The case for surgical skills centres in Sub Saharan Africa: The benefits and the challenges.

The purpose of this paper is to describe the educational and practice utilities of establishing Surgical Skills Centres. The paper also defines significant obstacles to the establishment of such centres in Sub- Saharan Africa. In 1996, the Royal College of Physicians and Surgeons Canada responded to the evolving roles and obligations of medical specialists by implementing a framework of core competencies called the “CanMEDS Roles” which define surgeons as medical experts, communicators, collaborators, managers, health advocates, scholars and professionals. A key competency expected of the medical expert is the demonstration of proficiency in procedural skills2

Early Career Experiences of Pediatricians Pursuing or Not Pursuing Fellowship Training

BACKGROUND AND OBJECTIVES: Choosing career paths can be difficult decisions for residents contemplating fellowship training. This study compares the experiences of early career pediatricians who did and did not pursue fellowships. METHODS: We analyzed national, weighted data from pediatricians 8 to 10 years after residency (n = 842). Work environment, work–life balance, and satisfaction were compared for pediatricians who had pursued fellowship training (fellowship trained) and those who did not pursue fellowship training (generalist trained). Logistic and linear regression examined the independent effects of fellowship training while controlling for demographic differences. RESULTS: A total of 39% of the pediatricians (328/842) pursued fellowship training. The fellowship-trained group was less likely than the generalist-trained group to spend time in direct patient care and more likely to report learning opportunities in their work environment. This group was also more likely to report an income of ≥$150 000, although no difference was found when only full-time pediatricians were examined. Generalist-trained pediatricians were more likely to work <50 hours per week, have flexibility with their schedules, and be satisfied with time spent with their own children. Pediatricians in both the fellowship-trained and generalist-trained groups generally found their work to be rewarding and were satisfied with their lives. CONCLUSIONS: Although residents need to consider important life and career differences when contemplating fellowship training and general care, pediatricians in both groups can achieve overall life and career satisfaction

EU Peatlands: Current Carbon Stocks and Trace Gas Fluxes

Peatlands in Europe has formed a significant sink for atmospheric CO2 since the last glacial maximum. Currently they are estimated to hold ca. 42 Gt carbon in the form of peat and are therefore a considerable component in the European carbon budget. Due to the generally wet soil conditions in peatlands they are also significant emitters of the strong greenhouse gas (GHG) methane (CH4) and in some cases also of nitrous oxide (N2O). The EU funded CarboEurope-GHG Concerted Action attempts to develop a reliable and complete greenhouse gas budget for Europe and this report aims to provide a review and synthesis of the available information about GHG exchanges in European peatlands and their underlying processes. A best estimate for all the European countries shows that some are currently sinks for atmospheric CO2 while others are sources. In contrast, for CH4 and N2O, only the sources are relevant. Whilst some countries are CO2 sinks, all countries are net GHG emitters from peatlands. The results presented, however, carry large uncertainties, which cannot be adequately quantified yet. One outstanding uncertainty is the distribution of land use types, particular in Russia, the largest European peat nation. The synthesis of GHG exchange, nevertheless, indicates some interesting features. Russia hosts an estimated 41% of European peatlands and contributes most to all GHG exchanges (CO2: 25%, CH4: 52%, N2O: 26%, Total: 37%). Germany is the second-largest emitter (12% of European total) although it contains only 3.2% of European peatlands. The reason is the use of most of the peatland area for intensive cropland and grassland. The largest CO2 emitters are countries with large agricultural peatland areas (Russia, Germany, Belarus, Poland), the largest N2O emitters are those with large agricultural fen areas (Russia, Germany, Finland). In contrast, the largest CH4 emitters are concentrated in regions with large areas of intact mires, namely Russia and Scandinavia. High average emission densities above 3.5 t C-equiv. ha-1 are found in the Southeast Mediterranean, Germany and the Netherlands where agricultural use of peatlands is intense. Low average emission densities below 0.3 t C-equiv. ha-1 occur where mires and peatland forests dominate, e.g. Finland and the UK. This report concludes by pointing at key gaps in our knowledge about peatland carbon stocks and GHG exchanges which include insufficient basic information on areal distribution of peatlands, measurements of peat depth and also a lack of flux datasets providing full annual budgets of GHG exchanges

Optical studies of Ge islanding on Si(111)

We report an experimental study of the optical properties of island layers resulting from molecular beam epitaxial deposition of Ge on Si(111) substrates. The combination of electroreflectance spectroscopy of the E1 transition and Raman scattering allows us to separately determine the strain and composition of the islands. For deposition at 500 °C a deposited layer of 1.36 nm of Ge assembles into 80 nm diameter islands 11 nm thick. The average Si impurity content in the islands is 2.5% while the average in-plane strain is 0.5%. Both strain and Si impurity content in islands decrease with increasing Ge depositio

Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study

OBJECTIVE: To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART). DESIGN: The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children. SETTING: UK and Ireland. POPULATION: A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants. METHODS: Descriptive analysis of NSHPC data. MAIN OUTCOME MEASURES: Rates of MTCT. RESULTS: In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml. CONCLUSIONS: No association was found between duration of ROM and MTCT in women taking cART. TWEETABLE ABSTRACT: Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term

Development of the dry tape battery concept

High energy anode and cathode for dry tape battery - incapsulation of electrolyte - manufacturing and testing of devic

Effects of ON and OFF subthalamic nucleus-DBS on prefrontal cortex activation during a cognitive task: an fNIRS study

Subthalamic nucleus (STN) deep brain stimulation (DBS) therapy is an effective treatment for the appendicular motor symptoms of Parkinson’s disease (PD). The STN contains multiple segregated circuits subserving motor, cognitive and mood functions through distinct connectivity to cortical regions. Therefore, we examined prefrontal cortical (PFC) effects of “ON” and “OFF” STN-DBS on executive function (Go/NoGo) using functional near-infrared spectroscopy (fNIRS). Methods Out of 8 PD STN-DBS patients, we present here preliminary analysis of a male (62y) PD patient with bilateral STN-DBS (unipolar, 180Hz, 3.5V). The patient was tested after 12h withdrawal of dopamine medications in both an “OFF” and “ON” DBS session separated by 30min. The subject performed a computerised GoNoGo task with 3 alternating Go/NoGo blocks of 30s duration (20 trials/block) interspersed with 30s rest. Reaction time (RT) and accuracy (omission-Om and commission-Cm errors) results were the average of the 3 Go/NoGo blocks. During performance of the Go/NoGo blocks, changes in oxygenated (O2Hb) and deoxygenated (HHb) haemoglobin concentrations were measured by a fNIRS system (Oxymon MkIII, Artinis Medical Systems) covering the bilateral PFC regions. Results/Discussion Clinical motor performance (UPDRSIII) improved from OFF (31) to ON (20). RT during Go and NoGo was ∼40ms faster in OFF (460 and 364ms) than ON (516 and 407ms). Furthermore, the NoGo condition increased misses (Om) in ON (7%) than OFF (0%); while false alarms (Cm) were similarly increased in ON (27%) and OFF (30%). The Go and NoGo conditions increased bilateral PFC activation (i.e., increase in O2Hb and decrease in HHb). However, there was a general decrease in PFC activation in OFF relative to ON, and this was more obvious in Go than NoGo (see Fig. 1) Conclusion These preliminary results indicate that STN-DBS modulates neurovascular responses in the bilateral PFC that are associated with response inhibition

Initial/boundary-value problems of tumor growth within a host tissue

This paper concerns multiphase models of tumor growth in interaction with a surrounding tissue, taking into account also the interplay with diffusible nutrients feeding the cells. Models specialize in nonlinear systems of possibly degenerate parabolic equations, which include phenomenological terms related to specific cell functions. The paper discusses general modeling guidelines for such terms, as well as for initial and boundary conditions, aiming at both biological consistency and mathematical robustness of the resulting problems. Particularly, it addresses some qualitative properties such as a priori nonnegativity, boundedness, and uniqueness of the solutions. Existence of the solutions is studied in the one-dimensional time-independent case.Comment: 30 pages, 5 figure

Characterising Cancer Cell Responses to Cyclic Hypoxia Using Mathematical Modelling

In vivo observations show that oxygen levels in tumours can fluctuate on fast and slow timescales. As a result, cancer cells can be periodically exposed to pathologically low oxygen levels; a phenomenon known as cyclic hypoxia. Yet, little is known about the response and adaptation of cancer cells to cyclic, rather than, constant hypoxia. Further, existing in vitro models of cyclic hypoxia fail to capture the complex and heterogeneous oxygen dynamics of tumours growing in vivo. Mathematical models can help to overcome current experimental limitations and, in so doing, offer new insights into the biology of tumour cyclic hypoxia by predicting cell responses to a wide range of cyclic dynamics. We develop an individual-based model to investigate how cell cycle progression and cell fate determination of cancer cells are altered following exposure to cyclic hypoxia. Our model can simulate standard in vitro experiments, such as clonogenic assays and cell cycle experiments, allowing for efficient screening of cell responses under a wide range of cyclic hypoxia conditions. Simulation results show that the same cell line can exhibit markedly different responses to cyclic hypoxia depending on the dynamics of the oxygen fluctuations. We also use our model to investigate the impact of changes to cell cycle checkpoint activation and damage repair on cell responses to cyclic hypoxia. Our simulations suggest that cyclic hypoxia can promote heterogeneity in cellular damage repair activity within vascular tumours