Training and experience of doctors administering obstetric anaesthesia in the Free State Level 1 and 2 Hospitals

Background All the published Saving Mothers Reports generated by the National Committee of the Confidential Enquiries into MaternalDeaths in South Africa have associated anaesthesia-related maternal deaths with the lack of skills of the doctors administering the anaesthesia. The Reports have shown the Free State to be one of the provinces in South Africa with the highest rate of obstetric anaesthesia deaths. Therefore, the current study was performed to determine whether a deficiency exists in the training and experience of doctors administering obstetric anaesthesia. The identifying of such a deficiency would call for the implementation of remedial measures.Methods The study was performed in 2005 using questionnaires designed by the first two authors of this paper. All Level 1 and 2hospitals in the Free State performing Caesarean sections (CSs) were visited. The doctors administering obstetric anaesthesia were each asked to respond to a questionnaire. The questionnaires enquired about previous training and experience in anaesthesia and, more specifically, obstetric anaesthesia, as well as anaesthesia and nonanaesthesia qualifications. In addition, questions were asked regarding supervision, and whether other duties were performed while administering anaesthesia. Results The response rate was 69% (105/148 doctors). Of the respondents, 9.5% were interns, 24.7% community service doctors, 47.6% medical officers, 15.2% general practitioners (GPs) and 2.9% specialists. Twenty-three per cent of respondents had been in their present post for five years or more. Most doctors had received 4 weeks or less training in anaesthesia as an Intern, not including obstetric anaesthesia in 13 cases. Six doctors (GPs or medical officers) had been appointed in posts in which obstetric anaesthesia was required, without previously having administered obstetric anaesthesia. At the time of the survey, two doctors had never performed spinal anaesthesia and five had never administered general anaesthesia for CS, although all were regularly administering obstetric anaesthesia. Apart from the specialists, the Diploma in Anaesthesia was held by only one doctor, a medical officer. Half of the interns were not directly supervised while administering obstetric anaesthesia, while more than half the community service doctors were employed in hospitals where no senior support wasavailable. The doctors frequently had both to administer the anaesthetic and to perform neonatal resuscitation. Twelve ofthe doctors concerned had often also to perform the surgery itself. Most of the doctors requested further training in obstetricanaesthesia and improved senior anaesthetic assistance.Conclusions There is a lack of experience, training and supervision amongst doctors administering obstetric anaesthesia in the Free State.Doctors regularly have to perform other duties, whilst administering obstetric anaesthesia, which may put the mother atrisk from inadequate observation. These may be contributory factors to the high rate of maternal deaths from anaesthesia

A preliminary systematic review of computer science literature on cloud computing research using open source simulation platforms.

Research and experimentation on live hyperscale clouds is limited by their scale, complexity, value and and issues of commercial sensitivity. As a result, there has been an increase in the development, adaptation and extension of cloud simulation platforms for cloud computing to enable enterprises, application developers and researchers to undertake both testing and experimentation. While there have been numerous surveys of cloud simulation platforms and their features, few surveys examine how these cloud simulation platforms are being used for research purposes. This paper provides a preliminary systematic review of literature on this topic covering 256 papers from 2009 to 2016. The paper aims to provide insights into the current status of cloud computing research using open source cloud simulation platforms. Our two-level analysis scheme includes a descriptive and synthetic analysis against a highly cited taxonomy of cloud computing. The analysis uncovers some imbalances in research and the need for a more granular and refined taxonomy against which to classify cloud computing research using simulators. The paper can be used to guide literature reviews in the area and identifies potential research opportunities for cloud computing and simulation researchers, complementing extant surveys on cloud simulation platforms

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Genetic analyses of diverse populations improves discovery for complex traits

Genome-wide association studies (GWAS) have laid the foundation for investigations into the biology of complex traits, drug development and clinical guidelines. However, the majority of discovery efforts are based on data from populations of European ancestry1–3. In light of the differential genetic architecture that is known to exist between populations, bias in representation can exacerbate existing disease and healthcare disparities. Critical variants may be missed if they have a low frequency or are completely absent in European populations, especially as the field shifts its attention towards rare variants, which are more likely to be population-specific4–10. Additionally, effect sizes and their derived risk prediction scores derived in one population may not accurately extrapolate to other populations11,12. Here we demonstrate the value of diverse, multi-ethnic participants in large-scale genomic studies. The Population Architecture using Genomics and Epidemiology (PAGE) study conducted a GWAS of 26 clinical and behavioural phenotypes in 49,839 non-European individuals. Using strategies tailored for analysis of multi-ethnic and admixed populations, we describe a framework for analysing diverse populations, identify 27 novel loci and 38 secondary signals at known loci, as well as replicate 1,444 GWAS catalogue associations across these traits. Our data show evidence of effect-size heterogeneity across ancestries for published GWAS associations, substantial benefits for fine-mapping using diverse cohorts and insights into clinical implications. In the United States—where minority populations have a disproportionately higher burden of chronic conditions13—the lack of representation of diverse populations in genetic research will result in inequitable access to precision medicine for those with the highest burden of disease. We strongly advocate for continued, large genome-wide efforts in diverse populations to maximize genetic discovery and reduce health disparities. © 2019, The Author(s), under exclusive licence to Springer Nature Limited

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy