicaemia. 7. Risk factors associated with poor outcome were, anuria, bleeding, shock, hypotension,hypertension, sepsis, AGN, high blood urea, serum creatinine values. 8.Clinically, predictive factors for poor outcome in acute kidney injury found were anuria, shock, hypotension. Hence extra attention should be given for these cases in future to reduce the mortality. 9. Significant reversible factors of acute kidney injury observed were dehydration , sepsis, shock . 10. Hence,prevention or early diagnosis and treatment of these factors will improve the outcome

The effects of precision teaching and self-regulation learning on early multiplication fluency

Fluent recall of basic facts is essential to the development of more complex math skills. Therefore, failure to develop fluency with basic facts may impede the development of these skills. The present study used a between groups experimental design to investigate whether a basic facts fluency program, implemented within a self-regulated learner (SRL) framework, could lead to increased fluency with multiplication facts for Year 5 and Year 6 New Zealand students (9–10 years old). This study also investigated the extent to which the SRL program altered students’ basic facts practice behavior outside of school hours. The study found that the SRL program resulted in rapid fluency development that was maintained over time. Nomothetic and idiographic analysis confirmed that the program was suitable for use within Tier 1 of the response to intervention framework. In addition, the study also found that students who received the program altered their practice behavior outside school hours. The results from this study show how elements of self-regulated learning and precision teaching can be successfully combined to enhance students’ mathematics achievement

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Implementation of modular manufacturing in the clothing industry in KwaZulu-Natal : a case study

There are many challenges facing the clothing and textile industry in countries worldwide, and South Africa is no exception. Intense competition from both the domestic and international markets is crippling both the clothing and textile industries. However, with a reservoir of experience and expertise within the industry, it could re-establish itself as a forceful industry with an ability to challenge competitors both domestically and internationally through a focus on added value, exceptional quality, and the effective application of all resources through technological innovation. One such innovation in the clothing industry in South Africa may be the use of modular manufacturing. Qualitative narrative interviews and text analysis results on the experiences of individuals through the implementation of modular manufacturing are presented and evaluated as a case study.'n Verskeidenheid uitdagings staar die kleding- en tekstielindustrie wêreldwyd in die gesig. Suid-Afrika is ook hieraan blootgestel. Intense kompetisie in nasionale en internasionale markte het tans 'n besonder negatiewe uitwerking op die kleding- en tekstielindustrie. Daar is egter 'n goeie bron van ervaring en kennis in die bedryf wat kan meehelp om die besondere kompetisie die hoof te bied. Dit kan geskied deur te fokus op toegevoegde waarde, uitsonderlike kwaliteit, en die effektiewe aanwending van hulpbronne deur tegnologiese innovasie. Een so 'n innovasie in die Suid-Afrikaanse kledingindustrie kan die aanwending van modulêre vervaardiging wees. Kwalitatiewe narratiewe resultate van onderhoude, sowel as teks- en inhoudanalise van die ervarings van werknemers tydens die implementering van modulêre vervaardiging, word as 'n gevallestudie aangebied

Randomized cross-over study and a qualitative analysis comparing virtual microscopy and light microscopy for learning undergraduate histopathology

Background: Virtual microscopy (VM) use in teaching and learning is increasing worldwide. However, there is a paucity of information comparing it to light microscopy (LM) in learning undergraduate histopathology. We investigated whether VM or LM had a higher impact on student learning and performance in histopathology. In addition, we investigated whether students preferred VM over LM, and whether VM use provided a platform to fulfill the Accreditation Council for Graduate Medical Education core competencies. Materials and Methods: We used a sequential exploratory mixed method study design. A qualitative phase inquiring about student preference for VM or LM was followed by a randomized cross-over study. Student preference was measured by an online survey based on a Likert scale. In the cross-over study, students were randomized to either the VM or the LM arm, and their mean scores in standardized exams were compared after using VM and LM. Results: A total of 152 students completed the qualitative study and a total of 64 students participated in the cross-over study. Eighty-three percent (83%) of the students preferred to use VM over LM. Students who used VM scored significantly (P < 0.001) higher [(87.1% vs. 72.4%) and (85.3% vs. 76.1%)], respectively, in both phases of the cross-over study compared to those who used LM. Conclusions: Using VM to learn histopathology has significantly increased student learning and performance compared to using LM