The assessment of non-technical skills in ENT surgery: a multidisciplinary simulation programme to improve patient safety

Surgical patients are at particular risk of harm, with 41% of all adverse events in hospital occurring in the operating theatre. Failures in Human factors are the leading cause. Despite recognition of the importance of human factors training to patient safety, there is a lack of theatre ENT crisis management simulation, and no formal assessment of the requisite skills. Aims: To Develop a psychometrically robust assessment tool for assessing Non-technical skills in the ENT theatre – to be termed ENT-NOTECHS. To Develop and validate an ENT themed multidisciplinary simulation programme for the assessment and feedback of non-technical skills. Methods: A multimodal method approach was used to create a novel behavioural marker tool to capture non-technical skills in the ENT theatre environment. Alongside this, a prospective, observational study involving a multidisciplinary team training day in ENT and airway themed crisis’ in a high fidelity simulated theatre environment was designed. Teams undertook 6 high fidelity simulation scenarios and non-technical skills were assessed using the ENT-NOTECHS tool. The ENT-NOTECHS tool was assessed for its psychometric robustness; reliability and construct validity. Candidate feedback was obtained to determine overall effectiveness of training. Results: We successfully designed and delivered a novel multidisciplinary team ENT themed training day. Over 15 months, 74 trainees (surgeons, anaesthetists and nurses) participated in 6 MDT simulation days, totalling 54 hours of simulation training and 210 assessments. Excellent Face and content validity was demonstrated. 100% of participants reported improved confidence in managing ENT crisis scenarios and demonstrated an improvement in non-technical skills (ENT-NOTECHS). The ENT-NOTECHS tool demonstrated excellent psychometric robustness. Good inter-rater reliability scores (cronbachs >0.7) were shown and the tool discriminated between novice and expert trainees (p<0.001). Conclusion: Multidisciplinary team training in ENT-themed crisis is feasible and well received training intervention. The simulated operating theatre serves as an excellent environment for the assessment and training of non-technical skills. ENT -NOTECHS is a novel assessment tool with evidence for reliability, content and construct validity in ENT teams.Open Acces

\u3ci\u3eKabul Times\u3c/i\u3e, April 1964

Kabul Times, April 1964 *This is a large file and may take a couple of minutes to download

Root Causes of Low Vaccination Coverage and Under-Immunisation in Sub-Saharan Africa

Academy of Science of South Africa (ASSAf), (2021). Root Causes of Low Vaccination Coverage and Under-Immunisation in Sub-Saharan Africa.Sub–Saharan Africa (SSA) alone accounts for 40% of all global deaths, a phenomenon attributed to lack of access to available lifesaving vaccines (Wiysonge, Uthman, Ndumbe, & Hussey, 2012). WHO estimates that in 2019 the African region accounted for approximately 43% of unimmunised and incomplete immunised infants in the world (i.e.: 8.5 million of the global 19.4 million). Relatedly, the region scores the lowest immunisation coverage, at 76% versus the global coverage of 86% (WHO, 2020a). This is despite several documented efforts by different stakeholders to improve coverage in the region (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017). Many studies have been conducted on coverage and drivers for and bottlenecks against immunisation in SSA. (Wiysonge, Uthman, Ndumbe, & Hussey, 2012), (Wiysonge, Young, Kredo, McCaul, & Volmik, 2015), (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017), (Madhi & Rees, 2018),(Bangura, et al., 2020), all of which have observed that there is varied performance among the constituent countries, and also within countries over time, denoting some implicitly common underlying correlates threading through areas of higher performance; and the same is seen with the poorer performing areas. This consensus study therefore seeks to categorise and make explicit these “root causes” and based on documented successes, to make recommendations to address the bottlenecks and harness the opportunities for reaching every child with all the recommended vaccines. The theory of change presentation style used in this report, categorising the root causes under four broad interlinked themes, can provide a common basis to rally like-minded partners around a thematic cause and thus develop multi-component, comprehensive strategies to bring about impactful change. This is in line with the call made by the World Health Organisation Strategic Advisory Group of Experts on Immunisation, which recommended that countries, regions and global immunisation partners commit to a comprehensive review of progress, impact, and implementation of the WHO Global Vaccine Action Plan to inform a post-2020 strategy taking into account lessons learned. This strategy will assist with attaining the relevant United Nations Sustainable Development Goals by 2030.Department of Science and Innovation (DSI) South African Medical Research Council (SAMRC

Pragmatic approach to Arab gulf states development cooperation: the conceptual and practical basis

In designing a viable approach to development cooperation, on two planes, horizontal (geo-economic circles) and vertical (function and form of cooperation) analysis was conducted of AGS' development structural needs for development. Forms of cooperation found both in development literature and in practice were surveyed. Analysis of the opportunities and constraints associated with the structural characteristics of the AGS' Sub-region, indicated that, whilst current development is concentrated on material production i.e. 'quantitative' aspects, the need for structural change demands priority for 'qualitative' development. Quantitative development is concerned with the structural and infra- structural base, in broad terms, including fields such as human-resources development, training, research, science and technological base, development administration, the industry of finance, environment preservation, and the socio-cultural values necessary for 'mobilized development' rather than 'passive pseudo-development'. The present situation can be more accurately described as 'development diversion' rather than 'development creation'. Development determinants of the AGS produce strong motivations to, even the necessity for cooperation. Such cooperation, between relevant geo-economic zones - the 'horizontal' element - is found to be viable if based on a Trilateral approach involving three circles: the Sub-region stimulates the AGS to pooling their financial surpluses within an investment strategy, which is based upon the qualitative needs within the Sub-region, wider opportunities for AGS investment on productive activities and which will also benefit the recipients of investment motivate cooperation within the Regional and International circles. To achieve the structural change necessary for self-sustaining development, a viable, functional 'vertical' approach is necessary, identified as: piece-meal, partial, development-oriented and based upon programmed cooperation within an integratory realm. This approach, within the Trilateral framework, would create new development forces, counteracting the limitations of absorptive capacity and other constraints inhibiting AGS economic diversification. It would establish the platform on which to build self- sustaining economic development onward into the post-oil era. OAPEC projects and the AAAID programme on food security within the Region are especially significant operational examples of the applicability of our approach, since the food security issue is identified as a strong motivation for trilateral cooperation. The operational side of the proposed approach is determined by an investment strategy which is based upon the principles of equitable distribution of costs and benefits, reciprocity, additionality, and, through cooperation the harmonious relationships within all three circles which are necessary for but also created by successful development cooperation

Herbicides

Weeds severely affect crop quality and yield. Therefore, successful farming relies on their control by coordinated management approaches. Among these, chemical herbicides are of key importance. Their development and commercialization began in the 1940's and they allowed for a qualitative increase in crop yield and quality when it was most needed. This book blends review chapters with scientific studies, creating an overview of some the current trends in the field of herbicides. Included are environmental studies on their toxicity and impact on natural populations, methods to reduce herbicide inputs and therefore overall non-target toxicity, and the use of bioherbicides as natural alternatives

The Chinese Communist bases (Ken-Chü-Ti) in North China, 1938-1943 : A study of their growth and anti-Japanese activities, with special reference to administration and mass mobilization programmes at the village level.

During the Sino-Japanese War (1937-1945), the Chinese Communist Party (CCP) established behind the Japanese lines four bases in north China which eventually became the main source of strength for the Communist victory over the KMT in 1949. In these bases the party played the leading role in uniting all anti-Japanese forces, and bringing the army under control, while good coordination was also maintained between the party headquarters in Yenan and the sub-bureaux behind the Japanese lines. The thesis shows that up to 1940 was a period of expansion, when the Communists succeeded in extending their control into the village, putting tenants and poor peasants in key positions to counteract the influence of the landlords. Mass mobilization programmes were also successful. In 1941-1942, the bases suffered a recession, however, as a result of tremendous Japanese military and economic pressure. In face of this threat, the CCP adopted a policy of retrenchment. With the launching of the Rectification Campaign in February 1942, the Communist position in the bases was strengthened, and reform programmes made the party better equipped to reassert its leadership. Mass mobilization was emphasized and the village became the base for the launching of important campaigns like those for the reduction of rent and interest, which succeeded by 1943 in arousing peasant political consciousness and effecting tremendous expansion in the organization of the people's armed forces of various descriptions, and the production teams. Japanese setbacks in the Pacific contributed further to Communist expansion, and by 1945, the CCP had become the dominant power in rural north China

Współpraca regionalna państw Grupy Wyszehradzkiej : doświadczenia i perspektywy

The book is an attempt at summarizing the 25 years of existence of the Visegrad Group asa regional formation, founded in 1991 under the name of the Visegrad Triangle, and only later, due to the break-up of Czechoslovakia, renamed to the Visegrad Group, from then on including four cooperating countries – the Czech Republic, Poland, Slovakia and Hungary. The work consists of five chapters that sketch the three dimensions of cooperation within the group: political, sectorial and civic. In the first chapter the author familiarizes the reader with the concepts of the region, regionalism, regional cooperation, the idea of the Central Europe, and then consequently presents the Visegrad Group against the backdrop of other regional formations that sprouted in the Central-Eastern Europe in the beginning of the 90s of the 20th century, as part of the wider trend of the period called the New Regionalism. The second chapter, dedicated to the creation and functioning of the Visegrad Group, discusses the genesis of the Group, the aims of cooperation in both the preaccession and postaccession period, the stages and mechanisms of cooperation, the attitudes of particular countries to the very idea of the visegrad cooperation and the motivations for creating this structure. The third chapter outlines the subject of the visegrad cooperation in reference to its four most important areas: political and economic coooperation within the group itself, cooperation within the European Union, cooperation in terms of the NATO membership, and cooperation with other partners, particularly with regards to the Visegrad plus formula. The fourth chapter tackles the activity of the only institutional structure the member countries of the Visegrad Group have formed, namely the International Visegrad Fund. The author analyses all of the forms of financial support such as grants, scholarships or artist-in-residence programs granted by the Fund as part of numerous programs within its offer. In the fifth chapter the author assesses the successes and failures of the Visegrad Group over the course of the twenty five years of its existence, points to the factors that have influenced, and will continue so, the development of the visegrad cooperation in both positive and negative ways, as well as attempts to sketch the future prospects of the Group