Christian Salmon

Cassava flour slurry as a low‐cost alternative to commercially available gel for obstetrical ultrasound: a blinded non‐inferiority trial comparison of image quality

amongst pregnant women undergoing routine scans, thereby suggesting the growing need of implementation of patient-safety procedures during pregnancy management and subsequent clinical follow-up. The authors convincingly demonstrated a lack of significant difference between the perceived image quality obtained with CFS (mean = 6.2; SD = 1.2) and that obtained with commercial gel (mean = 6.4; SD = 1.2): t(28) = 1.1 (P = 0.3). Despite the negative and non-significant statistical output, it was interesting to observe that all five experienced sonographers rated CFS as being easy to use to obtain clear images, and simple for patient and machine clean-up, thereby emphasising the patient-friendliness, cost-effectiveness, and feasibility of incorporating CFS in routine diagnostics in lowresource settings. The pilot data suggest that CFS produced comparable image quality to that achieved with commercial ultrasound gel. We would like to add that technical artefacts and inter-observer differences in the interpretation(s) of image quality and resolution may be further evaluated in pooled case cohorts with a large sample size of women with singleton, twin, and multiple pregnancies, for further corroboration of the current findings. As experienced clinical researchers propagating good practice in research, teaching and meaningful patient-centric interactions at the Indira Fertility Academy, Indira-IVF Hospital, Udaipur, India, we would recommend additional research along similar lines with diverse population subsets and cohorts of reproductive-aged pregnant women for a Wider investigation of these results. We strongly agree with the study group that the simple CFS recipe could significantly increase access to ultrasound for screening, monitoring, and diagnostic purposes in resource-limited settings on a global platform.& References

Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent

&NA; Significant evidence identifies point‐of‐care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource‐limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high‐impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource‐rich PoCUS curricula and delivery methods to resource‐limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing.

Albendazole Treatment Improves Work Capacity in Women Smallholder Farmers Infected with Hookworm: A Double-Blind Randomized Control Trial

An estimated 4.7 billion people live in regions exposed to soil-transmitted helminths, intestinal parasites that have significant impacts on the health of women smallholder farmers. The goal of this trial was to determine whether treatment with albendazole impacts the work capacity of these farmers. This is a prospective double-blind, randomized effectiveness trial. Participants (N = 250) were randomly selected from safe motherhood groups in the Democratic Republic of Congo. Prevalence/intensity of hookworm infection, hemoglobin, and demographics was obtained. At study (Time = 0), participants were randomized into treatment (albendazole 400 mg) and placebo (similar placebo tablet) groups. A step test was administered as a proxy metric for work capacity. Work capacity was defined as ∆heart rate before and after 3 minutes of step testing, in beats per minute. At study (time = 7 months), the step test was repeated and work capacity remeasured. The ∆work capacity (time = 0 minus time = 7 months) was the primary outcome. Investigators/field assistants were blinded to who was enrolled in groups, hookworm status, and step test results. Regression showed highly significant interactive effects of hookworm status and treatment group relative to ∆work capacity after controlling for resting pulse rate and age (P < 0.002). Estimated marginal means for work capacity (WC) for each of four groups (hookworm positive plus placebo, hookworm positive plus treatment, hookworm negative plus placebo, and hookworm negative plus treatment) showed women who were hookworm positive and received treatment decreased heart rate by 9.744 (95% confidence interval [CI]: 6.42, 13.07) beats per minute (increased WC), whereas women who were hookworm positive and received placebo saw a nonsignificant decrease of 0.034 (95% CI: -3.16, 3.84) beats per minute. Treatment with albendazole was associated with improved aerobic work capacity posttreatment. Given modest costs of drug distributions, risk benefits of periodic deworming warrants further study in larger controlled trials.

A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks

Introduction Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management. Methods This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa. Results A standardised survey was conducted with 64 participants working in emergency medicine [30/64 (46.9%)] and orthopaedics [34/64 (53.1%)]. Twenty-three of 64 (35.9%) respondents had received formal training. Knowledge was acquired from didactic/workshop format for 15/23 (65.2%), followed by peer training 6/23 (39.1%). The majority, 62/64 (96.9%), believed that knowledge of general anatomy and nerve blocks are very important. Thirty-one of 64 (48%) of the respondents did not routinely perform peripheral nerve blocks. A majority, 27/31 (87.1%) stated they lacked the required skills. Ultrasound guidance of the femoral nerve 16/33 (48.5%) was the most commonly performed peripheral nerve block, followed by ankle block using anatomic landmarks 15/33 (45.5%). Almost all (15/16) ultrasound-guided nerve blocks were done by emergency medicine providers, while all anatomic land mark guided blocks were done by orthopaedic teams. A majority of the respondents (93.8%) (n = 60) were optimistic that their practice on peripheral nerve blocks would increase in future. A highly significant association was found between previous training on peripheral nerve blocks and the number of peripheral nerve blocks performed in a month; p value – 0.006. Discussion This study indicates peripheral nerve blocks are likely underutilised due to lack of training. There was a positive attitude towards peripheral nerve blocks but gaps on knowledge and practice.

Nerve block training phantom for use with ultrasound systems in low-resource environments

A nerve block training phantom is being developed for use with ultrasound systems in low-resource environments. Two design options are being pursued: make-as-needed and temporally stable. The make-as-needed design is intended for production within the low-resource environment using locally available materials. The temporally stable design will be produced in the United States and transported to the low-resource environment where it will ultimately be used. Both phantom designs include objects that represent nerves of different sizes and depths for progressive training purposes. If successful, the phantom may be used to improve training for medical professionals prior to performing clinical nerve block procedures, thus enhancing the quality of care experienced by patients.

Modeling Hazard and Threat Risks to Populations Surrounding Public-Use, Non-Towered Airports due to General Aviation Operations

This paper considers the potential future wherein the General Aviation (GA) infrastructure of airports and aircraft becomes an integral part of the commercial aviation transportation network. Further, this paper discusses inherent individual and societal risks sourced in the very characteristic that makes the GA infrastructure attractive: accessibility and ubiquity.Air traffic controller furloughs, mergers, surface transportation congestion and infrastructure degradation are a few examples of system discontinuities that have led to increased travel time for short and medium air travel (200–500 miles). These, amongst other constraints, are drivers of various initiatives that seek to mitigate these delays via transfer of travel demand from larger towered airport infrastructure to the General Aviation infrastructure via development of aircraft, business plans, operation oversight processes. An example being the nascent air taxi industry coupled with the development of the Very Light Jet designed to operate on 3,000 ft runways.The development of High Volume Operations (HVO) capability in the GA infrastructure (specifically non-towered airports) will subsequently increase risks to communities situated in the vicinity of GA airports via increased potential for accidents. Modeling and understanding these inherent risks in is important if public safety and negative reaction to operational changes, particularly at community airports, is to be avoided; a negative public opinion that could forestall the development of HVO.Similarly, the potential for security threats (i.e. use of aircraft as a missile) from unsecured community airports are greater, but qualitatively less severe than TSA regulated commercial airports.With the potential of 4,000+ additional airports being added to the national commercial air transportation infrastructure, a risk-based allocation of security resources would need to be implemented for efficient allocation of scarce resources.Copyright