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ABSTRACT Trauma in South Africa has been described as a “malignant epidemic” (Muckart DJ, 1991)5. Trauma is most acute in Sub-Saharan Africa, where deaths from trauma is higher than in any other region of the world where the risk of death from injury is greatest, especially for men aged 15-29 years (Murray CJL, in Bowley etal, 2002)5.The recognition of concurrent life threatening injuries is critical, given that patients with facial fractures seldom die in the absence of airway problems, massive bleeding, aspiration of blood into the lungs and massive head injury30. There are several reports in the literature regarding multisystem trauma and facial fractures. Head injuries are commonly associated with facial fractures, and facial fractures can be markers for brain injury16 .This study is aimed to identify the prevalence of head injuries associated with maxillofacial trauma in the Johannesburg General Hospital, Gauteng, South Africa. The data was collected from 1st January 2003 to 30th June 2003. A total of 196 patients with maxillofacial injuries were treated and 176 were included in the study. The data was analyzed using SASTM for WindowsTM. From the results it was found that of the 176 patients the majority were males comprising 88.07% of the study. Based on the GCS scores alone it was shown that 38.06% patients suffered head injuries. After reviewing patient records, it was found that of the whole sample only 31.25% of patients suffered true head injuries based on CT scan and neurosurgery findings. It was also shown that the most frequent mechanism of injury with headinjuries was gunshot wounds at 52.72% and the most common maxillofacial injury associated with head injury was panfacial fractures at 23.63%. In this study we also reviewed the outcome of the patients based on mortality rates. A total of 24 patients (13.63%) died from associated injuries. Of these patients 2 (1.13%) died from associated injuries due to polytrauma and 22 (12.5%) died due to severe head injury. We found that severe maxillofacial injuries involving the midfacial region such as panfacial fractures, zygomatic complex fractures and Le Fort fractures are frequently seen in patients with significant head injury. This should alert trauma unit personnel during assessment of patients to the fact that if a patient presents with significant midfacial trauma, one might expect that an underlying head injury is present. It is important to make note, that of the associated injuries present with maxillofacial trauma, involvement of the central nervous system including concussion, is the most frequent.

Beginning prior to the foundational study conducted by Felitti et al. (1998), individuals of all ages have been exposed to a variety of traumatic events that had the capacity to alter overall functioning in a variety of ways. Children and adolescents are a vulnerable subset of individuals who are often exposed to various types of trauma which has the capacity to impact academic, behavioral, and social/emotional functioning (Cohen, Berliner, & Mannarino, 2010). The adverse effects related to trauma exposure in children and adolescents have been correlated with externalizing and internalizing disorders, and decreased academic performance (American Psychiatric Association, 2013). An individual’s proximity, or closeness, to traumatic events has also been correlated with increased negative outcomes to include meeting diagnostic criteria for Post-Traumatic Stress Disorder (PTSD). There is a gap in the literature, however, in determining the relationship between proximity to traumatic events and its impact on academic functioning in elementary students. The present study sought to analyze the relationship between PTSD symptomology and academic achievement in elementary students while determining if proximity was a moderating factor in the hypothesized relationship. Participants included 81 children in Grades 3 through 5 enrolled in elementary schools in a school district in the Southeastern United States. Linear regression analyses indicated the hypothesized relationship between PTSD symptomology and academic achievement was nonsignificant. However, when proximity was included as a moderator the increase in variance of explanation of the relationship was noted to be significant. Implications of these results suggest that inclusion of proximity as a pertinent contributor to adverse reactions may be imperative in engaging in prevention, intervention, and postvention strategies for elementary students exposed to trauma.

The current study investigated a model explaining sexual assault victims’ severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma—cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences.

Schädel-Hirn Trauma ist die führende Ursache von Tod und Behinderung unter jungen Erwachsenen in den USA und Europa. Darüber hinaus steigert Schädel-Hirn Trauma das Risiko eine Demenzerkrankung oder andere neurodegenerative Erkrankung zu erleiden. Aus diesem Grund stellt eine bessere Erkenntnis der subakuten und chronischen pathophysiologischen Prozesse eine wichtige Grundlage für eine mögliche zukünftige neuroprotektive Therapie dar. Ziel dieser Arbeit war es daher eine Übersicht von funktionellen Einschränkungen und zellulären Veränderungen in der subakuten Phase innerhalb der ersten drei Monate darzustellen. Dazu wurden Verhaltensexperimente zu kognitiven Leistungen wie räumliches Lernen, kognitive Plastizität, episodisches Gedächtnis, Angstverhalten und allgemeine Lokomotion durchgeführt. Dabei konnten funktionale Einschränkungen der Tiere im Bereich der kognitiven Flexibilität, dem räumlichen Lernen, dem belohnungsmotivierten Verhalten, sowie Hyperaktivität beobachtet werden. Weiterführend erfolgten histologische und immunhistologische Untersuchungen an den Mäusegehirnen. So konnten in unserem Tiermodell sowohl lokale neuroinflammatorische Veränderungen nachgewiesen werden, also auch generalisierte Veränderungen, welche sich auf Isocortex und Hippocampus erstreckten und beide Hemisphären gleichermaßen betrafen. Ebenso konnten demyelinisierende Prozesse im Bereich der Läsion beobachtet werden. Im Bereich des Cortex zeigte sich außerdem eine axonale Schädigung mit begleitender Neuroinflammation, sowie eine Infiltration von B-Zellen. Anschließend wurde eruiert, ob eine Korrelation von funktionalem Outcome und histologischen Veränderungen besteht. Dabei zeigte sich eine signifikante Korrelation neuroinflammatorischer Prozesse mit Einschränkungen im räumlichen Lernen und Umlernen, sowie Auffälligkeiten im Bereich des belohnungsmotivierten Verhaltens. Damit ordnet sich diese Arbeit in die bestehenden Erkenntnisse zur Pathophysiologie des SHTs ein und ergänzt diese weiter. / Traumatic brain injury is the leading cause of death and disability among young adults in the USA and Europe. Traumatic brain injury increases the risk for neurodegenerative diseases and dementia. However, the underlying pathomechanisms that contribute to the increased risk for neurodegeneration remain unclear. The aim of this thesis is to provide an overview of behavioral and cellular changes in the subacute phase of the first three months after injury. Therefore, behavioral experiments were performed with a focus on spatial learning, cognitive plasticity, episodic memory, anxiety, and general locomotion. Deficits in spatial learning, cognitive plasticity, reward-motivated behavior as well as hyperactivity were monitored in mice after traumatic brain injury. Furthermore, histological and immunohistochemical analysis were performed on brain tissue three months after injury. Local neuroinflammatory changes were seen in the lesion area as well as global inflammation in cortex and hippocampus. Both hemispheres showed similar levels of inflammation. Demyelination colocalized with neuroinflammation around the lesion area. In the cortex axonal damage, neuroinflammatory changes, and migration of B-cells were detected. We further investigated the correlation between behavioral and cellular changes. Neuroinflammation correlated significantly with deficits in spatial learning, cognitive plasticity, and reward-motivated behavior. This thesis, therefore, provides an important overview of behavioral changes and cellular pathomechanisms and further knowledge of the subacute phase of traumatic brain injury.

Indiana University-Purdue University Indianapolis (IUPUI) / Hospital costs are the largest contributor to US health expenditures, making them a common target for cost containment policies. Policies that reduce fragmentation in health care and related systems could increase the value of these expenditures while improving outcomes. Efforts to address fragmentation of health care services, such as Accountable Care Organizations, have typically been enacted at the scale of health systems. However, coordination within health care facilities should also be explored. In three essays, I analyze the role of coordination in several forms. First, I examine the introduction of interdisciplinary care teams within a hospital. This analysis features care coordination within a health care facility with the potential to reduce resource utilization through improved communication between team members and between patients and their care providers. I find that care coordination reduced length of stay for some patients while maintaining care quality. This combination results in higher value care for patients and hospitals. Second, I explore whether these interdisciplinary care teams impact resource utilization and patient flow throughout the hospital. The primary outcome is reduction in patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as well as coordination between interdisciplinary teams and intensivists in ICUs. Findings from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national database of trauma patients to compare mortality among adolescent patients with isolated traumatic brain injury between adult trauma centers and pediatric trauma centers. Previous work has shown that younger pediatric patients with this injury benefit from treatment at pediatric trauma centers. However, it is unclear whether this benefit extends to older pediatric patients on the cusp of adulthood. I find that, after adjusting for differences in injury severity, adolescent patients have no difference in mortality risk when treated at adult or pediatric trauma centers. This finding supports the current regionalized model of trauma care where severely injured patients are taken to the nearest trauma center, regardless of designation as pediatric or adult. / 2023-07-01

Ureteral injuries although rare can cause serious issues. The mechanism of injury is most commonly penetrating but in some rare cases blunt forces can contribute. It is important to diagnose ureteral injuries as soon as possible because they can have significant morbidity and mortality. Here we present two cases of isolated ureteral injury secondary to blunt force trauma. Both patients had the ureteral injury diagnosed by computed tomography (CT) scan and confirmed by a ureterogram with extravasation of contrast. Both patients also had peripelvic cyst, which could have been a contributing risk factor for injury. In both cases, the ureteral injury was repaired using a stent and both patients had no complications. We present these cases along with presentation, diagnostic work-up, and treatment.

Employees who have had a traumatic life experience (TLE) and are returning to the workplace face a difficult road to recovery. The workplace as it exists today is not well equipped to handle such individuals. Managers and co-workers lack knowledge of a recovery framework to facilitate and support the survivor-employee's re-entry. This research addressed the development of a cost-free short-term adult educational intervention called Study Circles to assist both managers and co-workers in understanding the dynamics of recovery for individuals after a traumatic life experience (TLE). Herman's (1992) three stage recovery process is used as a model for the Study Circle intervention: (1) Establishing a safety net, (2) Telling the trauma story and (3) Reconnecting the individual back to the work community. As an educational intervention, this Study Circle is designed to complement any individual or psychotherapeutic intervention for TLE survivors. This research considered these questions: (1) How can Study Circles be designed and used to engage managers in a discussion of the problems of returning TLEs? (2) How can Study Circles be designed for and used by managers and co-workers to facilitate the TLEs re-entry? (3) Does a manager having previous experience with a TLE in the workplace engage more easily and intensively in a dialogue with a TLE than managers without such experience? (4) What examples of group-participation dynamics are likely to occur during such a Study Circle? (5) How open are managers to dialogue with a TLE in the workplace? (6) Does the environment and setting of a government agency have relevance for Study Circles in assisting managers to help returning TLEs? The research clearly showed that Study Circles can and do work successfully in the workplace especially in a government agency. Two groups of Study Circles (Group A and Group B), conducted during the lunch hour, attracted both managers and employees. The lunch hour served as an excellent time for Study Circle sessions since it did not interrupt the work schedule of the participants. Each Study Circle program consisted of three sessions where participants, managers and returning TLEs, engaged in open dialogue and discussed questions pertaining to creating a "safety net", "telling the trauma story" and "reconnecting the employee to the workplace." Each session provided insights to the participants on the issues and concerns managers may have in "welcoming" a returning TLE to the workplace, along with feedback from returning TLEs on the expectations they have of managers and the organization. These sessions provided an opportunity to explore uncharted territory in the organization, that of bringing a sensitive topic to the workplace and openly talking about its effect on management and its employees. Both Study Circle groups were different. Group A was homogeneous and shared more feelings and suggested that the organization needed";guidelines to assist managers" in their task. On the other hand, group B managers did not share their stories or experiences with the group, but encouraged the organization to focus on training its managers to "communicate" better and learn "active listening skills." Although Group B managers were not as open as group A managers, the employees in both groups were equally open and eager to share their stories with the other participants. Both groups created their own group culture engaging not only in the session's topic but other pertinent issues relative to manager/employee concerns such as acknowledging differences (each TLE will be different), communicating more openly, and recognizing performance issues when the TLE returns to the workplace. It was concluded that to appropriately welcome a returning TLE employee, managers did not need to have previous experience in dealing with a returning TLE. Their success in this depended on the individual and his/her career experience, how comfortable they felt in engaging the returning TLE, and the managers own personal experience with trauma. Although the Study Circle format has been extensively used in community meetings, church groups and home study groups, it has only rarely been tried in workplace settings. These Study Circles proved that this adult educational process applied in business and corporate settings with business and corporate settings with excellent results. / Ph. D.

We performed quantitative analysis on transcriptions of 784 interviews with Holocaust survivors. The interviews were collected by the University of Southern California Shoah Foundation, and the first 15 minutes of each interview had been transcribed using automatic speech recognition. The survivors were an aging population as the interviews were conducted around fifty years after the end of the Holocaust. We used statistical methods and algorithms to analyze the data including keyness analysis, topic modeling, and emotionality analysis. We used the Contemporary Corpus of American English (COCA) as a comparative corpus for these analyses. Overall, we found that survivors prioritized themes of the Holocaust and their families in the interviews. Specific words and themes reoccurred across the corpus demonstrating a collective and consistent memory of trauma. Our emotionality analyses revealed that survivors used slightly more positive language and fewer words relating to anger, disgust, and fear than the speakers in our comparative corpus. / Thesis / Master of Science (MSc) / For this thesis, we analyzed 784 transcribed interviews with Holocaust survivors. The interviews were conducted by the Shoah Foundation and took place from 1994-2000; around 50 years after the end of World War II. We compared the language in the interviews to the spoken component of a large corpus (collection of texts) called The Contemporary Corpus of American English (COCA). In our analyses, we found the words that are most representative of the survivors' language across the corpus. We also found topics that were discussed most frequently in the interviews. Words and topics relating to family, Judaism, and experiences of the Holocaust were the most common. We also analyzed the emotionality of the survivors' language and found that overall, they used slightly more positive words than the words in COCA. They also used fewer words associated with the emotions anger, fear, and disgust.

Most scholars would agree that Josiah’s death in the Book of Chronicles is negatively portrayed, especially as contrasted with his laudable Passover. But why should the king par excellence, according to 2 Kings, die such an ignominious death in the Chronicler’s portrayal? By applying a methodological framework derived from cultural trauma theory in its relation to social identity theory, this dissertation argues that the Chronicler’s negative recounting of Josiah’s death not only marks the initiation of cultural trauma for the Chronicler’s community but ends by encouraging the hopeful alleviation of the community’s enduring cultural trauma. In analysing the Chronicler’s markers of cultural trauma within the context of the social identities that appear in the genealogies and subsequent narratives in the book of Chronicles, the failure of Josiah can be most clearly seen in his seeking battle with Pharaoh Neco without seeking YHWH. Not only did Josiah fail to heed the word of God not to confront Neco, but his very disobedience initiates the cultural trauma experienced through the fall of Jerusalem and subsequent forced migration, which follows swiftly after the death of Josiah according to the Chronicler. In turn, the narrative of Josiah’s death is connected to the cultural trauma of the broader community primarily through the appearance of Jeremiah. The first reference of Jeremiah in the book of Chronicles has him issuing a lament in the wake of Josiah’s death (2 Chr 35:25), while Jeremiah’s final reference recounts the fulfilment of his prophecy of “seventy years” rest (2 Chr 36:21-22) signalling the end of forced migration in the wake of the fall of Jerusalem. At the same time, by examining the Chronicler’s markers of cultural trauma, this dissertation presents evidence that the Chronicler is seeking to recategorize the community within a superordinate identity of “all Israel” as a means to alleviate their cultural trauma that was initiated and symbolised by the death of Josiah. / Thesis / Doctor of Philosophy (PhD)