The earliest possible initiation of reperfusion therapy is necessary to reduce morbidity and mortality from acute STEMI. Therefore improving the time to thrombolysis where percutaneous coronary interventional facilities are limited or do not exist is critical. The most effective system would integrate three key components to deliver continuous patient care, including: 1) from time of call for help through to emergency response; 2) transportation to and admission to hospital; 3) assessment and initiation of thrombolytic therapy. The purpose of this prospective study is: to develop a chest pain awareness education programme appropriate for the South African context; to assess safe initiation of thrombolytic therapy by emergency care practitioners for STEMI; and to compare the performance of emergency care practitioner thrombolysis with historical control data.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Surgery Johannesburg, 2012 / Trauma and intentional injury form a major burden of disease in South Africa. This study examines the patterns of injury resulting from interpersonal violence presenting at a Level One trauma centre serving an urban population. This was a cross-sectional analysis of patients attending the Johannesburg Hospital Trauma Unit, over a period of forty-one consecutive days. In keeping with the worldwide experience of trauma care, the study showed the burden of trauma rests heavily upon young males. A majority of the incidents involved a weapon, used for penetrating or blunt injury. In cases where the weapon was documented, it was more commonly a weapon carried by one of the individuals involved such as a firearm or knife, than an item obtained spontaneously during the conflict. Patients subjected to weapon-based violence were significantly more likely to require advanced or invasive radiology, admission and operation. Weapon type influenced the pattern of injury sustained and the need for specialist consultation. It did not significantly affect admission or operation rates. Although blunt assault without a weapon may cause multiple injuries, they tended to be superficial injuries either allowing for discharge from the emergency room immediately or following a period of observation. This study showed the presence of a weapon greatly increases the morbidity resulting from the event for the patient and increases the subsequent cost to the healthcare system.

Introduction: The incidence of traumatic brain injury was reported to be 360 per 100 000 in South Africa. The consequences of traumatic brain injury include physical, cognitive, psychological, behavioural and emotional deficits. Prognostic factors such as age, mechanism of injury and severity of injury as well as medical history (extent of intervention) assist in determining the outcome of the patient. It is believed that the predictors of recovery assist both the patient as well as family members in determining the duration of rehabilitation as well as potential outcomes for the patient. Aim: The aim of this study was to determine the factors that influence the functional mobility outcome of patients with traumatic brain injury. Method: A cross sectional study was used to collect data where participants were assessed pre-discharge. A self designed questionnaire was administered by the interviewer and the Modified Mini Mental State questionnaire and the Rivermead Mobility Index were also administered. Results: Of the 60 participants, 56 were male and four were female. Half of the patients were able to walk indoors with an assistive device at the time of assessment, with only 36.7 percent of the patients having a higher functional level than walking indoors. The following factors increased the likelihood of functional mobility: the gender of the patient, Grade 12 education, being either self employed or unemployed, an income of between R800 and R2000 as well as more than R5000, having both bowel and bladder continence and Occupational therapy sessions. Factors that were found to have a negative influence on functional mobility include: age, premorbid smoking and drinking, having a craniotomy and physiotherapy sessions. Conclusion: Male gender, high education, being either self employed or unemployed, high income, bowel and bladder continence positively impacted on the functional mobility of the patient on discharge. Older age, premorbid smoking and drinking, having a craniotomy has a negative impact on the physical function of the patient with traumatic brain injury on discharge.

This thesis is submitted in partial fulfillment of the requirements for the degree of Master of Science in Emergency Medicine( Msc Med EM), Division of Emergency Medicine, University of Witwatersrand , Faculty of Health Sciences , School of Clinical Medicine, Department of Family Medicine, 2012 / 1. BACKGROUND AND SETTING The study was conducted at Vryheid district hospital in the Kwazulu- Natal province. The increasing number of traumatic brain injuries seen at the hospital has prompted me to describe traumatic brain injuries in the community. Data was collected from the records of casualty department and the hospital wards. 2. AIM This thesis describes traumatic brain injuries at Vryheid district hospital during 2009. 3. METHODS It is a retrospective cohort study with a total sample size of 596 participants; retrieved from patients’ registers at the hospital’s casualty department and hospital wards. 4. RESULTS - The peak age of occurrence of traumatic brain injuries (TBI) at Vryheid is between 20 and 30 years with 75% of injuries happening in younger than 35 years and a mean age of 29 years. - 78% of traumatic brain injuries occurred in female patients but it is important to note that females are in greater number than males at Abaqulusi municipality. - Blacks are the most affected by the traumatic brain injuries at Vryheid: 97% versus 2.4% in white and 0.3 in Asians. - Blunt traumatic brain injuries are the most common type of TBI at Vryheid: 97%. - Assault injuries constitute the major cause of traumatic brain injuries ( 57 %) followed by motor vehicle accidents (40%) - Mild traumatic brain injuries represent 75% of traumatic brain injuries presenting at Vryheid during 2009. - The majority of TBI patients at Vryheid were discharged either from casualty department or from the wards and only as small number of patients died or was transferred out. Moreover, 60% of patients were treated as ambulatory patients. - 94% of TBI at Vryheid hospital had a good prognosis and only a small percentage was associated with bad prognosis. - The mean hospital length stay at Vryheid was 2.2 days with a minimum of less than a day (62%) and a maximum of 129 days. 5. CONCLUSION In 2009, traumatic brain injuries were found to be common at Vryheid hospital in the black population and were mainly due to assault injuries and motor vehicle accidents. Moreover, motor vehicle accidents were associated with high mortality. Although, the majority of traumatic brain injuries at Vryheid hospital were mild, 10% were severe. Thus, TBI at Vryheid constitutes a public health concern that needs to be addressed by the SA government in consultation and collaboration with various stakeholders.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / This research makes a meaningful contribution to the development of effective injury prevention strategies among adolescent cricket pace bowlers. This dissertation, specifically investigated two screening procedures, the Functional Movement Screen (FMS) and ultrasound measured abdominal wall muscle thickness, both of which aim to predict injury among the general and sporting population. More specifically, the dissertation investigated the applicability of these screening procedures to adolescent cricket pace bowlers. Adolescent pace bowlers are prone to injury due to the high load and complex nature of the bowling action as well the risk factors associated with the adolescent growth spurt. Studies related to the validity of the FMS in terms of the prediction of injuries among various sporting disciplines have been conducted but none among cricket pace bowlers. Studies related to the association between abdominal wall muscle morphometry (i.e. thickness at rest and during the performance of abdominal drawing in manoeuvre (ADIM), as measured by ultrasound imaging (USI), and injury among professional and amateur cricket pace bowlers have had conflicting results and limited research related to abdominal muscle morphometry among the adolescent pace bowlers exist. Adolescent pace bowlers that were injury free at the start of the season were recruited for this study. Details related to the nature of past injuries as well as injuries sustained during the season were monitored and recorded over a three month period. Included in this dissertation are three original papers. The first two investigated the association between prospective in-season injury and the two above mentioned screening procedures. The third investigated the concurrent validity of FMS overhead deep squat (DS) when observer rating was compared to kinematic analysis. The first paper (Chapter 4) investigated the association between muscle morphometry of transverse abdominis (TA), internal oblique (IO) and external oblique (EO), as measured by USI, at the start of the season and in-season injury. Results indicated that non-dominant internal oblique is thicker than dominant IO (p=0.01, effect size (ES) =0.65) in injury free pace bowlers but that non-dominant and dominant internal oblique (p=0.47; ES=0.24) is symmetrical in injured pace bowlers. Based on these findings we concluded that asymmetry in IO thickness may play a protective role against injury rather than being a predisposing risk factor to injury. The second paper (Chapter 5) investigated the association between pre-season total FMS score and in-season injury among adolescent pace bowlers. Results indicated that there was no significant difference in total pre-season FMS scores of bowlers that sustained injuries during the season and those that remained injury free (p=0.58). Also, a total FMS score of 14 (the score previously found to be an accurate cut-off score) does not provide the sensitivity needed to assess injury risk among adolescent pace bowlers. It was therefore concluded that the FMS was not associated with in-season injury among adolescent pace bowlers and that the usefulness of this tool in the prediction of injuries among these cricketers is doubtful Paper 3 (Chapter 7) investigated the concurrent validity of the overhead DS included in the FMS when observer rating is compared to kinematic analyses. The FMS attempts to systematically score the quality of movements, among other the DS, based on specific criteria. The developers of the FMS suggest that specific mechanics related to the DS differ between levels of scoring. There were significant differences in the degree to which the torso was flexed forward, away from the vertical (p=0.03), where groups 3 and 2 (i.e. those participants who scored a rating of 3 and 2 respectively for the performance of the DS) remained more upright compared to Group 1. There was also a significant difference in the degree to which the femur passed the horizontal line (p=0.05) between the three groups. At the point of deepest descent, the femurs of Groups 3 and 2 were below the horizontal while that of Group 1 remained above. The findings of this part of the study suggest that, while raters correctly identified differences in biomechanics between groups for two of the scoring criteria (femur below horizontal and feet remaining flat on floor or board) , they did not rate the groups correctly for the remaining criteria. The concurrent validity of the observer rating of the FMS DS is therefore questionable. In conclusion, the high load nature and complexity of the pace bowling action together with the intrinsic risk factors related to the adolescent growth spurt, expose school boy cricket pace bowlers to injury. The ability of these screening procedures to accurately identify individuals at risk of sustaining injuries are therefore of the utmost importance. Despite the popularity of the FMS, the concurrent validity of this screening tool and its lack of association with in- season injury among adolescent pace bowlers brings the use of FMS into question. Symmetry, not asymmetry, of the IO and under-, not over-activation of the dominant TA muscles were associated with in-season injuries among pace bowlers. All of the above conflicting findings pose uncertainty regarding the applicability of these screening procedures to injury prediction among adolescent cricket pace bowlers. / MT2017

Sepsis and multi-organ failure are the most frequently reported causes of death in burn injuries. Their early identification allows therapies and resources to be targeted in a more effective and efficient way. Due to its frequent antibiotic drug resistance Acinetobacter baumannii (MRAB) is increasingly causing a problem in burns units. New strategies need to be found to combat infection and sepsis in the burn ICU. This study examines the potential of the Albumin Creatinine Ratio, a marker of systemic endothelial dysfunction in predicting outcomes, sepsis and multi-organ failure; the role of Acinetobacter in causing organ failure; and explores for the presence of the cathelicidin, LL-37 in the burn wound and examines it potential utility for treating infection and sepsis. It was found that ACR on admission and at 48 hours is predictive of patient outcomes and the development of sepsis, and may be of use predicting multi-organ failure. Multi-organ failure occurs more frequently in MRAB patients compared to those patients with drug sensitive Acinetobacter baumannii. The number of agency nursing staff and work intensity are possible contributing factors in MRAB acquisition. LL-37 has been found in both acute burn wounds as well as in the grafted healing burn wound and is active against drug resistant Acinetobacter baumannii. ACR can therefore identify those patients at risk of sepsis and may have a role in predicting multi-organ failure. MRAB acquisition in the burns intensive care unit is a significant cause for concern as patients are more likely to suffer from multi-organ failure as well as prolonging their hospital stay and resulting in poorer outcomes. LL-37 has many functions and importantly plays a role in the body’s innate immune system. In the era of increasing antibiotic resistance it may provide a novel therapeutic role in treating MRAB infection.

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Mok, Kam Ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 36-44). / Abstracts in English and Chinese. / Abstract --- p.ii / Chinese abstract --- p.iii / Acknowledgement --- p.iv / Table of contents --- p.V / List of figures --- p.vii / List of tables --- p.viii / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Review of literature --- p.3 / Chapter 2.1 --- Why prevent ankle ligamentous sprain? --- p.3 / Chapter 2.2 --- A sequence of injury prevention --- p.4 / Chapter 2.3 --- Biomechanical approaches in defining injury mechanism --- p.5 / Chapter 2.4 --- Injury mechanism of ankle ligamentous sprain in sports --- p.6 / Chapter 2.5 --- Model-Based Image-Matching motion analysis --- p.7 / Chapter Chapter 3: --- Development of an ankle joint Model-Based Image-Matching motion analysis technique --- p.9 / Chapter 3.1 --- Introduction --- p.9 / Chapter 3.2 --- Materials and method --- p.10 / Chapter 3.2.1 --- Cadaver test --- p.10 / Chapter 3.2.2 --- Model-Based Image-Matching motion analysis --- p.12 / Chapter 3.2.3 --- Statistical analysis --- p.14 / Chapter 3.3 --- Results --- p.15 / Chapter 3.3.1 --- Validity --- p.15 / Chapter 3.3.2 --- Intra-rater reliability --- p.16 / Chapter 3.3.3 --- Inter-rater reliability --- p.17 / Chapter 3.4 --- Discussion --- p.17 / Chapter 3.5 --- Conclusion --- p.21 / Chapter Chapter 4: --- Biomechanical motion analysis on ankle ligamentous sprain injury cases --- p.22 / Chapter 4.1 --- Introduction --- p.22 / Chapter 4.2 --- Materials and method --- p.24 / Chapter 4.2.1 --- Case screening --- p.24 / Chapter 4.2.2 --- Model-Based Image-Matching motion analysis --- p.24 / Chapter 4.3 --- Results --- p.28 / Chapter 4.3.1 --- High Jump Injury --- p.28 / Chapter 4.3.2 --- Field hockey Injury --- p.28 / Chapter 4.3.3 --- Tennis Injury --- p.29 / Chapter 4.4 --- Discussion --- p.30 / Chapter 4.5 --- Conclusion --- p.34 / Chapter Chapter 5: --- Summary and future development --- p.35 / References --- p.36 / List of publications --- p.42 / List of presentations at international and local conference --- p.43 / List of Awards --- p.44

Thesis (M Dent(MFOS))--University of Limpopo, 2010. / Introduction-Craniofacial reconstruction following trauma is different for each individual as it highly depends on the nature and location of the patient’s injuries. The mandible is a unique bone, which has a complex role in both esthetics of the face and functional occlusion. Due to the prominent position of the lower jaw, mandibular fractures are the most common fracture of the facial skeleton Aim- The aim of this study is to assess the prevalence and distribution of combination fractures in the mandible among patients presenting at the University of Limpopo, Medunsa Campus, department of Maxillofacial and Oral surgery. The nature and site of injuries occurring in the mandible will be recorded, and correlated with the cause of injury. The data should establish a preoperative idea of fractures that can be expected in the mandible when associated with a particular type of injury, especially of the combination type. Materials and methods- The patient’s records and radiographs at the University of Limpopo Medunsa Campus, Department of Maxillofacial and Oral Surgery (MFOS) were accessed. Patients with mandibular fractures who presented to the department over a four-year period (ranging from January 2002 to December 2005) were included in this study. Results- There were 1755 patients treated for maxillofacial injuries during the period 2002 to 2005 (4 years). A total of 1222 (69.63%) patients sustained fractures to the mandible. However 505 (41.33%) patients sustained combination fractures of the mandible. This evidence statistically proves that there is a 41.33% chance of another fracture occurring in a patient who has been diagnosed with a single fracture to the mandible. Various etiological factors contributed to these mandibular fractures. Interestingly the major contributing factor was found to be assault. This study confirms the results that males are affected more than females. This study found the average male to female ratio to be 8.18:1. The age distribution ranged from 2 years to 86 years. The mean age was found to be 31.07 years with a standard deviation of 12.06 years. The highest frequency was recorded between 20 to 29 years (42.77%) followed by 30 to 39 vi years (24.36%). The sites of fractures varied with different combinations. The highest number of fractures was recorded in the left angle (159) followed by the right parasymphysis region (142). In the combination category however the left angle right parasymphysis combination (70) showed the highest incidence of combination fractures followed by left parasymphysis and right angle combination (47), right angle and left body combination (37) and left angle and right body (36) combination fractures. The incidence of sustaining a left angle and right parasymphysis combination fracture is 13.86%. A total of 92 (18.22%) condyles sustained fractures with various combinations. Fifty fractures occurred on the left side while 42 occurred on the right side. Conclusion- In conclusion this study has shown that there is a 41.33% chance of a combination fracture occurring in a fractured mandible. These results are statistically high given the fact that the mandible is a commonly injured bone. Therefore careful evaluation of diagnostic radiographs is necessary since some fractures are not diagnosed clinically. This can help improve treatment outcomes and reduce possible postoperative complications.

Cricket is one of Australia's most popular sports, both in terms of participation rates and spectator interest. However, as with all sports, participation in cricket can be associated with a risk of injury. Injury surveillance in Australia and internationally has consistently identified fast bowlers as the players at the greatest risk of injury. This clearly establishes fast bowlers as the priority group for continued risk factor research. The primary aim of this thesis is to describe the epidemiology of repetitive microtrauma injuries and identify the risk factors for these injuries to male adolescent and adult fast bowlers. The program of research consists of three sequential prospective cohort studies, which were conducted over four cricket seasons. The rate of injury was high in all these studies, with nearly half of the 305 bowlers sustaining an injury. The first of the three studies, which was conducted over three seasons, recruited 95 adult first-class fast bowlers and investigated bowling workload as a risk factor for injury. The findings suggested that there were thresholds for both low and high workload, beyond which the risk of injury increased. The second study recruited 47 adolescent high performance fast bowlers for one season, and identified a significant association between high bowling workload and injury. Based on the results of these two studies, workload guidelines for adult and adolescent fast bowlers are described in detail in this thesis. The third study expanded on the first two workload studies and concurrently investigated a range of potential injury risk factors relating to bowling workload, physical characteristics and bowling technique. A total of 91 adult and adolescent high performance fast bowlers participated in the third study for one season. Two independent predictors of injury were identified: increased hip internal rotation and reduced ankle dorsiflexion. This program of research has provided information that is essential for the development of evidence-based injury prevention guidelines for adolescent and adult fast bowlers. The next stage in the injury prevention process is to implement measures that control the exposure to the injury risk factors identified in this thesis.