A collaborative and evolving response to the needs of frontline workers, patients and families during the COVID-19 pandemic at Tygerberg Hospital, Western Cape Province, South Africa

The global devastation caused by the COVID-19 pandemic and its mental health impact is undeniable. The physical and psychological consequences are wide-ranging – affecting patients fighting the disease, frontline workers in the trenches with them, healthcare staff deployed in high-care settings, and families disconnected from their loved ones in their darkest hours. Within 6 weeks of the COVID-19 outbreak in South Africa, the Department of Psychiatry at Stellenbosch University established the TBH/SU COVID Resiliency Clinic to provide psychological support to frontline workers at Tygerberg Hospital. Identified barriers in healthcare workers accessing mental healthcare resulted in moving towards an on-site visibility to try to remove some of these barriers. This greater on-site presence enabled networking and building of relationships with frontline staff that over time highlighted other frontline needs, such as providing psychosocial and spiritual support to patients and their families. We share challenges, lessons learned and recommendations from two initiatives: the TBH/SU COVID-19 Resiliency Clinic, and an embedded COVID Care Team (CCT). We describe the establishment, roll-out and progress of the Clinic and the subsequent CCT

The A-ring reduction of 11-ketotestosterone is efficiently catalysed by AKR1D1 and SRD5A2 but not SRD5A1

Testosterone and its 5α-reduced form, 5α-dihydrotestosterone, were previously thought to represent the only active androgens in humans. However, recent studies have shown that the potent androgen, 11-ketotestosterone, derived from the adrenal androgen precursor, 11β-hydroxyandrostenedione, may in fact serve as the primary androgen in healthy women. Yet, despite recent renewed interest in these steroids, their downstream metabolism has remained undetermined. We therefore set out to investigate the metabolism of 11-ketotestosterone by characterising the 5α- or 5β-reduction commitment step. We show that inactivation of 11-ketotestosterone is predominantly driven by AKR1D1, which efficiently catalyses the 5β-reduction of 11-ketotestosterone, committing it to a metabolic pathway that terminates in 11-ketoetiocholanolone. We demonstrate that 5α-reduction of 11-ketotestosterone is catalysed by SRD5A2, but not SRD5A1, and terminates in 11-ketoandrosterone, but is only responsible for a minority of 11-ketotestosterone inactivation. However, as 11-ketoetiocholanolone is also generated by the metabolism of the glucocorticoid cortisone, 11-ketoandrosterone should be considered a more specific urinary marker of 11-ketotestosterone production

Shallow rainwater lenses in deltaic areas with saline seepage

In deltaic areas with saline seepage, freshwater availability is often limited to shallow rainwater lenses lying on top of saline groundwater. Here we describe the characteristics and spatial variability of such lenses in areas with saline seepage and the mechanisms that control their occurrence and size. Our findings are based on different types of field measurements and detailed numerical groundwater models applied in the south-western delta of the Netherlands. By combining the applied techniques we could extrapolate measurements at point scale (groundwater sampling, temperature and electrical soil conductivity (TEC)-probe measurements, electrical cone penetration tests (ECPT)) to field scale (continuous vertical electrical soundings (CVES), electromagnetic survey with EM31), and even to regional scale using helicopter-borne electromagnetic measurements (HEM). The measurements show a gradual mixing zone between infiltrating fresh rainwater and upward flowing saline groundwater. The mixing zone is best characterized by the depth of the centre of the mixing zone <i>D</i><sub>mix</sub>, where the salinity is half that of seepage water, and the bottom of the mixing zone <i>B</i><sub>mix</sub>, with a salinity equal to that of the seepage water (Cl-conc. 10 to 16 g l<sup>−1</sup>). <i>D</i><sub>mix</sub> is found at very shallow depth in the confining top layer, on average at 1.7 m below ground level (b.g.l.), while <i>B</i><sub>mix</sub> lies about 2.5 m b.g.l. The model results show that the constantly alternating upward and downward flow at low velocities in the confining layer is the main mechanism of mixing between rainwater and saline seepage and determines the position and extent of the mixing zone (<i>D</i><sub>mix</sub> and <i>B</i><sub>mix</sub>). Recharge, seepage flux, and drainage depth are the controlling factors

Knee movement patterns of injured and uninjured adolescent basketball players when landing from a jump: A case-control study

BACKGROUND: A common knee injury mechanism sustained during basketball is landing badly from a jump. Landing is a complex task and requires good coordination, dynamic muscle control and flexibility. For adolescents whose coordination and motor control has not fully matured, landing badly from a jump can present a significant risk for injury. There is currently limited biomechanical information regarding the lower limb kinetics of adolescents when jumping, specifically regarding jump kinematics comparing injured with uninjured adolescents. This study reports on an investigation of biomechanical differences in landing patterns of uninjured and injured adolescent basketball players. METHODS: A matched case-control study design was employed. Twenty-two basketball players aged 14–16 years participated in the study: eleven previously knee-injured and eleven uninjured players matched with cases for age, gender, weight, height and years of play, and playing for the same club. Six high-speed, three-dimensional Vicon 370 cameras (120 Hz), Vicon biomechanical software and SAS Version 8 software were employed to analyse landing patterns when subjects performed a "jump shot". Linear correlations determined functional relationships between the biomechanical performance of lower limb joints, and paired t-tests determined differences between the normalised peak biomechanical parameters. RESULTS: The average peak vertical ground reaction forces between the cases and controls were similar. The average peak ground reaction forces between the cases and controls were moderately correlated (r = -0.47). The control (uninjured) players had significantly greater hip and knee flexion angles and significantly greater eccentric activity on landing than the uninjured cases (p < 0.01). CONCLUSION: The findings of the study indicate that players with a history of knee injuries had biomechanically compromised landing techniques when compared with uninjured players matched for gender, age and club. Descriptions (norms) of expected levels of knee control, proprioceptive acuity and eccentric strength relative to landing from a jump, at different ages and physical developmental stages, would assist clinicians and coaches to identify players with inappropriate knee performance comparable to their age or developmental stage

Fly-by-Pi: open source closed-loop control for geotechnical centrifuge testing applications

Geotechnical centrifuges are valuable instruments for physical modelling of complex geotechnical problems in a controlled laboratory setting. In comparison to full-scale testing, scaled models are cost effective to construct and instrument and, when tested in a geotechnical centrifuge at increased centrifugal accelerations, are capable of replicating full-scale stress–strain soil behaviour. Centrifuge modellers require specialised hardware and instruments capable of functioning under high accelerations. Such hardware is costly, nearly always purpose built, and often rely on commercial, closed-source data acquisition systems, hardware and control systems. This paper demonstrates a novel and versatile, low cost, open source logger and control system that works in parallel alongside existing centrifuge hardware. This solution, termed Fly-by-Pi, was developed using the Raspberry Pi microcomputer. The system provides closed-loop control of linear actuators with the ability to operate in either cyclic, monotonic, or static load- or displacement-control. The control mechanism can be reprogrammed according to experimental requirements, even during flight in the centrifuge. Three independent experiments are described which included the Fly-by-Pi controller as a key component in their operation. Based on the experience gained during these experiments, the authors encourage wide-spread adoption of open-sourced hardware solutions in extreme testing environments

Shaping public Opinion for confrontation : catalan independence claims as represented in spanish, catalan, valencian, and basque editorials

Editorials represent a newspaper's principal means of ideological positioning and serve to identify the attitude of each newspaper and its readership to some of the main actors in any given conflict, especially those that are political in nature. Catalonia's independence movement has experienced a surge in recent years. The turning point came in July 2010, after Spain's constitutional court ruled against some aspects of Catalonia's Statute of Autonomy (the legislation regulating the relationship between the Catalan autonomous community and the Spanish state). The ruling annulled some of the articles of the statute. The demonstration in support of Catalan independence that took place on September 11, 2012, was considered the most important among several mass rallies held for this purpose over successive years on Catalonia's National Day. This article presents the results of a qualitative and quantitative analysis of editorial articles published around these two key dates, with the goal of studying each newspaper's treatment of political actors and their degree of identification with these actors. Their use of arguments aimed at persuading readers and legitimizing a given position during the specified time periods in 2010 and 2012 will also be studied. The study focuses on the editorial articles published by several newspapers in four distinct regional contexts: Catalonia, Valencia, the Basque Country, as well as the whole of Spain. The analyzed articles were published a few days before and after July 10, 2010, and September 11, 2012

Postmortem lung biopsies from four patients with COVID-19 at a tertiary hospital in Cape Town, South Africa

CITATION: Bruce-Brand, C. et al. 2020. Postmortem lung biopsies from four patients with COVID-19 at a tertiary hospital in Cape Town, South Africa. South African Medical Journal, 110(12):1195-1200, doi:10.7196/SAMJ.2020.v110i12.15290.The original publication is available at http://www.samj.org.zaPublication of this article was funded by the Stellenbosch University Open Access FundBackground. An outbreak of a novel coronavirus in China in late 2019 has resulted in a global pandemic. The virus (SARS-CoV-2) causes a severe acute respiratory syndrome and had been responsible for >14 000 deaths in South Africa (SA) at the time of writing, 30 August 2020. Autopsies in our setting have not been prioritised owing to the infective risks for staff, resulting in a lack of information on the histopathology of the disease in the SA setting. Postmortem biopsies are relatively quick and easy to perform and reduce the infective risk posed by full autopsies. Objectives. To determine whether postmortem biopsies of lung tissue could be used to determine cause of death in lieu of full autopsies in patients dying from COVID-19. Methods. We performed postmortem biopsies of lung tissue on 4 patients with SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction who died in the Tygerberg Hospital (Cape Town, SA) intensive care unit (ICU) in June - July 2020, in order to determine their cause of death. The biopsies were performed in the ICU with the necessary personal protective equipment within 2 hours after death. Clinical information was obtained from the hospital records and the histopathology was reviewed by two consultant histopathologists. Microbiology and electron microscopy were also performed on this tissue. Results. All 4 patients were aged >50 years and had multiple comorbidities. Pulmonary pathology was present in only 3 cases, and the findings were surprisingly heterogeneous. One case demonstrated several findings including diffuse alveolar damage, extensive fibrin thrombi in pulmonary arteries with pulmonary infarction, organising pneumonia and bronchopneumonia. Other findings included type 2 pneumocyte hyperplasia, intra-alveolar macrophages and squamous metaplasia. An organising pneumonia was present in 2 other cases, although these findings were not deemed to be severe enough to be the cause of death. Fibrin thrombi were present in pulmonary arteries of 3 cases. One case showed no significant acute pulmonary pathology. The cause of death could only be determined in 1 case. Conclusions. The pulmonary findings we observed are in keeping with those described in the international literature. However, the pathology was surprisingly heterogeneous between cases, and was only deemed severe enough to be the cause of death in 1 of 4 cases. While lung-targeted, standardised postmortem biopsies may be safe, easy to perform and provide useful insights into the disease, they are not suitable to replace full autopsies in determining cause of death.http://www.samj.org.za/index.php/samj/article/view/13116Publisher's versio