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Home > Palliative Care for People Living With Hiv/Aids in Uganda: An Investigation of Patients &Amp; Caregiver’S Outcome and Professional Perspectives

Palliative Care for People Living With Hiv/Aids in Uganda: An Investigation of Patients &Amp; Caregiver’S Outcome and Professional Perspectives

Thesis Info

Author

Too, Wesley

Department

School of Nursing and Midwifery, East Africa

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2011

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728056552

Similar


Background: Although antiretroviral treatment is expanding in sub-Saharan Africa, the World Health Organization advocates for integration of palliative care with HAART because pain, other distressing symptoms and complex psychosocial challenges persist throughout the HIV trajectory. Palliative care improves the outcome for patients with HIV and may complement antiretroviral treatment by increasing adherence through better management of side effects from the treatment, providing patient and family-centred holistic care, and giving end-of-life care when necessary. However, integrating what have become two disciplines is challenging. Aim: To study the implications for palliative care provision in the context of changing policy to universal access to HAART for people living with advanced AIDS (PLWA) in Uganda. Research questions addressed in the study included: 1. How do patients with advanced AIDS (stage 1Il and IV) and with palliative care needs and their families experience care delivery and receipt over a period of 8 weeks? 2. How is the morphine roll-out programme among advanced AIDS patients operationalized in Uganda? 3. What are the challenges faced by health care workers involved in delivery and implementation of integrated palliative care for patients with advanced AIDS? 4. What are the views of key opinion leaders on development of palliative care policies in Uganda? Methods: A mixed methods approach was employed. The study comprised of three phases. In phase one, a consecutive sample of 30 newly enrolled patients advanced AIDS (stage III & IV) and their carers were recruited at Hospice Africa Uganda and followed up for 8 weeks. Qualitative interviews were conducted with patients and their carers at one time point and an outcome measure using African Palliative Care Association-Palliative Outcome Scale (APeA-POS) was used to assess changes in their experiences over 8 weeks, following access to palliative care. In phase two, 10 palliative care staff members participated in individual interviews and one focus group to explore the challenges they faced in delivering services to patients. Phase three explored, by the use of interviews with 7 key stakeholders, the broader context of palliative care policy development and opinions about key priorities for the future. Findings: Out of 30 patients, 14 were male and 16 were female. They ranged in age from 18-60 years. The majority of patients were bed-ridden and experienced distressing symptoms related to advanced AIDS and AIDS-defining cancers which necessitated timely palliative care intervention. The key findings of the study relate to the range of physical symptoms experienced
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سدرہ کا مکیں چومے سرکارؐ کے قدموں کو


سدرہ کا مکیں چومے سرکارؐ کے قدموں کو
جبریلِ امیں چومے سرکارؐ کے قدموں کو

سدرہ سے بھی آگے کی رفعت کو چھو آئے
جو خاک نشیں چومے سرکارؐ کے قدموں کو

آفاق بھی کیوں رہتے محروم سعادت سے
جب روئے زمیں چومے سرکارؐ کے قدموں کو

قبلہ کبھی اقصیٰ سے کعبہ نہیں ہو سکتا
جب تک نہ جبیں چومے سرکارؐ کے قدموں کو

سلمانؓ کی قسمت میں برسوں کی مسافت تھی
صدیقؓ وہیں چومے سرکارؐ کے قدموں کو

عرفانؔ کی پلکوں کی حسرت ہی رہی لیکن
طیبہ کی زمیں چومے سرکارؐ کے قدموں کو

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Improved Matrix Pencil Methods for Parameters Estimation of Plane Wave Signals

The problem of parameters estimation of plane wave signals using an array of sen- sors has received a considerable attention from researchers and engineers during the last few decades. In general, the parameters of interest are the frequencies and direction-of-arrivals of incoming signals. Although, a number of methods have been proposed in literature, the subspace-based methods including MUSIC and ESPRIT are widely used to estimate the required parameters because of their relatively less computational cost and high resolution. In the presence of coher- ent signals, these covariance-based methods require an additional step of spatial smoothing. Another subspace based method is Matrix Pencil method that is a direct data domain method and analyzes the data on snapshot by snapshot bases; consequently, a non-stationary environment can be handled, easily. Moreover, Ma- trix Pencil method is directly applicable in scenarios where the input signals are fully correlated or coherent since it implicitly performs spatial smoothing while constructing the data matrix. The main focus in this thesis is on several improve- ments to the existing Matrix Pencil methods (especially related to reduction in computational complexity with comparable estimation accuracy). First of all, in Matrix Pencil method it is commonly assumed that noise is spatially uncorrelated. In the presence of correlated noise, matrix pencil method often fails to yield unbiased estimates of required parameters since the signal sub- space estimated through singular value decomposition of the (noisy) data matrix is biased. To combat with spatially correlated noise, we proposed a Generalized Matrix Pencil method which utilizes a generalized singular value decomposition to obtain unbiased estimates of the required parameters. Since, parameters estimation of plane wave signals is a real-time problem, it is vital to maintain the computational burden of parameters estimation algorithms as low as possible. Many efforts have already been made to minimize the com- putational burden of exiting methods. In the context of Matrix Pencil method algorithms, the (existing) Unitary Matrix Pencil method reduces the computa- tional complexity to about one-fourth by converting the complex data matrix in Matrix Pencil method into a real matrix using a unitary matrix transformation. If some a priori information about direction-of-arrival or frequency of incoming signals is available, as in radar and sonar applications, then a reduced dimensional processing of covariance/data matrix is possible. For such scenarios, a number of researchers have proposed the beamspace approach, which first projects the original data into a subspace of lower dimensions (using DFT) and then processes the beamspace data by using well known algorithms such as MUSIC and ESPRIT. In order to reduce the computational complexity of Matrix Pencil based algorithms, we propose Beamspace Matrix Pencil methods that transform the complex data matrix into a real and reduced dimensional matrix using selected rows of a DFT matrix. Depending upon the number of selected rows, the computational burden is reduced several times with comparable estimation accuracy to that of existing methods. Moreover, if there is no a priori information available then Beamspace technique can be applied via parallel processing with overlapped sectors as can be done in the case of Beamspace MUSIC and ESPRIT. 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This system is subsequently used to compare the performance of various Matrix Pencil methods for real-world data. Key words: Sensor array, array signal processing, direction-of-arrival estimation, parameters estimation, plane wave signals, coherent signals, spatially correlated noise, subspace based method, computational complexity, unitary matrix pencil, beamspace matrix pencil, DFT transformation, multiple invariance, multiple snap- shot matrix pencil, automatic grouping, comparison analysis, real-world data.