3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge(2009-02-12T13:01:29Z) Van Aswegen, HelenaABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects.Item Subjective accounts of recovery from anorexia nervosa(2008-08-06T12:07:16Z) Furniss, SamanthaLiterature on recovery from anorexia nervosa indicates that research studies often exclude the experience of recovery from a subjective point of view. As a result there seems to be a lack of understanding as to what the process of recovery entails. The aim of this study is to explore the process of recovery from the participants’ perspective. The focus of this study is on the narratives of young women who consider themselves recovered from anorexia nervosa with or without formal treatment. Semi-structured interviews were conducted with nine young women who reported recovery from adolescent-onset anorexia nervosa. The resulting interview transcripts were subsequently analysed qualitatively using a narrative analytic perspective in order to explore the ways in which participants narrated their recovery experiences. Particular attention was paid to the subjective perspective of the perceived causes of anorexia nervosa, how participants narrated what it was like to be anorexic, how treatment was experienced and various aspects of the recovery process. The narratives of recovery suggest that recovery has diverse meanings, creates different expectations and has different manifestations for different individuals. The narratives suggest that, rather than a dichotomy within recovery, there are shades of recovery through which traces of anorexia emerge. Experiences of treatment too are not clear cut with a tension existing between resistance to treatment and dissatisfaction with treatment. By presenting these narratives, this study aims to explore the contradictions and difficulties within recovery experiences in order to extend that which is already known about recovery from anorexia nervosa.Item Electrochemical reactors for PGM recovery(2006-02-14) Ferreira, Bronwynne KimThe employment of an electrochemical process is an attractive alternative for the treatment of effluents. When dealing with solutions of low metal ion concentrations mass transport limitations are significant and large electrode surfaces are required. The use of a reactor containing a three-dimensional electrode is preferable as the surface area per unit volume is orders of magnitude greater than that of the familiar plate type reactor. A benchscale electrochemical reactor was designed and constructed to incorporate a cylindrical packed bed cathode. The flow of electrolyte is perpendicular to the direction of the flow of the current and the system is operated galvanostatically in a batch recirculation mode. The industrial stream selected for examination contains palladium and copper ions and a small concentration of platinum in a chloride medium containing ammines. The evolution of chlorine gas at the anode by the oxidation of the chloride ions is prevented by the inclusion of a cation exchange membrane and a separate anolyte, namely sulphuric acid, is introduced to the outer anodic chamber. Tests were conducted on both synthetic and industrial solutions and a simplified model which was derived was used to estimate the mass transfer coefficients. The concentrations of the palladium, copper and platinum in the plant effluent were approximately 150, 200 and 10 ppm respectively. The results show that the metal ions can be rapidly reduced to well below 1 ppm in each case. The separation of the palladium and copper ions is shown to occur to a limited degree during electrodeposition, with the extent of separation increasing for lower current densities. Enhanced separation may be possible during the removal of the deposited metals from the cathode either by anodic stripping or chemical treatment. A further method for the recovery of the metals is the combustion of the graphite particles. The high value of palladium, coupled with the significant recoveries shown to be achievable, suggest economic viability in addition to the environmental benefits.