HIV testing and the Employment Equity Act--putting an end to the confusion.
Explore the source record for details and available documents.
Employment↗
Biomedical subjects
D H Bass
Publications and source records attributed to D H Bass.
Performance of air sparging systems: a review of case studies.
Fluor Daniel GTI (now IT Corporation) has compiled a database of 49 completed in-situ air sparging case studies. Air sparging is a commonly used remediation technology which volatilizes and enhances aerobic biodegradation of contamination in groundwater and saturated zone soil. The air sparging database was compiled to address questions regarding the effectiveness and permanence of air sparging, and to provide predictive indicators of air sparging success to aid in optimization of existing and future air sparging systems. In each case study, groundwater concentrations were compared before sparging was initiated, just before sparging was terminated, and in the months following shutdown of the sparging system. The case studies included both chlorinated solvents and petroleum hydrocarbon contamination, and covered a wide range of soil conditions and sparge system parameters. In many cases, air sparging achieved a substantial and permanent decrease in groundwater concentrations. Successful systems were achieved with both chlorinated and petroleum contamination, both sandy and silty soils, and both continuous and pulsed flow sparging. In other cases, however, a significant rebound of groundwater concentrations was observed after sparging was terminated. Rebound sometimes required 6 to 12 months to develop fully. Rebound was more frequently observed at sites contaminated with petroleum hydrocarbons than with chlorinated solvents. Petroleum-contaminated sites were more likely to rebound when initial groundwater contamination levels were high enough to suggest the presence of LNAPL or a smear zone of residual LNAPL. Rebound at petroleum sites appeared to be minimized by a high density of sparge wells addressing the entire source area and a high sparge air injection rate. In some cases, rebound appeared to be related to a rising water table.
Aerobiosis↗
Inhalation burns in children.
Survival from serious burns in children has improved substantially in recent years. Mortality is predominantly determined by the total body surface area burned and the often unrecognised inhalation injury. A retrospective review of 4,451 consecutive children with thermal injuries over a 10-year period was undertaken to determine the incidence, clinical presentation, and pathology of inhalation injury and its contribution to morbidity and mortality. Inhalation burns were diagnosed clinically and confirmed endoscopically and post-mortem in 97 (2.2%) children; 77 sustained fire burns (mean age 4 years) and 20 hot-water burns (mean age 18 months). The Moylan classification stratified them into upper-airway burns in 59 children, major-airway burns in 29, and parenchymal burns in 44. Major-airway burns were always seen in conjunction with either upper-airway or parenchymal injury. Stridor and acute progressive respiratory distress were the two main symptoms, the onset of which was occasionally delayed for up to 72 h. Endoscopy was most helpful in confirming the diagnosis and determining airway management. Endotracheal intubation was needed in more than 50% of children, usually for less than 5 days, and was converted to tracheostomy in only 6. Persistent laryngeal and tracheal damage was identified in 4. Secondary pneumonia occurred in 41.5% of children with fire burns and 55% with hot-water burns. Extensive surface burns, parenchymal injury, and secondary pneumonia all contributed to the significant mortality. Post-mortem findings corroborated clinical and endoscopic evidence. This study suggests that inhalation burns were often not recognised, could present late, and usually had significant consequences. Early clinical diagnosis, supported by endoscopic findings and appropriate management, is essential if the high morbidity and mortality amongst these children is to be improved.
Burns, Inhalation↗
Severe head injury in children--a preventable but forgotten epidemic.
OBJECTIVE: To determine the outcome of seriously head-injured children and to analyse the factors that affect their prognosis. DESIGN: A retrospective analysis of all severely head-injured children treated between 1990 and 1993. SETTING: Red Cross War Memorial Children's Hospital's trauma unit and neurosurgery service. PATIENTS: One hundred and two children under the age of 14 years with admission Glasgow Coma Scores (GCSs) of below 8. RESULTS: There were 57 boys and 45 girls. The average time of assessment after injury was 2.8 hours. Eighty-three injuries were caused by pedestrian motor vehicle accidents. Thirty-seven were associated with other serious organ system injuries. Fifty-eight children died and only 36 made a good recovery. All children with a GCS of 3-4 died. Factors that were particularly associated with a poor prognosis were: (i) age less than 3 years; (ii) associated extracranial injury; (iii) GCS 3-4 following resuscitation; and (iv) diffuse cerebral swelling on computed tomography. CONCLUSION: Pedestrian motor vehicle accidents are the most common cause of serious paediatric head injury in the Cape Town area. Children with a presenting coma score of less than 8 have an extremely high mortality and morbidity rate, despite modern intensive care. Preventive strategies are essential.
Accidents, Traffic↗
Child abuse services at a children's hospital in Cape Town, South Africa.
UNLABELLED: Since the establishment of a Child Abuse Management Service at the Red Cross War Memorial Children's Hospital in the early 1980s, there has been a steady increase in patient numbers. In order to assess the profile of patients, and also the allocation of staff to the service, all child abuse related patients seen at the Red Cross War Memorial Children's Hospital in Cape Town over the period of June 1989 through July 1990 were reviewed. Five hundred and three children with a median age of less than 7 years were seen. Abuse was confirmed in 389 (160 physical abuse and 229 sexual abuse). Abuse was suspected and not confirmed in 114 (41 physical and 73 sexual). Half of the patients presented to the hospital outside of normal working hours. Eighty-one percent of children less than 5 years of age were seen in the Trauma Unit by surgical residents with minimal pediatric training. One hundred and thirty four of the patients were Xhosa speaking while only one social worker and no medical staff could speak Xhosa. Pediatric residents were involved in the care of less than 2% of cases. CONCLUSION: Management of child abuse constitutes a significant commitment and appropriate staff allocation is essential. Although it is not possible for each child in whom abuse is suspected to be seen by a specialist, they should be seen by those staff with the most expertise. Staff allocation must take into account the needs for education, training, and audit as well as service provision.
Child↗
The management of ingested foreign bodies in children--a review of 663 cases.
Over a 3-year period, 663 children aged under 13 years were seen with a history of foreign body (FB) ingestion. Seventy-six per cent of the children were less than 6 years old. Coins and chicken or fish bones were the most common objects ingested. In 27 (4%) children, the FB had been expelled or removed before arrival, and in a further 133 (20%), no FB could be identified. Three patients required emergency airway management. Less than 50% of the children presenting with dysphagia or vomiting had identifiable FBs lodged in the oropharynx or proximal oesophagus, whilst 22% of the children with FBs requiring removal from these sites were asymptomatic. Oesophageal FBs were removed under direct vision (six cases), by rigid oesophagoscopy under general anaesthetic (77 cases), or using a balloon catheter under sedation (26 cases). All 224 FBs detected in the stomach or beyond were allowed to pass naturally, and delayed passage occurred in only one case. Passage of 11 alkaline disc batteries occurred without complication. No patient required surgical removal of an FB.
Adolescent↗
Traumatic duodenal haematoma in children.
Over a 15-year period, 967 children presenting to Red Cross War Memorial Children's Hospital with blunt abdominal trauma included nine cases in whom traumatic intramural duodenal haematomas were diagnosed on clinical and radiological grounds. Motor vehicle collisions were the commonest cause of injury. Review of these nine cases and their management confirms the efficacy of non-operative treatment and that laparotomy should be reserved for only those children with additional intra-abdominal injuries, or where the diagnosis remains in doubt.
Accidents, Traffic↗
The effects of arterial interruption on bone growth in a rat model.
A controlled study was undertaken to examine the effects of temporary arterial interruption on bone growth in a laboratory rat model. Under general anaesthesia, the right external iliac artery (EIA) was exposed in each of 80 male rats weighing 110-120 g. Twenty of the rats served as sham controls while three groups of 20 rats each underwent ligation of the artery for 6, 24 and 48 hours respectively. All rats underwent measurement of right and left femoral and tibial length 12 weeks after artery ligation. Measurements were performed in vivo using three-dimensional stereoscopic analysis, the method of which is described. Results revealed that EIA ligation for 6 hours had no effect on bone growth but that ischaemia for 24 hours and 48 hours produced leg length discrepancies equalling 3.1% and 3.6% respectively. We conclude that a time-dependent relationship may exist between ischaemia and compromised bone growth in a developing animal.
Animals↗
Gastrointestinal tract perforation in children due to blunt abdominal trauma.
Over a 14-year period 587 children under 13 years of age were admitted with blunt injury to the abdomen. Twenty-nine (4.9 per cent) of these were found to have bowel rupture. Evidence of peritonitis was present at initial evaluation in 11 children (38 per cent). Radiological evidence of perforation (pneumoperitoneum) was present in only five of 27 (19 per cent) with a further six of 27 (22 per cent) showing dilated loops of bowel or fluid levels. Thus 59 per cent of radiographs were not diagnostic. The mean time from admission to laparotomy was 17 h. Proximal bowel perforation was common and perforation at multiple sites occurred in five patients; 59 per cent had a concomitant injury which resulted in two deaths (from head injury). Initial clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeated clinical examination is advocated; progression of abdominal signs should alert the clinician to proceed to laparotomy.
Abdominal Injuries↗
Mercury absorption following button battery ingestion.
A case of button battery ingestion with resulting disintegration of the battery, mercury spillage, and absorption of elemental mercury from the colon is reported. In the light of this case and other recorded complications following button battery ingestion, a plan of management is suggested.
Child, Preschool↗
Road traffic collisions involving children as pedestrians. Provisional results of a hospital-based study.
In December 1990 a study was undertaken at Red Cross Children's Hospital to examine the circumstances surrounding pedestrian injuries in children under the age of 13. The provisional results, based on the first 154 parental interviews, are reported here. There is a strong correlation between pedestrian injury and children playing or running errands in residential areas during day-light hours, particularly in the late afternoon. Lack of adult supervision may be an important factor. The relevance of these findings to future road safety strategies is discussed.
Accidents, Traffic↗
Financial compensation following road traffic injury: who is footing the bill?
A study was undertaken at Red Cross Children's Hospital to assess how aware parents were of motor vehicle accident (MVA) claim procedures on behalf of their children. Of 160 questionnaires sent out to the parents of road traffic injury (RTI) victims, 100 were answered. Sixty-six per cent of parents who responded had an income below R500 per month. The identity of the motorist responsible for injuring the child was known to only 26 parents. Third party damages were claimed by only 32 parents or guardians; the remaining 68 failed to do so principally through lack of awareness. The implications of these findings for both RTI victims and the hospitals where they are treated are discussed here.
Accidents, Traffic↗
Perineal injuries in children.
Over a 12-year period, 463 children under 13 years of age were treated for perineal injuries. The most common cause of injury was a fall astride, but motor vehicle trauma and rape were responsible for most of the severe and multiple injuries. Physical or sexual abuse was evident in 178 (38 per cent) of children, and four sustained injuries from forceful enema. Minor abrasions or first degree tears (88 per cent) and second degree tears (6 per cent) were sutured primarily or allowed to granulate with sepsis rates of 1.2 per cent and 14 per cent respectively. Twenty-nine (6 per cent) children sustained third degree lacerations; one died from secondary pelvic haemorrhage. In the 28 survivors, the outcome of primary (18) or delayed (ten) surgical repair was related to whether or not early defunctioning colostomy had been performed.
Accidents, Home↗
Blunt liver trauma in children.
From 1978 to 1988 228 children under 13 years of age with liver injury following blunt abdominal trauma were studied prospectively. Motor vehicle related accidents were responsible for 85 per cent of the injuries. Isotope liver scan established the diagnosis and identified the pattern of injury. Multiple injuries were seen in 157 patients--predominantly head injuries. The liver was the only intra-abdominal organ injured in 119 patients. There were 69 associated splenic, 33 renal, 21 pancreatic and 3 bowel injuries. There were two deaths (0.88 per cent). Management was non-operative in 215 patients, with resolution of the liver injury in 214. Blood was transfused in 92 patients (40 per cent) (mean volume 20 ml/kg). There were 10 complications; two liver abscesses responded to antibiotics. Follow-up showed complete resolution of the liver injuries. Eight underwent laparotomy because of instability, deterioration or other extrahepatic visceral injuries. All required blood transfusion (mean volume 30 ml/kg). There were eight complications following surgery.
Accidents, Traffic↗
Investigation and management of blunt renal injuries in children: a review of 11 years' experience.
Over an 11-year period, 333 patients aged 6 months to 13 years were investigated for suspected blunt renal trauma. Ninety-one renal injuries were demonstrated. All patients who had preexisting pathology sustained major (ie, grade III or IV) injuries and all those who required surgery presented with 4+ or macroscopic hematuria with or without loin signs. Intravenous pyelography (IVP) showed no injury in 140 (89%) of 157 patients who had 0 to 3+ microscopic hematuria, and did not influence management in the remaining 17 patients. Seventy-eight (84%) patients were treated nonoperatively, with one death and few complications. Thirteen (14%) patients underwent early laparotomy, with a nephrectomy rate of 92%. No patient with a renal pedicle injury was considered suitable for vascular reconstruction. We conclude that (1) contrast studies are of little value in pediatric patients with asymptomatic microscopic hematuria after blunt trauma; (2) IVP remains the most cost-effective means of investigating renal injuries; and (3) laparotomy is only indicated for ongoing hemorrhage from the severely injured kidney and in a few selected patients with renal pedicle injuries.
Adolescent↗
Pancreatic injuries in children.
Pancreatic injuries over an 11-year period were reviewed. Pedestrian motor vehicle accidents accounted for 45% of the injuries. Diagnosis was made clinically and on raised serial serum amylase levels. Eighty per cent of the patients were managed conservatively. Two patients required emergency surgery for pancreatic trauma. There were no deaths. It is concluded that a conservative approach is successful in most paediatric patients with pancreatic trauma.
Child↗
Blunt splenic trauma in children.
Splenic trauma in 96 patients over an 11-year period is reviewed. Almost 80% of injuries resulted from motor vehicle accidents in which the patients was a pedestrian, and over 80% of patients sustained multiple injuries. Splenic injury was confirmed by isotope scanning at laparotomy. Non-operative management was feasible in 87.5% of the children, with no mortality or morbidity. In patients requiring surgery, splenic salvage was possible in 75%.
Child↗
Five years' experience of injured children.
This study was undertaken to analyse admission data on all patients seen in the Red Cross War Memorial Children's Hospital Trauma Unit during the period 24 April 1984 - 31 March 1989. Data were retrieved from computerised records completed on admission and were reviewed descriptively. Variations in age, sex and population group pattern for different causes of injury were evaluated together with data on the nature and place of injury and time seen. Data for analysis of nature of injury by cause were also retrieved, but over a 2-year period only (1986-1987). Accuracy of recorded data was assessed from a random sample of hospital records. During the 5-year period 57,468 patients were seen in the Trauma Unit, of whom 17.1% were admitted. In addition 6,377 cases of poisoning and 119 of near-drowning were seen by the medical departments. Forty-three per cent of injuries were due to falls, which were the most important cause of injury in both admitted and non-admitted patients of all age, sex and population groups. Other main cause groups were bumps and blows (15%), transport (11%) and burns (11%). Transport and burn injuries had the highest admission rates. This is the first study of children's injuries in southern Africa and provides information essential to future design of paediatric trauma care systems and accident prevention programmes.
Accidents, Traffic↗