Trainee participation affects outcomes in emergency general surgery procedures: an analysis of the National Surgical Quality Improvement Program database

Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. With the current project, we aim to identify if a similar effect exists in emergency general surgery. A total of 141,010 patients who underwent emergency general surgery procedures were identified in the 2005-2010 National Surgical Quality Improvement Program database. Due to the non-random assignment of the more complex cases to resident participation, patients were matched (1:1) on known risk factors [age, gender, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol use, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and on preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t- or chi-squared test. The impact of resident participation on outcomes was quantified with multivariable regression modeling, adjusting for both the aforementioned risk factors and operative time. The most common procedures in the matched cohort (n=83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%) and adhesiolysis (6.6%). Our findings suggest that trainee participation in emergency general surgery procedures prolongs operative time, increases intraoperative transfusions, and is independently associated with adverse postoperative outcomes, including wound, pulmonary, and venous thromboembolic complications, as well as urinary tract infections. This effect appears to be independent of the total intraoperative time, case complexity, and preexisting comorbid conditions. We also demonstrate that operative time is another important factor independently associated with intra- and post-operative transfusions, unplanned reoperations, longer hospital stays, infections, as well as wound, pulmonary, and venous thromboembolic complications, when baseline comorbidities and resident participation were adjusted for. Remediation strategies could include increased use of simulation training and increased faculty supervision of residents

STRAIGHT OUTTA FILMS: A QUALITATIVE MEDIA ANALYSIS OF THE HYPERREALITIES OF YOUTH GANGS

Much of what people learn outside their neighbourhoods and personal boundaries is through mass media. As such, it is not surprising that the media has potential to significantly influence public perceptions (Bourke, 2013). Due to the media’s profuse ability to influence public perceptions and the frequency in which gangs are depicted within the media, it is important to understand how they are portrayed. Involvement in a gang is depicted in the media as being intriguing for individuals, and as Preston et al. (2012), note that the media is often inclined to sensationalize criminal gang activity. They cite Gordon’s 2001 research which proposes that gangs often benefit from media focus to glamorize gang memberships, increasing perceptions of recognition and power within specific communities (Preston et al., 2012). Although the media glorifies gang involvement, this is most often not the reality. Additionally, the issue of fake news is a recurring issue when looking at the accuracy of the media, particularly when it comes to the portrayal of youth gangs. The theory of the Social Construction of Social Problems is used to direct this research to determine the accuracy of the media representation of youth gangs. This study fills the gaps in the minimal research that has been completed on this topic, and its findings confirm that the media does not truly portray the true accuracy of youth gangs overall. Furthermore, it was found that films portray youth gangs as social problems in society; although they accurately depicted the events that occurred during the time the film was made, they did not correctly illustrate gangs, gang activity, and gang members within society

A critical appraisal of collaborative partnerships between business and NGOs in post-conflict settings in Africa

Collaborative relationships between business and non-governmental organisations (NGOs), is offering innovative business practices, as a new and emerging concept. The potential of this phenomenon to offer market-orientated solutions to the social and developmental challenges confronting us globally is imminent. The significance of this concept for businesses in post-conflict settings in Africa is particularly relevant for Africa as the next growth market. Critically examining this evolving concept, this study looks at the perceptions and nature of collaborative relationships between business and NGOs in post-conflict settings, the contributory and inhibiting factors, as well as its characteristics towards closing the gap in knowledge.Twenty leaders of businesses and NGOs in Burundi, Sierra Leone and Liberia, involved in collaborative relationships, were interviewed. The concept was scrutinized in a qualitative study, using in-depth interviewing with qualitative and quantitative data collection methods. The methodology allowed innovative practices of collaborative relationships in post-conflict countries to be reflected on.The findings related to the embryonic and evolving nature of collaborative relationships between businesses and NGOs in post-conflict countries reflect a model of innovative cases for enhancing business processes. The model of Business Process Enhancement (BPE) is conceptualised from the results of this study. Concomitantly, the study presents new insights into the strategic potential of collaborative relationships and offers both business and NGOs in post-conflict countries a framework of the benefits, and the contributory and inhibiting factors.Dissertation (MBA)--University of Pretoria, 2012.Gordon Institute of Business Science (GIBS)unrestricte

Small Organic Molecule as Corrosion Inhibitors for Mitigating Metal Corrosion

Metal corrosion constitutes degradation of metals in the presence of favorable corrosive atmosphere. It worsens metal quality. The prevention of metal corrosion is so significant to save metals for their better utility. Corrosion inhibitors are widely used for the mitigation of metal corrosion. Small organic molecules as corrosion inhibitors are showed prominent corrosion inhibitive property because of their unique electron donating capacity to the metal orbitals. The bonding occurred between organic molecules and metals are main aspect to retard the corrosive environment toward metal

Standards for epiphyseal union in South African children between the ages of 6 to 24 years using low dose X-ray (lodox)

Includes bibliographical referencesSkeletal age is a measure of biological maturation and is based on the stages of formation of bones. As age increases, skeletal maturation progresses and the various hard tissue changes which take place are uniquely identifiable and defining to each stage of development. Age assessment using skeletal maturation is a diagnostic tool used clinically and in forensic investigations. Radiographs of the hand and wrist are frequently used to estimate age (Greulich and Pyle,1959); however studies conducted in South Africa have shown that these methods are not applicable to South Africans since the method over estimates age in the 17 - 22 year olds(Dembetembe and Morris, 2013) and both over and underestimates age in 0 - 13 year old individuals (Speed, 2012). There currently is a lack of comprehensive data and studies on the union of the major joints in South African children despite the need for population specific data in age estimations. The LODOX Statscan system, which emits low dose radiation and full body radiographs in thirteen seconds, was used to assess radiographs of1891 individuals between the ages of 6 - 24 years. Union was classified in four stages ranging from one (non-union) to stage four (complete union). Radiographs were obtained from the Red Cross War Memorial hospital and Groote Schuur hospital in Cape Town and Tygerberg and Salt River mortuaries in Cape Town as well as the Chris Hani Baragwanathand Milpark hospitals in Johannesburg. The standards developed on radiographs were later used to conduct gross analysis of skeletal material obtained from the Raymond Dart Collection. Complete union was classified as the age at which 95% of the both males and females showed stage 4 of union. Complete union of all joints in females occurs by age 21 years and 24 years in males with the iliac crest being the last epiphysis to fuse in both males and females. Ordinal logistic regression found significant differences between males and females in the stages of union and age (p 0.05).Data for union times in South African children show that maturity in females at the elbow, hip and ankle are achieved at approximately 15 years of age followed by the knee at 16 years, wrist at 18 years, and shoulder at 20 years. The radiographically visible epiphyses the iliac crest are the last epiphyses to complete union at 21 years. Males progress through union in the same sequence with the exception that there is a two year delay in age at maturity. The elbow in males completes union at approximately 17 years followed by the hip and ankle at 18 years, knee at 19 years, wrist at 20 years, and shoulder at 21 years and finally the iliac crest at 22 years. The methodology derived on radiographs was successfully applied to gross observations of skeletal material. It therefore provides a useful diagnostic tool for use in skeletonised forensic cases in the absence of skeletal material from which to derive such standards. The current work provides an alternative to the Greulich and Pyle (1959) method and is specifically tailored toward South African children