A mobile based user centred integrated remote patient monitoring framework for low resource settings
- Authors: Ndlovu, Nkanyiso
- Date: 2017
- Subjects: Health services accessibility Medical telematics Patient monitoring -- Remote sensing
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/8563 , vital:33128
- Description: There is a gap in healthcare service delivery within low resource settings of South Africa. These areas are under-serviced because of poor health infrastructure and few available medical experts. This contributes immensely to poor health care delivery especially to chronically ill diabetic patients and increases mortality rates. However, innovative remote patient monitoring (RPM) systems have been developed to curb the above challenge in recent years. Unfortunately, most of these systems are standalone and are incompatible with one another. Most of them relay on Internet for connectivity which is imminent in low resource settings. This makes continuity of care of chronic ill patients a great challenge. Additional, the efficacy and feasibility of RPM using mobile phones in low resource settings of South Africa are still unknown. It was also noted that none of these systems have been developed for a clinical trial. The goal of this study was to provide a standard framework that allows optimal design of mobile RPM systems which are interoperable. The objectives were to investigate the RPM system efficacy and reliability in low resource settings and determine its effects on clinical management, self-care and health outcomes. The framework was validated with a clinical trial to remotely monitor diabetic adults in Limpopo province of South Africa. A prototype system was developed based on sound user centric design process and enterprise architectural principles to remotely monitor diabetic elderly patients using cellular technologies and existing hospital infrastructure. It was evaluated using a controlled, randomized clinical trial for 6 months. There were 120 patients who took part in the study and were categorized into two groups, the intervention Group X and the control Group Y. Each group comprised of 60 participants. Evidence from this study justified the feasibility and possibility of long term implementation of RPM system to cater for chronic ill patients in low resource settings worldwide. Results showed that the self-care and normal blood glucose levels improved for both groups whereas quality of life improved only for Group X. It was shown that extensive self-care knowledge with the help of RPM system improved self-care and helped normalize their glucose levels. The hospital admissions and mortality between the two groups did not differ much. However, the intervention group had more hospital visits than the control group because the participants were requested to visit the hospitals in case of emergency. The users perceived the RPM system as feasible and effective way of clinical management and self-care. Due to wide acceptance, some patients were even willing to continue using the system after the trial. Home measurements proved to be reliable and helped improve self-care. In future, a standardized and unified framework based on rule set would provide comprehensive remote healthcare allowing continuous patient monitoring at a reduced overall cost thereby decreasing mortality rates.
- Full Text:
- Date Issued: 2017
A mobile based user centred integrated remote patient monitoring framework for low resource settings
- Authors: Ndlovu, Nkanyiso
- Date: 2017
- Subjects: Health services accessibility Medical telematics Patient monitoring -- Remote sensing
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/8563 , vital:33128
- Description: There is a gap in healthcare service delivery within low resource settings of South Africa. These areas are under-serviced because of poor health infrastructure and few available medical experts. This contributes immensely to poor health care delivery especially to chronically ill diabetic patients and increases mortality rates. However, innovative remote patient monitoring (RPM) systems have been developed to curb the above challenge in recent years. Unfortunately, most of these systems are standalone and are incompatible with one another. Most of them relay on Internet for connectivity which is imminent in low resource settings. This makes continuity of care of chronic ill patients a great challenge. Additional, the efficacy and feasibility of RPM using mobile phones in low resource settings of South Africa are still unknown. It was also noted that none of these systems have been developed for a clinical trial. The goal of this study was to provide a standard framework that allows optimal design of mobile RPM systems which are interoperable. The objectives were to investigate the RPM system efficacy and reliability in low resource settings and determine its effects on clinical management, self-care and health outcomes. The framework was validated with a clinical trial to remotely monitor diabetic adults in Limpopo province of South Africa. A prototype system was developed based on sound user centric design process and enterprise architectural principles to remotely monitor diabetic elderly patients using cellular technologies and existing hospital infrastructure. It was evaluated using a controlled, randomized clinical trial for 6 months. There were 120 patients who took part in the study and were categorized into two groups, the intervention Group X and the control Group Y. Each group comprised of 60 participants. Evidence from this study justified the feasibility and possibility of long term implementation of RPM system to cater for chronic ill patients in low resource settings worldwide. Results showed that the self-care and normal blood glucose levels improved for both groups whereas quality of life improved only for Group X. It was shown that extensive self-care knowledge with the help of RPM system improved self-care and helped normalize their glucose levels. The hospital admissions and mortality between the two groups did not differ much. However, the intervention group had more hospital visits than the control group because the participants were requested to visit the hospitals in case of emergency. The users perceived the RPM system as feasible and effective way of clinical management and self-care. Due to wide acceptance, some patients were even willing to continue using the system after the trial. Home measurements proved to be reliable and helped improve self-care. In future, a standardized and unified framework based on rule set would provide comprehensive remote healthcare allowing continuous patient monitoring at a reduced overall cost thereby decreasing mortality rates.
- Full Text:
- Date Issued: 2017
The 'failure-success' dichotomy in migration discourse and practice : revisiting reverse migration deterrents for South Africa based Zimbabwean skilled migrants
- Authors: Nzima, Divane
- Date: 2017
- Subjects: Return migration -- Zimbabwe Return migration -- South Africa Zimbabwe -- Emigration and immigration -- Economic aspects
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/5434 , vital:29243
- Description: The study was conceptualised against the background that leading migration theories explain return migration based on failure and success alone. The neo-classical economics theory of migration perceives return migration as a by-product of a failed migration experience while the new economics of labour migration perceives return as occurring after successful achievement of migration objectives. This study questions these theoretical positions through an exploration of the factors that deter South Africa-based Zimbabwean skilled migrants from returning home permanently notwithstanding a successful or failed migration experience. Furtive economic factors in Zimbabwe and South Africa that dissuade skilled migrants from returning home permanently are explored. Social factors in Zimbabwe and in South Africa that influence return migration decision making are also examined. Furthermore, the study analysed whether and how Zimbabwean skilled migrants are forced into a permanent settlement in South Africa as a result of what this study calls the ‘diaspora trap’. This ‘diaspora trap’ framework argues that Zimbabwean skilled migrants in South Africa do not return following their experiences of failure and success in South Africa. Central to the absence of return is the social construction of migrants as successful in Zimbabwe. Skilled migrants are deterred from returning due to their failure to meet family and communal expectations of success. In addition, return migration is deferred as a means to hide poverty in South Africa. Moreover, new diaspora family ties weaken attachments with Zimbabwe and contribute to deferred return migration. Skilled migrants are thus entrapped in South Africa by their failure to live up to the success social construct and the inability to mitigate adversities in the host country.
- Full Text:
- Date Issued: 2017
- Authors: Nzima, Divane
- Date: 2017
- Subjects: Return migration -- Zimbabwe Return migration -- South Africa Zimbabwe -- Emigration and immigration -- Economic aspects
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/5434 , vital:29243
- Description: The study was conceptualised against the background that leading migration theories explain return migration based on failure and success alone. The neo-classical economics theory of migration perceives return migration as a by-product of a failed migration experience while the new economics of labour migration perceives return as occurring after successful achievement of migration objectives. This study questions these theoretical positions through an exploration of the factors that deter South Africa-based Zimbabwean skilled migrants from returning home permanently notwithstanding a successful or failed migration experience. Furtive economic factors in Zimbabwe and South Africa that dissuade skilled migrants from returning home permanently are explored. Social factors in Zimbabwe and in South Africa that influence return migration decision making are also examined. Furthermore, the study analysed whether and how Zimbabwean skilled migrants are forced into a permanent settlement in South Africa as a result of what this study calls the ‘diaspora trap’. This ‘diaspora trap’ framework argues that Zimbabwean skilled migrants in South Africa do not return following their experiences of failure and success in South Africa. Central to the absence of return is the social construction of migrants as successful in Zimbabwe. Skilled migrants are deterred from returning due to their failure to meet family and communal expectations of success. In addition, return migration is deferred as a means to hide poverty in South Africa. Moreover, new diaspora family ties weaken attachments with Zimbabwe and contribute to deferred return migration. Skilled migrants are thus entrapped in South Africa by their failure to live up to the success social construct and the inability to mitigate adversities in the host country.
- Full Text:
- Date Issued: 2017
Nutrient digestibility in South African abalone (Haliotis Midae L.)
- Authors: Sales, James
- Date: 2002
- Subjects: Abalones -- Digestion Abalones -- Nutrition
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:5305 , http://hdl.handle.net/10962/d1005150
- Description: The evaluation of potential alternative protein sources for the formulation of least-cost optimal diets to satisfy the nutrient requirements of South African abalone (Haliotis midae) has been hampered by the absence of a suitable, practical, replicable and reliable digestibility technique. A suitable lowcost faeces collection technique was developed in this study to obtain suitable quantities of excreta for analysis from this species. Acid-insoluble ash was identified as a reliable, replicable and safe internal marker in comparison to chromic oxide and crude fibre for use in nutrient digestibility studies with H. midae. This was validated by the consistency and repeatability of the results and by comparison to total collection of faeces. The traditional substitution method used in digestibility studies with fish to evaluate protein digestibility of feed ingredients was found to be unsuitable for H. midae. Apparent protein digestibility values exceeding 100 % derived through this method could be attributed to associative effects between feed ingredients, differential diet and faecal nutrient leaching, and mathematical artifacts in calculations when using substitution versus single protein diets. An ingredient particle size of less than 450 μm in comparison to particle size classes of above 450 μm was shown to enhance nutrient (dry matter, organic matter, protein, fat) digestibility and minimise dry matter leaching from diets. The dietary inclusion level of both pre-gelatinised maize starch and a-cellulose did not influence (P > 0.05) apparent nutrient (protein, fat, fiber, starch) digestibility. Using the above digestibility protocol amino acid availability of all plants ingredients currently used in the South African animal industry was evaluated for H. midae. Soybean meal (96.86 %) and lupins (96.51 %) presented the highest apparent mean amino acid availability of all plant protein ingredients evaluated with H. midae. Canola meal (94.21 %), faba beans (92.87 %) sunflower meal (92.77 %), peanut meal (87.39 %) and cottonseed meal (85.15 %) presented higher apparent mean amino acid availability values than fish meal (82.75 %). Apparent protein digestibility was highly correlated (r = 0.99) with mean apparent amino acid availability, while true amino acid availability was 1.88 % units higher than apparent amino acid availability for all ingredients tested. Predicted apparent protein digestibility in compound diets was within 1.1-6.5 % of determined values. Calcium phosphate mono dibasic presented the lowest (P < 0.05) dietary phosphorus leaching (51.51 % maximum) and highest apparent phosphorus digestibility (66.27 %) in comparison to other inorganic phosphorus sources. Based on the method of direct experimentation to determine the optimal dietary protein level using graded levels of dietary protein 28.1-35.9 % dietary protein from good quality sources is recommended for maximum growth of juvenile H. midae. This study provides a scientifically sound research tool including a faecal collection technique, suitable marker and assay technique that could be use in further studies to improve least-cost diet formulation for H. midae. Future nutritional studies in H. midae should primarily concentrate on reducing dietary nutrient leaching and improving the intake of nutrients in order to properly evaluate responses of this species to different dietary regimes.
- Full Text:
- Date Issued: 2002
- Authors: Sales, James
- Date: 2002
- Subjects: Abalones -- Digestion Abalones -- Nutrition
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:5305 , http://hdl.handle.net/10962/d1005150
- Description: The evaluation of potential alternative protein sources for the formulation of least-cost optimal diets to satisfy the nutrient requirements of South African abalone (Haliotis midae) has been hampered by the absence of a suitable, practical, replicable and reliable digestibility technique. A suitable lowcost faeces collection technique was developed in this study to obtain suitable quantities of excreta for analysis from this species. Acid-insoluble ash was identified as a reliable, replicable and safe internal marker in comparison to chromic oxide and crude fibre for use in nutrient digestibility studies with H. midae. This was validated by the consistency and repeatability of the results and by comparison to total collection of faeces. The traditional substitution method used in digestibility studies with fish to evaluate protein digestibility of feed ingredients was found to be unsuitable for H. midae. Apparent protein digestibility values exceeding 100 % derived through this method could be attributed to associative effects between feed ingredients, differential diet and faecal nutrient leaching, and mathematical artifacts in calculations when using substitution versus single protein diets. An ingredient particle size of less than 450 μm in comparison to particle size classes of above 450 μm was shown to enhance nutrient (dry matter, organic matter, protein, fat) digestibility and minimise dry matter leaching from diets. The dietary inclusion level of both pre-gelatinised maize starch and a-cellulose did not influence (P > 0.05) apparent nutrient (protein, fat, fiber, starch) digestibility. Using the above digestibility protocol amino acid availability of all plants ingredients currently used in the South African animal industry was evaluated for H. midae. Soybean meal (96.86 %) and lupins (96.51 %) presented the highest apparent mean amino acid availability of all plant protein ingredients evaluated with H. midae. Canola meal (94.21 %), faba beans (92.87 %) sunflower meal (92.77 %), peanut meal (87.39 %) and cottonseed meal (85.15 %) presented higher apparent mean amino acid availability values than fish meal (82.75 %). Apparent protein digestibility was highly correlated (r = 0.99) with mean apparent amino acid availability, while true amino acid availability was 1.88 % units higher than apparent amino acid availability for all ingredients tested. Predicted apparent protein digestibility in compound diets was within 1.1-6.5 % of determined values. Calcium phosphate mono dibasic presented the lowest (P < 0.05) dietary phosphorus leaching (51.51 % maximum) and highest apparent phosphorus digestibility (66.27 %) in comparison to other inorganic phosphorus sources. Based on the method of direct experimentation to determine the optimal dietary protein level using graded levels of dietary protein 28.1-35.9 % dietary protein from good quality sources is recommended for maximum growth of juvenile H. midae. This study provides a scientifically sound research tool including a faecal collection technique, suitable marker and assay technique that could be use in further studies to improve least-cost diet formulation for H. midae. Future nutritional studies in H. midae should primarily concentrate on reducing dietary nutrient leaching and improving the intake of nutrients in order to properly evaluate responses of this species to different dietary regimes.
- Full Text:
- Date Issued: 2002
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