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Human Systems Integration Report / Low back pain (LBP) and work-related musculoskeletal disorders (WMSDs) can lead to employee absenteeism, sick leave, and permanent disability. Over the years, much work has been done in examining physical exposure to ergonomic risks. The current research presents a new approach for assessing WMSD risk during lifting related tasks that combines traditional observational methods with video recording methods. One particular application area, the Future Combat System Medical Evacuation Vehicle (FCS MV-E) mockup, was chosen to illustrate the use of a twodimensional motion capture system. Combat medics (MOS 91W) who perform casualty evacuation under stressful battlefield conditions may be at risk for musculoskeletal injuries, which would reduce their ability to perform their job. The objective of this study is to demonstrate the use of video motion technology for posture analysis of team lifting and loading tasks. The results contribute to a determination of whether combat medics are at risk for WMSD due to awkward postures involved in the evacuation of litter casualties. Based on lessons learned from the current study, recommendations are offered to guide further research in motion analysis of manual material handling tasks.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation / M

Ph.D (Industrial Psychology) / Brain injuries often occur suddenly and without warning, and from that instant, a normal life can be changed. Traumatic Brain Injury (TBI) may result in significant impairment of an individual’s physical, cognitive and psychosocial functioning. Although there is a fair amount of research on the concept of brain damage and the consequent effects on the family and return to work (RTW) prospects, there is far less information available on the actual assessment of workplace capability or workplace potential following the head injury incident. This is important, since the concept of work or job value has been well documented. Employment is far more than just a job; it not only provides for basic sustenance needs and decent living conditions, but also allows someone to fit into the world, create relationships, use talents and skills, learn, grow and build, and develop a sense of identity and belonging. While the value of work is well-documented, the statistics regarding unemployment following a head injury are concerning. It is estimated that approximately 1.5 million Americans sustain head injuries each year, with the majority of these people being under the age of 35 and in their prime years of vocational productivity. A baseline figure of 2% of the American population is currently living with disabilities as a result of head injuries. In South Africa, the rate of occurrence seems to be even more alarming, with published rates of 89,000 cases for 2009. In 2001, this was a baseline figure of 5% of the population living with disabilities resulting from head injuries. Various sources put the occurrence of head injuries in South Africa at 1.5 to 3.5 times higher than the estimated global rate. The negative impact of this on the individual, the family, community and economy is clear.

M.Tech. / Purpose: In soccer the re-injury rate of Hamstring muscle strains is between 12 and 14 percent. A previous or recent Hamstring injury is the most recognised risk factor for future injury. On recurrence of the injury, it tends to be more severe and disabling than the initial injury. Given the high recurrence rates, Hamstring injuries provide a significant challenge to the treating clinician. Knowledge surrounding optimal treatment and preventative measures is therefore critical (Hoskins and Pollard 2005). The aim of this study is to assess the effectiveness of lower lumbar spine segment adjustment, namely the L4/5 spinal level, in the contractile strength of the Hamstring muscle group in professional soccer players that have a history of a Hamstring strain. Design: Forty professional soccer players between the ages of 15 and 34 years with a history of a grade one or grade two Hamstring strain were considered for this study. Participants in this research were obtained from the University of Johannesburg inter-residence players and from the University of Johannesburg first soccer team. Two groups of twenty players were randomly assigned to one of two groups. Group A received spinal adjustive therapy (SAT) to the L4/5 spinal segment with an ultrasound treatment to their Hamstring muscle group and Group B will receive only the ultrasound treatment to the hamstring muscle group. Each participant was treated five times over a period of three weeks. Measurements: Before any intervention was given to either of the groups, Hamstring muscle contractile strength was first recorded using a Cybex system 2000. Hamstring contractile muscle strength measurements were taken again after the fifth treatment for both groups and compared to ascertain if there had been any change in the contractile strength of the Hamstring muscles. Results and Conclusion: Even though the two groups did not start at the same contractile strength for the Hamstring muscle in knee flexion, as measured a CCybex system 2000 possibly due to the selection criteria used in the study in terms of age and body weight of the participants, results showed that spinal adjustive therapy was more effective in improving the muscle contractile strength of the Hamstring muscle in knee flexion since there was a favourable difference in both Group A and Group B following intervention, but more so in Group A (in the once injured leg) which received spinal adjustive therapy due to a greater increase in the overall muscle contraction in the Hamstring muscle group. For the Chiropractic profession this opens huge potential with regards to the Chiropractic benefits and improving the functioning of professional soccer players.

O trauma desponta como mais uma doença a que os idosos podem estar vulneráveis. Além disso, tendo em vista o aumento desta faixa etária, é possível que, em breve, a realidade do trauma nesta população também cresça. Dessa forma, é fundamental que os profissionais dos serviços de saúde conheçam as alterações que ocorrem com o processo de envelhecimento e as características específicas do trauma, com a finalidade de melhor assistir esta população. Assim, os objetivos deste estudo foram: identificar o perfil sociodemográfico de idosos, vítimas de trauma; caracterizar as doenças preexistentes e os medicamentos em uso; descrever as características do trauma e sua evolução; verificar a existência de associação entre variáveis sociodemográficas, doenças preexistentes, características e evolução do trauma; verificar a existência de correlação entre dias internados em CTI e ISS. Trata-se de um estudo não experimental, retrospectivo e exploratório. Realizado a partir da análise de dados de natureza secundária contidos em um banco de dados do Núcleo Hospitalar de Epidemiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, referentes às notificações dos pacientes, vítimas de trauma, atendidos na Unidade de Emergência, deste hospital, no período de 2008 a 2010. Dessa forma, a coleta dos dados seguiu as informações contidas no referido banco, além da busca nos prontuários médicos para identificação de doenças preexistentes, do uso de medicamentos em domicílio e das complicações clínicas após o trauma. Foram estudados 131 idosos, vítimas de trauma, média de idade 69,9 anos (s=7,7); 73,3% eram homens; 55,1%, casados; 54,7%, aposentados; 65,6% possuíam doenças preexistentes, sendo 38,9% hipertensão arterial sistêmica e 19,8% etilismo, média de doenças 2,3 (s=1,4); 48,9% tomavam medicação em domicílio, média 3,2 medicamentos (s=2,3). Quanto às características do trauma, para 31,3%, o mecanismo de trauma foi queda e para 28,2%, pedestre; 83,2% por trauma contuso; 59,5% possuíam lesão em cabeça/pescoço, 45,8% em extremidades e ossos da pelve, média 1,8 (s=1,0); 44,3% obtiveram ISS entre 9 e 15 (trauma moderado) e 30,5% ISS de 25 ou mais (trauma muito grave); 80,2% apresentaram TRISS entre 51% ou mais (francas condições de se evitar o óbito). Com relação à evolução do trauma, 30,5% internaram em CTI, média de 4,2 dias; 62,6% desenvolveram complicações clínicas, sendo 43,5% infecciosas e 30,5% cardiovasculares; 46,1% foram submetidos à cirurgia ortopédica; 66,4% sobreviveram ao trauma, 47,3% receberam alta hospitalar com limitações moderadas e 33,6% faleceram, sendo 36,4% por traumatismo cranioencefálico e 22,7% por sepse. Houve associação entre mecanismo do trauma e doença preexistente (p=0,01) e associação entre mecanismo do trauma e sexo (p=0,03); a presença de doenças aumentou em 3,10 a chance para desenvolver complicações em relação aos que não apresentavam doenças (p=0,02); para os internados em CTI, a chance de ter complicações aumenta em 28,2 (p<0,01); conforme aumenta o índice de gravidade do trauma, maiores são as chances de complicações, odds = 3,07 entre ISS 16 e 24 (grave) e odds = 6,50 com ISS 25+ (muito grave) em relação ao ISS 9 a 15 (moderado); para idosos com complicações, a chance de morte aumenta em 5,56, quando comparados com aqueles que não apresentaram (p<0,01); para idosos com TRISS <50% (sobrevida inesperada), a chance de óbito foi de 10,13 em relação àqueles com TRISS >=50% (morte evitável) (p<0,01); a correlação entre os dias de internação no CTI e os escores do ISS foi fraca e positiva (r=0,18), indicando que quanto maior o número de dias de internação no CTI maiores são os índices de gravidade do trauma (p=0,03). O conhecimento das características e da evolução do trauma pode possibilitar aos profissionais de saúde o planejamento de medidas preventivas, além de viabilizar melhor atendimento aos idosos na atenção intra-hospitalar e após a alta, com vistas a melhorar a qualidade de vida. / Trauma emerges as another condition to which elderly individuals are vulnerable. Considering the increase in this population, trauma events are also likely to increase among older individuals. Hence, it is essential that health care providers are aware of changes that may occur with the aging process and the specific characteristics of trauma aiming to better care for this population. This study identifies the sociodemographic profile of elderly trauma victims; characterizes pre-existent diseases and used medications; describes the characteristics of trauma and its progression; verifies potential correlation between days hospitalized in ICU and Injury Severity Score (ISS). This non-experimental, retrospective and exploratory study was based on secondary data collected from a database of the Hospital Epidemiology Center at the Hospital das Clinicas, Medical School, University of São Paulo at Ribeirão Preto concerning reports of elderly trauma victims cared for in the hospital\'s emergency department from 2008 to 2010. Data collection was based on information contained in the database and search on medical charts to identify pre-existent diseases, medication used at home, and clinical complications after the trauma. A total of 131 elderly trauma victims participated in the study: 69.9 years old in average (sd=7.7); 73.3% men; 55.1% married; 54.7% retired; 65.6% with pre-existent diseases: 38.9% systemic arterial hypertension, and 19.8% alcoholism; average of diseases 2.3 (sd=1.4); 48.9% took medication at home, average of 3.2 medications (sd=2.3). In relation to the characteristics of trauma: 31.3% was caused by falls and 28.2% pedestrian; 83.2% was contusion trauma; 59.5% had head and neck injury; 45.8% had limbs and pelvic bones affected, average 1.8 (sd=1.0); 44.3% obtained ISS between 9 and 15 (moderate trauma) and 30.5% ISS was 25 or above (very severe trauma); 80.2% presented Trauma and Injury Severity Score (TRISS) between 51% or above (real conditions to avoid death). In relation to trauma progression, 30.5% was hospitalized in ICU, 4.2 days in average; 62.6% developed clinical complications: 43.5% infections and 30.5% cardiovascular; 46.1% was submitted to orthopedic surgery; 66.4% survived, 47.3% was discharged with moderate impairment and 33.6% died: 36.4% due to brain injury and 22.7% due to sepsis. An association between the mechanism of trauma and pre-existent diseases was found (p=0.01) as well as association between mechanism of trauma and gender (p=0.03). Pre-existent diseases increased 3.10 times the chance of complications comparing to those with no pre-existent diseases (p=0.02). The chances of complications increased 28.2 times for those hospitalized in ICU (p<0.01); the higher the index of trauma severity, the greater the chances of complications, odds = 3.07 between ISS 16 to 24 (severe) and odds = 6.50 with ISS 25+ (very severe) in relation to ISS 9 to 15 (moderate). The chances of dying increased 5.56 times for those with complications compared to those with no complications (p<0.01); chances of death was 10.13 times higher for individuals with TRISS <50% (unexpected survival) in relation to those with TRISS >=50% (evitable death) (p<0.01). Correlation between duration of hospitalization in ICU and ISS scores was weak and positive (r=0.18) indicating that the longer the hospitalization in ICU, the higher the trauma severity index (p=0.03). Knowledge concerning the trauma characteristics and progression can enable health care providers to plan preventive measures and provide better care to elderly individuals both at the hospital and after discharge aiming to improve their quality of life.

O objetivo do estudo foi realizar a adaptação cultural do STAR Skin Tear Classification System, para a língua portuguesa no Brasil e testar a validade de conteúdo e a confiabilidade inter-observadores da versão adaptada. O estudo é do tipo metodológico com abordagem quantitativa. A adaptação cultural foi desenvolvida em três fases: tradução, avaliação por comitê de juízes e retro-tradução. Foram testadas duas propriedades de medida: validade de conteúdo e confiabilidade inter-observadores. Para as análises estatísticas foi utilizado o índice kappa ponderado. A versão adaptada para o português obteve um nível regular de concordância (kw = 0,286), embora estatisticamente significativo (p = 0,000), quando de sua aplicação por enfermeiros em fotografias de lesão por fricção. Quando de sua aplicação na prática clínica, a versão adaptada em português obteve um nível moderado e estatisticamente significativo de concordância (kw = 0,596; p < 0,001). O estudo sobre o processo de adaptação cultural e validação das propriedades de medida do STAR Skin Tear Classification System possibilitou atestar a validade de conteúdo e a confiabilidade inter-observadores da versão adaptada para uso na língua portuguesa do Brasil / This study aims to perform a cultural adaptation of the STAR Skin Tear Classification System, to the Portuguese language spoken in Brazil and to test its contents validity and the reliability in the translated version. This is a methodological type of study with a quantitative approach. The cultural adaptation was developed in three stages: translation, evaluation by a judges committee and back translation. Two measures were tested: validity and reliability. The statistical analysis used the weighted kappa index. The adapted version had a regular concordance level (kw = 0,286), although statistically significant (p < 0,000) when tested by nurses in skin tears photographs. When tested in clinical practice, the adapted version achieved a moderate and statistically significant concordance level (kw = 0,596; p < 0,001). The study about the cultural adaptation process and validation of the measurements properties of the STAR Skin Tear Classification System confirmed the adapted Brazilian Portuguese version content validity and reliability

"Ultrasound phantoms that mimic injury are training devices that can emulate pre- and post-injury conditions within specific regions of human anatomy. They have the potential to be useful tools for teaching medical personnel how to recognize trauma conditions based on ultrasound images. This is particularly important because the increased use of portable ultrasound systems allows earlier diagnosis of internal trauma at locations such as traffic accidents, earthquakes, battlefields and terrorist attacks. A physical injury mimicking ultrasound phantom of the peritoneal cavity was constructed that mimicked the ultrasonic appearance of internal bleeding. Bleeding was simulated by injecting 600 mL of fluid of varying densities into the bulk of the phantom and comparing the ultrasonic appearance to before bleeding was simulated. The physical phantom was used to investigate whether or not the density of the injected fluid had any influence on the increase of inter-organ fluid volumes. The physical phantom was imaged in 3D with a 4.5 MHz phased array transducer, and two fluid volumes were segmented using the segmentation software ITK-SNAP. The 3D image representation of the phantom showed a difference qualitatively and quantitatively between pre-injury and post-injury conditions. Qualitatively, the physical model was analyzed. These specific criteria were analyzed within each image: 1) the number of individual organs that are present, 2) the number of other organs that each individual organ touches, 3) the appearance of fluid between the organs and the scanning membrane and 4) the merging of two separate fluid pockets. Using a Wilcoxon Rank-Sum test, a statistically significant difference was shown to exist between pre-injury and post-injury ultrasound images with a 95% level of confidence. Quantitatively, a Chi-Squared test was used to show that the volume of fluid between adjacent organs, calculated by ITK-SNAP, had no dependence on the density of the injected fluid. Furthermore, using a one-tailed T-test, there was at least a 99.9% confidence that the inter-organ volume estimations for the pre-injury and post-injury configurations were statistically different. As a final means of evaluation, the experimental phantom was taken to Harvard Medical School in November 2006 and analyzed by ultrasonographers. The doctors were very excited about its potential uses and found other interesting characteristics that the phantom was not designed for. In addition to modeling the appearance of an injected fluid volume, visualization of fluid flowing into the phantom, modeling the appearance of air in the inter-peritoneal space and simulating a surgical tool or bandage being accidentally left inside the patient could be modeled as well. The injury mimicking phantom was also modeled numerically, using ADINA finite element software. Using the same external dimensions as the experimental model, the numerical model showed that for physiologically unrealistic, very high fluid injection densities, the displacement of the organs had no statistical dependence on the density of the injected fluid, using an acceptance criterion of: P-value < 0.05. This was confirmed using an F-test of the average organ phantom tip displacement tabulated at several different times during simulation. The P-value obtained for analyzing the average tip displacement was 0.0506. However, a plot of the mass ratio, an expression of how the injected fluid has dispersed into the bulk of the phantom, showed that an unrealistically high fluid injection density had a different mass ratio profile than the other fluid injection densities that were simulated. This F-test revealed a strong indication, P-value = 0.0069, that the very high density caused a different fluid dispersion pattern. The numerical phantom offered a distinct advantage over the experimental model in that the dispersion of the injected fluid could be modeled numerically but not observed experimentally. Modeling the phantom numerically had some disadvantages. The numerical model had to have a large gap between adjacent organs. This had to occur because the contact algorithm within ADINA is incapable of modeling dynamic contact when fluid-structure interactions are modeled. This led to a volume fraction representation of the solid domain that was too low compared with the experimental model and what is found anatomically. For future iterations of the injury mimicking phantom, the numerical model will be used to help design the physical phantoms."

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Every year, in the United States alone, there are 1.7 million incidences of traumatic brain injury (TBI). Unfortunately, despite the tremendous societal and economic cost and decades of research, current pharmacological treatments for TBI are lacking. The specific aims of this thesis are: (1) to determine the efficacy of 17β-estradiol (E2) monotherapy treatment post-TBI, (2) determine if a combination treatment of E2 and memantine provides statistically significant benefits over monotherapy treatments post-TBI, and (3) to investigate the utility of an in vitro model to recapitulate the pathobiology of an in vivo model of TBI and to assess its potential to discover novel and clinically relevant therapeutic targets for future studies. The neuroprotective properties of E2 have been investigated for several decades in several different models including excitotoxicity, ischemia, and TBI. Organotypic hippocampal slice cultures (OHSCs) were mechanically injured at specified strain and strain rates which are relevant to TBI, and the efficacy of E2 post-TBI was investigated. Physiological concentrations of E2 were more effective at preventing cell death than supraphysiological concentrations. Further, GPR30, a novel G protein-coupled receptor, was not activated at physiological concentrations. These results suggest that the classical estrogen receptors (ERs) were primarily responsible for E2-mediated neuroprotection following TBI, and that GPR30 is neither necessary nor sufficient. While monotherapy treatments have shown preclinical success post-TBI, none have been successful in clinical trials. Combination therapies are a promising area of research that focuses on synergistic effects between compounds for significant increases in neuroprotection, potentially resulting in a clinically relevant treatment. A combination treatment of E2 and memantine was statistically more neuroprotective than either monotherapy post-TBI. Using micro-electrode arrays (MEAs), we recorded and quantified increased evoked responses in OHSCs after physiological concentrations of E2 and showed that memantine significantly reduces these effects. Our results suggest a potential combination treatment for TBI and a possible mechanism for its synergistic effects. TBI is a complex injury which initiates a multitude of secondary injuries causing delayed cell death for days or beyond. The utility of in vitro models depends on their ability to recapitulate the in vivo injury cascade after TBI. We used a genome wide approach to study changes in gene expression after injury in both an in vitro model and an in vivo model of TBI to compare the post-TBI pathobiology. There was a strong correlation in gene expression changes between the two models providing confidence that the in vitro model represented the in vivo injury cascade. From these data, we searched for genes with significant changes in expression over time and identified Sorla. Sorla directs amyloid precursor protein (APP) to the recycling pathway by direct binding and away from amyloid beta (Aβ) producing enzymes. Mutations of Sorla have been linked to Alzheimer's disease (AD). We confirmed the down regulation of SORLA expression in OHSCs by immunohistochemistry (IHC) and western blotting. Together, these data suggests that the in vitro model of TBI that was tested strongly recapitulates the in vivo TBI pathobiology and is well-suited for future mechanistic or therapeutic studies. The data also suggest a novel target, Sorla, which may play a role in AD caused by TBI. In conclusion, we discovered a potentially clinically relevant combination treatment of E2 and memantine for post-TBI therapy. We also confirmed that our in vitro model of TBI is well representative of in vivo models, and that relevant, novel targets for future TBI studies can be elucidated with this model. A potential link between AD and TBI was suggested and warrants future study. Together, these studies address the growing public health concern of TBI.