An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole

Background. Operating theatres account for a significant proportion of hospital costs. There is a paucity of data evaluating utilisation of South African (SA) state operating theatres.Objectives. To measure operating theatre utilisation and the rate of day-of-surgery cancellations (DOSCs) in a state hospital theatre complex.Methods. A prospective audit of a state operating theatre complex at a Durban regional hospital was performed between 26 February and 26 April 2018. Times were collected for each theatre case from the entry of the patient into theatre to their departure to the post-anaesthetic care unit. This was done on weekdays between 08h00 and 16h00. The factors causing any delays and DOSCs were identified and recorded.Results. Over the study period, 125 220 operative minutes were available for both elective and emergency operating theatres; 655 elective cases and 359 emergency cases were performed. Overall theatre utilisation was 55.2%, with actual operating time comprising only 36.9% of all available time. Non-operative time occupied 63.1% of all available time, split between late starts (9.3%), early list finishes (16.1%), changeover times (19.4%) and anaesthetic time (18.3%). The DOSC rate was 26.2%, with 232 cases cancelled on the day of surgery. Just under half of the DOSCs were avoidable. The most common reason for cancellation was lack of operative time.Conclusions. Measured theatre utilisation was higher than previously quoted figures for SA state hospitals, but below international benchmarks. A significant amount of time was wasted as a result of delayed first-case starts, prolonged changeovers and early terminations of lists, all of which contributed to a high DOSC rate. Before more theatre time can be made available, theatre users must first optimise use of currently available time. Further studies quantifying the effect of staff shortages in state operating theatres on inefficient use of time are required.

Two neuroanatomical signatures in schizophrenia: Expression strengths over the first 2 years of treatment and their relationships to neurodevelopmental compromise and antipsychotic treatment

BACKGROUND AND HYPOTHESIS: Two machine learning derived neuroanatomical signatures were recently described. Signature 1 is associated with widespread grey matter volume reductions and signature 2 with larger basal ganglia and internal capsule volumes. We hypothesized that they represent the neurodevelopmental and treatment-responsive components of schizophrenia respectively. STUDY DESIGN: We assessed the expression strength trajectories of these signatures and evaluated their relationships with indicators of neurodevelopmental compromise and with antipsychotic treatment effects in 83 previously minimally treated individuals with a first episode of a schizophrenia spectrum disorder who received standardized treatment and underwent comprehensive clinical, cognitive and neuroimaging assessments over 24 months. Ninety-six matched healthy case-controls were included. STUDY RESULTS: Linear mixed effect repeated measures models indicated that the patients had stronger expression of signature 1 than controls that remained stable over time and was not related to treatment. Stronger signature 1 expression showed trend associations with lower educational attainment, poorer sensory integration, and worse cognitive performance for working memory, verbal learning and reasoning and problem solving. The most striking finding was that signature 2 expression was similar for patients and controls at baseline but increased significantly with treatment in the patients. Greater increase in signature 2 expression was associated with larger reductions in PANSS total score and increases in BMI and not associated with neurodevelopmental indices. CONCLUSIONS: These findings provide supporting evidence for two distinct neuroanatomical signatures representing the neurodevelopmental and treatment-responsive components of schizophrenia

Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders

CITATION: Smit, A. M. et al. 2021. Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders. South African Journal of Psychiatry, 27:a1639, doi:10.4102/sajpsychiatry.v27i0.1639.The original publication is available at https://sajp.org.zaBackground: Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim: We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma’s moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting: We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods: Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results: Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion: In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.https://sajp.org.za/index.php/sajp/article/view/1639Publisher's versio

Factors moderating the relationship between childhood trauma and premorbid adjustment in first-episode schizophrenia

CITATION: Kilian, S. et al. 2017. Factors moderating the relationship between childhood trauma and premorbid adjustment in first-episode schizophrenia. PLoS ONE, 12(1):e0170178, doi:10.1371/journal.pone.0170178.The original publication is available at http://journals.plos.org/plosoneChildhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170178Publisher's versio

Foresight Africa: Top Priorities for the Continent 2020-2030

The new year 2020 marks the beginning of a promising decade for Africa. Through at least the first half of the decade, economic growth across Africa will continue to outperform that of other regions, with the continent continuing to be home to seven of the world's 10 fastest-growing economies. Collective action among African and global policymakers to improve the livelihoods of all under the blueprint of the Sustainable Development Goals and the African Union's Agenda 2063 is representative of the shared energy and excitement around Africa's potential. With business environments improving, regional integration centered around the African Continental Free Trade Agreement progressing, and the transformational technologies of Fourth Industrial Revolution spreading, never before has the region been better primed for trade, investment, and mutually beneficial partnerships. The recent, unprecedented interest of an increasingly diversified group of external partners for engagement with Africa highlights this potential. Despite the continent's promise, though, obstacles to success linger, as job creation still has not caught up with the growing youth labor force, gaps in good and inclusive governance remain, and climate change as well as state fragility threaten to reverse the hard-fought-for gains of recent decades.This special edition of Foresight Africa highlights the triumphs of past years as well as strategies from our experts to tackle forthcoming, but surmountable, obstacles to a prosperous continent by 2030

Serpin Induced Antiviral Activity of Prostaglandin Synthetase-2 against HIV-1 Replication

The serine protease inhibitors (serpins) are anti-inflammatory proteins that have various functions. By screening a diverse panel of viruses, we demonstrate that the serpin antithrombin III (ATIII) has a broad-spectrum anti-viral activity for HIV-1, HCV and HSV. To investigate the mechanism of action in more detail we investigated the HIV-1 inhibition. Using gene-expression arrays we found that multiple host cell signal transduction pathways were activated by ATIII in HIV-1 infected cells but not in uninfected controls. Moreover, the signal pathways initiated by ATIII treatment, were more than 200-fold increased by the use of heparin-activated ATIII. The most up-regulated transcript in HIV-1 infected cells was prostaglandin synthetase-2 (PTGS2). Furthermore, we found that over-expression of PTGS2 reduced levels of HIV-1 replication in human PBMC. These findings suggest a central role for serpins in the host innate anti-viral response. Host factors such as PTGS2 elicited by ATIII treatment could be exploited in the development of novel anti-viral interventions

Balance de energía, nitrógeno y fósforo en sistemas de ceba bovina en pastoreo

Objective: The aim of this work was to perform balances of energy, nitrogen, and phosphorus in pre-fattening and fattening bovine systems at Turiguanó Livestock Breeding Company, in the province of Ciego de Ávila, Cuba. Materials and methods: The botanical composition of the farms evaluated was determined, and energy, nitrogen, and phosphorus balances were performed. Results: The annual energy, nitrogen, and phosphorus balances were negative on the farms in the study. Conclusions: New strategies are required to enhance energy and nutrient (nitrogen and phosphorus) use to increase beef production during the final stage. Accordingly, improvements in recycling, balance, and efficiency in the use of energy and these minerals are linked to increases in live weight/day, and better final weights for the industry during that stage.Objetivo: Realizar el balance de energía, nitrógeno y fósforo de sistemas de ceba inicial y ceba final bovina en la Empresa Pecuaria Genética Turiguanó en la provincia Ciego de Ávila en Cuba. Materiales y métodos: Se determinó la composición botánica en las unidades evaluadas y se realizaron los balances de energía, nitrógeno y fósforo. Resultados: Las unidades estudiadas presentaron balances negativos anuales en lo energético y en el nitrógeno y fósforo. Conclusiones: Son necesarias estrategias para aumentar el aprovechamiento de energía y los nutrientes como nitrógeno y fósforo e incrementar la producción bovina de carne en su fase final, por lo que las mejoras del reciclaje, el balance y la eficiencia de utilización de la energía y estos minerales, están ligadas a los incrementos en peso vivo/día y a mejores pesos finales a industria en esta fase

Recycling between cortisol and cortisone in human splanchnic, subcutaneous adipose, and skeletal muscle tissues in vivo

11β-Hydroxysteroid dehydrogenase type 1 (11βHSD1) is a therapeutic target in metabolic syndrome because it catalyses reductase regeneration of cortisol from cortisone in adipose and liver. 11βHSD1 can also catalyze the reverse dehydrogenase reaction in vitro (e.g., if cofactor is limited). We used stable isotope tracers to test the hypothesis that both 11βHSD1-reductase and -dehydrogenase activities occur in human metabolic tissues in vivo. 1,2-[2H]2-Cortisone (d2-cortisone) was validated as a tracer for 11β-dehydrogenase activity and its inhibition by licorice. d2-Cortisone and 9,11,12,12-[2H]4-cortisol (d4-cortisol) (to measure 11β-reductase activity) were coinfused and venous samples obtained from skeletal muscle, subcutaneous adipose (n = 6), and liver (n = 4). Steroids were measured by liquid chromatography–tandem mass spectrometry and arteriovenous differences adjusted for blood flow. Data are means ± SEM. 11β-Reductase and -dehydrogenase activities were detected in muscle (cortisol release 19.7 ± 4.1 pmol/100 mL/min, d3-cortisol 5.9 ± 1.8 pmol/100 mL/min, and cortisone 15.2 ± 5.8 pmol/100 mL/min) and splanchnic (cortisol 64.0 ± 11.4 nmol/min, d3-cortisol 12.9 ± 2.1 nmol/min, and cortisone 19.5 ± 2.8 nmol/min) circulations. In adipose, dehydrogenase was more readily detected than reductase (cortisone release 38.7 ± 5.8 pmol/100 g/min). Active recycling between cortisol and cortisone in metabolic tissues in vivo may facilitate dynamic control of intracellular cortisol but makes consequences of dysregulation of 11βHSD1 transcription in obesity and diabetes unpredictable. Disappointing efficacy of 11βHSD1 inhibitors in phase II studies could be explained by lack of selectivity for 11β-reductase

Recurrent Signature Patterns in HIV-1 B Clade Envelope Glycoproteins Associated with either Early or Chronic Infections

Here we have identified HIV-1 B clade Envelope (Env) amino acid signatures from early in infection that may be favored at transmission, as well as patterns of recurrent mutation in chronic infection that may reflect common pathways of immune evasion. To accomplish this, we compared thousands of sequences derived by single genome amplification from several hundred individuals that were sampled either early in infection or were chronically infected. Samples were divided at the outset into hypothesis-forming and validation sets, and we used phylogenetically corrected statistical strategies to identify signatures, systematically scanning all of Env. Signatures included single amino acids, glycosylation motifs, and multi-site patterns based on functional or structural groupings of amino acids. We identified signatures near the CCR5 co-receptor-binding region, near the CD4 binding site, and in the signal peptide and cytoplasmic domain, which may influence Env expression and processing. Two signatures patterns associated with transmission were particularly interesting. The first was the most statistically robust signature, located in position 12 in the signal peptide. The second was the loss of an N-linked glycosylation site at positions 413–415; the presence of this site has been recently found to be associated with escape from potent and broad neutralizing antibodies, consistent with enabling a common pathway for immune escape during chronic infection. Its recurrent loss in early infection suggests it may impact fitness at the time of transmission or during early viral expansion. The signature patterns we identified implicate Env expression levels in selection at viral transmission or in early expansion, and suggest that immune evasion patterns that recur in many individuals during chronic infection when antibodies are present can be selected against when the infection is being established prior to the adaptive immune response