Estimating the optimal growth-maximising public debt threshold for Zimbabwe

This paper attempts to estimate an optimal growth-maximising public debt threshold for Zimbabwe. The public debt threshold is estimated by assessing the relationship between public debt and economic growth. The analysis is undertaken to determine the tipping point beyond which increases in public debt adversely affect economic growth. The paper contributes to the debate on the link between public debt and growth by testing the presence of a Laffer-curve type relationship, where the contribution of public debt to growth is theorised to be positive at lower levels and negative at higher levels of public debt. The analysis confi rms the existence of an inverted U-shaped relationship between public debt and economic growth in Zimbabwe. The optimal growth-maximising public debt threshold was estimated at a public debt-to-GDP ratio of between 45 and 50 per cent. The policy implication of the analysis is the need to ensure that public debt management policies are in line with the growth-maximising public debt threshold. This will ensure sustained economic growth and employment rates, which are key tenets for sustainable economic development.Key words: public debt threshold, growth maximising, Laffer curv

Gunshot injuries of the spine

The Acute Spinal Injury Unit, relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003, admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence, particularly gunshot wounds. Aim. To review patients with gunshot injuries to the spine, with reference to neurological injury, associated injuries, need for surgery and complications. Methods. A comprehensive database is maintained to collect data on all spinal injury admissions. These data, as well as case notes and X-rays, were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 ± 8.53). The average stay in the acute unit was 30 (4 - 109 ± 28) days. Results. The spinal injury was complete in 38 and incomplete in 8, with 3 having no neurological deficit. The level was cervical in 13, thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. There were 55 significant associated injuries, viz. 14 haemo-pneumothoraces, 16 abdominal visceral injuries, 3 vascular injuries, 4 injuries of the brachial plexus and 3 of the oesophagus, 2 tracheal injuries, 1 soft palate injury and 11 non-spinal fractures. Complications included 3 deaths and discitis in 3 cases, pneumonia in 6 and pressure sores in 6. Conclusion. Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit, but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit

THE ATTITUDES OF OLDER SOUTH AFRICANS TOWARDS EUTHANASIA

The purpose of this study was to determine the attitudes of older South African adults (65 years and older) towards euthanasia. The subjects of the study were people 65 years of age and older who resided in homes for the aged within the rural and urban areas of the Cape Town Metropolis. An equal number of subjects from the African, Coloured and European communities were randomly selected. A biographical questionnaire, the Euthanasia Attitude Scale and the Purpose In Life Test were administered. The influence of four variables – namely age, ethnicity, meaning in life and health – was investigated. A Pearson correlation coefficient analysis and a one-way ANOVA analysis were used. Age was the only variable found to have a significant correlation with euthanasia. The findings are discussed and certain recommendations are made

Financial burden of orthopaedic gunshot-related injury management at a major trauma centre

Background. Violence and injuries are a significant global public health concern, and have a substantial emotional, physical and economic impact on society. In South Africa (SA), the Western Cape Injury Mortality Profile shows that homicides increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016. This increase is directly related to an increase in firearm-related homicides, which doubled from 2010 to 2016. Previous research estimated the average cost per gunshot wound (GSW)-related orthopaedic patient at USD2 940. GSW-related patient numbers as well as treatment costs have escalated exponentially over the past few years.Objectives. To calculate the financial costs involved in managing gunshot-related orthopaedic injuries both surgically and non-surgically at a tertiary centre in SA.Methods. After ethics approval, a retrospective review of all GSW patients seen in the emergency unit at Tygerberg Hospital in 2017 was undertaken. Patient records yielded data on the following parameters: injury site and characteristics, imaging modalities, orthopaedic management, hospital admission and duration of hospitalisation, theatre episodes, orthopaedic implants and blood products administered. Cost analysis was performed using this information.Results. A total of 389 patients (360 male and 29 female), average age (range, standard deviation) 28 (3 - 69, 9.50) years, were treated during the study period. Patient records identified a total of 449 orthopaedic injuries. A total of 187 patients were admitted, with 175 requiring surgical fixation. The conservatively calculated cost of managing this patient group was ZAR10 227 503. The average management cost per patient was ZAR26 292, with an average of ZAR46 670 per case requiring surgical management and ZAR8 810 for non-surgical cases (the average USD-ZAR exchange rate in 2017 was USD1-ZAR13.30).Conclusions. The total cost of managing 389 patients with gunshot-related orthopaedic injuries at a tertiary hospital was ZAR10 227 503. Improved understanding of these costs will help the healthcare system better prioritise orthopaedic trauma funding and training and highlights the urgent need for cost-saving measures, specifically primary prevention initiatives

Design aspects of a hospital playroom to aid the well-being of hospitalised oncology children - a case study

Published ArticleThe aim of this research was to identify the design aspects necessary to create an aesthetically appealing playroom environment to aid the well-being of hospitalised oncology children at a public hospital in Bloemfontein, South Africa. The methodology design is overall qualitative within the interpretivist paradigm with a triangulation methodology design with explanatory components. These components consisted of a literature review which was further explored by means of a qualitative questionnaire. The playroom was created as part of a community project according to the literature review and questionnaire after which semi-structured individual interviews were conducted with the children themselves

The reliability of physical examination in diagnosing arterial injury in penetrating trauma to extremities: A first look at different anatomical regions and injury mechanisms

Background. The accuracy of physical examination to exclude arterial injury in penetrating trauma to extremities has been well established. Objectives. To determine whether the accuracy of physical examination to exclude arterial injury is similar to that of a computed tomography arteriogram (CTA) for different anatomical regions and mechanisms of injury, and in patients with concomitant fractures compared with those without. Methods. A retrospective review was conducted on all patients who underwent CTA for penetrating injuries to an extremity between 1 June 2016 and 30 June 2017. The presence of arterial injuries was noted, and these were grouped into anatomical areas. Clinical notes were reviewed for the presence of hard signs of arterial injury at initial examination. Results. A total of 220 lower limb and 133 upper limb CTAs were included. The mean patient age was 28.9 years (range 11 - 68). The overall sensitivity of physical examination in detecting a CTA-confirmed arterial injury was 95.3% (95% confidence interval (CI) 88.4 - 98.7), with a specificity of 93.9% (95% CI 90.2 - 96.4). Physical examination of the thigh had the highest specificity of 96.4% (95% CI 91.8 - 98.8), followed by the lower leg at 94.4% (95% CI 81.3 - 99.3), the upper arm at 89.6% (95% CI 79.7 - 95.7) and the forearm at 77.8% (95% CI 40.0 - 97.2). For gunshot wounds the specificity was 96.1% (95% CI 92.4 - 98.3), while for stab wounds it was 86.8% (95% CI 74.7 - 94.5). Conclusions. This study agrees with current literature indicating that physical examination has high specificity in detecting arterial injury in the setting of penetrating trauma to an extremity. However, it shows that the specificity is not equal for all anatomical regions or mechanisms of injury

The reliability of physical examination in diagnosing arterial injury in penetrating trauma to extremities: A first look at different anatomical regions and injury mechanisms

Background. The accuracy of physical examination to exclude arterial injury in penetrating trauma to extremities has been well established.Objectives. To determine whether the accuracy of physical examination to exclude arterial injury is similar to that of a computed tomography arteriogram (CTA) for different anatomical regions and mechanisms of injury, and in patients with concomitant fractures compared with those without.Methods. A retrospective review was conducted on all patients who underwent CTA for penetrating injuries to an extremity between 1 June 2016 and 30 June 2017. The presence of arterial injuries was noted, and these were grouped into anatomical areas. Clinical notes were reviewed for the presence of hard signs of arterial injury at initial examination.Results. A total of 220 lower limb and 133 upper limb CTAs were included. The mean patient age was 28.9 years (range 11 - 68). The overall sensitivity of physical examination in detecting a CTA-confirmed arterial injury was 95.3% (95% confidence interval (CI) 88.4 - 98.7), with a specificity of 93.9% (95% CI 90.2 - 96.4). Physical examination of the thigh had the highest specificity of 96.4% (95% CI 91.8 - 98.8), followed by the lower leg at 94.4% (95% CI 81.3 - 99.3), the upper arm at 89.6% (95% CI 79.7 - 95.7) and the forearm at 77.8% (95% CI 40.0 - 97.2). For gunshot wounds the specificity was 96.1% (95% CI 92.4 - 98.3), while for stab wounds it was 86.8% (95% CI 74.7 - 94.5).Conclusions. This study agrees with current literature indicating that physical examination has high specificity in detecting arterial injury in the setting of penetrating trauma to an extremity. However, it shows that the specificity is not equal for all anatomical regions or mechanisms of injury

The genetic relatedness of E. coli associated with post- collection drinking water contamination in rural households

Rural households are often dependent on rivers, springs, boreholes or standpipes some distance from their homes for their daily water requirements. Water for drinking and domestic use is consequently stored in containers in-house which are prone to post-collection contamination. The objective of the study was to determine the most likely origin or place of introduction of E. coli associated with post-collection contamination in rural households, by assessing the degree of genetic relatedness of E. coli present in the stored water and other environmental samples. E. coli isolates were obtained using either mFC agar with confirmation of indole production (44 isolates) or Colilert®-18 (52 isolates). Amplified fragment length polymorphism (AFLP) fingerprinting was applied to determine the genetic relatedness of E. coli isolated from in-house storage containers, drinking cups, hand-swab samples, cattle dung and from the source water (spring water). DNA fingerprints of E. coli produced a number of clusters (>85% similarity scores calculated with the cosine coefficient). Identical E. coli genetic patterns were observed at closely linked points within the domestic pathway of water handling, such as between hand-swab and drinking-cup samples, between storage container and source isolates, and between drinking cups, source water and storage containers. The results indicated that AFLP fingerprinting could be applied to determine the genetic relatedness of E. coli isolated from closely linked points within the domestic pathway of water use within a household. However, the high genetic diversity observed for E. coli bacteria isolated from the difffferent water and environmental samples tested in this study, hampered the identification of post collection points of contamination.Keywords: typing, fingerprinting, amplified fragment length polymorphism, E. coli, water quality, genetic relatedness, AFL

The Influence of Intensity of Tree Thinning on the Redistribution of Soil Water in Southern African Mopani Veld

The investigation was conducted on a densely wooded area in the Mopani veld of South Africa. Six plots were subjected to different intensities of tree thinning, ranging from a totally cleared plot (0 %) to plots thinned to the equivalent of 10%, 20%, 35%, 50% and 75% of the leaf biomass of a control plot (100%). Soil water measurements were taken at six different depths to a depth of 825 mm. The infiltration of rain water and redistribution within the soil profile exhibited marked differences between experimental plots. The soil water was predominantly held at a very shallow depth (\u3c450 mm). Increased infiltration in plots with a low tree density occurred and was associated with the establishment of grasses. No stratification of soil water between the topsoil and subsoil could be established which means that the C. mopane trees and grasses are in direct competition for soil water in the upper soil layers

Shortest Constrained Inter-Domain Traffic Engineering Label Switched Paths Status of This Memo

This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the "Internet Official Protocol Standards " (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (c) 2009 IETF Trust and the persons identified as the document authors. All rights reserved. This document is subject to BCP 78 and the IETF Trust’s Legal Provisions Relating to IETF Documents in effect on the date of publication of this documen