review of paediatric liver resections in Johannesburg: Experiences and preferred technique

Background. Liver resections are widely performed in paediatric surgery. Many techniques exist to achieve vascular control, minimise bleeding and complete the parenchymal division.Methods. We retrospectively reviewed all liver resections performed in the Department of Paediatric Surgery at our institution between January 2005 and June 2012. Data pertaining to basic demographics, indications for surgery, parenchymal transection techniques, morbidity, mortality and histology were collated.Results. Twenty-one resections were performed in children aged 6 weeks - 11 years; 18 for malignant liver disease (including 9 hepatoblastomas), and 3 for benign disease. We describe 1 perioperative mortality secondary to torsion of the liver remnant, and no surgical morbidity. Three cases underwent total hepatic vascular exclusion with sharp parenchymal transection. The remaining patients underwent selective vascular inflow and outflow control using the Cavitron Ultra Sonic Aspirator and Harmonic Scalpel to divide the parenchyma.Conclusion. Care for these patients should be multidisciplinary.High-volume units and access to liver transplantation offer optimal results. No technique is proven superior to the ‘clamp crush’ technique of parenchymal transection. Knowledge of hepatic anatomy is key to minimising morbidity, and surgeons should be familiar with and have the flexibility to use all techniques of vascular control

A new methodology to simulate subglacial deformation of water-saturated granular material

The dynamics of glaciers are to a large degree governed by processes operating at the ice–bed interface, and one of the primary mechanisms of glacier flow over soft unconsolidated sediments is subglacial deformation. However, it has proven difficult to constrain the mechanical response of subglacial sediment to the shear stress of an overriding glacier. In this study, we present a new methodology designed to simulate subglacial deformation using a coupled numerical model for computational experiments on grain-fluid mixtures. The granular phase is simulated on a per-grain basis by the discrete element method. The pore water is modeled as a compressible Newtonian fluid without inertia. The numerical approach allows close monitoring of the internal behavior under a range of conditions. <br><br> Our computational experiments support the findings of previous studies where the rheology of a slowly deforming water-saturated granular bed in the steady state generally conforms to the rate-independent plastic rheology. Before this so-called critical state, deformation is in many cases accompanied by volumetric changes as grain rearrangement in active shear zones changes the local porosity. For previously consolidated beds porosity increases can cause local pore-pressure decline, dependent on till permeability and shear rate. We observe that the pore-water pressure reduction strengthens inter-granular contacts, which results in increased shear strength of the granular material. In contrast, weakening takes place when shear deformation causes consolidation of dilated sediments or during rapid fabric development. Both processes of strengthening and weakening depend inversely on the sediment permeability and are transient phenomena tied to the porosity changes during the early stages of shear. <br><br> We find that the transient strengthening and weakening in turn influences the distribution of shear strain in the granular bed. Dilatant strengthening has the ability to distribute strain during early deformation to large depths, if sediment dilatancy causes the water pressure at the ice–bed interface to decline. Oppositely, if the ice–bed interface is hydrologically stable the strengthening process is minimal and instead causes shallow deformation. The depth of deformation in subglacial beds thus seems to be governed by not only local grain and pore-water feedbacks but also larger-scale hydrological properties at the ice base

Dealing with a traumatic past: the victim hearings of the South African truth and reconciliation commission and their reconciliation discourse

In the final years of the twentieth and the beginning of the twenty-first century, there has been a worldwide tendency to approach conflict resolution from a restorative rather than from a retributive perspective. The South African Truth and Reconciliation Commission (TRC), with its principle of 'amnesty for truth' was a turning point. Based on my discursive research of the TRC victim hearings, I would argue that it was on a discursive level in particular that the Truth Commission has exerted/is still exerting a long-lasting impact on South African society. In this article, three of these features will be highlighted and illustrated: firstly, the TRC provided a discursive forum for thousands of ordinary citizens. Secondly, by means of testimonies from apartheid victims and perpetrators, the TRC composed an officially recognised archive of the apartheid past. Thirdly, the reconciliation discourse created at the TRC victim hearings formed a template for talking about a traumatic past, and it opened up the debate on reconciliation. By discussing these three features and their social impact, it will become clear that the way in which the apartheid past was remembered at the victim hearings seemed to have been determined, not so much by political concerns, but mainly by social needs

The role of age and mode of delivery in the STEPS intervention: a longitudinal pilot-study in treatment of posttraumatic stress symptoms in Danish survivors of sexual assault

Background: The STEPS programme has been succesfully implemented as a group-based treatment of trauma symptoms after rape for adolescents. The STEPS intervention was translated from Dutch to Danish and offered to adults in addition to adolescents as well as an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. The programme was translated from Dutch to Danish and expanded to adults in addition to adolescents as well as to an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. Objective: The present study observes  development in trauma symptoms and ICD-11 diagnostic status during an adapted version of the intervention programme ‘STEPS’ for survivors of sexual assault. Methods: A prospective uncontrolled study was conducted, monitoring symptoms of posttraumatic stress and other trauma-related symptomatology before treatment, after treatment and at 6 and 12 months' follow up for 103 referrals receiving individual or group-based STEPS. Tentative diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD were assigned to participants according to the ICD-11 to observe the development in diagnostic status across time, and multilevel modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery. Results: A loglinear function representing large and statistically significant decline in symptomatology over time provided the best fit for all measures of trauma-related symptomatology. The decline was not moderated by age-group or mode of intervention. Dropout rates were independent of mode of intervention and age. Conclusion: The adaption of the STEPS programme to adults and as an individual intervention is feasible and maintains effect sizes comparable to those observed in the original intervention. Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS programme

The racist bodily imaginary: the image of the body-in-pieces in (post)apartheid culture

This paper outlines a reoccurring motif within the racist imaginary of (post)apartheid culture: the black body-in-pieces. This disturbing visual idiom is approached from three conceptual perspectives. By linking ideas prevalent in Frantz Fanon’s description of colonial racism with psychoanalytic concepts such as Lacan’s notion of the corps morcelé, the paper offers, firstly, an account of the black body-in-pieces as fantasmatic preoccupation of the (post)apartheid imaginary. The role of such images is approached, secondly, through the lens of affect theory which eschews a representational ‘reading’ of such images in favour of attention to their asignifying intensities and the role they play in effectively constituting such bodies. Lastly, Judith Butler’s discussion of war photography and the conditions of grievability introduces an ethical dimension to the discussion and helps draw attention to the unsavory relations of enjoyment occasioned by such images

Lichens facilitate seedling recruitment in alpine heath

Abstract Questions How do mat thickness, physical structure and allelopathic properties of terricolous mat-forming lichens affect recruitment of vascular plants in dwarf-shrub and lichen heath vegetation?. Location The mountains of Dovrefjell, central Norway. Methods In autumn, seeds of ten vascular plant species were collected and sown in a common garden experiment with mats of six lichen species and bare-soil controls as experimental treatments. We recorded growing season soil temperature and moisture, and seedling recruitment and growth after one year. The effect of lichen secondary compounds on germination was tested in a growth chamber experiment and compared to the lichen-plant interactions detected under field conditions. Results The lichen mats buffered extreme soil temperatures and soil drying in dry weather, with soils below the thickest mats (Cladonia stellaris and C. rangiferina) experiencing the lowest temperature fluctuations. Seedling recruitment and seedling growth in the field and seed germination in the lab were species-specific. Seedling recruitment rates were overall higher within lichen mats than on bare soil, but the c. 6.5 cm thick mats of C. stellaris reduced recruitment of many species. The lab experiment suggested no overall strong effect of lichen allelopathy on seed germination, and effects on seed germination were only moderately correlated with the lichen-plant interactions observed for seedling recruitment in the field. Conclusions In harsh environments like alpine dwarf-shrub and lichen heaths, the presence of lichens and the resulting amelioration of the microclimate seems more important for vascular plant recruitment than are allelopathic effects often reported in lab experiments. We might therefore expect most terricolous lichens, depending on the plant species in focus, to facilitate rather than hamper the early stages of plant recruitment into lichen-dominated arctic-alpine heath vegetation. This article is protected by copyright. All rights reserved.Peer reviewe

Birth outcomes following antiretroviral exposure during pregnancy : initial results from a pregnancy exposure registry in South Africa

CITATION: Mehta, U. C. et al. 2019. Birth outcomes following antiretroviral exposure during pregnancy : initial results from a pregnancy exposure registry in South Africa. Southern African Journal of HIV Medicine, 20(1):a971, doi:10.4102/sajhivmed.v20i1.971.The original publication is available at https://sajhivmed.org.zaBackground: In 2013, a pregnancy exposure registry and birth defects surveillance (PER/BDS) system was initiated in eThekwini District, KwaZulu-Natal (KZN), to assess the impact of antiretroviral treatment (ART) on birth outcomes. Objectives: At the end of the first year, we assessed the risk of major congenital malformations (CM) and other adverse birth outcomes (ABOs) detected at birth, in children born to women exposed to ART during pregnancy. Method: Data were collected from women who delivered at Prince Mshiyeni Memorial Hospital, Durban, from 07 October 2013 to 06 October 2014, using medicine exposure histories and birth outcomes from maternal interviews, clinical records and neonatal surface examination. Singleton births exposed to only one ART regimen were included in bivariable analysis for CM risk and multivariate risk analysis for ABO risk. Results: Data were collected from 10 417 women with 10 517 birth outcomes (4013 [38.5%] HIV-infected). Congenital malformations rates in births exposed to Efavirenz during the first trimester (T1) (RR 0.87 [95% CI 0.12–6.4; p = 0.895]) were similar to births not exposed to ART during T1. However, T1 exposure to Nevirapine was associated with the increased risk of CM (RR 9.28 [95% CI 2.3–37.9; p = 0.002]) when compared to the same group. Other ABOs were more frequent in the combination of HIV/ART-exposed births compared to HIV-unexposed births (29.9% vs. 26.0%, adjusted RR 1.23 [1.14–1.31; p < 0.001]). Conclusion: No association between T1 use of EFV-based ART regimens and CM was observed. Associations between T1 NVP-based ART regimen and CM need further investigation. HIV- and ART-exposed infants had more ABOs compared to HIV-unexposed infants.Publisher's versio