Outcomes and Predictors of Mortality in Neurosurgical Patients at Mbarara Regional Referral Hospital

Background:

Knowing the scope of neurosurgical disease at Mbarara Hospital is critical for infrastructure planning, education and training. In this study, we aim to evaluate the neurosurgical outcomes and identify predictors of mortality in order to potentiate platforms for more effective interventions and inform future research efforts at Mbarara Hospital.

Methods:

This is retrospective chart review including patients of all ages with a neurosurgical disease or injury presenting to Mbarara Regional Referral Hospital (MRRH) between January 2012 to September 2015. Descriptive statistics were presented. A univariate analysis was used to obtain the odds ratios of mortality and 95% confidence intervals. Predictors of mortality were determined using multivariate logistic regression model.

Results:

A total of 1876 charts were reviewed. Of these, 1854 (had complete data and were?) were included in the analysis. The overall mortality rate was 12.75%; the mortality rates among all persons who underwent a neurosurgical procedure was 9.72%, and was 13.68% among those who did not undergo a neurosurgical procedure. Over 50% of patients were between 19 and 40 years old and the majority of were males (76.10%). The overall median length of stay was 5 days. Of all neurosurgical admissions, 87% were trauma patients. In comparison to mild head injury, closed head injury and intracranial hematoma patients were 5 (95% CI: 3.77, 8.26) and 2.5 times (95% CI: 1.64,3.98) more likely to die respectively. Procedure and diagnostic imaging were independent negative predictors of mortality (P <0.05). While age, ICU admission, admission GCS were positive predictors of mortality (P <0.05).

Conclusions:

The majority of hospital admissions were TBI patients, with RTIs being the most common mechanism of injury. Age, ICU admission, admission GCS, diagnostic imaging and undergoing surgery were independent predictors of mortality. Going forward, further exploration of patient characteristics is necessary to fully describe mortality outcomes and implement resource appropriate interventions that ultimately improve morbidity and mortality.

Influence of Increased Human Presence in the Mills River Basin on Water Availability and Drought

Periods of drought and low streamflow can have profound impacts on both human and natural systems. People depend on a reliable source of water for numerous reasons including potable water supply and to produce economic value through agriculture or energy production. Aquatic ecosystems depend on water in addition to the economic benefits they provide to society through ecosystem services. Given that periods of low streamflow may become more extreme and frequent in the future, it is important to study the factors that control water availability during these times. In the absence of precipitation the slower hydrological response of groundwater systems will play an amplified role in water supply. Understanding the variability of the fraction of streamflow contribution from baseflow or groundwater during periods of drought provides insight into what future water availability may look like and how it can best be managed. The Mills River Basin in North Carolina is chosen as a case-study to test this understanding. First, obtaining a physically meaningful estimation of baseflow from USGS streamflow data via computerized hydrograph analysis techniques is carried out. Then applying a method of time series analysis including wavelet analysis can highlight signals of non-stationarity and evaluate the changes in variance required to better understand the natural variability of baseflow and low flows. In addition to natural variability, human influence must be taken into account in order to accurately assess how the combined system reacts to periods of low flow. Defining a combined demand that consists of both natural and human demand allows us to be more rigorous in assessing the level of sustainable use of a shared resource, in this case water. The analysis of baseflow variability can differ based on regional location and local hydrogeology, but it was found that baseflow varies from multiyear scales such as those associated with ENSO (3.5, 7 years) up to multi decadal time scales, but with most of the contributing variance coming from decadal or multiyear scales. It was also found that the behavior of baseflow and subsequently water availability depends a great deal on overall precipitation, the tracks of hurricanes or tropical storms and associated climate indices, as well as physiography and hydrogeology. Evaluating and utilizing the Duke Combined Hydrology Model (DCHM), reasonably accurate estimates of streamflow during periods of low flow were obtained in part due to the model’s ability to capture subsurface processes. Being able to accurately simulate streamflow levels and subsurface interactions during periods of drought can be very valuable to water suppliers, decision makers, and ultimately impact citizens. Knowledge of future droughts and periods of low flow in addition to tracking customer demand will allow for better management practices on the part of water suppliers such as knowing when they should withdraw more water during a surplus so that the level of stress on the system is minimized when there is not ample water supply.

Knowing The Way: Scriptural Imagination and the Acts of the Apostles

In this dissertation, I offer a pedagogical proposal for learning the Christian Scriptures guided by respect for the nature of the reader and the integrity of the biblical text. Christian educators have profitably developed recent theoretical interest in the body’s role in human meaning with regard to worship and praxis methodologies, but the implications of this research for communal study of the biblical text merit further development. I make the case for adopting scriptural imagination as the goal of pedagogically constructed encounters with the Christian Scriptures. The argument proceeds through a series of questions addressing both sides of the text/reader encounter.

Chapter one considers the question “what is the nature of the reader and, subsequently, the shape of the reader’s ways of knowing?” This investigation into recent literature on the body’s involvement in human knowing includes related epistemological shifts with Christian education. On the basis of this survey, imagination emerges as a compelling designator of an incorporative, constructive creaturely capacity that gives rise to a way of being in the world. Teachers of Scripture who intend to participate in Christian formation should account for the imagination’s centrality for all knowing. After briefly situating this proposal within a theological account of creatureliness, I make the initial case for Scriptural imagination as a pedagogical aim.

Imagination as creaturely capacity addresses the first guiding value, but does this proposal also respect the integrity and nature of the biblical text, and specifically of biblical narratives? In response, in chapter two I take up the Acts of the Apostles as a potential test case and exemplar for the dynamics pertinent to the formation of imagination. Drawing on secondary literature on the genre and literary features of Acts, I conclude that Acts coheres with this project’s explicit interest in imagination as a central component of the process of Christian formation in relationship to the Scriptures.

Chapters three and four each take up a pericope from Acts to assess whether the theoretical perspectives developed in prior chapters generate any interpretive payoff. In each of these chapters, a particular story within Acts functions as a test case for readings of biblical narratives guided by a concern for scriptural imagination. Each of these chapters begins with further theoretical development of some element of imaginal formation. Chapter three provides a theoretical account of practices as they relate to imagination, bringing that theory into conversation with Peter’s engagement in hospitality practices with Cornelius in Acts 10:1-11:18. Chapter four discusses the formative power of narratives, with implications for the analysis of Paul’s shipwreck in Acts 27:1-28:16.

In the final chapter, I offer a two-part constructive pedagogical proposal for reading scriptural narratives in Christian communities. First, I suggest adopting resonance above relevance as the goal of pedagogically constructed encounters with the Scriptures. Second, I offer three ways of reading with the body, including the physical, ecclesial, and social bodies that shape all learning. I conclude by identifying the importance of scriptural imagination for Christian formation and witness in the twenty-first century.