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Ultrasonography is a crucial tool in successful assisted reproduction but requires a steady hand and can often be difficult for unconfident clinicians. A comprehensive ultrasound imaging reference, this is an essential guide for trainee clinicians, ultrasonographers, and nurses working in the field of assisted reproductive technology. Providing the reader with an overview of the process and a foundation to direct their ultrasound assessment of each patient, it contains highly practical tips and tricks for obtaining the best images. Heavily illustrated with example images, the role of ultrasound in fertility treatment is explained, as well as how to identify the uterus and ovaries, measure the endometrium, count follicles and recognize pathology. The role of ultrasound in assisted reproduction is covered, including transvaginal oocyte collection, embryo transfer, early pregnancy, miscarriage and ectopic pregnancy. This is an indispensable reference for clinicians new to ultrasound in assisted reproduction.
Additive manufacturing (AM) has made long strides in the recent past and rapidly evolved into a promising alternative in specific applications. The aircraft industry is not an exception to this. The true just-intime production possibility is critical for the aircraft maintenance industries, though the lack of material freedom is a major hurdle. Several fire-retardant materials were investigated for AM in the aerospace context, but mainly for fused deposition modeling (FDM). The material consolidation constraints in FDM led to the expansion to the use of selective laser sintering (SLS) to some extent. Nevertheless, the material options are still limited, proprietary, and lack scientific insights into the material consolidation mechanics. Attempts are made in this paper to fill this gap, evaluating a new fire-retardant material for processing by SLS. Experiments conducted to ascertain the material, process, structure, and consolidation relationships indicated energy density levels 0.062–0.070 J/mm2 with laser power 13 W and scan speed varied slightly around 390 mm/s to give the best laser sintering and mechanical property results in polyetherimide powders.
Background:Uganda is prone to viral hemorrhagic fever (VHF) outbreaks. Infection prevention and control capacity is critical to supporting patient care, to preventing nosocomial transmission to health workers, and to limiting spread within the community. Offsite didactic training may increase healthcare worker knowledge, but this approach may be inadequate for assuring confident execution of practical clinical tasks in patient care settings. We aimed to develop a competency-based, onsite mentorship model for sentinel case isolation and management of viral hemorrhagic fever syndromes in Uganda. Methods: The Naguru Regional Referral Hospital (China Uganda Friendship Hospital) Kampala was selected as a site for training after its designation by the Uganda Ministry of Health (MoH) as facility for isolation of healthcare workers with suspected or confirmed VHF. The need for mentorships was determined from information from training providers, MoH assessments, hospital management, and key hospital staff. A list of skills was developed by reviewing WHO case management guidelines and Uganda-approved VHF trainings. The skills, exercised using scenario-based drills, focused on safety practices, identification and isolation of suspect cases, and delivery of optimized clinical care to suspected cases of VHF, among others. Trained facilitators (n = 2–4) supervised drills attended by staff from Naguru and other Kampala-based health facilities. Drills were scheduled weekly and were ordered to progressively increase in complexity. Specific drills could be repeated at the subsequent mentorship visit if gaps were identified. Results: Over 3 months, 12 drills were completed (Table 1). Cadres trained included 10 medical doctors, 12 nurses, 3 clinical officers, 5 laboratory technicians, 6 hygienists, 2 security officers, and 3 administrative officers. On average, 8 hospital staff attended weekly drills. During 3 months of the intervention, 1 suspected case of VHF and 3 cases with laboratory confirmed cholera were managed by the hospital team, and staff demonstrated the capacity for safe handling of patients with infectious bodily fluids. Barriers encountered included practice fatigue from repeated drills, challenges with team cohesion since members were from different institutions, limited personal protective equipment for repeated trainings, and competing routine hospital activities that reduced numbers of staff available for training. Repeated drills included clinical management, cadaver management, and infectious spills. Conclusions: This onsite mentorship project supported healthcare workers to gain confidence in the management of suspected VHF infection and other highly infectious diseases. Continued mentorship, hospital administration support and increase in exercise complexity are needed to consolidate on these gains.
Disclosures: Mohammed Lamorde reports contract research for Janssen Pharmaceutica, ViiV, and Mylan.
To provide comprehensive information on the epidemiology and burden of respiratory syncytial virus hospitalisation (RSVH) in preterm infants, a pooled analysis was undertaken of seven multicentre, prospective, observational studies from across the Northern Hemisphere (2000–2014). Data from all 320–356 weeks' gestational age (wGA) infants without comorbidity were analysed. RSVH occurred in 534/14 504 (3.7%) infants; equating to a rate of 5.65 per 100 patient-seasons, with the rate in individual wGA groups dependent upon exposure time (P = 0.032). Most RSVHs (60.1%) occurred in December–January. Median age at RSVH was 88 days (interquartile range (IQR): 54–159). Respiratory support was required by 82.0% of infants: oxygen in 70.4% (median 4 (IQR: 2–6) days); non-invasive ventilation in 19.3% (median 3 (IQR: 2–5) days); and mechanical ventilation in 10.2% (median 5 (IQR: 3–7) days). Intensive care unit admission was required by 17.9% of infants (median 6 days (IQR: 2–8) days). Median overall hospital length of stay (LOS) was 5 (IQR: 3–8) days. Hospital resource use was similar across wGA groups except for overall LOS, which was shortest in those born 35 wGA (median 3 vs. 4–6 days for 32–34 wGA; P < 0.001). Strategies to reduce the burden of RSVH in otherwise healthy 32–35 wGA infants are indicated.