Anaesthesia in Ethiopia: providers' perspectives on the current state of the service

The improvement of surgical and anaesthetic safety in low-resource settings is hampered by a lack of reliable information on the current provision of these services. Ethiopia is one of the world's poorest countries and, despite large amounts of both foreign and domestic investment, still reports some of the worst health outcomes. However, information on anaesthesia and surgical provision is sparse. This work reproduces a questionnaire study, first used in Uganda in 2006, to survey practising anaesthetists regarding the current state of anaesthesia services across Ethiopia. The results indicate that a large proportion of centres remain unable to provide safe general, spinal, paediatric and obstetric anaesthesia, at all levels of hospital and across almost all of the country's regions. In addition to a lack of equipment and pharmaceuticals, anaesthetists report problems with professional recognition and a lack of access to continuing professional development as key barriers to service development

What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health.

'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings

Uniform Color Space-Based High Dynamic Range Video Compression

© 1991-2012 IEEE. Recently, there has been a significant progress in the research and development of the high dynamic range (HDR) video technology and the state-of-the-art video pipelines are able to offer a higher bit depth support to capture, store, encode, and display HDR video content. In this paper, we introduce a novel HDR video compression algorithm, which uses a perceptually uniform color opponent space, a novel perceptual transfer function to encode the dynamic range of the scene, and a novel error minimization scheme for accurate chroma reproduction. The proposed algorithm was objectively and subjectively evaluated against four state-of-the-art algorithms. The objective evaluation was conducted across a set of 39 HDR video sequences, using the latest x265 10-bit video codec along with several perceptual and structural quality assessment metrics at 11 different quality levels. Furthermore, a rating-based subjective evaluation ( $n=40$ ) was conducted with six sequences at two different output bitrates. Results suggest that the proposed algorithm exhibits the lowest coding error amongst the five algorithms evaluated. Additionally, the rate-distortion characteristics suggest that the proposed algorithm outperforms the existing state-of-the-art at bitrates ≥ 0.4 bits/pixel

Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low-income and middle-income countries.

The Global Burden of Diseases, Injuries, and Risk Factors Study showed that in 2010 trauma accounted for 9% of the world's deaths - around 5 million people - while also resulting in millions of non-fatal injuries with resultant disability. Around 90% of injury-related deaths occurred in low and middle income countries (LMICs) which also saw the greatest rise in these injuries due to road traffic collisions.1 More recent Global Health Estimates from the World Health Organisation for 2015 show a similar picture.2 As a disease subtype, Traumatic Brain Injury (TBI) is one of the most devastating, with clinical, societal, and economic sequelae.3 It is also startlingly common with an estimated 50 million or more cases per year; enough for half of the world's population to suffer a TBI in their lifetime and again disproportionately affecting lower-income regions.

The global variation of medical student engagement in teaching: Implications for medical electives.

INTRODUCTION: International medical electives, whereby undergraduates visit an institution in a country other than their own, are a common part of medical training. Visiting students are often asked to provide local teaching, which may be acceptable where the visitor is acting within the bounds of their own competency and the normal practices of both their home and host institutions. However, the extent to which teaching is an accepted student activity globally has not previously been described. This study aims to address this using an international survey approach. METHODS: A voluntary electronic survey, created using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) framework, was distributed across established international medical student networks. This assessed the involvement of medical students in teaching and the educator training they receive, with the intention of comparing experiences between high-income countries (HICs) and low/middle-income countries (LMICs) to gauge the engagement of both "host" and "visiting" students. RESULTS: 443 students from 61 countries completed the survey, with an equal proportion of respondents from LMICs (49.4%, 219/443) and HICs (50.6%, 224/443). Around two thirds of students reported providing teaching whilst at medical school, with most reporting teaching numerous times a year, mainly to more junior medical students. There was with no significant difference between LMICs and HICs. Around 30 per cent of all medical students reported having received no teacher training, including 40 per cent of those already providing teaching. CONCLUSION: This study suggests that students are engaged in teaching globally, with no difference between HIC and LMIC contexts. However, students are underprepared to act as educators in both settings. Providing teaching as part of an elective experience may be ethically acceptable to both host and home institutions, but needs to be supported by formal training in delivering teaching.NIHR Global Health Research Group on Neurotraum

The digital resurrection of Margaret Thatcher: Creative, technological and legal dilemmas in the use of deepfakes in screen drama

This article develops from the findings of an interdisciplinary research project that has linked film practice research with computer science and law, in an exercise that seeks to digitally resurrect Margaret Thatcher to play herself in a contemporary film drama. The article highlights the imminent spread of machine learning techniques for digital face replacement across fiction content production, with central research questions concerning the ethical and legal issues that arise from the appropriation of the facial image of a deceased person for use in drama

AI classification of respiratory illness through vocal biomarkers and a bespoke articulatory speech protocol

Speech biomarkers represent a powerful indicator for detecting, monitoring and categorising neurological, psychological , pathological and pulmonary conditions. Facilitated by advances in computational power and artificial intelligence (AI) techniques, we present a novel ecosystem for data acquisition , analysis and storage, using an articulatory speech task. By automatically segmenting, aligning and extracting features from the vocal recordings, we present a feature extraction pipeline toward the classification of pathological conditions, specifically respiratory disease through recorded voice. Data is stored within a Trusted Research Environment, for which this work also presents a range of ethical considerations

Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study.

INTRODUCTION: Chronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest. OBJECTIVES: We used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay. DESIGN, SETTING AND PARTICIPANTS: Single-centre, retrospective cohort of 530 cases of cSDH (2014-2019) surgically evacuated under general anaesthesia at a neurosciences centre in Cambridge, UK. METHODS AND OUTCOME DEFINITION: Complications were defined using a modified Electronic Postoperative Morbidity Score. Association between complications and intraoperative care (time with mean arterial pressure <80 mm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3-5 kPa, maintenance anaesthetic, operative time and opioid dose) on postoperative stay was assessed using Cox regression. RESULTS: 53 (10%) patients suffered myocardial injury, while 24 (4.5%) suffered acute renal injury. On postoperative day 3 (D3), 280 (58% of remaining) inpatients suffered at least 1 complication. D7 rate was comparable (57%). Operative time was the only intraoperative event associated with postoperative stay (HR for discharge: 0.97 (95% CI: 0.95 to 0.99)). On multivariable analysis, postoperative complications (0.61 (0.55 to 0.68)), anticoagulation (0.45 (0.37 to 0.54)) and cognitive impairment (0.71 (0.58 to 0.87)) were associated with time to discharge. CONCLUSIONS: There is a high postoperative morbidity burden in this cohort, which was associated with postoperative stay. We found no evidence of an association between intraoperative events and postoperative stay.Wellcome Trust Studentshi

Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle-income countries: a qualitative study protocol

Low-income and middle-income countries (LMICs) face the greatest burden of neurotrauma. However, most of the research published in scientific journals originates from high-income countries, suggesting those in LMICs are either not engaging in research or are not publishing it. Evidence originating in high-income countries may not be generalisable to LMICs; therefore, it is important to nurture research capacity in LMICs so that a relevant evidence base can be developed. However, little is published about specific challenges or contextual issues relevant to increasing research activity of neurosurgeons in LMICs. Therefore, the aim of this study was to understand neurosurgeons’ experiences of, aspirations for and ability to conduct and disseminate clinical research in LMICs.Methods and analysisThis is a pragmatic qualitative study situated within the naturalistic paradigm using focus groups and interviews with a purposive sample of neurosurgeons from LMICs. First, we will conduct asynchronous online focus groups with 36 neurosurgeons to broadly explore issues relevant to the study aim. Second, we will select 20 participants for follow-up semistructured interviews to explore concepts in more depth and detail than could be achieved in the focus group. Interviews will be audio-recorded and transcribed verbatim. A thematic analysis will be conducted following Braun and Clarke’s six stages and will be supported by NVIVO software.Ethics and disseminationThe University of Cambridge Psychology Research Ethics Committee reviewed this study and provided a favourable opinion in January 2020 (REF PRE.2020.006). Participants will provide informed consent, be able to withdraw at any time and will have their contributions kept confidential. The findings of the study will be shared with relevant stakeholders and disseminated in conference presentations and journal publications.</jats:sec

Curved-crease origami face shields for infection control

The COVID-19 pandemic has created enormous global demand for personal protective equipment (PPE). Face shields are an important component of PPE for front-line workers in the context of the COVID-19 pandemic, providing protection of the face from splashes and sprays of virus-containing fluids. Existing face shield designs and manufacturing procedures may not allow for production and distribution of face shields in sufficient volume to meet global demand, particularly in Low and Middle-Income countries. This paper presents a simple, fast, and cost-effective curved-crease origami technique for transforming flat sheets of flexible plastic material into face shields for infection control. It is further shown that the design could be produced using a variety of manufacturing methods, ranging from manual techniques to high-volume die-cutting and creasing. This demonstrates the potential for the design to be applied in a variety of contexts depending on available materials, manufacturing capabilities and labour. An easily implemented and flexible physical-digital parametric design methodology for rapidly exploring and refining variations on the design is presented, potentially allowing others to adapt the design to accommodate a wide range of ergonomic and protection requirements