An audit of trauma intercostal drains at Tembisa hospital

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master in Science in Medicine (Emergency Medicine).Background: Chest trauma is a common Emergency Department presentation. Most patients are treated by the Advanced Trauma and Life Support (ATLSTM) principles and the insertion of an intercostal drain (ICD) where indicated. However, the procedure has complications. Aim: The aim of this research project was to study trauma ICDs at Tembisa Hospital. Objectives: The objectives were to (a) obtain demographics, (b) determine complications, (c) compare the complications between those of Tembisa Hospital and Tygerberg Hospital (d) determine whether mechanism of injury, indication for the ICD, time of day, trauma team, ICD duration, length of hospital stay and the patient’s age were risk factors for developing complications. Results: (a) Of the 251 patients and 285 ICDs, 244 (97.2%) were males. The ages varied between 14 and 61 years (28.77 mean). ICD duration ranged from 1 to 35 days (5 mean). Length of hospital stay was between 1 to 68 days (6.32 mean). Stab wounds were the most frequent type of injury (81.6%). Penetrating injuries accounted for 94% of all injuries. Indications for ICD insertion were 89 (34%), 86 (32.8%) and 81 (30.9%) for haemopneumothoraces, haemothoraces and pneumothoraces respectively. (b) There were 64 complications (22.5%) among 49 patients (19.5%). (c) Both Tembisa Hospital and Tygerberg Hospital had “loose” ICDs and malpositions among their commonest complications. (d) Only ICD duration and length of hospital stay were risk factors for developing complications at Tembisa Hospital. Conclusion: Doctors should be taught proper ICD insertion and fixation techniques. ICD duration should be minimized

Increases in salience of ethnic identity at work: the roles of ethnic assignation and ethnic identification

To better understand how ethnicity is actually experienced within organisations, we examined reported increases in ethnic identity salience at work and responses to such increases. Thirty British black Caribbean graduate employees were interviewed about how and when they experienced their ethnic identity at work. The findings demonstrated that increased salience in ethnic identity was experienced in two key ways: through ‘ethnic assignation’ (a ‘push’ towards ethnic identity) and ‘ethnic identification’ (a ‘pull’ towards ethnic identity). We explore how and when ethnic assignation and ethnic identification occur at work, and their relevance to how workplaces are experienced by this group of minority ethnic employees. The findings suggest the need for further research attention to the dynamic and episodic nature of social identity, including ethnic identity, within organisations, and to the impact of such increases in salience of social identities on behaviour at work

The business case for women leaders: Meta-analysis, research critique, and path forward

Since the 1990s, a growing body of research has sought to quantify the relationship between women’s representation in leadership positions and organizational financial performance. Commonly known as the “business case” for women’s leadership, the idea is that having more women leaders is good for business. Through meta-analysis ( k = 78, n = 117,639 organizations) of the direct effects of women’s representation in leadership (as CEOs, on top management teams, and on boards of directors) on financial performance, and tests that proxy theoretical arguments for moderated relationships, we call attention to equivocal findings. Our results suggest women’s leadership may affect firm performance in general and sales performance in particular. And women’s leadership—overall and, specifically, the presence of a female CEO—is more likely to positively relate to firms’ financial performance in more gender egalitarian cultures. Yet taking our findings as a whole, we argue that commonly used methods of testing the business case for women leaders may limit our ability as scholars to understand the value that women bring to leadership positions. We do not advocate that the business case be abandoned altogether but, rather, improved and refined. We name exemplary research studies to show how different perspectives on gender, alternative conceptualizations of value, and the specification of underlying mechanisms linking leadership to performance can generate changes in both the dominant ontology and the epistemology underlying this body of research.</jats:p

High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis

Aims: High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome. Methods and results: Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 ± 0.4 cm2) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity. Conclusions: In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death

Children's daily travel to school in Johannesburg-Soweto, South Africa: geography and school choice in the Birth to Twenty cohort study

This paper has two aims: to explore approaches to the measurement of children’s daily travel to school in a context of limited geospatial data availability, and to provide data regarding school choice and distance travelled to school in Soweto-Johannesburg, South Africa. The paper makes use of data from the Birth to Twenty cohort study (n=1428) to explore three different approaches to estimating school choice and travel to school. Firstly, straight-line distance between home and school is calculated. Secondly, census geography is used to determine whether a child's home and school fall in the same area. Thirdly, distance data are used to determine whether a child attends the nearest school. Each of these approaches highlights a different aspect of mobility, and all provide valuable data. Overall, primary school aged children in Soweto-Johannesburg are shown to be travelling substantial distances to school on a daily basis. Over a third travel more than 3km, one-way, to school, 60% attend schools outside of the suburb in which they live, and only 18% attend their nearest school. These data provide evidence for high levels of school choice in Johannesburg-Soweto, and that families and children are making substantial investments in pursuit of high quality educational opportunities. Additionally, these data suggest that two patterns of school choice are evident: one pattern involving travel of substantial distances and requiring a higher level of financial investment, and a second pattern, involving choice between more local schools, requiring less travel and a more limited financial investment

Contextual expertise and the development of organization and management theory

Generating theory from research settings requires researchers to adeptly engage with the social intricacies of the field. They need to develop a contextual understanding by gaining in-depth insights into the setting, while retaining a critical distance from it. Researchers must practice this along the entire research journey, from site selection, through data collection and analyses, to theory development and explanation. However, contextual expertise has been assumed rather than actively considered as a critical component in organization and management studies. We lay out steps for understanding the nature of contextual expertise, offer systematic advice for research projects and outline methodological practices across the research process to choose, capture, comprehend, convey, and confirm contextual specificities. The growing social complexity of research settings renders the development of contextual expertise increasingly important for the generation of enriched and more diverse theory. It also has implications for organization and management studies as a scientific community