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

Magnetism Among the Shakers

The article reprinted from the May 1849, issue of Sartain’s Union Magazine of Literature and Art (volume 4, no. 5, pages [337]-38) records a particularly personal account of a visit by a long-time Shaker to the home of an old friend. The Shaker brother had been a member of an unnamed Shaker village for forty years and had joined with his wife and two children. He describes how his daughter left the faith and married and how his wife soon joined the daughter in the World. The son then apostasized, leaving the father alone with the Shakers. The account describes visions from the Era of Manifestations and describes the man’s uneasiness with this new development

Full-size solar dynamic heat receiver thermal-vacuum tests

The testing of a full-size, 120 kW, solar dynamic heat receiver utilizing high-temperature thermal energy storage is described. The purpose of the test program was to quantify receiver thermodynamic performance, operating temperatures, and thermal response to changes in environmental and power module interface boundary conditions. The heat receiver was tested in a vacuum chamber with liquid nitrogen cold shrouds and an aperture cold plate to partly simulate a low-Earth-orbit environment. The cavity of the receiver was heated by an infrared quartz lamp heater with 30 independently controllable zones to allow axially and circumferentially varied flux distributions. A closed-Brayton cycle engine simulator conditioned a helium-xenon gas mixture to specific interface conditions to simulate the various operational modes of the solar dynamic power module on the Space Station Freedom. Inlet gas temperature, pressure, and flow rate were independently varied. A total of 58 simulated orbital cycles, each 94 minutes in duration, was completed during the test conduct period

Ground test program for a full-size solar dynamic heat receiver

Test hardware, facilities, and procedures were developed to conduct ground testing of a full size, solar dynamic heat receiver in a partially simulated, low Earth orbit environment. The heat receiver was designed to supply 102 kW of thermal energy to a helium and xenon gas mixture continuously over a 94 minute orbit, including up to 36 minutes of eclipse. The purpose of the test program was to quantify the receiver thermodynamic performance, its operating temperatures, and thermal response to changes in environmental and power module interface boundary conditions. The heat receiver was tested in a vacuum chamber using liquid nitrogen cold shrouds and an aperture cold plate. Special test equipment were designed to provide the required ranges in interface boundary conditions that typify those expected or required for operation as part of the solar dynamic power module on the Space Station Freedom. The support hardware includes an infrared quartz lamp heater with 30 independently controllable zones and a closed Brayton cycle engine simulator to circulate and condition the helium xenon gas mixture. The test article, test support hardware, facilities, and instrumentation developed to conduct the ground test program are all described

The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently ‘normal’ valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis

Advanced Echocardiography for the Diagnosis and Management of Infective Endocarditis

Echocardiography is fundamental for the management of infective endocarditis (IE) across all stages of the illness including diagnosis, surveillance during medical therapy, identification of prognostic markers, planning perioperative intervention, postoperative assessment, and follow-up after completion of definitive therapy. Modern era echocardiography (echo) offers outstanding temporal and spatial image resolution, providing the opportunity for early diagnosis of this life-threatening infection. Emerging imaging modalities, such as real-time three-dimensional (3D) echocardiography, offer a novel way of readily visualizing the extent of intracardiac infection and the relationship of pathology to adjacent cardiac structures, well before surgical intervention, without radiation exposure or significant risk to the patient. Echocardiography can have a positive impact on the management of every stage of this disease, with the opportunity to improve outcomes

Helping community-based students on a final consolidation placement make the transition to registered practice.

The pressure of role transition on new nurse registrants has affected recruitment and retention, which, along with an ageing workforce, has resulted in a global shortage of nurses that is now reaching crisis point. This article examines and discusses what can be done to attract and prepare the future workforce in the community, focusing on helping students to make the transition to registered practice that begins during their final consolidation of practice placement. There is currently limited evidence on the effectiveness of how community placement teams prepare finalist students for registered practice and this could be seen as an opportunity lost given the urgent need to recruit more registered nurses to work in primary care. Recommendations for enhancing this crucial stage of the student journey are made, and a case for the need to know more from students about how they experience their final practice placement when allocated to a community setting is presented

The <i>AKARI</i> deep fields: early results from multi-wavelength follow-up campaigns

We present early results from our multi-wavelength follow-up campaigns of the AKARI Deep Fields at the North and South Ecliptic Poles. We summarize our campaigns in this poster paper, and present three early outcomes. (a) Our AAOmega optical spectroscopy of the Deep Field South at the AAT has observed over 550 different targets, and our preliminary local luminosity function at 90 ?m from the first four hours of data is in good agreement with the predictions from Serjeant & Harrison (2005). (b) Our GMRT 610 MHz imaging in the Deep Field North has reached ?30 ?Jy RMS, making this among the deepest images at this frequency. Our 610 MHz source counts at >200 ?Jy are the deepest ever derived at this frequency. (c) Comparing our GMRT data with our 1.4 GHz WSRT data, we have found two examples of radio-loud AGN that may have more than one epoch of activity