Early screening for the post intensive care syndrome in a tertiary ICU follow-up clinic in the Eastern Cape
- Authors: van der Merwe, Elizabeth
- Date: 2024-04
- Subjects: Critical care medicine , Post-traumatic stress disorder -- Patients , Psychology, Pathological
- Language: English
- Type: Doctral theses , text
- Identifier: http://hdl.handle.net/10948/63915 , vital:73626
- Description: The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS. , Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
- Full Text:
- Date Issued: 2024-04
- Authors: van der Merwe, Elizabeth
- Date: 2024-04
- Subjects: Critical care medicine , Post-traumatic stress disorder -- Patients , Psychology, Pathological
- Language: English
- Type: Doctral theses , text
- Identifier: http://hdl.handle.net/10948/63915 , vital:73626
- Description: The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS. , Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
- Full Text:
- Date Issued: 2024-04
The adoption of international financial reporting standards and foreign direct investment inflows: the moderating effect of the institutional environment in Africa
- Authors: Simbi, Chipo
- Date: 2023-10-13
- Subjects: International Financial Reporting Standards , Investments, Foreign , Institutional infrastructure , Accounting Law and legislation , Auditing Law and legislation , Generalized method of moments , Difference in differences
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/419230 , vital:71627 , DOI 10.21504/10962/419230
- Description: Globalisation has created a need for an international accounting language to facilitate the smooth flow of trade across countries. In 2003, in an effort to establish a global financial reporting language, the International Accounting Standards Board (IASB) developed a single set of high-quality accounting principles known as the International Financial Reporting Standards (IFRS). Over the last decade, several African countries have adopted IFRS, and Africa has become the second-largest adopting continent after Europe. IFRS promotes improved quality of disclosure of accounting transactions, reduces information asymmetry between preparers and users of financial information, lowers the cost of investing, and breaks down information barriers to cross-border investment. Researchers suggest many benefits of IFRS adoption for macroeconomic indicators such as Foreign Direct Investment (FDI). The reduction in information acquisition and processing costs which translates into the reduction in investment costs, has been cited by most researchers. Researchers have argued, however, that the economic benefits of IFRS in Africa depend on the strength of the institutional environment. They also argue that the Western environment in which the IFRS was developed differs from the African environment. Thus, the universal approach of the IASB may not be appropriate due to the historical, social, economic and political context of African countries. The impact of the adoption of IFRS by African countries requires further examination, particularly as a weak institutional environment confronts many African countries. Three research questions are designed for this study; (1) Is there a significant change in FDI inflows for IFRS adopters in selected African countries after the adoption? (2) Is there a significant change in FDI inflows due to the institutional environment? (3) Does the institutional environment in IFRS-adopting countries moderate the effect of IFRS on FDI in selected African countries? The present study is underpinned by the new institutional theory, the information asymmetry theory, the eclectic theory and the signalling theory, each of which provide reasons why African countries have adopted IFRS. Nine hypotheses are developed, based on the research questions, and tested using the Systems General Method of Moments and the Difference-in-Difference method. The study uses data from 26 African countries, 15 adopting and 11 non-adopting countries, over the period 1996 - 2018. First, the study establishes that the adoption of IFRS positively and significantly affects FDI inflows into the selected sample of African countries. Second, the study concludes that legal enforcement, accounting and auditing standards enforcement, and language origin positively and significantly impact FDI inflows into these countries. Legal origin, however, has a positive but insignificant association with FDI inflows. Third, legal enforcement, historical ties, accounting and auditing enforcement and the quality of the institutional environment are found to moderate the effect of IFRS adoption on FDI inflows. These results indicate that IFRS is a crucial determinant of FDI inflows into African countries, but a supportive institutional environment is needed for African countries to attract FDI inflows after adoption. The results contribute to the accounting and finance literature on FDI into African countries, and may assist the investment community to assess the institutional risk associated with investing in IFRS adopting African countries. , Thesis (PhD) -- Faculty of Commerce, Accounting, 2023
- Full Text:
- Date Issued: 2023-10-13
- Authors: Simbi, Chipo
- Date: 2023-10-13
- Subjects: International Financial Reporting Standards , Investments, Foreign , Institutional infrastructure , Accounting Law and legislation , Auditing Law and legislation , Generalized method of moments , Difference in differences
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/419230 , vital:71627 , DOI 10.21504/10962/419230
- Description: Globalisation has created a need for an international accounting language to facilitate the smooth flow of trade across countries. In 2003, in an effort to establish a global financial reporting language, the International Accounting Standards Board (IASB) developed a single set of high-quality accounting principles known as the International Financial Reporting Standards (IFRS). Over the last decade, several African countries have adopted IFRS, and Africa has become the second-largest adopting continent after Europe. IFRS promotes improved quality of disclosure of accounting transactions, reduces information asymmetry between preparers and users of financial information, lowers the cost of investing, and breaks down information barriers to cross-border investment. Researchers suggest many benefits of IFRS adoption for macroeconomic indicators such as Foreign Direct Investment (FDI). The reduction in information acquisition and processing costs which translates into the reduction in investment costs, has been cited by most researchers. Researchers have argued, however, that the economic benefits of IFRS in Africa depend on the strength of the institutional environment. They also argue that the Western environment in which the IFRS was developed differs from the African environment. Thus, the universal approach of the IASB may not be appropriate due to the historical, social, economic and political context of African countries. The impact of the adoption of IFRS by African countries requires further examination, particularly as a weak institutional environment confronts many African countries. Three research questions are designed for this study; (1) Is there a significant change in FDI inflows for IFRS adopters in selected African countries after the adoption? (2) Is there a significant change in FDI inflows due to the institutional environment? (3) Does the institutional environment in IFRS-adopting countries moderate the effect of IFRS on FDI in selected African countries? The present study is underpinned by the new institutional theory, the information asymmetry theory, the eclectic theory and the signalling theory, each of which provide reasons why African countries have adopted IFRS. Nine hypotheses are developed, based on the research questions, and tested using the Systems General Method of Moments and the Difference-in-Difference method. The study uses data from 26 African countries, 15 adopting and 11 non-adopting countries, over the period 1996 - 2018. First, the study establishes that the adoption of IFRS positively and significantly affects FDI inflows into the selected sample of African countries. Second, the study concludes that legal enforcement, accounting and auditing standards enforcement, and language origin positively and significantly impact FDI inflows into these countries. Legal origin, however, has a positive but insignificant association with FDI inflows. Third, legal enforcement, historical ties, accounting and auditing enforcement and the quality of the institutional environment are found to moderate the effect of IFRS adoption on FDI inflows. These results indicate that IFRS is a crucial determinant of FDI inflows into African countries, but a supportive institutional environment is needed for African countries to attract FDI inflows after adoption. The results contribute to the accounting and finance literature on FDI into African countries, and may assist the investment community to assess the institutional risk associated with investing in IFRS adopting African countries. , Thesis (PhD) -- Faculty of Commerce, Accounting, 2023
- Full Text:
- Date Issued: 2023-10-13
Integrating blockchain and microgrid technology to enable peer-to-peer energy trading: a business process model
- Authors: Higgs, James
- Date: 2022-04-06
- Subjects: Blockchains (Databases) , Peer-to-peer architecture (Computer networks) , Electric power-plants Decentralization South Africa , Microgrids (Smart power grids) South Africa , Energy trading , Business process model
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/284559 , vital:56074
- Description: Traditional centralised energy systems are coming under increasing pressure because of decarbonisation, decentralisation, and digitisation. A lack of energy security and the inability to manage bi-directional electricity flows constitute two of the biggest challenges faced by centralised systems. Furthermore, in South Africa, the country’s energy system remains monopolised with one large utility satisfying most of the country’s electricity demand. This study is motivated by the need to address energy security within such a monopolised market. To redress the problems highlighted above, this study explores how blockchain and microgrid technology can be integrated to enable decentralised energy production and trading in South Africa. As such, this study develops a fully integrated blockchain-based microgrid energy trading system model. The functional requirements of the system are presented in the form of a business process model. Amongst other benefits, an active blockchain-based microgrid energy trading system provides a means to bolster energy security for the systems’ users. A unique aspect of this study’s approach to energy trading is the utilisation of blockchain’s native tokenizing capabilities. Prosumer energy tokens are minted to create a digital currency for local peer-to-peer energy exchange. A commons-rule based approach is adopted for governing energy resources. As such, this study demonstrates that commons-based solutions provide a feasible alternative to market and profit driven trading for organizing local energy exchange. The primary deliverable of this study satisfies the request of various blockchain researchers for blockchain research to focus on holistic conceptualisations, rather than on the minutiae of blockchain technicalities. Eight core functional requirements of a blockchain energy trading system were identified prior to the construction of the process model. The functional requirements were elicited during a scoping review as a part of the secondary data collection process. Expert review was utilised to verify the functional requirements of the blockchain energy trading system. Once the experts were identified, each expert completed a questionnaire with the intention to verify the requirements. The above process constituted the expert review process for the study. Additionally, the syntactic correctness of the business process model was verified by a business process modelling expert. Weber’s Theory of Evaluation constitutes the theoretical underpinning for the evaluation of the system parts. This study contributes the first publicly accessible business process models of a blockchain-based microgrid energy trading system. This study seeks to advance the discussion of a more integrative and cross disciplinary approach concerning blockchain research, particularly as it pertains to microgrid energy trading. , Thesis (MCom) -- Faculty of Commerce, Department of Information Systems, 2022
- Full Text:
- Date Issued: 2022-04-06
- Authors: Higgs, James
- Date: 2022-04-06
- Subjects: Blockchains (Databases) , Peer-to-peer architecture (Computer networks) , Electric power-plants Decentralization South Africa , Microgrids (Smart power grids) South Africa , Energy trading , Business process model
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/284559 , vital:56074
- Description: Traditional centralised energy systems are coming under increasing pressure because of decarbonisation, decentralisation, and digitisation. A lack of energy security and the inability to manage bi-directional electricity flows constitute two of the biggest challenges faced by centralised systems. Furthermore, in South Africa, the country’s energy system remains monopolised with one large utility satisfying most of the country’s electricity demand. This study is motivated by the need to address energy security within such a monopolised market. To redress the problems highlighted above, this study explores how blockchain and microgrid technology can be integrated to enable decentralised energy production and trading in South Africa. As such, this study develops a fully integrated blockchain-based microgrid energy trading system model. The functional requirements of the system are presented in the form of a business process model. Amongst other benefits, an active blockchain-based microgrid energy trading system provides a means to bolster energy security for the systems’ users. A unique aspect of this study’s approach to energy trading is the utilisation of blockchain’s native tokenizing capabilities. Prosumer energy tokens are minted to create a digital currency for local peer-to-peer energy exchange. A commons-rule based approach is adopted for governing energy resources. As such, this study demonstrates that commons-based solutions provide a feasible alternative to market and profit driven trading for organizing local energy exchange. The primary deliverable of this study satisfies the request of various blockchain researchers for blockchain research to focus on holistic conceptualisations, rather than on the minutiae of blockchain technicalities. Eight core functional requirements of a blockchain energy trading system were identified prior to the construction of the process model. The functional requirements were elicited during a scoping review as a part of the secondary data collection process. Expert review was utilised to verify the functional requirements of the blockchain energy trading system. Once the experts were identified, each expert completed a questionnaire with the intention to verify the requirements. The above process constituted the expert review process for the study. Additionally, the syntactic correctness of the business process model was verified by a business process modelling expert. Weber’s Theory of Evaluation constitutes the theoretical underpinning for the evaluation of the system parts. This study contributes the first publicly accessible business process models of a blockchain-based microgrid energy trading system. This study seeks to advance the discussion of a more integrative and cross disciplinary approach concerning blockchain research, particularly as it pertains to microgrid energy trading. , Thesis (MCom) -- Faculty of Commerce, Department of Information Systems, 2022
- Full Text:
- Date Issued: 2022-04-06
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