A rare variant branch from the lateral cord and a communicating branch between the musculocutaneous and median nerve

During routine educational gross anatomy dissections of the upper extremities, one right upper limb was observed to have an unusual branch from the  lateral cord that pierced coracobrachialis towards its origin. This variant branch emerged from the lateral cord before it branched to give its contribution  to the median nerve and musculocutaneous nerve in the axilla. The same limb also had a communicating branch between the musculocutaneous nerve  to the median nerve at the mid arm level. These variations may be of interest to neurologists, anatomists and surgeons operating in the upper limb  region

Omecamtiv mecarbil in Black patients with heart failure and reduced ejection fraction: insights from GALACTIC-HF

Background: Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. Objectives: The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. Methods: In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. Results: Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro–B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs −0.7 mm Hg, P-interaction = 0.02). Conclusions: GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

AfriQA:Cross-lingual Open-Retrieval Question Answering for African Languages

African languages have far less in-language content available digitally, making it challenging for question answering systems to satisfy the information needs of users. Cross-lingual open-retrieval question answering (XOR QA) systems -- those that retrieve answer content from other languages while serving people in their native language -- offer a means of filling this gap. To this end, we create AfriQA, the first cross-lingual QA dataset with a focus on African languages. AfriQA includes 12,000+ XOR QA examples across 10 African languages. While previous datasets have focused primarily on languages where cross-lingual QA augments coverage from the target language, AfriQA focuses on languages where cross-lingual answer content is the only high-coverage source of answer content. Because of this, we argue that African languages are one of the most important and realistic use cases for XOR QA. Our experiments demonstrate the poor performance of automatic translation and multilingual retrieval methods. Overall, AfriQA proves challenging for state-of-the-art QA models. We hope that the dataset enables the development of more equitable QA technology

Creating Dependency: Land and Gift-giving Practices in Uganda

President Museveni's re-election in February 2011 demonstrated once more the skills of the Ugandan leader to remain in control ever since he took over power in 1986 heading a guerrilla movement. Some of the campaign themes dealt with land and administration, others with security and the role of the armed forces in bringing back peace to the country. Museveni's populist stance in favour of squatters, in places where user rights are threatened by the progress of individual titling, came out prominently. Actual gifts and many promises of money, land, new districts as well as offers of protection were made during the campaign. These were meant to foster moral indebtedness and political support for the regime and its leader, making it difficult to break off from such an uneven relationship. This paper focuses on the double-edged politics of dependency and protection in Uganda

AfriQA: Cross-lingual Open-Retrieval Question Answering for African Languages

African languages have far less in-language content available digitally, making it challenging for question answering systems to satisfy the information needs of users. Cross-lingual open-retrieval question answering (XOR QA) systems -- those that retrieve answer content from other languages while serving people in their native language -- offer a means of filling this gap. To this end, we create AfriQA, the first cross-lingual QA dataset with a focus on African languages. AfriQA includes 12,000+ XOR QA examples across 10 African languages. While previous datasets have focused primarily on languages where cross-lingual QA augments coverage from the target language, AfriQA focuses on languages where cross-lingual answer content is the only high-coverage source of answer content. Because of this, we argue that African languages are one of the most important and realistic use cases for XOR QA. Our experiments demonstrate the poor performance of automatic translation and multilingual retrieval methods. Overall, AfriQA proves challenging for state-of-the-art QA models. We hope that the dataset enables the development of more equitable QA technology

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa