A pilot training program for point-of-care ultrasound in Kenya.

INTRODUCTION: Ultrasound is an effective and affordable clinical diagnostic tool highly attractive for use in low and middle income countries (LMICs), but access to training programs in these countries is limited. The objective of our study was to develop and pilot a program for healthcare providers in Kenya in the use of point-of-care ultrasound. METHODS: Trainees were recruited in district hospitals for participation in three all-day workshops held every 3-5 months from September 2013 through November 2014. Prior to the initial workshop, trainees were asked to study a training manual, and a knowledge test was administered. Ultrasound-credentialed emergency physicians provided brief didactic lessons then hands-on training for eFAST and obstetric training. This was followed by an observed assessment of scanning image quality (IM) and diagnostic interpretation (IN). RESULTS: Eighty-one trainees enrolled in four initial training sessions and 30 attended at least one refresher session. Among those trainees who attended refresher sessions, there was an increase in the proportion passing both the knowledge and practical tests at the follow-up, as compared to the initial session. Overall, mean practical skill scores also trended toward an increase over time, with a significantly higher mean score in November 2014 (2.64 + 0.38, p = 0.02) as compared to March 2014 (2.26 + 0.54), p < 0.05. Pre-workshop preparation evolved over time with the goal of maximizing trainee readiness for the hands-on course. A strong correlation was observed between knowledge and practical skill scores illustrating the importance of pre-workshop training. CONCLUSIONS: Our pilot workshop showed promise in promoting knowledge and practical skills among participants, as well as increasing use in patient care. Results also suggest that refresher training may provide additional benefits for some participants. These findings provide a strong rationale for expanding the training program and for measuring its clinical impact.

INTRODUCTION: L'échographie est un outil de diagnostic clinique efficace et abordable très attrayant pour les pays à revenu faible et intermédiaire (PFR-PRI), mais l'accès aux programmes de formation dans ces pays est limité. L'objectif de notre étude était de développer et de piloter un programme destiné aux fournisseurs de soins de santé au Kenya visant à les former à l'utilisation de l'échographie sur le lieu de soins. MÉTHODES: Les stagiaires ont été recrutés dans les hôpitaux de district pour participer à trois ateliers d'une journée complète tous les 3 à 5 mois, de septembre 2013 à novembre 2014. Avant le premier atelier, il a été demandé aux stagiaires d'étudier un manuel de formation, et leurs connaissances ont ensuite été évaluées. Des médecins d'urgence qualifiés en matière d'échographie ont délivré de brèves leçons didactiques, puis une formation pratique à eFAST et en obstétrique. La formation a été suivie d'une évaluation sous observation de la qualité d'image (IM) de balayage et de l'interprétation en termes de diagnostic (IN). RÉSULTATS: Quatre-vingt-un stagiaires se sont inscrits à quatre sessions de formation initiale et 30 ont participé à au moins une session de remise à niveau. Parmi les stagiaires ayant assisté à des séances de remise à niveau, lors du suivi, une augmentation de la proportion réussissant les contrôles des connaissances comme les tests pratiques a été observée par rapport à la première session. Dans l'ensemble, la moyenne des notes en compétences pratiques a aussi connu une tendance à la hausse dans le temps, avec une note moyenne bien plus élevée en novembre (2,64 + 0,38, p = 0,02) par rapport à mars (2,26 + 0,54), p < 0,05. La préparation avant l'atelier a évolué dans le temps dans le but de maximiser l'état de préparation des stagiaires à la formation pratique. Une forte corrélation a été observée entre les notes sur les connaissances et celles sur les compétences pratiques, ce qui montre l'importance de la formation préalable à l'atelier. CONCLUSIONS: Notre atelier pilote s'est révélé prometteur en termes de promotion des connaissances et des compétences pratiques auprès des participants, ainsi que d'utilisation croissante dans le cadre des soins aux patients. Les résultats suggèrent également que la formation de remise à niveau peut offrir des avantages supplémentaires pour certains participants. Ces résultats apportent une justification solide au developpement du programme de formation et de la mesure de son impact clinique.

Outbreak-related Hendra virus infection in a NSW pet dog.

Hendra virus (HeV) infection is a zoonosis of importance in Australia. An outbreak of HeV occurred on the mid-north coast region of New South Wales (NSW) in June and July 2013. Four unvaccinated horses on four separate properties were confirmed to have HeV infection. A pet dog that had close contact with one of the horses was also confirmed to be infected with HeV. This paper documents the response to the canine infection and the resulting change to the public health management of HeV infection.

A field study of household attack rates and the effectiveness of macrolide antibiotics in reducing household transmission of pertussis.

Bordetella pertussis (whooping cough) is an endemic, highly contagious bacterial respiratory infection, which is notifiable to Australian state and territory health departments. Between 2008 and 2011 there was a substantial outbreak in New South Wales with an initial increase in cases occurring in North Coast New South Wales from late 2007. During September and October 2011 the North Coast Public Health Unit conducted a household study of secondary attack rates to assess the effectiveness of pertussis vaccination as well as the timely use of antibiotics in preventing household transmission. At the time the study was commenced, notified cases included a large proportion of individuals with a documented history of vaccination against pertussis. We found lower attack rates amongst vaccinated compared with non-vaccinated subjects in all age groups, with the exception of the 5-11 years age group, who were also primarily responsible for the introduction of pertussis into the household. There was an increased risk of pertussis transmission from the household first primary case to contacts when antibiotic treatment was commenced later than 7 days after the onset of symptoms compared with within 7 days. This protective effect of timely antibiotic treatment in relation to transmission highlights the need to control for antibiotic treatment in field studies of pertussis. The benefits of timely diagnosis and use of antibiotics in preventing household transmission underscore the importance of early presentation and diagnosis of pertussis cases, particularly in households with susceptible occupants.

Development and characterization of genomic SSR markers in Cynodon transvaalensis Burtt-Davy.

Simple sequence repeat (SSR) markers are a major molecular tool for genetic and genomic research that have been extensively developed and used in major crops. However, few are available in African bermudagrass (Cynodon transvaalensis Burtt-Davy), an economically important warm-season turfgrass species. African bermudagrass is mainly used for hybridizations with common bermudagrass [C. dactylon var. dactylon (L.) Pers.] in the development of superior interspecific hybrid turfgrass cultivars. Accordingly, the major objective of this study was to develop and characterize a large set of SSR markers. Genomic DNA of C. transvaalensis '4200TN 24-2' from an Oklahoma State University (OSU) turf nursery was extracted for construction of four SSR genomic libraries enriched with [CA](n), [GA](n), [AAG](n), and [AAT](n) as core repeat motifs. A total of 3,064 clones were sequenced at the OSU core facility. The sequences were categorized into singletons and contiguous sequences to exclude redundancy. From the two sequence categories, 1,795 SSR loci were identified. After excluding duplicate SSRs by comparison with previously developed SSR markers using a nucleotide basic local alignment tool, 1,426 unique primer pairs (PPs) were designed. Out of the 1,426 designed PPs, 981 (68.8 %) amplified alleles of the expected size in the donor DNA. Polymorphisms of the SSR PPs tested in eight C. transvaalensis plants were 93 % polymorphic with 544 markers effective in all genotypes. Inheritance of the SSRs was examined in six F(1) progeny of African parents 'T577' × 'Uganda', indicating 917 markers amplified heritable alleles. The SSR markers developed in the study are the first large set of co-dominant markers in African bermudagrass and should be highly valuable for molecular and traditional breeding research.

Loss of genetic accuracy in mutants of the thermoacidophile Sulfolobus acidocaldarius.

To investigate how hyperthermophilic archaea can propagate their genomes accurately, we isolated Sulfolobus acidocaldarius mutants exhibiting abnormally high rates of spontaneous mutation. Our isolation strategy involved enrichment for mutator lineages via alternating selections, followed by screening for the production of spontaneous, 5-fluoro-orotate-resistant mutants in micro-colonies. Several candidates were evaluated and found to have high frequencies of pyrE and pyrF mutation and reversion. Neither an increased efficiency of plating of mutants on selective medium, nor the creation of a genetically unstable pyrE allele, could be implicated as the cause of these high frequencies. The strains had elevated frequencies of other mutations, and exhibited certain phenotypic differences among themselves. A large increase in sensitivity to DNA-damaging agents was not observed, however. These properties generally resemble those of bacterial mutator mutants and suggest loss of functions specific to genetic accuracy.