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A general notarial bond registered over movable property grants the bondholder a real security right enforceable against third parties only if the bond has been perfected by transferring possession of the property to the bondholder. Based on the facts and judgment in Absa Bank Limited v Go On Supermarket (Pty) Limited, this analysis revisits the basic principles of and requirements for the perfection of a general bond. We ultimately criticise the judgment on three scores. Firstly, the court regarded the form of delivery (transfer of possession) applicable in this matter as symbolic delivery, but we point out that it amounted to constitutum possessorium – meaning that the attempted perfection of the bond was ineffective. Secondly, the parties conceded and the court accepted that the general bond could not be perfected over property subject to the special notarial bond of another creditor. We reason that this is incorrect. It is indeed possible to attach property subject to the security right of another creditor, although the first creditor's rights will be preferred over those of the creditor who subsequently attached the property. Thirdly, the court rejected the argument that the general bond could not be perfected over property owned by another creditor in terms of a reservation-of-ownership clause in a sale agreement. However, the court should not have rejected this argument, since it was correct. A general bond indeed cannot cover property belonging to someone other than the debtor, unless the person agreed, and thus it was not possible in this case to attach the property belonging to someone other than the debtor. [ABSTRACT FROM AUTHOR]

The National Credit Act 34 of 2005 prohibits the granting of reckless credit and also provides for certain remedies that courts can grant to consumers who have fallen victim to reckless lending practices. Depending on the circumstances, these remedies are the partial or full setting aside of the consumer's rights and obligations under the agreement; the temporary suspension of the effect of the agreement; and the restructuring of the consumer's obligations. This article investigates these remedies with a focus on the effect that they would have on a credit provider under a mortgage agreement. The argument is made that the contractual and security rights of credit providers amount to "property" for the purposes of section 25(1) of the Constitution of the Republic of |South Africa, 1996 (the property clause) and that, to some degree or another, each of these remedies involves a "deprivation" (limitation or modification) of the creditor provider's rights (property). The consequence is that, when one of these remedies is granted to a consumer, the court must tailor the remedy in such a way that the effect on the credit provider is not "arbitrary" as meant in the property clause. Therefore, the proposal is that there must be a sufficient relationship between the purpose of the remedy (to discourage reckless lending and to rectify the damage caused) and the effects thereof on the credit provider. In general, the remedy should not go further than is necessary to rectify the prejudice suffered by the consumer due to the credit provider's conduct. The formulation of the remedy should accommodate considerations such as whether and to what extent either or both parties have already performed under the agreement, and it should accordingly ensure that the consumer will not be unjustifiably enriched. The remedy should also account for the effect that it would have if the consumer is permitted to keep the property that was subject to the reckless credit agreement. The article furthermore raises doubts regarding the recent high court judgment in ABSA v De Beer 2016 3 SA 432 (GP), where all the consumer's rights and obligations under a mortgage agreement were set aside due to the credit provider's reckless conduct. Remedies like this have serious consequences and therefore it is imperative that courts carefully investigate all the effects that the order would have, so that a just and reasonable outcome is achieved. This article accordingly aims to provide some guidance with reference to the principles of constitutional property law. [ABSTRACT FROM AUTHOR]

The ability of a coal-fired power station to meet its generation targets is influenced by periods of coal shortage. In this article, we propose a multi-objective inventory model to assist with the management of coal stockpiles. The model is applicable to power utilities with a network of two or more coal-fired power stations. The aim is to determine the near-optimal amount of coal inventory to stockpile at each station in the network. A Monte Carlo coal stockpile simulator is used to incorporate stochastic uncertainty into the stockpile levels, while a metaheuristic uses the simulator as an estimator of two objective functions. The metaheuristic finds good values for the coal stockpile level at each power station in the network. The algorithm for multi-objective optimisation using the cross-entropy method is proposed as a suitable metaheuristic. A hypothetical case study is used to validate the inventory model and to showcase the optimisation results. [ABSTRACT FROM AUTHOR]

The article reviews the volume 16, number 4 of the "Arbitrary Deprivation of an Unregistered Credit Provider's Right to Claim Restitution of Performance Rendered."

Introduction: Out-of-hospital cardiac arrests (OHCA) witnessed by Emergency Medical Services (EMS) are reported to have more favourable survival than bystander-witnessed arrests, even after adjusting for patient and arrest factors known to be associated with increased OHCA survival. This study aims to determine whether the survival advantage in EMS-witnessed arrests can be attributed to differences in the EMS response time to the arrest., Methods: Using registry data we conducted a retrospective, population-based cohort study of bystander- and EMS-witnessed OHCAs of medical aetiology who received an EMS resuscitation attempt in Western Australia between 2018-2021. EMS response time to arrest was assumed to be zero for EMS-witnessed arrests. Multivariable logistic regression was used to compare 30-day OHCA survival by witness and bystander CPR (B-CPR) status, adjusting for EMS response time to arrest, and patient and arrest characteristics., Results: Of 2,130 OHCA cases, 510 (23.9%) were EMS-witnessed and 1620 were bystander-witnessed: 1318/1620 (81.4%) with B-CPR, and 302/1620 (18.6%) with no B-CPR. The median EMS response time to bystander-witnessed arrests who received B-CPR was 9.9 [Q1,Q3: 7.4, 13.3] minutes. After adjusting for the EMS response time and patient and arrest factors, 30-day survival remained significantly lower in both the bystander-witnessed group with B-CPR (aOR 0.56; 95% CI 0.34 - 0.91) and bystander-witnessed group without B-CPR (aOR 0.23; 95% CI 0.11 - 0.46)., Conclusion: An increased EMS response time does not fully account for the higher OHCA survival in EMS-witnessed arrests compared to bystander-witnessed arrests., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jason Belcher and Rudolph Brits are employees of SJWA. Judith Finn and Stephen Ball hold adjunct research positions with SJWA. David Majewski, Milena Talikowska, Judith Finn and Stephen Ball are employees of the Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU) at Curtin University; PRECRU receives research funding from SJWA. There are no other conflicts of interest to declare., (© 2024 The Author(s).)

Aim: To compare out-of-hospital cardiac arrest (OHCA) characteristics and outcomes between people aged ≥ 65 years who arrested in a residential aged care facility (RACF) versus a private residence in Perth, Australia., Methods: We undertook a retrospective cohort study of OHCA cases attended by emergency medical services (EMS) in Perth, January 2018-December 2021. OHCA patient and event characteristics and survival outcomes were compared via univariate analysis. Multivariable logistic regression was used to investigate the relationship between residency type and (i) return of spontaneous circulation (ROSC) at emergency department (ED) and (ii) 30-day survival., Results: A total of 435 OHCA occurred in RACFs versus 3,395 in private residences. RACF patients were significantly older (median age: 86 [IQR 79, 91] vs 78 [71, 85] years; p  < 0.001), more commonly female (50.1% vs 36.8%; p  < 0.001), bystander-witnessed arrests (34.9% vs 21.5%; p  < 0.001), received bystander cardiopulmonary resuscitation (42.1% vs 28.6%; p  < 0.001), had less shockable first monitored rhythms (4.0% vs 8.1%; p  = 0.002) and more frequently had a "do not resuscitate" order identified (46.0% vs 13.6%; <0.001). Among those with EMS-attempted resuscitation or with defibrillation before EMS arrival, ROSC at ED and 30-day survival were significantly lower in the RACF group (6.2% vs 18.9%; p  < 0.001 and 1.9% vs 7.7%; p  < 0.001). The adjusted odds of ROSC at ED (aOR: 0.22 [95%CI: 0.10, 0.46]) and 30-day survival (aOR: 0.20 [95%CI 0.05, 0.92]) were significantly lower for RACF residents., Conclusion: RACF residency was an independent predictor of lower survival from OHCA, highlighting the importance of end-of-life planning for RACF residents., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jason Belcher and Rudolph Brits are employees of SJWA. Judith Finn and Stephen Ball hold adjunct research positions with SJWA. Milena Talikowska, David Majewski, Lyndall Finn Sheryl Gallant, Judith Finn and Stephen Ball are employees of the Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU) at Curtin University; PRECRU receives research funding from SJWA. There are no other conflicts of interest to declare., (© 2023 The Authors.)

Introduction: Demand for emergency ambulances is increasing, therefore it is important that ambulance dispatch is prioritised appropriately. This means accurately identifying which incidents require a lights and sirens (L&S) response and those that do not. For traffic crashes, it can be difficult to identify the needs of patients based on bystander reports during the emergency phone call; as traffic crashes are complex events, often with multiple patients at the same crash with varying medical needs. This study aims to determine how well the text sent to paramedics en-route to the traffic crash scene by the emergency medical dispatcher (EMD), in combination with dispatch codes, can predict the need for a L&S ambulance response to traffic crashes., Methods: A retrospective cohort study was conducted using data from 2014 to 2016 traffic crashes attended by emergency ambulances in Perth, Western Australia. Machine learning algorithms were used to predict the need for a L&S response or not. The features were the Medical Priority Dispatch System (MPDS) determinant codes and EMD text. EMD text was converted for computation using natural language processing (Bag of Words approach). Machine learning algorithms were used to predict the need for a L&S response, defined as where one or more patients (a) died before hospital admission, (b) received L&S transport to hospital, or (c) had one or more high-acuity indicators (based on an a priori list of medications, interventions or observations., Results: There were 11,971 traffic crashes attended by ambulances during the study period, of which 22.3 % were retrospectively determined to have required a L&S response. The model with the highest accuracy was using an Ensemble machine learning algorithm with a score of 0.980 (95 % CI 0.976-0.984). This model predicted the need for an L&S response using both MPDS determinant codes and EMD text., Discussion: We found that a combination of EMD text and MPDS determinate codes can predict which traffic crashes do and do not require a lights and sirens ambulance response to the scene with a high degree of accuracy. Emergency medical services could deploy machine learning algorithms to improve the accuracy of dispatch to traffic crashes, which has the potential to result in improved system efficiency., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Calls for emergency medical assistance at the scene of a motor vehicle crash (MVC) substantially contribute to the demand on ambulance services. Triage by emergency medical dispatch systems is therefore important, to ensure the right care is provided to the right patient, in the right amount of time. A lights and sirens (L&S) response is the highest priority ambulance response, also known as a priority one or hot response. In this context, over triage is defined as dispatching an ambulance with lights and sirens (L&S) to a low acuity MVC and under triage is not dispatching an ambulance with L&S to those who require urgent medical care. We explored the potential for crash characteristics to be used during emergency ambulance calls to identify those MVCs that required a L&S response., Methods: We conducted a retrospective cohort study using ambulance and police data from 2014 to 2016. The predictor variables were crash characteristics (e.g. road surface), and Medical Priority Dispatch System (MPDS) dispatch codes. The outcome variable was the need for a L&S ambulance response. A Chi-square Automatic Interaction Detector technique was used to develop decision trees, with over/under triage rates determined for each tree. The model with an under/over triage rate closest to that prescribed by the American College of Surgeons Committee on Trauma (ACS COT) will be deemed to be the best model (under triage rate of ≤ 5% and over triage rate of between 25-35%., Results: The decision tree with a 2.7% under triage rate was closest to that specified by the ACS COT, had as predictors-MPDS codes, trapped, vulnerable road user, anyone aged 75 + , day of the week, single versus multiple vehicles, airbag deployment, atmosphere, surface, lighting and accident type. This model had an over triage rate of 84.8%., Conclusions: We were able to derive a model with a reasonable under triage rate, however this model also had a high over triage rate. Individual EMS may apply the findings here to their own jurisdictions when dispatching to the scene of a MVC., (© 2022. The Author(s).)

Background: Clinical effects and outcomes of a single dose etomidate prior to intubation in the intensive care setting is controversial. The aim of this study is to evaluate the association of a single dose effect of etomidate prior to intubation on the mortality of septic cirrhotic patients and the impact of the subsequent use of low dose hydrocortisone., Methods: This is a nested-cohort study within a randomized double blind placebo controlled study evaluating the use of low dose hydrocortisone in cirrhotic septic patients. Cirrhotic septic patients ≥ 18 years were included in the study. Patients who received etomidate prior to intubation were compared to those who did not receive etomidate for all cause 28-day mortality as a primary outcome., Results: Sixty two intubated patients out of the 75 patients randomized in the initial trial were eligible for this study. Twenty three of the 62 intubated patients received etomidate dose prior to intubation. Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02). Etomidate patients who received subsequent doses of hydrocortisone required lower doses of vasopressors and had more vasopressor-free days but no improvement in mortality., Conclusions: In this group of septic cirrhotic patients with very high mortality, etomidate increased ICU mortality. Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements. The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.

Background: Nutritional support has been recognized as an essential part of intensive care unit management. However, the appropriate caloric intake for critically ill patients remains ill defined., Objective: We examined the effect of permissive underfeeding compared with that of target feeding and of intensive insulin therapy (IIT) compared with that of conventional insulin therapy (CIT) on the outcomes of critically ill patients., Design: This study had a 2 × 2 factorial, randomized, controlled design. Eligible patients were randomly assigned to permissive underfeeding or target feeding groups (caloric goal: 60-70% compared with 90-100% of calculated requirement, respectively) with either IIT or CIT (target blood glucose: 4.4-6.1 compared with 10-11.1 mmol/L, respectively)., Results: Twenty-eight-day all-cause mortality was 18.3% in the permissive underfeeding group compared with 23.3% in the target feeding group (relative risk: 0.79; 95% CI: 0.48, 1.29; P = 0.34). Hospital mortality was lower in the permissive underfeeding group than in the target group (30.0% compared with 42.5%; relative risk: 0.71; 95% CI: 0.50, 0.99; P = 0.04). No significant differences in outcomes were observed between the IIT and CIT groups., Conclusion: In critically ill patients, permissive underfeeding may be associated with lower mortality rates than target feeding. This trial was registered at controlled-trials.com as ISRCTN96294863.

Objective: Recent literature showed that development of hypomagnesemia is associated with higher mortality. The objective of this study is to evaluate the impact of magnesium supplementation on mortality rates of critically ill patients., Methods: All patients admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City, Riyadh, Saudi Arabia since September 2003 were included. We recorded the demographics data, APACHE score, daily magnesium levels and magnesium supplementation. We collected the data for 30 days or until discharge from ICU. Statistical analysis was performed using the student t-test for continuous data and the Fischers exact test for categorical data. Nothing was carried out to influence the behavior of intensivists in replacing magnesium., Results: During the study period, 71 patients (45 males and 26 females) were admitted to the ICU, the mean age was 54 +/- 18 years for males and 56 +/- 19.2 years for females. The mean magnesium level on admission was 0.78 +/- 0.2 mmol/L and the majority of the patients were medical admissions. Approximately 39.4% had hypomagnesemia on admission and the overall mortality rate was 31%. In able to standardize the supplementation of magnesium among groups, the daily magnesium supplementation index (DMSI = total magnesium supplement in grams/length of stay in days) was calculated. The mortality rates for DMSI with <1 grm/day (low groups) was statistically significant higher than that of DMSI with >or=1 grm/day (high group) (43.5% versus 17%, p=0.035). There was no statistically significant differences between magnesium levels of both groups of DMSI except at admission where DMSI group had higher magnesium levels (<1 grm/day)., Conclusion: Daily magnesium supplementation index higher than 1 grm/day is associated with lower mortality rates for critically ill patients. This effect was not found to be independent and may be related to severity of illness. Given that magnesium levels were similar between the 2 groups of DMSI at almost all points of the study, magnesium supplementation per se may be beneficial in lowering mortality rates. The exact cause of this effect is unknown. An aggressive magnesium supplementation protocol may be warranted. A larger scale randomized study is necessary to evaluate this effect.

The clinical and pathologic findings are reported in a case of primary hyperaldosteronism due to a functional black (pigmented) adenoma of the adrenal cortex. Cortical atrophy of the involved gland was present, the mechanism of which was obscure.