Review of Damage Control Laparotomy (DCL) outcomes in a Major Urban Trauma Center

Introduction Damage control laparotomy (DCL) in an urban trauma centre is associated with high mortality. Aim The purpose of this prospective study was to review the outcomes of DCL in a level one urban trauma centre, looking particularly at primary closure rate and other factors influencing outcomes. Methods All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were retrieved from the prospectively recorded eTHR data base. Data retrieved were basic demographics, mechanism of injury, perioperative vitals and biochemical parameters. Injury severity was described by the Revised Trauma Score (RTS), Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). Indications for DCL were determined as well as length of ICU stay, days of ventilation, number of procedures and primary abdominal closure rates. Complications and mortality were recorded. Results During the study period, 51 patients underwent DCL. Three patients sustained stab wounds and 47 patients suffered from gunshots. Only 1 female was included in the study with the other 50 being male. The mean age was 28 years and 4 months (range 15 to 48 years). Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The means for the different severity scores were RTS 7.36, ISS 17.5, TRISS 93.76 and PATI 28. Means were calculated for different physiological markers of trauma (lowest pH 7.12, highest lactate 7.11, lowest core temp 34.9˚C and lowest systolic BP 63.8 mmHg). The organs most commonly injured, in decreasing frequency, were small bowel (n = 33), large bowel (n = 25), abdominal vasculature (n = 22), liver (n = 18), stomach (n = 14), kidney (n = 10), diaphragm (n = 10), spleen (n = 9) and pancreas (n = 8). DCL procedures performed were abdominal packing (n = 36), bowel ligation (n = 30), vascular shunting (n = 5) and shunting of the ureter (n = 1). The median number of laparotomies done per patient was 3, with a primary fascial closure rate of 69%. The mortality rate was 29%. Conclusion DCL in our setting is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24hours and median PATI score more than 47 are independent factors associated with increased mortality

Africa and the Paris Agreement

The African continent is one of the most vulnerable regions to future climate change. Research now demonstrates that constraining anthropogenic warming to 1.5 °C instead of 2 °C will significantly lower the risk of heatwaves to inhabitants.http://www.nature.com/nclimate2018-11-01hj2018Geography, Geoinformatics and Meteorolog

Is the summer season losing potential for solar energy applications in South Africa?

Seasonal trends using in situ sunshine duration (SD) and satellite, incoming shortwave solar radiation (SIS) data for South Africa over a period up to six decades were investigated. Trend analysis was applied to SD data of 22 sunshine-recording stations from the South African Weather Service that cover the length and breadth of South Africa. Satellite application facility on climate monitoring provided the high-resolution derived SIS for the period 1983–2013. A number of stations show a statistically significant decreasing trend in SD in all four seasons on a seasonal scale. Declines (number of stations showing significant trend) in SD at 17(7), 8(3), 7(3) and 3(0) stations, were observed for summer, autumn, winter and spring, respectively. The SIS has also shown a decreasing trend over South Africa in most of the regions during the summer season followed by autumn. The results indicated a general tendency of decrease in incoming solar radiation mostly during summer which could be of some concern for solar energy applications

Historical rainfall trends in South Africa: 1921–2015

The aim of this study is to update the analysis of historical rainfall trends with reference to the work from previous studies, through optimizing the highest spatial resolution with the longest possible period of analysis, i.e., 1921–2015. Two interlinked datasets, namely the district rainfall and individual rainfall stations datasets were used for the trend analyses, namely, daily time series of 60 individual rainfall stations and the daily district rainfall of 88 of 94 rainfall districts in South Africa. The extreme precipitation indices defined by the World Meteorological Organization Expert Team on Climate Change Detection and Indices were applied. In general, the results show an increase in rainfall for most rainfall stations in the southern interior of South Africa, and indications of decreases in rainfall in the far northern and north-eastern parts. The increase in the annual rainfall in the south is reflected in the seasonal trends, where summer rainfall shows a similar increase, but also extends into the central interior. For other seasons, most of the country shows no significant historical trends in annual total rainfall. From the extreme rainfall analyses, an increase in daily rainfall extremes in the southern to western interior is apparent. Also, most of the country experienced increases in the intensity of daily rainfall, which confirms global results in general. Decreases in rainfall from wet spells were noted in most places over the east and north-east, while the southern and eastern parts along the escarpment experienced shorter annual dry spells. This study improves on previous studies in the region by more than doubling the analysis period, largely eliminating the influence that decadal-scale cycles might have on analyses over shorter periods. However, some differences in the trend results compared to previous studies are apparent, e.g., less pronounced drying in the east and the previously observed increase in rainfall in the western and southern interior not extending as far as the south-western Cape. The observed trends broadly confirm those of projected changes in summer rainfall, i.e., an increase in the west and decrease in the east.http://www.wrc.org.zaam2017Geography, Geoinformatics and Meteorolog

Historical rainfall trends in South Africa : 1921–2015

The aim of this study is to update the analysis of historical rainfall trends with reference to the work from previous studies, through optimizing the highest spatial resolution with the longest possible period of analysis, i.e., 1921–2015. Two interlinked datasets, namely the district rainfall and individual rainfall stations datasets were used for the trend analyses, namely, daily time series of 60 individual rainfall stations and the daily district rainfall of 88 of 94 rainfall districts in South Africa. The extreme precipitation indices defined by the World Meteorological Organization Expert Team on Climate Change Detection and Indices were applied. In general, the results show an increase in rainfall for most rainfall stations in the southern interior of South Africa, and indications of decreases in rainfall in the far northern and north-eastern parts. The increase in the annual rainfall in the south is reflected in the seasonal trends, where summer rainfall shows a similar increase, but also extends into the central interior. For other seasons, most of the country shows no significant historical trends in annual total rainfall. From the extreme rainfall analyses, an increase in daily rainfall extremes in the southern to western interior is apparent. Also, most of the country experienced increases in the intensity of daily rainfall, which confirms global results in general. Decreases in rainfall from wet spells were noted in most places over the east and north-east, while the southern and eastern parts along the escarpment experienced shorter annual dry spells. This study improves on previous studies in the region by more than doubling the analysis period, largely eliminating the influence that decadal-scale cycles might have on analyses over shorter periods. However, some differences in the trend results compared to previous studies are apparent, e.g., less pronounced drying in the east and the previously observed increase in rainfall in the western and southern interior not extending as far as the south-western Cape. The observed trends broadly confirm those of projected changes in summer rainfall, i.e., an increase in the west and decrease in the east.http://www.wrc.org.zaam2017Geography, Geoinformatics and Meteorolog

Surface temperature trends from homogenized time series in South Africa : 1931-2015

Previous assessments of historical trends of measured surface temperature in South Africa have all shown a general upward trend, in both mean and extreme values, over recent decades. In addition, some regional differences in trends have been identified. Most of these studies focused on the period from about 1961 up to the last year that could be included before publication, as only climate stations situated in the same position for the entire analysis period were analysed. A data homogenisation procedure enabled the combination of time series of stations from which trend analysis could be applied, extending the common analysis period for this study back to around 1931. The trend results, based on the WMO ETCCDI indices, continue to show the general warming trend shown in previous analyses, with a general increase in extreme warm events, and a general decrease in extreme cold events across South Africa. The analysis of seasonal trends show that, while there are noteworthy differences on a regional basis, austral summer shows on average the strongest warming, followed by autumn, winter and spring. The central interior, which exhibited significant cooling in previous analyses, now shows non-significant or similar trends when compared to the other parts of South Africa. There is no countrywide acceleration in the warming trends, but some regional consistencies in the temporal changes in trends could be determined, i.e. increases in trends in the central interior and decreases in trends along most of the coastal region.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-00882018-04-30hb2017Geography, Geoinformatics and Meteorolog

Development of an updated fundamental basic wind speed map for SANS 10160-3

This paper evaluates the need for updating the strong wind climate stipulations of South Africa for the design of structures in accordance with SANS 10160-3:2010, as based on the latest information presented by Kruger et al (2013a; 2013b). The primary objective is to provide the geographic distribution of the characteristic gust wind speed by means of the fundamental value of the basic wind speed, stipulated as vb,0 in SANS 10160-3. A reassessment of previously published information is made to incorporate additional wind speed modelling results and to investigate identified anomalies. The format of presentation, based on local municipal districts, is subsequently motivated, assessed and implemented. In order to provide for situations requiring the consideration of the dynamic effects of wind loading, similar information on characteristic hourly mean wind speed is provided. It is concluded that the presentation of wind speed on a district basis provides an effective balance between the spatial resolution of the available information and its use in operational standardised design.http://www.journals.co.za/ej/ejour_civileng.htmlam2018Geography, Geoinformatics and Meteorolog