This research report is presented to the University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / BACKGROUND: The game of cricket requires the repetitive use of the upper limbs in batting, bowling and fielding. Shoulder injuries are prevalent in cricket players with the most common activities causing injury being fielding and bowling. There is no research on pectoralis minor muscle length in cricketers or the role that the throwing arc range of movement (ROM) plays in shoulder injuries, in a male only cricket population older than 18 years of age. OBJECTIVE: The objective of this study was to determine if there is an association between shoulder rotation ROM, throwing arc ROM, pectoralis minor muscle length, and incidence of shoulder injury, as monitored in the first three months of a cricket season METHOD: This was a prospective, observational cohort study. Thirty six male, provincial and club cricket players, with and without shoulder pain, were recruited. Shoulder internal rotation ROM, external rotation ROM and pectoralis minor muscle length test distance were measured at the beginning of a cricket season and during the first three weeks of the in-season. Glenohumeral internal rotation deficit (GIRD), external rotation gain (ERG) and throwing arc ROM were calculated from these measurements. The incidence of injury was monitored for three months. Comparisons were made between the injured and uninjured groups. Parametric data were analysed using independent t-tests and paired t-tests. Non-parametric data were analysed with the Mann-Whitney U tests, chi-squared tests and Sign tests. A logistic regression model was used to determine the relationship between variables. RESULTS: Thirty six participants were recruited and underwent the baseline testing procedure, although only thirty two participants’ data were analysed. During the study, four participants were not exposed to the typical cricket training and match workloads and were therefore excluded from the study. The mean age of participants was 23.56 (SD ± 4.27) years. Nine participants (28%) sustained dominant shoulder injuries and twenty-three (72%) remained uninjured. The presence of initial shoulder pain at rest, during or after training (p = 0.007) at the beginning of the season occurred in six participants who sustained shoulder injuries during the season. There were no statistically significant differences between the injured and uninjured group in any of the other variables. All pre-season measurements in the entire group were significantly different between the dominant and non-dominant upper limb. The external rotation ROM (p = 0.0037) was increased on the dominant side and the internal rotation ROM (p < 0.0001), throwing arc ROM (p = 0.016) and pectoralis minor muscle length (p = 0.0001) (decreased pectoralis minor length test distance) was increased on the non-dominant side. In the injured group, there was no significant difference between dominant and non-dominant measurements. The uninjured group had a smaller dominant internal rotation ROM (p = 0.0001), throwing arc ROM (p = 0.005) and pectoralis minor muscle length (p = 0.0002) (larger pectoralis minor length test distance) which was statistically significantly different to the non-dominant shoulder. A logistic regression analysis found no association between the variables and injury. CONCLUSION: Shoulder pain at the beginning of the season may be a precursor to shoulder injuries in cricket players. The presence of pain should be questioned during the pre-season screening, so that preventative programmes may be put into place to prevent shoulder injuries which result in time out of play. Asymmetries were found in the uninjured group with internal rotation ROM, throwing arc ROM and pectoralis minor muscle length although, no asymmetries existed in the injured group. These asymmetries may have a protective role in injury prevention whereas, non-asymmetries (as seen in the injured participants) may precipitate dominant shoulder injuries. / MT2017

Thesis (M. Sc. (Botany)) -- University of the North, 1999 / Refer to the document

Gun violence and violent injury are major concerns in our society today, especially in urban settings. Research has demonstrated that there are specific risk factors for violent gun injury among men, but literature in this area has historically disregarded women. Previous research on men found that participation in criminal activities significantly increases risk of violent injury, but it is unknown whether criminal behaviour increases the risk of violent victimization in women. This study aims to determine whether criminal arrests differ significantly between violently injured women and women in the general population. To pursue this aim, rates of gun, drug, property, violent, and prostitution crime arrests were compared between women treated for violent injuries at a Level I Trauma Centre and women in the community at large. Chi-square analyses found that violently injured women are significantly more likely to have criminal arrests than women in the comparison population, indicating that criminal behaviour may be an important risk factor for violent injury in women. Supplementary analyses found that violent crimes contribute uniquely to the risk of violent injury in comparison to other crimes. Implications for female victims of violence are discussed. / 1 / Samia Lalani

No description available.

Information from injury data collections is widely used to formulate injury policy, evaluate injury prevention initiatives and to allocate resources to areas deemed a high priority. Obtaining quality data from injury surveillance is essential to ensure the appropriateness of these activities. This thesis seeks to develop a framework to assess the capacity of an injury data collection to perform injury surveillance and to use this framework to assess the capacity of both injury mortality and morbidity data collections in New South Wales (NSW) Australia to perform work-related or motor vehicle crash (MVC)-related injury surveillance. An Evaluation Framework for Injury Surveillance Systems (EFISS) was developed through a multi-staged process, using information from the literature to identify surveillance system characteristics, SMART criteria to assess the suitability of these characteristics to evaluate an injury data collection, and by obtaining feedback on the characteristics from a panel of surveillance experts using a two round modified Delphi study. At the conclusion of development, there were 18 characteristics, consisting of 5 data quality, 9 operational, and 4 practical characteristics, that were identified as important for inclusion within an EFISS. In addition, a rating system was created for the EFISS characteristics, based on available evidence and reasonable opinion. The evaluation of six injury data collections using the EFISS for their capacity to perform either work- or MVC-related injury surveillance illustrated the inability of any of the data collections to enumerate all cases of either work- or MVC-related injury mortality or morbidity in NSW or to capture all of the data considered necessary for work- or MVC-related injury surveillance. This evaluation has identified areas for improvement in all data collections and has demonstrated that for both work- and MVC-related injury surveillance that multiple collections should be reviewed to inform both work- and MVC-related policy development and injury prevention priority setting in NSW. The development of an EFISS has built upon existing evaluation guidelines for surveillance systems and provides an important step towards the creation of a framework specifically tailored to evaluate an injury data collection. Information obtained through an evaluation conducted using an EFISS would be useful for agencies responsible for injury data collections to identify where these collections could be improved to increase their usefulness for injury surveillance, and ultimately, for injury prevention.

The aim of this study was to improve current counselling services at the Auckland Spinal Unit. This purpose was achieved by co-researching the topic with people who have extensive experience of living in the community with a spinal cord injury to reveal what they believe was helpful, or believe would have been helpful, in terms of the counselling, when they were newly injured. Listening to the stories of the research participants, through supervision of my own practice, doing a literature review and writing a journal became sources that provided rich knowledges to reflect on my current counselling practice. A qualitative study was conducted using aspects of action research, feminist research and post-structuralist methods. In November 2005, an information pack was mailed to the sixteen patients who had been discharged from the Auckland Spinal Unit between June 2002 and June 2004, who were under the age of sixty -five and lived in the Auckland area, inviting them to participate in this research. Seven people agreed and were available to participate. I interviewed these seven participants, using unstructured interviews. All the interviews were audio-taped and then transcribed verbatim. These verbatim transcripts were then sent back to the participants for any additions/deletions/alterations they chose to make. To initiate the reflecting process, I then went through all the interviews and identified common themes. I understand that if the research participants had been involved in this process, other themes might have emerged for them. The themes identified were loss and grief as a result of a spinal cord injury, sexuality, family (whanau) involvement and how counselling services should be positioned in a setting such as the Auckland Spinal Unit. These themes formed the iii foci of the chapters, with an additional chapter on weaving cultural threads into counselling. The main findings of the study centre on the very important role of counselling at the Auckland Spinal Unit. In particular, the study highlighted the importance of counselling as a place for conversations that make room for multiple positionings and multiple versions of events, a space that respects a patient's hopes, beliefs and dreams for his/her life (which often does not include wheelchairs, catheters and caregivers) but that also supports the patient to make meaning of living life with a spinal cord injury. The study also identified the importance of sexuality counselling. Not including sexuality as a topic in the rehabilitation services provided perpetuates dominant discourses that a person with a spinal cord injury does not want sexual intimacy or cannot be sexually intimate and cannot have children. Family (whanau) involvement in and family's becoming part of the rehabilitation team was very important to most participants. This study looks at how this involvement can be achieved and explores some of the structures currently in place at the Auckland Spinal Unit to facilitate this involvement. Participants in this study expressed a desire for counselling to be highly accessible to both themselves and their families (whanau). They would prefer the counsellors to get to know the patients in their own environment first (in their rooms), so that the patients are positioned to have agency to make choices about how they would like to use the available counselling services. The study concludes with my personal journey of working as a counsellor at the Auckland Spinal Unit and how this research has shaped and fine-tuned my practice.

Doctor of Philosophy / Work-related injuries and road traffic injuries are common causes of morbidity and are major contributors to the burden of disease worldwide. In developed countries, these injuries are often covered under compensation schemes, and the costs of administering these schemes is high. The compensation systems have been put in place to improve the health outcomes, both physical and mental, of those injured under such systems; yet there is a widespread belief, and some evidence, that patients treated under these schemes may have worse outcomes than if they were treated outside the compensation system. Chapter One of this thesis explores the literature pertaining to any effect that compensation may have on patient outcomes. It is noted that the concept of “compensation neurosis” dates from the nineteenth century, with such injuries as “railway spine”, in which passengers involved in even minor train accidents at the time, would often have chronic and widespread symptoms, usually with little physical pathology. Other illnesses have been similarly labelled over time, and similarities are also seen in currently diagnosed conditions such as repetition strain injury, back pain and whiplash. There are also similarities in a condition that has been labelled “shell shock”, “battle fatigue”, and “post-traumatic stress disorder”; the latter diagnosis originating in veterans of the Vietnam War. While there is evidence of compensation status contributing to the diagnosis of some of these conditions, and to poor outcomes in patients diagnosed with these conditions, there is little understanding of the mechanism of this association. In contrast to popular stereotypes, the literature review shows that malingering does not contribute significantly to the effect of compensation on health outcomes. Secondary gain is likely to play an important role, but secondary gain is not simply confined to financial gain, it also includes gains made from avoidance of workplace stress and home and family duties. Other psychosocial factors, such as who is blamed for an injury (which may lead to retribution as a secondary gain) or the injured person’s educational and occupational status, may also influence this compensation effect. The literature review concludes that while the association between compensation and health after injury has been widely reported, the effect is inconsistent. These inconsistencies are due, at least in part, to differences in definitions of compensation (for example, claiming compensation versus using a lawyer), the use of different and poorly defined diagnoses (for example, back pain), a lack of control groups (many studies did not include uncompensated patients), and the lack of accounting for the many possible confounding factors (such as measures of injury severity or disease severity, and socio-economic and psychological factors). The literature review also highlighted the variety of different outcomes that had been used in previous studies, and the paucity of literature regarding the effect of compensation on general health outcomes. This thesis aims to explore the association between compensation status and health outcome after injury. It addresses many of the methodological issues of the previously published literature by, i selecting study populations of patients with measurable injuries, ii clearly defining and separating aspects of compensation status, iii including control groups of non-compensated patients with similar injuries iv allowing for a wide variety of possible confounders, and v using clearly defined outcome measures, concentrating on general health outcomes. Before commencing the clinical studies reported in Chapters Three and Four, a systematic review and meta-analysis was performed to quantify and analyse the effect of compensation on outcome after surgery. This allowed a clearly defined population of studies to be included, and was relevant to the thesis as the surgeries were performed as treatment of patients who had sustained injuries. The study, which is reported in Chapter Two, hypothesised that outcomes after surgery would be significantly worse for patients treated under compensation schemes. The study used the following data sources: Medline (1966 to 2003), Embase (1980 to 2003), CINAHL, Cochrane Controlled Trials Register, reference lists of retrieved articles and textbooks, and contact with experts in the field. The review included any trial of surgical intervention where compensation status was reported and results were compared according to that status, and no restrictions were placed on study design, language or publication date. Data extracted were study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. Studies were selected by two unblinded independent reviewers, and data were extracted by two reviewers independently. Data were analysed using Cochrane Review Manager (version 4.2). Two hundred and eleven papers satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (worker's compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and one paper described a benefit associated with compensation. A meta-analysis of 129 papers with available data (20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval 3.28 to 4.37, random effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all sub-groups. This study concludes that compensation status is associated with poor outcome after surgery, and that this effect is significant, clinically important and consistent. Therefore, the study hypothesis is accepted. However, as data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Determination of the mechanism for the association between compensation status and poor outcome, shown in the literature review (Chapter One) and the systematic review (Chapter Two) required further study. Two studies were designed to further explore this association and these are reported in Chapters Three and Four. The retrospective study reported in Chapter Three, the Major Trauma Outcome Study (MTOS), aimed to explore the association between physical, psychosocial, and compensation-related factors and general health after major physical trauma. The primary hypothesis predicted significantly poorer health outcomes in patients involved in pursuing compensation, allowing for possible confounders and interactions. The study also examined other health outcomes that are commonly associated with compensation, and examined patient satisfaction. Consecutive patients presenting to a regional trauma centre with major trauma (defined as an Injury Severity Score greater than 15) were surveyed between one and six years after their injury. The possible predictive factors measured were: general patient factors (age, gender, the presence of chronic illnesses, and the time since the injury), injury severity factors (injury severity score, admission to intensive care, and presence of a significant head injury), socio-economic factors (education level, household income, and employment status at the time of injury and at follow-up), and claim-related factors (whether a claim was pursued, the type of claim, whether the claim had settled, the time to settlement, the time since settlement, whether a lawyer was used, and who the patient blamed for the injury). Multiple linear regression was used to develop a model with general health (as measured by the physical and mental component summaries of the SF-36 General Health Survey) as the primary outcome. The secondary outcomes analysed were: neck pain, back pain, post-traumatic stress disorder, and patient satisfaction. On multivariate analysis, better physical health was significantly associated with increasing time since the injury, and with lower Injury Severity Scores. Regarding psychosocial factors, the education level and household income at the time of injury were not significantly associated with physical health, but pursuit of compensation, having an unsettled claim, and the use of a lawyer were strongly associated with poor physical health. Measures of injury severity or socio-economic status were not associated with mental health. However, the presence of chronic illnesses and having an unsettled compensation claim were strongly associated with poor mental health. Regarding the secondary outcomes, increasing neck pain and back pain were both significantly associated with lower education levels and the use of a lawyer, but not significantly associated with claiming compensation. The severity of symptoms related to post-traumatic stress disorder was not associated with measures of injury severity, but was significantly and independently associated with the use of a lawyer, having an unsettled compensation claim, and blaming others (not themselves) for the injury. The strongest predictor of patients’ dissatisfaction with their progress since the injury was having an unsettled compensation claim, and as with the other secondary outcomes, patient satisfaction was not significantly associated with injury severity factors. Factors relating to the compensation process were among the strongest predictors of poor health after major trauma, and were stronger predictors than measures of injury severity. The hypothesis that general physical and mental health would be poorer in patients involved in seeking compensation for their injury was accepted. This study concludes that the processes involved with claiming compensation after major trauma may contribute to poor health outcomes. The prospective study reported in Chapter Four, the Motor Vehicle Accident Outcome Study (MVAOS), aimed to explore the effect of compensation related factors on general health in patients suffering major fractures after motor vehicle accidents (MVAs). The study hypothesized that general health would be poorer in patients claiming compensation for their injuries. Patients presenting to 15 hospitals with one or more major fractures (any long bone fracture, or fracture of the pelvis, patella, calcaneus or talus) after a motor vehicle accident were invited to participate in this prospective study. Initial data was obtained from the patient and the treating doctors. Both the patients and treating surgeons were followed up with a final questionnaire at six months post injury. General factors (age, gender, treating hospital, country of birth, presence of chronic illnesses and job satisfaction), injury factors (mechanism of injury, number of fractures, and the presence of any non-orthopaedic injuries), socioeconomic factors (education level, income, and employment status), and compensation-related factors (whether a claim was made, the type of claim, whether a lawyer was used, and who was blamed for the injury) were used as explanatory variables. The primary outcome was general health as measured by the physical and mental component summaries of the SF-36 General Health Survey. The secondary outcomes were neck pain, back pain, and patients’ ratings of satisfaction with progress and of recovery. Multiple linear regression was used to develop predictive models for each outcome. Completed questionnaires were received from 232 (77.1%) of the 301 patients included in the study. Poor physical health at six months was strongly associated with increasing age, having more than one fracture, and using a lawyer, but not with pursuit of a compensation claim. Poor mental health was associated with using a lawyer and decreasing household income. Increasing neck pain and back pain were both associated with the use of a lawyer and with lower education levels. Higher patient satisfaction and patient-rated recovery were both strongly associated with blaming oneself for the injury, and neither were associated with pursuit of compensation. Although the use of a lawyer was a strong predictor of the primary outcomes, the pursuit of a compensation claim was not remotely associated with these outcomes, and therefore the study hypothesis was rejected. The studies reported in this thesis are compared in the final chapter, which concludes that poor health outcomes after injury are consistently and strongly associated with aspects of the compensation process, particularly the pursuit of a compensation claim, involvement of a lawyer, and having an unsettled claim. Compensation systems may be harmful to the patients that these systems were designed to benefit. Identification of the harmful features present in compensation systems my allow modification of these systems to improve patient outcomes.

Doctor of Philosophy / Work-related injuries and road traffic injuries are common causes of morbidity and are major contributors to the burden of disease worldwide. In developed countries, these injuries are often covered under compensation schemes, and the costs of administering these schemes is high. The compensation systems have been put in place to improve the health outcomes, both physical and mental, of those injured under such systems; yet there is a widespread belief, and some evidence, that patients treated under these schemes may have worse outcomes than if they were treated outside the compensation system. Chapter One of this thesis explores the literature pertaining to any effect that compensation may have on patient outcomes. It is noted that the concept of “compensation neurosis” dates from the nineteenth century, with such injuries as “railway spine”, in which passengers involved in even minor train accidents at the time, would often have chronic and widespread symptoms, usually with little physical pathology. Other illnesses have been similarly labelled over time, and similarities are also seen in currently diagnosed conditions such as repetition strain injury, back pain and whiplash. There are also similarities in a condition that has been labelled “shell shock”, “battle fatigue”, and “post-traumatic stress disorder”; the latter diagnosis originating in veterans of the Vietnam War. While there is evidence of compensation status contributing to the diagnosis of some of these conditions, and to poor outcomes in patients diagnosed with these conditions, there is little understanding of the mechanism of this association. In contrast to popular stereotypes, the literature review shows that malingering does not contribute significantly to the effect of compensation on health outcomes. Secondary gain is likely to play an important role, but secondary gain is not simply confined to financial gain, it also includes gains made from avoidance of workplace stress and home and family duties. Other psychosocial factors, such as who is blamed for an injury (which may lead to retribution as a secondary gain) or the injured person’s educational and occupational status, may also influence this compensation effect. The literature review concludes that while the association between compensation and health after injury has been widely reported, the effect is inconsistent. These inconsistencies are due, at least in part, to differences in definitions of compensation (for example, claiming compensation versus using a lawyer), the use of different and poorly defined diagnoses (for example, back pain), a lack of control groups (many studies did not include uncompensated patients), and the lack of accounting for the many possible confounding factors (such as measures of injury severity or disease severity, and socio-economic and psychological factors). The literature review also highlighted the variety of different outcomes that had been used in previous studies, and the paucity of literature regarding the effect of compensation on general health outcomes. This thesis aims to explore the association between compensation status and health outcome after injury. It addresses many of the methodological issues of the previously published literature by, i selecting study populations of patients with measurable injuries, ii clearly defining and separating aspects of compensation status, iii including control groups of non-compensated patients with similar injuries iv allowing for a wide variety of possible confounders, and v using clearly defined outcome measures, concentrating on general health outcomes. Before commencing the clinical studies reported in Chapters Three and Four, a systematic review and meta-analysis was performed to quantify and analyse the effect of compensation on outcome after surgery. This allowed a clearly defined population of studies to be included, and was relevant to the thesis as the surgeries were performed as treatment of patients who had sustained injuries. The study, which is reported in Chapter Two, hypothesised that outcomes after surgery would be significantly worse for patients treated under compensation schemes. The study used the following data sources: Medline (1966 to 2003), Embase (1980 to 2003), CINAHL, Cochrane Controlled Trials Register, reference lists of retrieved articles and textbooks, and contact with experts in the field. The review included any trial of surgical intervention where compensation status was reported and results were compared according to that status, and no restrictions were placed on study design, language or publication date. Data extracted were study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. Studies were selected by two unblinded independent reviewers, and data were extracted by two reviewers independently. Data were analysed using Cochrane Review Manager (version 4.2). Two hundred and eleven papers satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (worker's compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and one paper described a benefit associated with compensation. A meta-analysis of 129 papers with available data (20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval 3.28 to 4.37, random effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all sub-groups. This study concludes that compensation status is associated with poor outcome after surgery, and that this effect is significant, clinically important and consistent. Therefore, the study hypothesis is accepted. However, as data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Determination of the mechanism for the association between compensation status and poor outcome, shown in the literature review (Chapter One) and the systematic review (Chapter Two) required further study. Two studies were designed to further explore this association and these are reported in Chapters Three and Four. The retrospective study reported in Chapter Three, the Major Trauma Outcome Study (MTOS), aimed to explore the association between physical, psychosocial, and compensation-related factors and general health after major physical trauma. The primary hypothesis predicted significantly poorer health outcomes in patients involved in pursuing compensation, allowing for possible confounders and interactions. The study also examined other health outcomes that are commonly associated with compensation, and examined patient satisfaction. Consecutive patients presenting to a regional trauma centre with major trauma (defined as an Injury Severity Score greater than 15) were surveyed between one and six years after their injury. The possible predictive factors measured were: general patient factors (age, gender, the presence of chronic illnesses, and the time since the injury), injury severity factors (injury severity score, admission to intensive care, and presence of a significant head injury), socio-economic factors (education level, household income, and employment status at the time of injury and at follow-up), and claim-related factors (whether a claim was pursued, the type of claim, whether the claim had settled, the time to settlement, the time since settlement, whether a lawyer was used, and who the patient blamed for the injury). Multiple linear regression was used to develop a model with general health (as measured by the physical and mental component summaries of the SF-36 General Health Survey) as the primary outcome. The secondary outcomes analysed were: neck pain, back pain, post-traumatic stress disorder, and patient satisfaction. On multivariate analysis, better physical health was significantly associated with increasing time since the injury, and with lower Injury Severity Scores. Regarding psychosocial factors, the education level and household income at the time of injury were not significantly associated with physical health, but pursuit of compensation, having an unsettled claim, and the use of a lawyer were strongly associated with poor physical health. Measures of injury severity or socio-economic status were not associated with mental health. However, the presence of chronic illnesses and having an unsettled compensation claim were strongly associated with poor mental health. Regarding the secondary outcomes, increasing neck pain and back pain were both significantly associated with lower education levels and the use of a lawyer, but not significantly associated with claiming compensation. The severity of symptoms related to post-traumatic stress disorder was not associated with measures of injury severity, but was significantly and independently associated with the use of a lawyer, having an unsettled compensation claim, and blaming others (not themselves) for the injury. The strongest predictor of patients’ dissatisfaction with their progress since the injury was having an unsettled compensation claim, and as with the other secondary outcomes, patient satisfaction was not significantly associated with injury severity factors. Factors relating to the compensation process were among the strongest predictors of poor health after major trauma, and were stronger predictors than measures of injury severity. The hypothesis that general physical and mental health would be poorer in patients involved in seeking compensation for their injury was accepted. This study concludes that the processes involved with claiming compensation after major trauma may contribute to poor health outcomes. The prospective study reported in Chapter Four, the Motor Vehicle Accident Outcome Study (MVAOS), aimed to explore the effect of compensation related factors on general health in patients suffering major fractures after motor vehicle accidents (MVAs). The study hypothesized that general health would be poorer in patients claiming compensation for their injuries. Patients presenting to 15 hospitals with one or more major fractures (any long bone fracture, or fracture of the pelvis, patella, calcaneus or talus) after a motor vehicle accident were invited to participate in this prospective study. Initial data was obtained from the patient and the treating doctors. Both the patients and treating surgeons were followed up with a final questionnaire at six months post injury. General factors (age, gender, treating hospital, country of birth, presence of chronic illnesses and job satisfaction), injury factors (mechanism of injury, number of fractures, and the presence of any non-orthopaedic injuries), socioeconomic factors (education level, income, and employment status), and compensation-related factors (whether a claim was made, the type of claim, whether a lawyer was used, and who was blamed for the injury) were used as explanatory variables. The primary outcome was general health as measured by the physical and mental component summaries of the SF-36 General Health Survey. The secondary outcomes were neck pain, back pain, and patients’ ratings of satisfaction with progress and of recovery. Multiple linear regression was used to develop predictive models for each outcome. Completed questionnaires were received from 232 (77.1%) of the 301 patients included in the study. Poor physical health at six months was strongly associated with increasing age, having more than one fracture, and using a lawyer, but not with pursuit of a compensation claim. Poor mental health was associated with using a lawyer and decreasing household income. Increasing neck pain and back pain were both associated with the use of a lawyer and with lower education levels. Higher patient satisfaction and patient-rated recovery were both strongly associated with blaming oneself for the injury, and neither were associated with pursuit of compensation. Although the use of a lawyer was a strong predictor of the primary outcomes, the pursuit of a compensation claim was not remotely associated with these outcomes, and therefore the study hypothesis was rejected. The studies reported in this thesis are compared in the final chapter, which concludes that poor health outcomes after injury are consistently and strongly associated with aspects of the compensation process, particularly the pursuit of a compensation claim, involvement of a lawyer, and having an unsettled claim. Compensation systems may be harmful to the patients that these systems were designed to benefit. Identification of the harmful features present in compensation systems my allow modification of these systems to improve patient outcomes.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2006. / Title from first page of PDF file (viewed on Feb. 22, 2007). Includes bibliographical references (p. 124-134).

Clomazone is an effective herbicide widely used for preemergence grass control in rice. However, use of clomazone on sandy textured soils of the western Texas rice belt may cause serious rice injury. When labeled for rice in 2001, sandy textured soils were excluded. Laboratory experiments were conducted to determine the effect of soil characteristics and water potential on plant-available clomazone and rice injury. A centrifugal double-tube technique was used to determine plant-available concentration in soil solution (ACSS), total amount available in soil solution (TASS), and Kd values for clomazone on four soils at four water potentials. A rice bioassay was conducted parallel to the plant-available study to correlate biological availability to ACSS, TASS, and Kd. TASS was significantly different in all soils at the 1% level of significance. The order of increasing TASS for the soils studied was Morey Edna Nada Crowley which correlated well with soil characteristics. Two field experiments at three locations were conducted in 2002 and 2003 to determine the optimum rate range that maximizes weed control and minimizes crop injury across a wide variety of soil textures and planting dates. At Beaumont, Eagle Lake, and Ganado, TX, preemergence application of 0.41 to 0.56, 0.38 to 0.43, and 0.36 to 0.42 kg ha-1 clomazone, respectively, provided optimum weed control with minimal rice injury. Data suggests that clomazone is safe to use on rice on sandy textured soils. Injury may occur, but, rates suggested from this research will minimize injury and achieve excellent weed control. As a result, amendments to the herbicide label will allow clomazone use on sandy textured soils giving rice producers more flexibility and access to another effective herbicide.