A best-practice guideline for facilitating adherence to anti-retroviral therapy for persons attending public hospitals in Ghana
- Authors: Agyeman-Yeboah, Joana
- Date: 2017
- Subjects: HIV infections -- Treatment -- Ghana , Health services administration -- Ghana Public health -- Ghana Hospital care -- Ghana
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/13603 , vital:27256
- Description: The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.
- Full Text:
- Date Issued: 2017
- Authors: Agyeman-Yeboah, Joana
- Date: 2017
- Subjects: HIV infections -- Treatment -- Ghana , Health services administration -- Ghana Public health -- Ghana Hospital care -- Ghana
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/13603 , vital:27256
- Description: The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.
- Full Text:
- Date Issued: 2017
The selection and evaluation of a sensory technology for interaction in a warehouse environment
- Zadeh, Seyed Amirsaleh Saleh, Greyling, Jean
- Authors: Zadeh, Seyed Amirsaleh Saleh , Greyling, Jean
- Date: 2016
- Subjects: Human-computer interaction User interfaces (Computer systems) Computer architecture
- Language: English
- Type: Thesis , Masters , MCom
- Identifier: http://hdl.handle.net/10948/13193 , vital:27160
- Description: In recent years, Human-Computer Interaction (HCI) has become a significant part of modern life as it has improved human performance in the completion of daily tasks in using computerised systems. The increase in the variety of bio-sensing and wearable technologies on the market has propelled designers towards designing more efficient, effective and fully natural User-Interfaces (UI), such as the Brain-Computer Interface (BCI) and the Muscle-Computer Interface (MCI). BCI and MCI have been used for various purposes, such as controlling wheelchairs, piloting drones, providing alphanumeric inputs into a system and improving sports performance. Various challenges are experienced by workers in a warehouse environment. Because they often have to carry objects (referred to as hands-full) it is difficult to interact with traditional devices. Noise undeniably exists in some industrial environments and it is known as a major factor that causes communication problems. This has reduced the popularity of using verbal interfaces with computer applications, such as Warehouse Management Systems. Another factor that effects the performance of workers are action slips caused by a lack of concentration during, for example, routine picking activities. This can have a negative impact on job performance and allow a worker to incorrectly execute a task in a warehouse environment. This research project investigated the current challenges workers experience in a warehouse environment and the technologies utilised in this environment. The latest automation and identification systems and technologies are identified and discussed, specifically the technologies which have addressed known problems. Sensory technologies were identified that enable interaction between a human and a computerised warehouse environment. Biological and natural behaviours of humans which are applicable in the interaction with a computerised environment were described and discussed. The interactive behaviours included the visionary, auditory, speech production and physiological movement where other natural human behaviours such paying attention, action slips and the action of counting items were investigated. A number of modern sensory technologies, devices and techniques for HCI were identified with the aim of selecting and evaluating an appropriate sensory technology for MCI. iii MCI technologies enable a computer system to recognise hand and other gestures of a user, creating means of direct interaction between a user and a computer as they are able to detect specific features extracted from a specific biological or physiological activity. Thereafter, Machine Learning (ML) is applied in order to train a computer system to detect these features and convert them to a computer interface. An application of biomedical signals (bio-signals) in HCI using a MYO Armband for MCI is presented. An MCI prototype (MCIp) was developed and implemented to allow a user to provide input to an HCI, in a hands-free and hands-full situation. The MCIp was designed and developed to recognise the hand-finger gestures of a person when both hands are free or when holding an object, such a cardboard box. The MCIp applies an Artificial Neural Network (ANN) to classify features extracted from the surface Electromyography signals acquired by the MYO Armband around the forearm muscle. The MCIp provided the results of data classification for gesture recognition to an accuracy level of 34.87% with a hands-free situation. This was done by employing the ANN. The MCIp, furthermore, enabled users to provide numeric inputs to the MCIp system hands-full with an accuracy of 59.7% after a training session for each gesture of only 10 seconds. The results were obtained using eight participants. Similar experimentation with the MYO Armband has not been found to be reported in any literature at submission of this document. Based on this novel experimentation, the main contribution of this research study is a suggestion that the application of a MYO Armband, as a commercially available muscle-sensing device on the market, has the potential as an MCI to recognise the finger gestures hands-free and hands-full. An accurate MCI can increase the efficiency and effectiveness of an HCI tool when it is applied to different applications in a warehouse where noise and hands-full activities pose a challenge. Future work to improve its accuracy is proposed.
- Full Text:
- Date Issued: 2016
- Authors: Zadeh, Seyed Amirsaleh Saleh , Greyling, Jean
- Date: 2016
- Subjects: Human-computer interaction User interfaces (Computer systems) Computer architecture
- Language: English
- Type: Thesis , Masters , MCom
- Identifier: http://hdl.handle.net/10948/13193 , vital:27160
- Description: In recent years, Human-Computer Interaction (HCI) has become a significant part of modern life as it has improved human performance in the completion of daily tasks in using computerised systems. The increase in the variety of bio-sensing and wearable technologies on the market has propelled designers towards designing more efficient, effective and fully natural User-Interfaces (UI), such as the Brain-Computer Interface (BCI) and the Muscle-Computer Interface (MCI). BCI and MCI have been used for various purposes, such as controlling wheelchairs, piloting drones, providing alphanumeric inputs into a system and improving sports performance. Various challenges are experienced by workers in a warehouse environment. Because they often have to carry objects (referred to as hands-full) it is difficult to interact with traditional devices. Noise undeniably exists in some industrial environments and it is known as a major factor that causes communication problems. This has reduced the popularity of using verbal interfaces with computer applications, such as Warehouse Management Systems. Another factor that effects the performance of workers are action slips caused by a lack of concentration during, for example, routine picking activities. This can have a negative impact on job performance and allow a worker to incorrectly execute a task in a warehouse environment. This research project investigated the current challenges workers experience in a warehouse environment and the technologies utilised in this environment. The latest automation and identification systems and technologies are identified and discussed, specifically the technologies which have addressed known problems. Sensory technologies were identified that enable interaction between a human and a computerised warehouse environment. Biological and natural behaviours of humans which are applicable in the interaction with a computerised environment were described and discussed. The interactive behaviours included the visionary, auditory, speech production and physiological movement where other natural human behaviours such paying attention, action slips and the action of counting items were investigated. A number of modern sensory technologies, devices and techniques for HCI were identified with the aim of selecting and evaluating an appropriate sensory technology for MCI. iii MCI technologies enable a computer system to recognise hand and other gestures of a user, creating means of direct interaction between a user and a computer as they are able to detect specific features extracted from a specific biological or physiological activity. Thereafter, Machine Learning (ML) is applied in order to train a computer system to detect these features and convert them to a computer interface. An application of biomedical signals (bio-signals) in HCI using a MYO Armband for MCI is presented. An MCI prototype (MCIp) was developed and implemented to allow a user to provide input to an HCI, in a hands-free and hands-full situation. The MCIp was designed and developed to recognise the hand-finger gestures of a person when both hands are free or when holding an object, such a cardboard box. The MCIp applies an Artificial Neural Network (ANN) to classify features extracted from the surface Electromyography signals acquired by the MYO Armband around the forearm muscle. The MCIp provided the results of data classification for gesture recognition to an accuracy level of 34.87% with a hands-free situation. This was done by employing the ANN. The MCIp, furthermore, enabled users to provide numeric inputs to the MCIp system hands-full with an accuracy of 59.7% after a training session for each gesture of only 10 seconds. The results were obtained using eight participants. Similar experimentation with the MYO Armband has not been found to be reported in any literature at submission of this document. Based on this novel experimentation, the main contribution of this research study is a suggestion that the application of a MYO Armband, as a commercially available muscle-sensing device on the market, has the potential as an MCI to recognise the finger gestures hands-free and hands-full. An accurate MCI can increase the efficiency and effectiveness of an HCI tool when it is applied to different applications in a warehouse where noise and hands-full activities pose a challenge. Future work to improve its accuracy is proposed.
- Full Text:
- Date Issued: 2016
Characterisation of the plasmodium falciparum Hsp40 chaperones and their partnerships with Hsp70
- Authors: Botha, Melissa
- Date: 2009
- Subjects: Heat shock proteins Plasmodium falciparum Protein folding Molecular chaperones Malaria
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3938 , http://hdl.handle.net/10962/d1003997
- Description: Central to this research, 40 kDa Heat shock proteins (Hsp40s) are known to partner (or cochaperone) 70 kDa Heat shock proteins (Hsp70s), facilitating the selection and transfer of protein substrate to Hsp70 and the stimulation of the protein folding ability of Hsp70. Members of the diverse Hsp70-Hsp40 protein complement of Plasmodium falciparum have been implicated in the cytoprotection of this malaria parasite, and are thought to facilitate the protein folding, assembly and translocation tasks required by the parasite to commandeer the infected human erythrocyte subsequent to invasion. In particular, the parasite has evolved an expanded and specialised 43- member suite of Hsp40 proteins, 19 of which bear an identifiable export motif for secretion into the infected erythrocyte cytoplasm where they potentially interact with human Hsp70. Although type I Hsp40 proteins are representative of typical regulators of Hsp70 activity, only two of these proteins are apparent in the parasite’s Hsp40 complement. These include a characteristic type I Hsp40 termed PfHsp40, and a larger, atypical type I Hsp40 termed Pfj1. Both Hsp40 proteins are predicted to be parasite-resident and are most likely to facilitate the co-chaperone regulation of the highly abundant and stress-inducible Hsp70 homolog, PfHsp70-I. In this work, the co-chaperone functionality of PfHsp40 and Pfj1 was elucidated using in vivo and in vitro assays. Purified recombinant PfHsp40 was shown to stimulate the ATPase activity of PfHsp70-I in in vitro single turnover and steady state ATPase assays, and co-operate with PfHsp70-I in in vitro aggregation suppression assays. In these in vitro assays, heterologous partnerships could be demonstrated between PfHsp70-I and the human Hsp40, Hsj1a, and human Hsp70 and PfHsp40, suggesting a common mode of Hsp70-Hsp40 interaction in the parasite and host organism. The functionality of the signature Hsp40 domain, the Jdomain, of Pfj1 was demonstrated by its ability to replace the equivalent domain of the A. tumefaciens Hsp40, Agt DnaJ, in interactions with the prokaryotic Hsp70, DnaK, in the thermosensitive dnaJ cbpA E. coli OD259 deletion strain. An H33Q mutation introduced into the invariant and crucial HPD tripeptide motif abrogated the functionality of the J-domain in the in vivo complementation system. These findings provide the first evidence for the conservation of the prototypical mode of J-domain based interaction of Hsp40 with Hsp70 in P. falciparum. Immunofluorescence staining revealed the localisation of PfHsp40 to the parasite cytoplasm, and Pfj1 to the parasite cytoplasm and nucleus in cultured intraerythrocytic stage P. falciparum parasites. PfHsp70-I was also shown to localise to the parasite cytoplasm and nucleus in these stages, consistent with the literature. Overall we propose that PfHsp40 and Pfj1 co-localise with and regulate the chaperone activity of PfHsp70-I in P. falciparum. This is the first study to identify and provide evidence for a functional Hsp70-Hsp40 partnership in P. falciparum, and provides a platform for future studies to elucidate the importance of these chaperone partnerships in the establishment and survival of the parasite in the intraerythrocytic-stages of development.
- Full Text:
- Date Issued: 2009
- Authors: Botha, Melissa
- Date: 2009
- Subjects: Heat shock proteins Plasmodium falciparum Protein folding Molecular chaperones Malaria
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3938 , http://hdl.handle.net/10962/d1003997
- Description: Central to this research, 40 kDa Heat shock proteins (Hsp40s) are known to partner (or cochaperone) 70 kDa Heat shock proteins (Hsp70s), facilitating the selection and transfer of protein substrate to Hsp70 and the stimulation of the protein folding ability of Hsp70. Members of the diverse Hsp70-Hsp40 protein complement of Plasmodium falciparum have been implicated in the cytoprotection of this malaria parasite, and are thought to facilitate the protein folding, assembly and translocation tasks required by the parasite to commandeer the infected human erythrocyte subsequent to invasion. In particular, the parasite has evolved an expanded and specialised 43- member suite of Hsp40 proteins, 19 of which bear an identifiable export motif for secretion into the infected erythrocyte cytoplasm where they potentially interact with human Hsp70. Although type I Hsp40 proteins are representative of typical regulators of Hsp70 activity, only two of these proteins are apparent in the parasite’s Hsp40 complement. These include a characteristic type I Hsp40 termed PfHsp40, and a larger, atypical type I Hsp40 termed Pfj1. Both Hsp40 proteins are predicted to be parasite-resident and are most likely to facilitate the co-chaperone regulation of the highly abundant and stress-inducible Hsp70 homolog, PfHsp70-I. In this work, the co-chaperone functionality of PfHsp40 and Pfj1 was elucidated using in vivo and in vitro assays. Purified recombinant PfHsp40 was shown to stimulate the ATPase activity of PfHsp70-I in in vitro single turnover and steady state ATPase assays, and co-operate with PfHsp70-I in in vitro aggregation suppression assays. In these in vitro assays, heterologous partnerships could be demonstrated between PfHsp70-I and the human Hsp40, Hsj1a, and human Hsp70 and PfHsp40, suggesting a common mode of Hsp70-Hsp40 interaction in the parasite and host organism. The functionality of the signature Hsp40 domain, the Jdomain, of Pfj1 was demonstrated by its ability to replace the equivalent domain of the A. tumefaciens Hsp40, Agt DnaJ, in interactions with the prokaryotic Hsp70, DnaK, in the thermosensitive dnaJ cbpA E. coli OD259 deletion strain. An H33Q mutation introduced into the invariant and crucial HPD tripeptide motif abrogated the functionality of the J-domain in the in vivo complementation system. These findings provide the first evidence for the conservation of the prototypical mode of J-domain based interaction of Hsp40 with Hsp70 in P. falciparum. Immunofluorescence staining revealed the localisation of PfHsp40 to the parasite cytoplasm, and Pfj1 to the parasite cytoplasm and nucleus in cultured intraerythrocytic stage P. falciparum parasites. PfHsp70-I was also shown to localise to the parasite cytoplasm and nucleus in these stages, consistent with the literature. Overall we propose that PfHsp40 and Pfj1 co-localise with and regulate the chaperone activity of PfHsp70-I in P. falciparum. This is the first study to identify and provide evidence for a functional Hsp70-Hsp40 partnership in P. falciparum, and provides a platform for future studies to elucidate the importance of these chaperone partnerships in the establishment and survival of the parasite in the intraerythrocytic-stages of development.
- Full Text:
- Date Issued: 2009
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