BACKGROUND: Crush injury is a common presenting clinical problem in South African trauma patients, causing acute kidney injury (AKI). It has been theorised previously that the AKI was not due to an anaerobic phenomenon. A previous local study noted the presence of a mild hyperlactataemia among patients with crush syndrome, but the significance and causes of this was not fully explored. This study aimed to examine the incidence of hyperlactataemia in patients with crush syndrome presenting to a busy emergency department (ED) in rural South Africa. METHODS: The study was conducted at Edendale Hospital in KwaZulu-Natal province in South Africa from 1 June 2016 to 31 December 2017. All patients from the ED who had sustained a crush injury secondary to a mob assault were included in the study. Patients with GCS on arrival of < 13 or polytrauma were excluded from analysis. The primary outcome of interest was the presence of hyperlactataemia (> 2.0mmol/L) on presentation. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to diagnose and stage AKI as a secondary outcome. RESULTS: A total of 84 patients were eligible for analysis. Sixty-nine (82%) patients presented with hyperlactataemia. The median serum lactate was 4.9mmol/L (IQR 2.3-7.2mmol/L). Fifteen (18%) patients were diagnosed with AKI on presentation according to serum creatinine. Ten patients were diagnosed as Stage 1, three were Stage 2 and two Stage 3 AKI respectively. There was no difference in the incidence of AKI in patients with or without hyperlactataemia (p = 0.428). Time from injury to presentation was a median 365 minutes (IQR 180-750 minutes). Six (7%) patients were admitted to high care unit and nine (11%) were admitted to the intensive care unit (ICU). No patients died within 48 hours of admission. Two patients received renal replacement therapy during the first 48 hours of admission to hospital. CONCLUSION: Hyperlactataemia is a common feature of patients presenting to the ED following crush syndrome secondary to beatings received during interpersonal violence. The origin of this hyperlactataemia is currently unknown. Further research needs to be conducted into the origin of the hyperlactataemia and its clinical significance. In this cohort, the utilisation of RRT was low but the incidence of AKI was high and developed rapidly following the injury. The utilisation of RRT also needs to be further studied in larger patient populations in South Africa to make local clinical recommendations for use.

BACKGROUND: Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES: To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD: A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS: There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION: The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.

Abstract As therapies are developed for rare disorders, challenges of early diagnosis become particularly relevant. This article focuses on clinical recognition of mucopolysaccharidoses (MPS), a group of rare genetic diseases related to abnormalities in lysosomal function. As quality of outcomes with current therapies is impacted by timing of intervention, minimizing time to diagnosis is critical. The objective of this study was to characterize how, when, and to whom patients with MPS first present and develop tools to stimulate earlier recognition of MPS. A tripartite approach was used, including a systematic literature review yielding 194 studies, an online physician survey completed by 209 physicians who described

Este artigo explora a importância do gerencialismo como um conceito para pensar sobre projetos de reforma do estado durante os últimos quarenta anos. Fazendo particular referência ao Reino Unido e seu papel na proliferação da Nova Gestão Pública, o artigo sugere que o gerencialismo (como ideologia) e a gerencialização (como um processo de transformação) se combinam para produzir o que descrevemos como um estado gerencial. Nesta forma de estado, arranjos organizacionais e sistemas de poder, autoridade e processo anteriores embasados em uma combinação de burocracia e profissionalismo são reconfigurados em torno da autoridade gerencial: o direito de gerir. Recorrendo a uma concepção da dispersão de poder em processos de reforma do estado, sugerimos que é o gerencialismo que fornece coerência tanto ideológica como organizacional aos cenários organizacionais complexos que emergiram de projetos de reforma do estado. Fronteiras borradas, formas organizacionais hibridizadas, arranjos de governança inovadores e novos aparelhos de responsabilização e avaliação são articulados pelas promessas de maior liberdade e autoridade gerencial. O artigo é concluído com a especulação sobre o que a volta à austeridade na política europeia poderia significar para o gerencialismo e a dispersão do poder do Estado.

This article explores the significance of managerialism as a concept for thinking about projects of state reform across the last forty years. Making particular reference to the United Kingdom and its role in the proliferation of the New Public Management, the article suggests that managerialism (as an ideology) and managerialisation (as a process of transformation) combine to produce what we describe as a managerial state. In such a form of state, previous organizational arrangements and systems of power, authority and process based around a combination of bureaucracy and professionalism are reconfigured around managerial authority: the right to manage. Drawing on a conception of the dispersal of power in processes of state reform, we suggest that it is managerialism that gives both ideological and organizational coherence to the complex organizational landscapes that have emerged from state reform projects. Blurred boundaries, hybridized organizational forms, innovative governance arrangements and new apparatuses of accountability and evaluation are articulated by the promises of greater managerial freedom and authority. The article concludes by speculating on what the turn to austerity in European politics might mean for managerialism and the dispersal of state power.

Usando um espectrômetro baseado em um SQUID (dispositivo supercondutor de interferência quântica), de alta temperatura de transição, polarizado continuamente, medimos sinais de ressonância magnética nuclear (RMN) de várias amostras a temperatura ambiente em campos magnéticos na faixa entre 0,05 mT e 2 mT. É possível observar sinais de prótons em uma amostra com 1 mL de óleo mineral em 2 mT com apenas uma aquisição. A sensibilidade do sistema também permite a detecção de RMN de prótons em um campo magnético tão baixo quanto 0,059 mT, o qual é comparável ao campo da Terra. Estes resultados tornam possíveis vários outros experimentos em imagens por ressonância magnética nuclear. Apresentamos uma imagem em duas dimensões obtida a temperatura ambiente em um campo magnético de 2 mT a partir de um padrão com uma estrutura interna preenchida com óleo mineral.

We have measured nuclear magnetic resonance (NMR) signals from several samples at room temperature in magnetic fields ranging from about 0.05 mT to 2 mT using a spectrometer based on a high-Tc dc SQUID (high transition temperature dc Superconducting QUantum Interference Device). We are able to observe proton signals from 1 mL of mineral oil in 2 mT in a single transient. The sensitivity of this system has also allowed the detection of proton NMR at magnetic fields as low as 0.059 mT, which is comparable to the Earth’s field. Such results make possible a number of new experiments in magnetic resonance imaging (MRI). We present a two-dimensional image of a phantom filled with mineral oil obtained in a field of 2 mT.