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- get a value for population mean
- test that this population mean is justified by using sample means

In hypothesis testing, a value for a population mean (or proportion or odds ratio or correlation
coefficient) is put forward (hypothesised or claimed) and then a procedure is followed to test
whether in fact this claim is justified. This procedure involves taking a sample and calculating its
mean (or a proportion or odds ratio or correlation coefficient) and then testing how close the sample mean is to the claimed population mean. The Null Hypothesis which makes a certain claim. The Alternative Hypothesis (or counter-claim) which disputes the null hypothesis.

LINK:
- in the last paragraph in case they talk about hypothesis testing to see if alcohol consumption is associated with trauma and violence

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*READING IN RESOURCE PACK*

- substance abuse increases the likelihood of being a patient in the trauma unit

- collect blood urine samples of all patients in trauma unit who are over 17 years old and required resuscitation
- first recieve consent to do blood urine tests
- they tested the blood samples via an enzymatic test for methanol levels.

LINK:

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- SA constitution protects the rights to healthcare for vulnerable groups
- Yet many people from LGBTQIAP+ still experience homophobia and are refused healthcare by professionals
- Many vulnerable groups such as  refugees and sex workers still experience discrimination and have their human rights violated

- What is the Bill of Rights?

- What are the different immigrant statuses? What are the rights for immigrants classified under these statuses?

LINK:
- Marc and Henri were a gay couple who experienced homophobia
- There sexual orientation might influence the healthcare they recieved.

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There are 3 regulatory mechanisms:
- the three major buffer systems
* protein buffer system
* phosphate buffer system
* carbonic acid-bicarbonate buffer
- renal mechanisms
- respiratory mechanisms

- The role of the kidney in pH maintenance:

Changes in rates of H+ and HCO3- secretion or reabsorption by the kidneys Acidosis: Kidneys respond by secreting H+ ions, removing CO2 and reabsorbing HCO3- to help replenish bicarbonate reserve. Alkalosis: Kidney tubules respond by conserving H+ ions and secreting HCO3-

LINK:
- Mark has a low pH than the normal range and more acidic than normal
- There might be an error in the regulatory systems involved in maintaining pH in the body

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Accidents, chronic diseases, homicides, stroke , cardiovascular diseases, diabetes

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The metabolis of amino acids is related to the central metabolic pathways because

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Site of synthesis and origin of plasma urea
-  Urea is formed in the liver, source: dietary proteins broken down into excess aa's.
High ammonia conc is toxic so urea needs to be synthesised
After urea formation carbon skeletons can be metabolised into: precursors of gluconeogenesis

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Renin secreted - causes angiotensinogen to be converted to angiotensin 1 and then its converted to angiotensin 2, which promotes water uptake in nephrons. ADH secreted by posterior pituitary causes water uptake in DCT. Aldosterone - Causes sodium reabsorption by kidneys and water follows sodium. Natriuretic peptides - Promotes water secretion by kidneys

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Urine formation occurs through three steps which are glomerular filtration, reabsorption and excretion
Urine Formation includes three processes: - glomerular filtration - tubular reabsorption - tubular secretion During glomerular filtration blood plasma is filteres through the capillary epithelium, then the dense layer and finaly the filtration sites formed by pedicles of the podocytes. Now a filtrate is formed. Only 20% of blood plasma becomes filtrate, the other 80% leaves via the efferent arteriole again. The filtrate then enters the PCT where 90% of the filtrate is reabsorbed into the venous system via the peritubular capillaries. This is called tubular reabsorption. Water and ions are also secreted into the nephron from the peritubular capillaries and this is called tubular secretion. Ultimately the remaining filtrate enter the collecting system via the collecting ducts and becomes urine when it passes from the collecting duct into the papillary duct into the minor calyx

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Gross anatomy and histology of urinary system
-Kidney (retroperitoneal and right kidney lies below the left kidney( due to right lung having three lobes) , made up of nephrons and collecting duct, found between T12 and L3 vertebra, renal artery and vein and there is a hilium where they enter the kidney, renal columns separating renal pyramids in renal medulla
Three layers in kidney
Fibrous capsule

• A layer of collagen fibers

• Covers outer surface of entireorgan
Perinephric fat capsule

• A thick layer of adipose tissue

• Surrounds renal capsule
Renal fascia

• A dense, fibrous outer layer

• Anchors kidney to surroundingstructures
Renal sinus - internal cavity within kidney, lined by fibrous capsule which stabilises structures. Renal pyramid - Triangular structures in renal medulla Renal column - Bands of cortical tissue separating adjacent renal pyramids and extends into medulla Renal lobe - consists of renal pyramid, overlying area of renal cortex and adjacent tissues of renal column

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Components of urinary system( functions)
-Ureter( transport urine to bladder)
-Bladder( temporary storage of urine)
-Urethra( transport urine to the environment from bladder)
- kidney( excretion, homeostasis, secretion of hormones)

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Determinants
-Lack of academic motivation, alienated, biological factors and mental illnesses
-Sociodemographic factors: age, sex, marital status, religious, household employment and incomes
Prevalence
-Most prevalent among males and adolescents use drugs more often than any other age group
- about 45 % of people who went to the trauma unit were on drugs

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• Biological risk factors

DETERMINANTS
Demographicfactors: age & sex

Biologicalfactors: unattended mental health disorders

• Behavioural risk factors

Poor childhooddevelopment: e.g. destructive behaviours

Alcohol andsubstance abuse

• Societal risk factors

Family environment: lowlevels of family cohesion; single parent households; harsh physical punishment;parental aggression

Community environment: violent neighbourhoods; gangs

• Socio-cultural risk factors

endorsement of violence to resolve conflict reinforced by media, traditional gender & social norms of oppression;

• Structural risk factors

Poverty and social status: relative deprivation & social inequality; low educational attainment; high rates of unemployment

Recent migration and urbanization
Definition of Intentional Trauma:
- interpersonal violence
- self-harm
- legal intervention

Distrubution:

- Frequency:
Of all deaths due to trauma, 40% were due to intentional trauma. In SA the homicide rate was 50 per 100 000 people which was 10 times higher than US rate. There has been an increase over the past five years.

- Pattern:
Predominantly in men. In WC peaks for men between 15 - 44 years old and for females a lower peak at 25-29 years old. Females more affected by sharp objects and men more affected by firearms

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Do a scatter plot and do correlation coefficient(r) to identify the relationship

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key issue-the impact of alcohol behaviour

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key issue-the impact of alcohol behaviour

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- The decrease in cognition ability and thinking is impaired
- Fetal alcohol syndrom

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key issue- the cause of interpersonal violence

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key issue- the cause of interpersonal violence

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-alcohol
- gangsterism
- community influence

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KEY ISSUE- the risk factor associated with same sex relatioship

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KEY ISSUE- the risk factor associated with same sex relatioship

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prior knowledge
- There is a high incident of homophobic atteck
- There is a huge stigma against people of same sex in a relationship
-

limitation
-

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key issue- The effect of excessive trauma on the abdomen cavity and the breathing rate

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key issue- The effect of excessive trauma on the abdomen cavity and the breathing rate

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- It can result in the damage of one of the organ
- The distruction of some of the systems in the body and homoestasis
-physical trauma is an injury to the body that occurs when the body is suddenly or briefly subjected to intolerable levels of energy

limitations
- The role of fitness on body homoestasis
- The relationship between the heart rate and the respiratory rate
-

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- The effect of excessive trauma on the abdominal cavity and the breathing rate
- The risks factor associated with the same sex realtionship
-the cause of interpersonal violence
-the impact of alcohol on behaviour
- the change on body fluid volume as the result of trauma
- how the kidney maintains the urea level and electrolyte content
- The relationship between speed and the distance covered
-

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clinical
- The doctor decided to consult the surgeon to perform a laparotomy
- Mark is also given the intravenous fluid to treat his hypovolaemic situation.

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clinical
- The doctor concluded that Mark is hypovolaemic
- Mark also has trauma to the abdomen
-
contextual
- The doctor realize that him Mark being gay places him at the greater risks of suffering from assault and violence

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CLINICAL
-Marc has the blood pressure 82/46 mm hg and the pulse rate  was 86 per minute( the blood pressure was too low)
- Mark also has the urea which is grossly elevated and the PH is elevated at 7.2.
- The respiratory rate is 40 per minute and is very high

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CLINICAL:
INDIVIDUAL:
CONTEXTUAL:

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CLINICAL:
INDIVIDUAL:
CONTEXTUAL:

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CLINICAL:
INDIVIDUAL:
CONTEXTUAL:

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CLINICAL:
- Marc has been passing dark brown
- He took medication which are analgesic
-he was punched and kicked several times in his back
-mark was in severe pain
- Marc collapsed.

INDIVIDUAL:
-he has been running in the marathon

CONTEXTUAL:
-Mark and henri a gay couples

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The patients name- Marc

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1. analgesic- to relieve pain
hypovolaemic- having low levels of blood in the body
intravenous fluid- the fluid that is found within the veins
laparotomy- making certain incision in the body to see what     is wrong
glossy-  concentrated too much