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A Framework for Sustainable Implementation of E-Medicine in Transitioning Countries
Stephen Robert Isabalija,Victor Mbarika,Geoffrey Mayoka Kituyi
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/615617
Abstract: Organizations in developed countries such as the United States of America and Canada face difficulties and challenges in technology transfer from one organization to another; the complexity of problems easily compounds when such transfers are attempted from developed to developing countries due to differing socioeconomic and cultural environments. There is a gap in the formation of research and education programs to address technology transfer issues that go beyond just transferring the technologies to sustaining such transfers for longer periods. This study examined telemedicine transfer challenges in three Sub-Sahara African countries and developed a framework for sustainable implementation of e-medicine. Both quantitative and qualitative research methods were used. The study findings indicate that e-medicine sustainability in Sub-Saharan Africa is affected by institutional factors such as institutional environment and knowledge management practices; technical factors such as the technological environment and technology transfer project environment; social environmental factors such as social environment and donor involvement. These factors were used to model the proposed framework. 1. Introduction Healthcare is unarguably one of the most fundamental needs for Sub-Saharan Africa (SSA), considering the region’s multiple medical problems. The health statistics of SSA are deplorable. The academic and practitioner literature report many medical problems of SSA. Yet SSA is the most vulnerable to disease, given the prevalent social, economic, and environmental factors. For instance, the World Health Organization (WHO) reports that by the end of year 2009, over 32.9 million people worldwide were living with HIV/AIDS. Out of these, 22 million (approximately 68%) live in SSA [1]. By the end of year 2009, the percentages of people living with HIV/AIDS in Botswana, Central African Republic, and Swaziland were still the highest in the world [1, 2]. Further to the above, out of the estimated 9.7 million number of children under the age of five who die every year due to lack of access to medical facilities worldwide, 41% live in SSA. Research shows that malaria is responsible for as many as half the deaths of African children under the age of five. This disease kills more than one million children (2,800 per day) each year in Africa alone. In regions of intense transmission, 40% of toddlers may die of acute malaria. In most malaria cases, however, there is a good chance of survival if timely and appropriate medical attention is provided. Other diseases that plague
Matrices That Commute with Their Conjugate and Transpose  [PDF]
Geoffrey Goodson
Advances in Linear Algebra & Matrix Theory (ALAMT) , 2013, DOI: 10.4236/alamt.2013.33005

It is known that if A∈Mn is normal (AA*=A*A) , then AA ̄=A ̄A if and only if AAT=ATA. This leads to the question: do both AA ̄=A ̄A and AAT=ATA imply that A is normal? We give an example to show that this is false when n=4, but we show that it is true when n=2 and n=3.

Postoperative Pain Management: Clinicians’ Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital.
WP Kituyi, KK Imbaya, JO Wambani, TM Sisenda, RT Kuremu
East and Central African Journal of Surgery , 2011,
Abstract: Background: Pain is the cardinal symptom common to diverse disease conditions and it is what drives many patients to seek treatment. It, therefore, commands a central position in health seeking behavior. In the post-operative period, the main concern about pain is not only the suffering it causes, but also because of its negative effects on the process of recovery. Its management has, however, remained a major challenge. Numerous myths and insufficient knowledge of pain assessment, measurement and treatment contribute to the challenges encountered by health providers in their service to patients. This study was aimed at determining the knowledge and practices among clinicians who manage postsurgical pain in a hospital setting at The Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. It was a cross-sectional survey. Methods: The study population consisted of Nurses, Clinical Officers and Doctors working in the post-operative areas at MTRH. A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of diverse objective questions set according to internationally recognized pain assessment instruments. Results: Among the 236 health care professionals who were included in the study, 38 (16%) were doctors, 170 (72%) nurses and 28 (12%) clinical officers. On average the duration of time since they were engaged as healthcare providers was 9.3 years (SD=+6.7yrs). Almost all (96%) confirmed that they routinely managed post-operative pain. Clinicians who indicated that they had knowledge on how to assess and manage postoperative pain constituted 88%. Among doctors, 54% felt that they had sufficient knowledge to recognize and manage post-operative pain while the proportions of nurses and clinical officers were 41% and 43% respectively. Fifty seven percent of the participants indicated that they had inadequate knowledge regarding the tools that may be employed for pain assessment and measurement. Those who had never had any formal teaching in relation to pain evaluation and management constituted 21%. Conclusion: Overall, a significant proportion of clinicians indicated an inadequacy of knowledge regarding objective evaluation and management of post-operative pain.
Groups Having Elements Conjugate to Their Squares and Connections with Dynamical Systems  [PDF]
Geoffrey R. Goodson
Applied Mathematics (AM) , 2010, DOI: 10.4236/am.2010.15055
Abstract: In recent years, dynamical systems which are conjugate to their squares have been studied in ergodic theory. In this paper we study the consequences of groups having elements which are conjugate to their squares and consider examples arising from topological dynamics and more general dynamical systems
Pharmacological Adjuvants to Limit Erythropoietin Stimulating Agents Exposure  [PDF]
Iqbal Masood, Geoffrey Teehan
Open Journal of Nephrology (OJNeph) , 2012, DOI: 10.4236/ojneph.2012.24015
Abstract: Anemia in chronic kidney disease (CKD) is common, causing morbidity and mortality, and is primarily due to reduced erythropoietin (EPO) release and, to a lesser degree, shortened red cell survival. Erythropoietin Stimulating Agents like epoetin Alfa and darbepoetin alpha are used commonly to treat this form of anemia. Recent evidence suggests increased morbidity and mortality associated with higher hemoglobin in the setting of these agents use. Whether these complications are due to higher dose of erythropoietin or its resistance (i.e. inflammation), or achieving a higher hemoglobin remains unclear. Tightening restrictions on these agents has led to increase interest in the use of non-ESA adjuvants to improve erythropoiesis. This review will highlight the most promising of these agents.
A Case of Type I Hepatorenal Syndrome Treated with Vasopressin  [PDF]
Laura Connor, Geoffrey Teehan
Open Journal of Nephrology (OJNeph) , 2013, DOI: 10.4236/ojneph.2013.33025

Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. Vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient’s chance of survival.

Forensic odontostomatology  [PDF]
Geoffrey H. Sperber
Forensic Medicine and Anatomy Research (FMAR) , 2013, DOI: 10.4236/fmar.2013.14019
Abstract: Teeth are the most durable and enduring structures of human anatomy, surviving fragmentation, partial incineration and severe decomposition. The role of teeth in identification is manifested as significant specifiers of deceased or living individuals. The characteristics of dentalmorphology are genetically-inherited and ascribable to racial or familial ancestry. Dental age identification is attributable to young individuals. The chemical composition of teeth identifies diets during life, as attritional wear patterns do. Bite marks transiently relate to the perpetrator of attacks. Dental restorations and prostheses are evidence of economic, cultural and social status of deceased individuals. Palatal rugae patterns are unique to individuals. The DNA identification of postmortem dental pulp tissue relating to a deceased individual or a living relative is the ultimate criterion of positive association of forensic recognition, as other means of identification become less effective, forensic dental identification increases in importance.
Letter to the Editor  [PDF]
Geoffrey H. Sperber
Forensic Medicine and Anatomy Research (FMAR) , 2013, DOI: 10.4236/fmar.2013.14012
Abstract: Letter to the Editor; Forensic Medicine and Anatomy Research
Manufacture of a Low Oxalate Mitsumame-Type Dessert Using Rhubarb Juice and Calcium Salts  [PDF]
Sophie Faudon, Geoffrey Savage
Food and Nutrition Sciences (FNS) , 2014, DOI: 10.4236/fns.2014.517174
Abstract: Rhubarb (Rheum rhabarbarum) juice was used to make a Japanese soft mitsumame-type dessert sweet. The dessert was prepared from extracted rhubarb juice, which was cooked with sugar, agar and guar gum, then allowed to set in sweet moulds. The total, soluble and insoluble oxalates were determined in the ingredients and the final products using HPLC chromatography. To reduce the soluble oxalate content of the dessert while retaining the colour and taste of the final product, increments of CaCl2 and CaCO3 were added to the test dessert mixes. The addition of CaCl2 reduced the pH from 3.55 ± 0.03 to pH 3.09 ± 0.02 while addition of CaCO3 increased the pH from 3.55 ± 0.03 to 4.96 ± 0.01. In both cases, the incremental addition of calcium reduced the soluble oxalate content of the sweets by converting it to insoluble oxalate.
Calcium and Oxalate Contents of Curly Leaf ( Petroselinum crispum) and Flat Leaf ( P. crispum var. neapolitanum ) Parsley Cultivars  [PDF]
Geoffrey Savage, Leo Vanhanen
Food and Nutrition Sciences (FNS) , 2015, DOI: 10.4236/fns.2015.616161
Abstract: The total, soluble and insoluble oxalate contents of the leaves and stems of curly leaf (Petroselinum crispum) and flat leaf (P. crispum var. neapolitanum) parsley cultivars were extracted from fresh tissue and measured using HPLC chromatography. There were no significant differences between the total and insoluble oxalate contents of the leaves between the flat leaf and curly leaf cultivars. There was a small difference (P < 0.05) between the soluble oxalate contents of the leaves of the two cultivars. The mean total, soluble and insoluble oxalates of the leaves of the two cultivars were 1137.0, 177.9 and 959.3 mg/100 g dry matter (DM), respectively. The mean total, soluble and insoluble oxalate contents of the stems were 1680.7, 386.2 and 1294.5 mg/100 g DM, respectively, and these were significantly higher than the mean values for the leaves of the two cultivars. Insoluble oxalate made up a mean of 77.0% of the curly leaf stems and leaves compared to a mean of 84.4% found in the flat-leaved cultivar. Unavailable calcium, that is, calcium bound to oxalate as insoluble oxalate, made up a mean of 26.9% of the total calcium in the leaves of both cultivars while the unavailable calcium made up 45.0% of the total calcium in the stems of the two cultivars. Overall, the oxalate contents of both parsley cultivars are relatively high, on a dry matter basis, but their overall contribution to dietary intake is likely to be quite small as parsley is an herb that is only used in small amounts to garnish foods.
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