Aim The aims of this project were to (i) evaluate whether the trauma care system established in Hong Kong has improved the survival rate among trauma patients; (ii) evaluate the effectiveness of trauma teams and their coordinators, primary trauma diversion, and performance improvement programmes, and assess the influence of gender and age on patient outcomes; and (iii) compare clinical outcomes before and after the establishment of a trauma system in Hong Kong and measure them against those achieved in an established regional trauma system in Australia. / Background Injury is a major public health problem that creates an enormous social burden. Although Hong Kong has tried to build up a trauma care system according to the criteria employed by the American College of Surgeons Committee on Trauma, there are a number of differences between the two. The effectiveness of the key components of trauma care processes and their clinical outcomes are unclear, and the final outcome in terms of survival rate is unknown. / Conclusion Proficient trauma teams, primary trauma diversion, and clinical guidelines are key components of the trauma system that contribute to improved outcomes. / Methods Retrospective analysis of data collected prospectively from the trauma registries in Hong Kong and Australia. The Trauma and Injury Severity Score (TRISS), the W score, the Z score, the M score, and Ws statistics are employed to evaluate the mortality rate. / Results The W score for Hong Kong improved significantly from - 4.79 in 1997 to 0.51 in 2009 after the trauma system was established (P<0.05). The improving trend observed in the Ws score (- 4.86 +/- SE 1.24 Vs 1.06 +/- SE 0.74) over the same period indicates that the survival rate increased from 1997 to 2009 (P < 0.01). The time taken to deliver the patient from the scene to definitive care was reduced by 97 minutes (P < 0.001) using a primary trauma diversion strategy. Proficient trauma teams are associated with reduced mortality in patients with a moderately poor probability of survival (p = 0.007) and trauma nurse coordinators play an essential role in conducting trauma audits and maintaining trauma registries. The introduction of guidelines and staff education could result in significant improvements to the trauma care process. Advancing age is associated with an increased mortality rate, whereas gender is not. Injury prevention programmes in Hong Kong are inadequate. / Yeung, Hiu Hung. / Advisers: Timothy H. Rainer; Wai Sang Poon. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 282-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

During a traumatic insult to the brain, tissue is subjected to large stresses at high rates which often surpass cellular thresholds leading to cell dysfunction or death. Cellular events that occur at the time of and immediately after an insult are poorly understood. Immediately following traumatic brain injury (TBI), the neuronal plasma membrane may become disrupted and potentiate detrimental pathways by allowing extracellular contents to gain access to the cytosol. In the current study, neuronal plasma membrane disruption was assessed in vivo following moderate unilateral controlled cortical impact in rats using a normally cell-impermeant fluorescent compound as a plasma membrane permeability marker. This fluorescent dye was injected into the cerebrospinal fluid and was allowed to diffuse into the brain. TBI caused a widespread acute disruption of neuronal membranes which was significantly different compared to uninjured brains. Affected cells were present in cortex and hippocampal regions. These findings were complemented by an in vitro model of TBI where membrane disruption was quantified and its mechanisms elucidated. Permeability marker(s) were added to neuronal cultures before the insult as indicators for increases in plasma membrane permeability. The percentage of cells containing the permeability marker was dependent on the molecular mass, as smaller molecules gained access to a higher percentage of cells than larger ones. Permeability increases were also positively correlated with the rate of insult. Membrane disruption was transient, evidenced by a robust resealing within the first minute after the insult. In addition, membrane resealing was found to be dependent on extracellular Ca2+, as chelation of the ion abolished a significant amount of resealing. We have also investigated the effects of mechanically-induced plasma membrane disruptions on neuronal network electrical activity. We have developed a multielectrode array system that allows the study of electrical activity before, during, and after a traumatic insult to neurons. Endogenous electrical activity of neuronal cultures presented a heterogeneous response following mechanical insult. Moreover, spontaneous firing dysfunction induced by injury outlasted the presence of membrane disruptions. This study provides a multi-faceted approach to elucidate the role of neuronal plasma membrane disruptions in TBI and its functional consequences.

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

No description available.

Dissertation submitted in compliance with the requirements for the Masters Degree in Chiropractic at the Durban University of Technology, 2009 / Occupational injuries sustained by Emergency Rescue Care workers have been well documented. However, despite their high rates of injury, the literature regarding the risk factors for work-related musculoskeletal injuries (WRMSIs) in the fire service has not been well-established, especially in South Africa. Objectives: To determine the prevalence and risk factors for musculoskeletal injuries in the Durban Metropolitan Fire Department and to evaluate the relationship between selected risk factors and the prevalence of musculoskeletal injuries. Methods: This was a descriptive study from a large urban Fire Department employing 350 active firefighters. Using a cross sectional study design, a retrospective analysis investigated the musculoskeletal injury prevalence from 2006-2008 by means of a questionnaire. Individuals reported on demographics, injury location, injury etiology, injury nature, extent of treatment rendered and time lost from work. Additionally, data was obtained regarding smoking, occupational stress, fitness, protective gear and injury prevention advice given by the Durban Metropolitan Fire Department. A 41% response rate was achieved. Results: The point prevalence of WRMSIs was 33.6% and the period prevalence was 81.1% of the sample. Low back injuries (47.9%) and strain injuries (40.8%) were the most common, followed by knee (22.5%), shoulder (19.7%) and ankle injuries (19%). The most common causes included lifting heavy objects, working in awkward postures and running. Weight, ethnic group, stress, lack of nutritional advice and alcohol consumption were all significantly associated with the prevalence of injuries. Ex-smoking was significant in the prevalence of low back injuries, stress was significant in the prevalence of knee injuries and alcohol consumption was associated with the prevalence of shoulder injuries. Conclusion: WRMSIs are of great concern in the fire service as their prevalence is substantial. Evaluation and implementation of further preventative measures and advice based on the results of this study can be effective in reducing WRMSIs.

[Truncated abstract] Anterior cruciate ligament injuries are a major problem in sport. The purpose of this thesis was to investigate the causative factors of ACL injuries and to study the effect of various types of lower-limb training on underlying neuromuscular mechanisms involved in stabilisation and risk of ACL injury. Investigation of the mechanisms was conducted on controlled balance and strength tests as well as in sporting manoeuvres. It was aimed to assess if the neuromuscular changes map over into the performance of sporting manoeuvres and if potential for loading on the ACL and risk of injury was reduced or exacerbated . . . ACL strain can be decreased through reduction in the applied loads and greater knee flexion. Further to this, muscle activation has the ability to reduce loading on the ACL through co-contraction and selective activation patterns. This thesis demonstrated differing neuromuscular adaptations from various training types that map over into the performance of sporting manoeuvres. The research indicated that the Balance-Training was the most favourable in reducing potential for injury risk on the ACL. Alternatively strength training elicited neuromuscular changes that were likely to increase the risk of force on the ACL. The Machine+Balance training resulted in some negative and positive outcomes with the balance training tending to counteract the negative affects of machine weights training resulting in small improvements in muscular support and load reduction. This study provides us with better understanding of the underlying mechanisms from various training types and their potential affect on risk of ACL injury.

Thesis (M.S.)--University of Michigan, 1996.

A study was conducted on the self-reported symptoms of Mild Traumatic Brain Injury sustained in Rugby Union at the pre- and post-season stages. A full sample of 30 rugby players at Rhodes University was compared to 27 non-contact sport controls. A reduced sample of 20 rugby players and 9 control participants provided improved control for education and IQ and was compared. Measures included the WAIS-III Vocabulary and Picture Completion Sub-tests to estimate IQ level, the symptom checklist on a widely used computer-based program (ImPACT), and a paper and pencil self-report 31-Item Post-Concussion Symptom Questionnaire. Independent and Dependent T-Test comparisons were conducted on the full and reduced samples. The symptoms reported by the rugby group appeared to be more pronounced on both the ImPACT Symptom Scale and the 31-Item Post-Concussion Symptom Questionnaire when compared to the control group at both the pre-and post-season stages. It was concluded that the rugby players demonstrated evidence to support the hypothesis of having sustained more previous concussions and reporting more symptoms at the pre-season stage when compared to comtrol participants. No prevalent changes for either the rugby or control groups were seen in dependent comparisons from pre-to post-season.

Submitted as the dissertation component in partial fulfilment of the requirements for the degree of a Masters in Technology in Chiropractic in the department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2017. / Background: Hip pain is a common problem. Motion palpation is a manual technique applied by the hands in various degrees of joint motion that specifically evaluates range of motion in relation to specific anatomical landmarks, joint play and end feel. Motion palpation remains one of the most used diagnostic techniques and yet it remains unclear whether or not it is a reliable, sensitive and specific tool; especially in the hip joint. Objectives: This study assessed intra- and inter-examiner reliability and clinical responsiveness of motion palpation when it is used as a diagnostic tool in patients with non-specific unilateral anterior hip pain and unilateral asymptomatic hip joints. Methods: Ten participants, between the ages of 18 and 60, were included in this study (three ballet dancers, three golfers and four participants from the general population). The participants were assessed randomly by three blinded examiners. All of the participants then received one adjustment delivered by the researcher (half on the symptomatic side and half on the asymptomatic). The participants were then re-assessed. Data was recorded on a data collection sheet and analysed using SPSS version 23. Intra-examiner reliability and clinical responsiveness were analysed using McNemar’s test and the Chi-Square Test of Independence. Inter-examiner reliability was analysed using Fleiss’ Kappa. Results: Intra-examiner reliability showed to be markedly better on the left-hand side for all three examiners. Kappa scores for inter-examiner reliability varied from none to perfect. The average pairwise agreement scores ranged from 33.3% to 100% at the first assessment, and from 46.6% to 100% in the second assessment. A mean and standard deviation were calculated for the pairwise agreements which represented the sensitivity and specificity respectively. Both showed improvement between the first and second assessments which is positive for inter-examiner reliability. Clinical responsiveness was shown to be absent for examiners A and B but was present for examiner C on the left. Conclusion: This study found that, contrary to the expectations of many clinicians, motion palpation has limited to poor levels of intra-examiner reliability, inter-examiner reliability and clinical responsiveness. This is however limited by the small sample size and methodological limitations in this study. Therefore, the role of palpation as a diagnostic tool used in the diagnosis hip dysfunction may be limited. / M

Magister Scientiae (Physiotherapy) - MSc(Physio) / This study aimed to determine health promotion needs of physically disabled youth with spinal cord injury. The study specifically explored health-related behaviours with reference to participation in physical activity and substance usage, factors that influenced these behaviours and major issues that needed to be targeted in health promotion. / South Africa