Rationale: Ng et al. (2008) demonstrated that sub-acute hippocampal atrophy occurred between 4.5 and 24 months following moderate-to-severe traumatic brain injury (TBI); it remains to be determined if atrophy occurred before 24 months. Objectives: (1) to determine if sub-acute hippocampal atrophy occurs by the first year of injury; (2) to determine associated clinical and demographic variables. Methods: Ten moderate-to-severe TBI patients underwent MRI at 5 and 12 months post-injury. Glasgow Coma Scale (GCS) and demographic variables were correlated with change. Results: Significant hippocampal volume decreases were observed for right (P< 0.002, Cohen’s d= 0.34) and left (P< 0.036, Cohen’s d= 0.22) sides. GCS was significantly correlated with right (r= -0.663, P< 0.037), but not left percent hippocampal volume change (r= -0.327, P< 0.356). No significant correlations were observed for demographic variables. Conclusion: Sub-acute hippocampal atrophy occurs between 5 and 12 months post-injury and is associated with injury severity.

Rationale: Ng et al. (2008) demonstrated that sub-acute hippocampal atrophy occurred between 4.5 and 24 months following moderate-to-severe traumatic brain injury (TBI); it remains to be determined if atrophy occurred before 24 months. Objectives: (1) to determine if sub-acute hippocampal atrophy occurs by the first year of injury; (2) to determine associated clinical and demographic variables. Methods: Ten moderate-to-severe TBI patients underwent MRI at 5 and 12 months post-injury. Glasgow Coma Scale (GCS) and demographic variables were correlated with change. Results: Significant hippocampal volume decreases were observed for right (P< 0.002, Cohen’s d= 0.34) and left (P< 0.036, Cohen’s d= 0.22) sides. GCS was significantly correlated with right (r= -0.663, P< 0.037), but not left percent hippocampal volume change (r= -0.327, P< 0.356). No significant correlations were observed for demographic variables. Conclusion: Sub-acute hippocampal atrophy occurs between 5 and 12 months post-injury and is associated with injury severity.

Objective: To describe the walking characteristics of a sample of ambulatory subjects with sub-acute incomplete spinal cord injury (iSCI). Methods: 52 subjects were included in a secondary analysis of clinical and spatiotemporal measures of walking. The study sample was described as a whole and subsequently divided into subgroups on the basis of 3 clinical factors (etiology, severity, and neurological level of injury) and 4 gait factors (gait aid, velocity, symmetry, and variability). Results: Clinical and spatiotemporal parameters were highly variable across the study population. Sub–groups with unique gait features were best identified by velocity and variability. Conclusions: Spatiotemporal measures of walking provide augmented description of walking in the sub-acute iSCI population. Sub-grouping by gait factors warrants further investigation with respect to their ability to act as predictors and modifiers of treatment effect.

Objective: To describe the walking characteristics of a sample of ambulatory subjects with sub-acute incomplete spinal cord injury (iSCI). Methods: 52 subjects were included in a secondary analysis of clinical and spatiotemporal measures of walking. The study sample was described as a whole and subsequently divided into subgroups on the basis of 3 clinical factors (etiology, severity, and neurological level of injury) and 4 gait factors (gait aid, velocity, symmetry, and variability). Results: Clinical and spatiotemporal parameters were highly variable across the study population. Sub–groups with unique gait features were best identified by velocity and variability. Conclusions: Spatiotemporal measures of walking provide augmented description of walking in the sub-acute iSCI population. Sub-grouping by gait factors warrants further investigation with respect to their ability to act as predictors and modifiers of treatment effect.

This dissertation investigates the need for a change in popular perception of what an institutional building should and could look and feel like. This is achieved through the exploration of ways to create a therapeutic environment that houses a sub-acute facility which provides operational after care for patients discharged from Louis Pasteur Private Hospital in the Pretoria CBD. As well as providing for certain functional requirements, the architectural exploration aims to enrich and encourage the healing process of patients within the city with a rich mixture of stimulating and therapeutic experiences and qualities. Through the exploration and incorporation of various theories, these aims are set as an end goal not only throughout the design process, but are also used to guide the technical development and solutions that are used within the finalization of the facility. With a constant concept of creating a space for healing within the city of Pretoria, a Centre for Healing is created which holds these ideals at the core of its existence. / Dissertation (MArch(Prof))--University of Pretoria, 2010. / Architecture / unrestricted

Mild blast-induced traumatic brain injury (bTBI) is a modality of injury that has been of major concern considering a large number of military personnel exposed to the blast wave from explosives. bTBI results from the propagation of high-pressure static blast forces and their subsequent energy transmission within brain tissue. Current literature presents a neuro-centric approach to the role of mitochondria dynamics dysfunction in bTBI; however, changes in astrocyte-specific mitochondrial dynamics have not been characterized. As a result of fission and fusion, the mitochondrial structure is constantly altering shape to respond to physiological stimuli or stress insults by adapting structure and function, which are intimately connected. Dysregulation of the protein regulator of mitochondrial fission, DRP1, and upregulation in the phosphorylation of DRP1 at the serine 616 site is reported to play a crucial role in astrocytic mitochondrial dysfunction, favoring fission over fusion post-TBI. Astrocytic mitochondria are starting to be recognized to play an essential role in overall brain metabolism, synaptic transmission, and neuron protection. Mitochondria are vulnerable to injury insults leading to the worsening of mitochondrial fission and increased mitochondrial fragmentation. In this study, a combination of in vitro and in vivo bTBI models were used to examine the effect of blast on astrocytic mitochondrial dynamics. Acute differential remodeling of the astrocytic mitochondrial network was observed, accompanied by an acute (4hr) and sub-acute (7 days) activation of the GTP-protein DRP1. Further, results showed a time-dependent reactive astrocyte phenotype transition in the rat hippocampus. This discovery can lead to innovative therapeutics targets to help prevent secondary injury cascades that involve mitochondria dysfunction. / Doctor of Philosophy / Blast-induced traumatic brain injury (bTBI) is a modality of injury that has become prominent considering a large number of military personnel exposed to a blast wave caused by explosives. Blast injury results from the energy transmission of the blast wave to the brain. Within the brain, there are specialized cells, called astrocytes, that help maintain a healthy environment. This work investigates the role that astrocytes play during the injury recovery process. Within the astrocytes, there are organelles called mitochondria, that help maintain the energy for the cell. The number and function of mitochondria can change in response to the brain injury. They can increase in number by a process called fission and they can decrease in number by a process called fusion. These events effect the function of the mitochondria. Researchers have methods that can identify changes in the number and function of the mitochondria. In this work, astrocyte mitochondrial dynamics were examined and compared using models of bTBI. We found significant changes in the mitochondria of astrocytes, which could lead to an unhealthy environment in the brain. This discovery can lead to new treatments for patients that may improve their quality of life following bTBI.

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.

Made available in DSpace on 2014-08-20T14:37:56Z (GMT). No. of bitstreams: 1 dissertacao_elizabeth_schwegler.pdf: 314372 bytes, checksum: 5a87d95b17fb4dee0132cf2f5b7f0824 (MD5) Previous issue date: 2009-03-17 / The aim of this study was to observe the efficiency of probiotics, monensin and selenium yeast fed to sheep induced to sub-acute ruminal acidosis (SARA) on the maintenance of normal ruminal and metabolic parameters. Thirty six sheep that averaged 12 months old and 31 ± 8 kg of body weight were used. The sheep were kept in a confinement system, receiving a diet based on tifton hay (Cynodon sp.) and concentrate. The sheep were divided in six groups, each one containing six animals. The treatments were: CO group, control, receiving the diet without any supplement; CS, with the addition of 1.5 g/animal/day of Sel-Plex® (selenium yeast); CM, with the addition of 11 ppm/kg of diet dry matter (DM) of monensin; CSM, with the addition of 11 ppm/kg of diet DM of monensin and 1.5 g/animal/day of Sel-Plex®; CY, with the addition of 3 g/animal/day of Yea-Sacc® (probiotic Saccharomyces cerevisiae); CSY, with the addition 3 g/animal/day of Yea-Sacc® and 1.5 g/animal/day of Sel-Plex®. The sheep receive this diet for 21 days before the start of the experiment. After the adaptation period the sheep were submitted to 2 days of fasting, receiving just the supplement and water ad libitum. After this, the sheep were submitted to 4 days of induced SARA, with concentrate ad libitum and received in the first morning meal the supplement specific for each group. Three days after the induction period, the sheep received the usual diet, but still receiving the supplements. Ruminal fluid collections were performed four times daily (8 and 12 AM and 4 and 7 PM) during the induction period and once daily (12 AM) in the recuperation period. The ruminal fluid was evaluated for pH, number of protozoa and chlorides concentration. Blood collection was performed once daily in the last day of adaptation, on the four days of induction and on the three days of recuperation. The metabolic parameters evaluated were: aspartate aminotransferase (AST), gamma glutamil transferase (GGT), lactate desidrogenase (LDH), glucose, calcium, chlorides, phosphorus, magnesium, sodium and potassium. The results showed that control group was superior regarding ruminal pH (P<0.05). Ruminal chlorides and number of protozoa did not differ between groups (P>0.05), only between day of the experiment (P<0.05). Also, there was no difference in the blood metabolic parameters between groups (P>0.05), but only between day of the experiment (P<0.05). Thus, the supplements used in this experiment were not efficient in maintaining ruminal and metabolic parameters at physiological levels in sheep submitted to sub-acute ruminal acidosis. / O objetivo do estudo foi determinar a eficácia do uso de probiótico (Saccharomyces cerevisiae), monensina e selênio levedura, sobre parâmetros ruminais e metabólicos de ovinos em situações de acidose ruminal sub-clínica (ARS). Foram utilizados 36 ovinos sem raça definida, com idade média de 12 meses e peso médio de 31 ± 8 kg. Os animais foram mantidos em sistema de confinamento, recebendo dieta a base de feno de tifton (Cynodon sp.) e concentrado. O experimento possuía 6 grupos experimentais, com 6 animais em cada grupo, tendo sido diferenciados pelo seu suplemento, sendo a dieta básica a mesma. Os tratamentos utilizados foram: grupo CO: controle, apenas a dieta básica; CS: com adição de 1,5 g /animal/ dia Sel-Plex® (selênio orgânico); CM: 11 ppm/ kg matéria seca da dieta de monensina sódica; CSM: 11ppm/kg matéria seca da dieta de monensina sódica, juntamente com 1,5 g/ animal/ dia de Sel-Plex®; CY: 3 g/ animal/ dia de Yea-Sacc® (probiótico a base de Saccharomyces cerevisiae); CSY: 3 g/ animal/ dia de Yea-Sacc® e ainda 1,5 g/ animal/ dia de Sel-Plex®. Os animais receberam esta dieta durante 21 dias, antes do início das coletas. Após o período de adaptação, os ovinos foram submetidos a 2 dias de restrição ao concentrado e volumoso, recebendo apenas o suplemento e água a vontade. Posteriormente os animais passaram por 4 dias de indução de ARS, com livre acesso à fração concentrada da dieta, recebendo no primeiro arraçoamento do dia os suplementos de cada tratamento. Nos três dias subseqüentes ao período de indução, os animais retornavam a dieta do período de adaptação recebendo os respectivos suplementos de acordo com cada tratamento (período de recuperação). Foram realizadas coletas de líquido ruminal 4 vezes ao dia (8, 12, 16 e 19 h), no período de indução, e às 12 h no período de recuperação. No líquido ruminal foi avaliado pH, contagem total de protozoários e teor de cloretos. A coleta de sangue foi realizada 1 vez ao dia no último dia de adaptação da dieta, nos quatro dias de indução e nos três dias de recuperação. Os parâmetros metabólicos avaliados foram: aspartato amino transferase (AST), gama glutaril transferase (GGT), desidrogenase láctica (LDH), glicose, cálcio, cloretos, fósforo, magnésio, sódio, potássio. Os resultados demonstram que o grupo controle se mostrou superior aos demais quanto ao pH do fluido ruminal (p<0,05). Os cloretos ruminais e a contagem total de protozoários não tiveram diferença entre grupos, apenas entre dias de indução. Nos parâmetros metabólicos, os resultados não tiveram diferença entre os tratamentos utilizados, apenas entre os dias de coleta. Conclui-se que os suplementos utilizados não foram eficazes em manter os parâmetros ruminais e metabólicos em níveis fisiológicos em animais submetidos à acidose ruminal sub-clínica.