The Basic Surgical Skills course in sub-Saharan Africa: an observational study of effectiveness

Background: The Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa. Methods: An observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery. Results: A cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p < 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees. Conclusion: The Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills

Non-isotopic Heegaard splittings of Seifert fibered spaces

We find a geometric invariant of isotopy classes of strongly irreducible Heegaard splittings of toroidal 3-manifolds. Combining this invariant with a theorem of R Weidmann, proved here in the appendix, we show that a closed, totally orientable Seifert fibered space M has infinitely many isotopy classes of Heegaard splittings of the same genus if and only if M has an irreducible, horizontal Heegaard splitting, has a base orbifold of positive genus, and is not a circle bundle. This characterizes precisely which Seifert fibered spaces satisfy the converse of Waldhausen's conjecture.Comment: This is the version published by Algebraic & Geometric Topology on 12 March 200

Sweepouts of amalgamated 3-manifolds

We show that if two 3-manifolds with toroidal boundary are glued via a `sufficiently complicated' map then every Heegaard splitting of the resulting 3-manifold is weakly reducible. Additionally, if Z is a manifold obtained by gluing X and Y, two connected small manifolds with incompressible boundary, along a closed surface F. Then the genus g(Z) of Z is greater than or equal to 1/2(g(X)+g(Y)-2g(F)). Both results follow from a new technique to simplify the intersection between an incompressible surface and a strongly irreducible Heegaard splitting.Comment: This is the version published by Algebraic & Geometric Topology on 24 February 200

Activities of organic farmers succeeding in reducing lameness in dairy cows

Sixty-seven organic producers were among 189 dairy farmers completing the “Healthy Feet Project” in the UK. This aimed to reduce lameness in dairy herds by implementing existing knowledge. Participants received input at two levels: monitoring alone, or monitoring with extra support through a single veterinary advisory visit, annual visits from a trained non-veterinary facilitator and materials and contacts to encourage change. On average lameness on organic farms reduced by 12 percentage points over the three year period. On the farms achieving the greatest reduction,the most common changes were improvements to tracks and cubicle comfort, and more frequent footbathing or foot trimming. Practices to improve foot cleanliness, such as more frequent removal of slurry, were less often adopted. Further progress might be achieved by improvements of foot hygiene. Several farms with low lameness that reduced prevalence further improved their handling facilities and treated cows more promptly

Non-Toxic Particulate Masks: A Quantitative Evaluation of Their Effectiveness During Paint Spraying Operations

It is commonly known that disposable dust masks offer a worker no protection from solvent vapors. However, they are frequently utilized during paint spraying operations. In one instance a workman wearing a disposable mask died from xylene poisoning while spray painting a boat outdoors. This study examined the possibility that the constant wetting of a dust mask during paint spraying may create an elevated solvent concentration in the breathing zone of a worker. Tests were conducted in a controlled laboratory system that determined simultaneous xylene concentrations in a mask and in the surrounding ambient air immediately following a paint spray of varying duration. Results consistently indicated a remarkably higher concentration inside the mask for the initial two minutes following the spray of paint. The theoretical dose was as much as 86% greater inside the mask as compared to outside the mask during those two minutes.Master of Science in Public Healt