Anaesthesia training for interns at a metropolitan training complex: does it make the grade?

Background: Most anaesthesia-related mortality that occurs in level 1 hospitals in South Africa is avoidable. Improving training during internship, and consequently the skills of community service officers, could lead to safer anaesthesia practices.Objectives: The objectives of the study were to determine whether or not the timing of the anaesthesia rotation during internship and other factors affected the outcome of the assessment at the end of the anaesthesia rotation, and to compare the perceptions of first- and second-year interns regarding their confidence levels at the end of their rotation.Method: We conducted a retrospective study that compared 298 intern assessments over a three-year period. It included the assessment of interns by senior doctors in respect of three cases, an overall assessment of the interns’ performance, and the number of cases carried out by them. In addition, a questionnaire was used to assess the interns’ confidence levels at the end of the rotation.Results: Little variation in the results was evident across comparisons of the year of internship, gender and age. Comparison according to university showed a slight variation. A wide variation in the number of obstetric cases (range 5–58) and endotracheal intubations (range 6–54) was observed. Over 80% of interns, regardless of the year, were confident enough to administer general anaesthesia and perform an endotracheal intubation. However, this perception of confidence by interns did not relate to the assessment of their competence.Conclusion: The variance in the ability of interns to perform anaesthesia could not be accounted for by the training year, institution of undergraduate study, age or gender. It is likely that the assessment technique used did not provide a true reflection of the acquired skills or longevity of knowledge by interns. Further research in this area is recommended.Keywords: anaesthesia, interns, training, standard

Development and validation of the isiZulu quality of recovery score

Background: Recovery from anaesthesia and surgery is an important marker of the quality of perioperative care. One extensively validated score in assessing this is the Quality of Recovery–15 items (QoR-15) score. This study aimed to translate the QoR-15 score into isiZulu and validate both the original and translated version on an isiZulu speaking population.Methodology: A randomised quantitative observational study was performed testing the original and the translated version of the QoR-15 score. In a crossover format, patients were asked to complete both questionnaires with 40 minutes allowed between each questionnaire. A 100 mm visual analogue score (VAS) was completed by each participant as a comparative tool for overall quality of recovery.Results: There was good correlation between the English and isiZulu score 0.91 (p < 0.001) and substantial agreement between the scores (mean weighted kappa: 0.69). There was a negative correlation between duration of surgery and total QoR-15 scores for both the English (–0.3; p < 0.001) and isiZulu (–0.29; p < 0.001) questionnaires, and a positive correlation between VAS scores and total QoR-15 scores for both the English (0.38; p < 0.001) and isiZulu (0.38; p < 0.001) questionnaires.Conclusion: This study demonstrates that the QoR-15 score is suitable to use in an isiZulu speaking patient population. The translated isiZulu version is comparable to the English QoR-15 score and should be used to assess the QoR to improve patient care.Keywords: isiZulu, QoR-15, quality of recovery, recovery, Zul

National priorities for perioperative research in South Africa

Background. Perioperative research is currently unco-ordinated in South Africa (SA), with no clear research agenda.Objective. To determine the top ten national research priorities for perioperative research in SA.Methods. A Delphi technique was used to establish consensus on the top ten research priorities.Results. The top ten research priorities were as follows: (i) establishment of a national database of (a) critical care outcomes, and (b) critical care resources; (ii) a randomised controlled trial of preoperative B-type natriuretic peptide-guided medical therapy to decrease major adverse cardiac events following non-cardiac surgery; (iii) a national prospective observational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a steppedwedge trial of an enhanced recovery after surgery programme for (a) surgery, (b) obstetrics, (c) emergency surgery, and (d) trauma surgery; (vi) a stepped-wedge trial of a surgical safety checklist on patient outcomes in SA; (vii) a prospective observational study of perioperative outcomes after surgery in district general hospitals in SA; (viii) short-course interventions to improve anaesthetic skills in rural doctors; (ix) studies of the efficacy of simulation training to improve (a) patient outcomes, (b) team dynamics, and (c) leadership; and (x) development and validation of a risk stratification tool for SA surgery based on the South African Surgical Outcomes Study (SASOS) data.Conclusions. These research priorities provide the structure for an intermediate term research agenda

Limnogeological studies of maar lake Ranu Klindungan, East Java, Indonesia

Ranu Klindungan is a lake at the northern lowlands of East Java close to the northern slope of the Tengger Caldera. Outcrops of phreatomagmatic base surge deposits at the inner southern crater slope indicate that the lake is situated in a maar crater. The lake has a surface of 2.1 km2 and a maximum depth of 126 m. Details to the morphometry are given. Groundwater inflow must be high. The lake is oligomictic and eutrophicated with a shallow epilimnion and a large anoxic hypolimnion. Mn, Fe, and TP have distinct peaks at the upper hypolimnion, probably caused by the groundwater inflow. Profundal sediments of Ranu Klindungan consist of carbonaceous diatom-gyttja and frequent turbidites. Often the fine layered sediments reveal a distinct cyclicity of layers of diatoms, carbonate and finally terrigenous material. Probably the diatom and carbonate layers represent the dry season (June-October), whereas the terrigenous layer is deposited by distal turbidites during the rain season (November-May). We interpret these cycles as varves. Despite tropical weathering, silt-sized minerals in terrigenous layers are mainly fresh feldspars, which points to rapid transport and embedding of these components. Thicker intraclast-turbidites may be associated with strong precipitation events during the rain season. The diatom record confirms this hypothesis: diatom layers are rich in complete valves of planktonic forms, whereas in the terrigenous layers few, mostly broken, valves of littoral species occur. The high proportion of turbidites contributes to the near-horizontal profundal lake bottom

Genetics, recombination and clinical features of human rhinovirus species C (HRV-C) infections; interactions of HRV-C with other respiratory viruses

To estimate the frequency, molecular epidemiological and clinical associations of infection with the newly described species C variants of human rhinoviruses (HRV), 3243 diagnostic respiratory samples referred for diagnostic testing in Edinburgh were screened using a VP4-encoding region-based selective polymerase chain reaction (PCR) for HRV-C along with parallel PCR testing for 13 other respiratory viruses. HRV-C was the third most frequently detected behind respiratory syncytial virus (RSV) and adenovirus, with 141 infection episodes detected among 1885 subjects over 13 months (7.5%). Infections predominantly targeted the very young (median age 6–12 months; 80% of infections in those <2 years), occurred throughout the year but with peak incidence in early winter months. HRV-C was detected significantly more frequently among subjects with lower (LRT) and upper respiratory tract (URT) disease than controls without respiratory symptoms; HRV-C mono-infections were the second most frequently detected virus (behind RSV) in both disease presentations (6.9% and 7.8% of all cases respectively). HRV variants were classified by VP4/VP2 sequencing into 39 genotypically defined types, increasing the current total worldwide to 60. Through sequence comparisons of the 5′untranslated region (5′UTR), the majority grouped with species A (n = 96; 68%, described as HRV-Ca), the remainder forming a phylogenetically distinct 5′UTR group (HRV-Cc). Multiple and bidirectional recombination events between HRV-Ca and HRV-Cc variants and with HRV species A represents the most parsimonious explanation for their interspersed phylogeny relationships in the VP4/VP2-encoding region. No difference in age distribution, seasonality or disease associations was identified between HRV-Ca and HRV-Cc variants. HRV-C-infected subjects showed markedly reduced detection frequencies of RSV and other respiratory viruses, providing evidence for a major interfering effect of HRV-C on susceptibility to other respiratory virus infections. HRV-C's disease associations, its prevalence and evidence for interfering effects on other respiratory viruses mandates incorporation of rhinoviruses into future diagnostic virology screening

THE GENUS HYPOGLOSSUM KÜTZING (DELESSERIACEAE, RHODOPHYTA) IN THE TROPICAL WESTERN ATLANTIC, INCLUDING H. ANOMALUM SP. NOV. 1

Observations are made on the occurrence and distribution of the red algal genus Hypoglossum KÜtzing (Delesseriaceae, Ceramiales) in the tropical western Atlantic. In addition to the type of the genus, H. hypoglossoides (Stackh.) Coll. & Herv., three other species are reported: H. anomalum sp. nov., H. involvens (Harv.) J. Ag., and H. tenuifolium (Harv.) J. Ag. A key is presented to distinguish these four species. The newly described species, H. anomalum, is like other species in the genus in that its branches arise endogenously from the primary axial row but it is unique in that the branches emerge from the parent blade at some point between the midline and the margin of the blade. The new species is reported from Puerto Rico and Florida.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65648/1/j.1529-8817.1986.tb04162.x.pd

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

From Expert Discipline to Common Practice: A Vision and Research Agenda for Extending the Reach of Enterprise Modeling

The benefits of enterprise modeling (EM) and its contribution to organizational tasks are largely undisputed in business and information systems engineering. EM as a discipline has been around for several decades but is typically performed by a limited number of people in organizations with an affinity to modeling. What is captured in models is only a fragment of what ought to be captured. Thus, this research note argues that EM is far from its maximum potential. Many people develop some kind of model in their local practice without thinking about it consciously. Exploiting the potential of this “grass roots modeling” could lead to groundbreaking innovations. The aim is to investigate integration of the established practices of modeling with local practices of creating and using model-like artifacts of relevance for the overall organization. The paper develops a vision for extending the reach of EM, identifies research areas contributing to the vision and proposes elements of a future research Agenda