A Shocking Discovery: Electrostatic Discharge-Induced Pump Failure in an Implantable Left Ventricular Assist Device.

Despite advancements in left ventricular assist device (LVAD) technology, numerous complications continue to be associated with these devices. The interactions between LVADs and other electronic devices and the effects of electrostatic discharge (ESD) are not well established. This study reports a rare case of ESD causing pump malfunction in an implantable LVAD.

Psychiatric education in Africa-a South African perspective.

Psychiatry is an under-resourced discipline, specifically in terms of personnel, not least of all in developing world settings. The capacity for training specialists does not seem to meet the requirements of an increasing disease burden. Notwithstanding the status quo, countries in such settings continue to train and graduate specialists. The current paper provides an overview of specialist training in South Africa, specifically noting the exposure to Psychiatry at undergraduate level, within the context of Psychiatric education in an African setting. An important issue is raised-if a country is not able to meet the personnel requirements at specialist level, is it time to reconsider such training within the broader context of psychiatric education based on country-specific needs. Further, the need for an assertive specialist psychiatrist discipline as well as one that is knowledgeable and respectful of indigenous practice is highlighted.

Mental health and the law: a South African perspective.

Mental health law in South Africa has been dominated in recent times by the Mental Health Care Act 2002. This paper provides selective insights into specific aspects of that Act and highlights its impact on clinical practice within a broad clinical setting and in so doing suggests areas for review and revision.

Mental health leadership and patient access to care: a public-private initiative in South Africa.

BACKGROUND: Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. METHODS: A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. RESULTS: Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training. CONCLUSIONS: Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. Ensuring that mental health receives the recognition and the resources it deserves requires that mental health care professionals become effective advocates through mental health leadership.

Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data.

BACKGROUND: Community mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents. AIM: The aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy. METHODS: The CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed. RESULTS: The organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover. CONCLUSION: Our audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

Psychiatric services for preschoolers: an emerging need.

OBJECTIVE: To describe clinical presentation and service requirements for those under six years of age referred to a specialised child and adolescent psychiatry unit. METHOD: This study used a retrospective review of preschoolers, six years and younger, assessed at a child, family and adolescent psychiatric unit (January 2006 to 31 December 2010). Data analysis established predominant diagnoses (prevalence percentages) and correlations and associations (diagnoses and a range of clinical variables - Fischer's exact test and chi-square test). RESULTS: The sample comprised 149 subjects. Males predominated (77.2%; N = 115). Mean age of presentation was 54 months (SD=12.59). Children were referred predominantly by health professionals (36.9%; N = 55) and schools (20.8%; N = 31). Attention-deficit hyperactivity disorder (ADHD) was the most common diagnosis (52.8%; N = 70), and was not over-represented amongst boys. Girls mostly presented with anxiety disorders (44.1%; 15/34) and reactive attachment disorder (RAD) (35.3%; 12/34), and boys mostly with pervasive developmental disorders (PDD) (26%; 30/115). Psychometric testing was frequent (68.5%; N = 102). Pharmacological intervention was common (46.3%; N = 69). The defaulting rate after initial assessment was high (42.1%; 48/114). CONCLUSION: The study demonstrates the existence of psychiatric illness in this sample, highlighting service needs. Vulnerability of this age group and limited sub-specialist resources emphasise the need for the development of community services leading to early recognition and intervention.

Disparate plasma cortisol concentrations in sexually abused female children from Johannesburg, South Africa.

A growing body of research indicates that a bidirectional response to a stressor may occur in maltreated children and may be associated with later life psychopathology. However, few studies have investigated stress reactivity in children when they first present to a sexual abuse clinic. Thus, in order to evaluate whether HPA axis dysregulation would be evident at first presentation to a sexual abuse clinic in young girls (n = 26), between the ages of 6-12 years old, blood samples were obtained immediately following examination at a forensic sexual abuse clinic and from the matched control group of children (n = 14; 10.1 ± 0.8) immediately following a bone density scan. Stratification of the sexually abused group into those children who were reportedly abused by a stranger and had no other family stressors (n = 15, 10.4 ± 1.8) and those children whose parents reported abuse of the child by a stranger and other family stressors (n = 11; 9.5 ± 1.8) revealed differences in stress reactivity. Plasma concentrations, of the children from the forensic clinic, were significantly increased in children who reported abuse by a stranger only (322.3 ± 117.4 nmol/l) and significantly decreased in children whose histories indicated sexual abuse by a stranger and other family stressors (149.6 ± 39.7 nmol/l) when compared to the control group (225.5 ± 47.5 nmol/l). In conclusion, following sexual abuse and a secondary stressor, the forensic examination, there is evidence of divergent cortisol responses in the stratified clinical group of children.

FT-IR spectroscopy and density functional theory calculations of 13C isotopologues of the helical peptide Z-Aib6-OtBu.

Isotope-edited FT-IR spectroscopy is a combined synthetic and spectroscopic method used to characterize local (e.g., residue-level) vibrational environments of biomolecules. We have prepared the 3(10) helical peptide Z-Aib6-OtBu and seven (13)C-enriched analogues that vary only in the number and position(s) of (13)C═O isotopic enrichment. FT-IR spectra of these eight peptides solvated in the nonpolar aprotic solvent dichloromethane have been collected and compared to frequency, intensity, and normal mode results of DFT calculations. Single (13)C enrichment of amide functional groups tends to localize amide I vibrational eigenmodes, providing residue-specific information regarding the local environment (e.g., hydrogen bonding or solvent exposure) of the peptide bond. Double (13)C enrichment of Z-Aib6-OtBu allows for examination of interamide coupling between two labeled amide functional groups, providing experimental evidence of interamide coupling in the context of 3(10) helical structure. Although the calculated and observed interamide couplings of Z-Aib6-OtBu are a few cm(-1) and less, the eight peptides exhibit distinct infrared spectra, revealing details of interamide coupling and residue level vibrational environments.

A model for the role of defined spirituality in South African specialist psychiatric practice and training.

The current bio-psycho-social approach in South African psychiatry refers to Engel's extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.

Competence of medical students and residents in psychiatry regarding spirituality, at a South African school of clinical medicine.

OBJECTIVE: Elsewhere, curricula for undergraduate and postgraduate psychiatry have been extended to include the role of spirituality. It has also become important to establish how, within accepted professional boundaries, spirituality should be incorporated appropriately into the current model for South African practice and training. The objectives included exploring, analyzing, and describing the views and experience of local academic psychiatrists on this topic. METHODS: This study was designed as an explorative, descriptive, phenomenological qualitative investigation. In-depth, semi-structured interviews were conducted with individual academic specialist psychiatrists as the primary data source. RESULTS: Data saturation was achieved after 13 interviews. "Training of spirituality in psychiatry" emerged as one of six main themes from the integrated interview and literature content. All participants proposed that spirituality must be included in undergraduate medical and specialist psychiatric training. They have suggested that a mentorship model should be considered, which implies the reorientation of the teachers of psychiatry in this regard. CONCLUSIONS: This view concurred with the international medical literature, recommending that spirituality has to be incorporated into specialist psychiatric practice and training, but within professional boundaries and with all faith traditions and belief systems considered equally.