Jikeleza labyrinth : reflexive essay.

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INCIDENCE AND FACTORS ASSOCIATED WITH BLOOD TRANSFUSION IN A SAMPLE OF SOUTH AFRICAN PATIENTS UNDERGOING PRIMARY HIP ARTHROPLASTY: A RETROSPECTIVE DATABASE STUDY.

Background: Despite improvements in arthroplasty and blood conservation practices, surgical blood loss remains a challenge. The blood products used to address perioperative bleeding are scarce and should be effectively managed. Our study objectives were to 1) establish the cumulative incidence of peri-operative transfusion in a sample of South African primary hip arthroplasty patients and 2) identify factors associated with transfusions. Methods: This study was a sub-analysis of an existing database of 174 adult primary hip arthroplasty patients who underwent surgery at Inkosi Albert Luthuli Central Hospital between 01 January 2015 and 30 June 2016. A retrospective chart review process was used to collect the data analyzed using descriptive statistical methods, Mann-Whitney testing, and Chi-squared testing. The study outcome was perioperative blood transfusion, defined as receipt of at least 1 unit of packed red cells anytime between the surgical incision and discharge from the hospital. Results: The incidence of perioperative blood transfusion was 13.8% (95%CI: 9.0-19.8%). The median number of blood units received was 2.0 (Range: 1.0-4.0) units.  The proportion of patients who received blood transfusions was higher in those who had longer surgery (41.7% vs. 14.7 % p=0.002) or received postoperative thromboprophylaxis (91.7% vs. 68% p=0.017). Conclusion: The incidence of perioperative blood transfusion observed in our study of patients undergoing primary hip arthroplasty was within range of that reported in international studies. Longer surgery and postoperative thromboprophylaxis are potentially important predictors of perioperative transfusion following hip arthroplasty in our setting. We recommend further research to confirm our findings

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

Dust depletion of of metals from local to distant galaxies II: Cosmic dust-to-metal ratio and dust composition

The evolution of the cosmic dust content and the cycle between metals and dust in the interstellar medium (ISM) play a fundamental role in galaxy evolution. The chemical enrichment of the Universe can be traced through the evolution of the dust-to-metals ratio (DTM) and the dust-to-gas ratio (DTG) with metallicity. We use a novel method to determine mass estimates of the DTM, DTG and dust composition based on our previous measurements of the depletion of metals in different environments (the Milky Way, the Magellanic Clouds, and damped Lyman-$\alpha$ absorbers, DLAs, toward quasars and towards gamma-ray bursts, GRBs), which were calculated from the relative abundances of metals in the ISM through absorption-line spectroscopy column densities observed mainly from VLT/UVES and X-shooter, and HST/STIS. We derive the dust extinction from the estimated dust depletion ($A_{V, \rm depl}$) and compare with the $A_{V}$ from extinction. We find that the DTM and DTG ratios increase with metallicity and with the dust tracer [Zn/Fe]. This suggests that grain growth in the ISM is a dominant process of dust production. The increasing trend of the DTM and DTG with metallicity is in good agreement with a dust production and evolution model. Our data suggest that the stellar dust yield is much lower than the metal yield and thus that the overall amount of dust in the warm neutral medium that is produced by stars is much lower. We find that $A_{V,\rm depl}$ is overall lower than $A_{V, \rm ext}$ for the Milky Way and a few Magellanic Clouds lines of sight, a discrepancy that is likely related to the presence of carbonaceous dust. We show that the main elements that contribute to the dust composition are, O, Fe, Si, Mg, C, S, Ni and Al for all the environments. Abundances at low dust regimes suggest the presence of pyroxene and metallic iron in dust.Comment: Accepted for publication in A&A. Abstract abridge

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

A Twenty-First Century Assessment of Values Across the Global

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societallevel analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self- transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s a statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and withinsociety agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research