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Spinal injury and pain can often be debilitating, leading to a significant decrease in quality of life. The development of these spinal conditions may be explained by changes spinal loading patterns. Since spinal loading patterns cannot be analyzed in vivo, biomechanical musculoskeletal models have been developed to estimate them. Incorporating muscle parameters such as cross sectional area and moment arms improves the accuracy of musculoskeletal models, but no current resource provides a comprehensive set of muscle parameters for a wide variety of subjects. This study aims to develop a method for estimating trunk muscle parameters from clinically attainable variables such as age, sex, height, weight, trunk width, and trunk depth. The regression models built in this study drew from in-vivo CT-based cross sectional area and moment arms measurements of an age- and sex- stratified community-based population. The base regression model used the independent variables age, sex, height, and weight, while subsequent models examined the differences when trunk depth or trunk width was incorporated. 27% of cross sectional area regressions were improved with the addition of trunk weight or trunk width; 26.6% of medial lateral moment arm regressions were improved with the addition of trunk width; 50% of anterior posterior moment arm regressions were improved with the addition of trunk depth. Although the addition of trunk depth or width improved model fit especially in moment arm regressions, the R2 values of regressions were not increased greatly. It is suspected that muscle position as related to distribution of fat may explain the mismatched contribution of trunk measurements to moment arm estimates in different muscles. Further investigation is needed to examine the effects of fat distribution on muscle parameter estimation.

The principal aim of the study was to establish the HIV Seroprevalence in an acute Orthopaedic trauma setting in an urban teaching hospital. Secondary aims were (i), to establish if the seroprevalence compares with the national averages and findings from other similar studies, and (ii), to establish the effect of informed consent on the response rate to recruitment in HIV related studies. Methodology All illegible patients (able and qualified to give an informed consent for HIV testing) admitted to the Orthopaedic trauma unit at the Johannesburg hospital, were pre-counselled and tested for HIV after admission. Those that tested positive were then counselled again and referred accordingly to the HIV clinics for follow up. Results A total of 797 patients were admitted during the period. 159 (20%) did not meet the inclusion criteria, declined counselling or could not be counselled for various reasons. The main reason for non response was cited as a need to wait until after the acute event before they considered the test. A total of 648 patients were therefore eligible for recruitment. All patients were pre-counselled for the test and 246 (39%) consented and signed the informed consent form. Of those that were tested, 57 (23%) tested positive and were followed up accordingly. This result was then compared with previous non Orthopaedic studies on the HIV Seroprevalence. The rate of HIV infection in our acute orthopaedic trauma setting was found to be 23%. This is higher than the national averages but compares with other studies. Most acutely traumatized patients are not willing to be tested for HIV in the acute setting. This has a huge bearing on recruitment of suitable candidates for future studies in HIV in an acute trauma setting. Higher response rates to recruitment in HIV studies are directly proportional to the use of qualified counsellors in organized centres like the Voluntary Counselling and Testing centres.

Fracture healing occurs in a discrete set of steps, which recapitulates embryonic endochondral bone formation. Pathophysiologies of the fracture healing that prolong the fracture repair or result in non-union may be associated with either environmental or congenital deficiencies. Phosphate deficiency resulting from either dietary or genetic perturbations can impede proper fracture healing and if prolonged can result in delayed union. The clinical assessment of regain of mechanical function is determined by measuring weight-bearing ability, palpation and various radiological approaches. These methods in general only provide qualitative evidence but are lacking in quantitative evidence of the regain in mechanical strength. The aim of this study was to characterize the microstructural properties obtained by micro-computed tomography of fracture calluses at various stages of healing and develop correlations between these structural parameters and mechanical properties that define regain of function. Transverse, mid-diaphyseal fractures were produced on the right leg in three different murine genetic strains—A/J (AJ), C57BL/6J (B6), and C3H/HeJ (C3). Each mouse was either fed a control or phosphate deficient diet that produces a hypophosphatemic state and generates an environmental state that impairs fracture healing. Those on a phosphate deficient diet were kept on this diet for 14 days post-fracture. Fractured limbs were studied at four different post-operative time points—14, 21, 35, and 42. These four time points were based on callus stability and various phases in callus development. Contralateral limbs served as a control, representing full regain of strength. Day 0 contralateral limbs were used for the control group. Contralateral limbs were imaged and torsion tested for each strain on both control and phosphate-deficient diets. The data reveals that in regards to bone volume fraction, bone mineral density, and tissue mineral density all three strains show a progressive return to non-fractured, control values but even by post-operative day 42 do not show a 100% regain in microstructural properties. While there are interactions between specific post-operative time points and the dietary restriction, by post-operative day 42 microstructural properties showed no significant differences between the two groups, suggesting that the effects of phosphate deficiency are reversible upon a return to normal dietary conditions. The AJ and B6 strains show significant interaction between post-operative time point and dietary restrictions earlier in the fracture repair process (post-operative days 14 and 21), whereas the C3 mice show these interactions at later time points, at post-operative 35 and 42 days. Phosphate deficiency induces an overshoot in mechanical properties at post-operative day 21 for AJ and B6 strains and at post-operative day 35 for the C3 strain that appears to be part of a process in which maximum torque and work to failure undergo a compensatory phase in which these two mechanical properties are significantly higher than in non-fractured, control limbs. The overshoot in maximum torque and work to failure is part of an adaptive process in which the callus first overshoots and subsequently returns to non-fractured control values. These results suggest that while microstructural properties and mechanical properties are often affected by diet, this is a reversible phenomenon, which holds implications for those with phosphate deficiency due to either a metabolic or dietary disorder. If normal phosphate intake and absorption are achieved by the period at which couple remodeling in initiated (14 post-fracture) the effects on microstructural and weight bearing levels are reversible. The slower healing seen in C3 mice evidenced by the later regain in microstructural and mechanical integrity may provide a model for patients whose fractures show delayed healing in the clinic. The microstructural properties discussed have the potential to play a role in the clinic to assess fracture healing. With the advent of greater resolution CT imaging assessing these microstructural properties can be useful in determining the progression of healing.

Thesis (Ph. D.)--University of Queensland, 2002. / Includes bibliographical references.

BACKGROUND: Until recently budget allocation for public hospitals in the Gauteng Province were based on the historical values and not on the costed activities. It is therefore unknown how much of the allocated budget is used per discipline in an institution. Because of recurrent over expenditure by institutions, Gauteng Department of Health and Social Development have decided to change policy for budget allocation of funding public health facilities from historical allocation to activity based costing. Although good financial management of hospitals is a priority for the government, data on real costs of providing health care services is scarce and unreliable. No formal study has been done to estimate the cost to provide inpatient services in the Helen Joseph Hospital, a regional hospital in the Gauteng Province. In view of that, it was decided to initiate this study at the Orthopaedic unit of the Hospital, which would then be extended to the other units. AIM: To estimate the caseload, profile of patients and operational cost of providing the inpatient orthopaedics services at a regional hospital in Gauteng. METHODOLOGY: A cross-sectional study design was used based on retrospective review of patients’ and hospital records of patients admitted during one month study period at the two Orthopaedic Ward in the Helen Joseph Hospital, situated in the Johannesburg Health District in the Gauteng Province. RESULTS: Total number of patients admitted in the Orthopaedic Unit of the Hospital in the year 2009/2010 was 2160 (The mean number of inpatients per month was 180 ± 28). Profile of patients One hundred and ninety seven patients were admitted during one month study period. There were more male than female patients. The median age was 41 years (IQR 31-53 years). More black patients were admitted during this period, even though the main catchment population for the Hospital is predominantly white and coloured. The majority of patients were from a low socio-economic class as reflected by their classification for user fee payment using the means test. The median inpatient day was 3. The most common cause of admissions is due to injury, poisoning and certain other consequences of external causes as expected in an Orthopaedic Ward. A low complication rate (4.5%) was found to be the lowest as compared to other units in the Hospital. The majority of patients were discharged. Cost drivers The major cost driver was human resource which accounted for 70% of the total expenditure. Other cost drivers were material resources used in the unit, which includes: laboratory, blood and blood products, radiology and pharmaceuticals. Expenditure on these items account for only 13.7% of total expenditure. Cost driver Amount Unit cost Laboratory R61,215.57 R412.26 Blood and blood products R53,164.41 R269.87 Radiology R52,085.50 R264.39 Pharmaceuticals R17,315.82 R87.90 The total expenditure during this period was R 1,481,363.30 or R 17,776,359.60 annually. The unit cost of laboratory services (Ward 4: R926.30 and Ward 5: R272.97), blood and blood products (Ward 4: R463.05 and Ward 5: R217.52), radiology (Ward 4: R659.97 and Ward 5: R157.20) and pharmaceuticals (Ward 4: R236.63 and Ward 5: R47.60) and varied significantly between Ward 4 and Ward 5 which might be due to difference in clinical practices between the two Wards. CONCLUSION: This study showed the operational costs needed to provide an inpatient orthopaedic service at a regional health facility. Further study based on more detailed costing at individual patient level is necessary to develop a better understanding of costing at these Wards. This study highlighted the significance of understanding the importance of determining the actual costs needed to provide an inpatient service in a health facility. Simple cost analysis method could easily be done at Unit/ Ward level to provide more insight to Hospital managers who are always criticized for overexpenditure.

Inaug.-Diss.--Universität Erlangen-Nürnberg, Erlangen. / At head of title: Aus dem Seminar für Geschichte der Medizín der Universität Erlangen-Nürnberg. Vita.

Thesis (MAppSc in Physiotherapy) -- University of South Australia, 1993

Thesis--University of Pittsburgh. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1978. 21 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 119-122).

Thesis--University of Pittsburgh. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1978. 21 cm. Includes bibliographical references (leaves 119-122).