Preoperative serum sodium measurements and postoperative inpatient mortality: A casecontrol analysis of data from the South African Surgical Outcomes Study

Background. Abnormal preoperative serum sodium measurements have been shown to be associated with increased postoperative mortality in US and European surgical populations. It is possible that such measurements are also associated with increased postoperative mortality in a South African (SA) setting, but this is yet to be confirmed. Establishing whether preoperative serum sodium measurements are associated with postoperative mortality could have implications for perioperative risk stratification in SA settings.Objectives. To determine whether preoperative serum sodium measurements are associated with postoperative mortality in SA surgical patients.Methods. This was an unmatched case-control study of patient data (demographics, comorbidities, procedure-related variables, and preoperative serum sodium measurements) collected during the South African Surgical Outcomes Study. Data were analysed using recommended statistical methods for unmatched case-control studies.Results. The study population comprised 103 patients and 410 controls. Cases were defined as patients who suffered postoperative inpatient mortality, while controls were defined as patients who did not suffer postoperative inpatient mortality. Preoperative hypernatraemia (i.e. a preoperative serum sodium measurement >144 mEq/L) was independently associated with a four-fold higher risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement of 135 - 144 mEq/L (odds ratio (OR) 4.21, 95% confidence interval (CI) 1.19 - 14.83, p=0.025). Preoperative hyponatraemia (i.e. a preoperative serum sodium measurement <135 mEq/L) was not independently associated with a higher or lower risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement (OR 1.39, 95% CI 0.70 - 2.76, p=0.346).Conclusions. Preoperative hypernatraemia, but not preoperative hyponatraemia, is a risk factor for postoperative inpatient mortality in SA surgical patients

Chemical diversity of gas in distant galaxies: The metal and dust enrichment and variations within absorbing galaxies

The chemical composition of gas in galaxies can be measured in detail from absorption spectroscopy. By studying gas in galaxies in this way, it is possible to investigate the small and faint galaxies, which are the most numerous in the universe. In particular, the chemical distribution of gas in absorbing systems gives us insight into cycles of gas in and around galaxies. Here we study chemical enrichment within 64 Damped Lyman-alpha Absorption (DLA) systems between $1.7 < z < 4.2$. We use high-resolution spectra from VLT/UVES to infer dust depletion from relative abundances of several metals. We perform a component-by-component analysis within DLAs, and characterise variations in their chemical enrichment. Unlike hydrogen, the metal columns can be characterised for individual components. We use them to derive the dust depletion ([Zn/Fe]fit), as an indicator for chemical enrichment. We find that some DLAs are chemically diverse within themselves, with [Zn/Fe]fit ranging up to 0.62 dex within a single system. This suggests that absorbing gas within these galaxies is chemically diverse. Although we do not find a clear trend of decreasing dust depletion with redshift, we do see that the most chemically enriched systems are at lower redshifts. We also observe evidence for dust-poor components at all redshifts, which may be due to the accretion of pristine gas onto galaxies. We combine the chemical and kinematic properties of the individual gas components and observe potential signatures of infalling gas, with low depletion at velocities below $\sim$100km/s, and outflows, with high depletion and velocities of $\sim$600km/s. We find over-abundances of alpha-elements (an enhancement of $\sim$0.3dex) and under-abundances of Mn in several components, which is likely a signature of core-collapse SNe nucleosythesis in the ISM. We observe these effects mostly at lower levels of chemical enrichment.Comment: 56 pages, 99 figures, Accepted for publication in A&A, Abstract abridged for arXi

First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa

A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC’s first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery

Dissecting the interstellar medium of a z=6.3 galaxy: X-shooter spectroscopy and HST imaging of the afterglow and environment of the Swift GRB 210905A

The study of the properties of galaxies in the first billion years after the Big Bang is one of the major topic of current astrophysics. Optical/near-infrared spectroscopy of the afterglows of long Gamma-ray bursts (GRBs) provide a powerful diagnostic tool to probe the interstellar medium (ISM) of their host galaxies and foreground absorbers, even up to the highest redshifts. We analyze the VLT/X-shooter afterglow spectrum of GRB 210905A, triggered by the Swift Neil Gehrels Observatory, and detect neutral-hydrogen, low-ionization, high-ionization, and fine-structure absorption lines from a complex system at z=6.3118, that we associate with the GRB host galaxy. We study the ISM properties of the host system, revealing the metallicity, kinematics and chemical abundance pattern. The total metallicity of the z~6.3 system is [M/H]=-1.72+/-0.13, after correcting for dust-depletion and taking into account alpha-element enhancement. In addition, we determine the overall amount of dust and dust-to-metal mass ratio (DTM) ([Zn/Fe]_fit=0.33+/-0.09, DTM=0.18+/-0.03). We find indications of nucleosynthesis due to massive stars and evidence of peculiar over-abundance of aluminium. From the analysis of fine-structure lines, we determine distances of several kpc for the low-ionization gas clouds closest to the GRB. Those farther distances are possibly due to the high number of ionizing photons. Using the HST/F140W image of the GRB field, we show the GRB host galaxy as well as multiple objects within 2" from the GRB. We discuss the galaxy structure and kinematics that could explain our observations, also taking into account a tentative detection of Lyman-alpha emission. Deep spectroscopic observations with VLT/MUSE and JWST will offer the unique possibility of combining our results with the ionized-gas properties, with the goal of better understanding how galaxies in the reionization era form and evolve.Comment: Accepted Publication (In Press on A&A) - 22 pages, 10 figures, 6 tables - Appendix: 6 figures, 3 table

Ethical preferences for influencing superiors: A 41-society study

With a 41-society sample of 9990 managers and professionals, we used hierarchical linear modeling to investigate the impact of both macro-level and micro-level predictors on subordinate influence ethics. While we found that both macro-level and micro-level predictors contributed to the model definition, we also found global agreement for a subordinate influence ethics hierarchy. Thus our findings provide evidence that developing a global model of subordinate ethics is possible, and should be based upon multiple criteria and multilevel variables

Societal-level versus individual-level predictions of ethical behavior: a 48-society study of collectivism and individualism

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed

South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

Approaches to Enhancing Student Learning: A Quality-Assured, Creative and Performing-Arts Model (ISBN 978-3-31963807-2)

Abstract Arts-based approaches to learning and teaching in higher education have a unique and distinct capacity to provide students with authentic and generative learning opportunities. This chapter, centred in the performing arts, demonstrates how an institutional approach to experiential learning influences and embeds collaborative and inter-disciplinary learning and assessment in the dynamic area of live theatrical production. It also seeks to demonstrate the impact of learning through collaboration and inter-disciplinarity, and how students’ reveal curiosity and empathy by engaging with the work of others, whilst cultivating the higher order critical and flexible thinking skills through a unique community of creative-arts practice. Strengthened by quality assured curricula, these learning and assessment strategies can be at once a measure of independent discipline expertise and the aggregated knowledge that leads to a collective dramatic performance. Further, this embodied learning is used as a model through which required higher education standards may be ‘read’. Informed by developments in the higher education sector, the authors present a framework in which learning and assessment outcomes in the creative and performing arts are strengthened through discipline standards and higher education sector regulations to ensure the highest quality in student learning nationally, and comparative standing internationally. Specifically, in a case study approach, application of the framework is demonstrated through the creative teaching methods used to produce live dramatic performances at one of Australia’s leading performing arts institutes, where learning outcomes are mapped to national higher education standards and benchmarked with parallel international standards. This approach ensures comparative standing and extended opportunities for students across the performing arts sector, cultures and disciplinary borders

Innovations in Student Learning in the Creative and Performing Arts

Student learning in the creative and performing arts holds a unique place in arts-basededucation in the Higher Education sector. This paper highlights a model that captureschanging trends in arts-based education, and shares approaches to delivery at a leadingperforming arts institution in Australia. It demonstrates an institutional shift from a trainingmodel that focused on professional skills development in the creative and performingarts, to one that incorporates an academic and Higher education focus with researchinformed practice, theoretical foundations of learning, and academic outcomes andcredentials. The integrated approach sets a new trajectory for students, and offersgreater opportunities for learning and engagement in the sector. The approach highlightsunique measures for assessing experiential learning, the ‘lived experience’, andcollaborative engagement across multiple disciplines that culminate in a collectivedramatic performance. It incorporates the development of an institutional qualityassurance system, mapped to national Higher Education standards and benchmarkedinternationally, and integrates strategies for external engagement in the arts to facilitateprofessional learning. The paper seeks to demonstrate innovations in arts-basededucation, identify challenges encountered, and showcase aspects of the uniquelyintegrated model as implemented at a leading creative and performing arts institution inAustralia