Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation.

Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.

[Disease burden on falls among 0-19 years old population in China, in 1990 and 2017].

Objective: To analyze and compare the disease burden of falls in Chinese population aged 0-19, in 1990 and 2017. Methods: Indicators including number of deaths, mortality rates, years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted of life years (DALY), on falls, were gathered from the Global Burden of Disease (GBD) 2017 and used to describe the disease burden and corresponding parameters on falls, between 1990 and 2017, in China. Results: In 2017, number of death, YLLs, YLDs, DALYs caused by falls were 5 321, 0.43 million person years, 0.14 million person years and 0.57 million person years respectively, among aged 0-19 group. Rates on standardized mortality, YLLs, YLDs and DALYs on falls were 1.76/100 000, 141.49/100 000, 46.99/100 000, and 188.48/100 000, respectively. The burden of falls decreased with the increase of age. Compared with 1990, disease burden of falls decreased in all age groups, both in male and female, with more seen in the lower age groups. Compared with 1990, the number of deaths, rates on YLLs, YLDs and DALYs caused by falls decreased by 65.08%, 46.63%, 47.38% and 36.33% respectively, in 2017. However, the YLDs rate increased by 73.31% between 1990 and 2017. The ratio of YLLs to DALYs decreased from 90.84% in 1990 to 75.07% in 2017, with a proportion as 17.36%. Conclusion: Compared with 1990, although the disease burden of falls among aged 0-19 group showed a decreasing trend, falls still caused serious disease burden for the aged 0-19 group. Research that targeting prevention on falls, should be continued.

[Disease burden of animal injury in China, 1990-2016].

Objective: To analyze the disease burden of animal injury in China between 1990 and 2016. Methods: Data obtained from the Global Burden of Disease 2016 were used to analyze the age and gender specific disease burden of animal injury in China, using the incidence and disability adjusted of life years (DALYs) rate. Relative and annual changes were evaluated. Results: In 2016, the age-standardized incidence and DALYs rate of animal injury in China showed as 245.05 per 100 000 people and 12.73 per 100 000. The age-standardized incidence of non-venomous animal injury was significantly higher than that of venomous animal injury, but the differences in age-standardized incidence and DALYs rate between venomous animal injury and non-venomous animal injury were not significant. Between 1990 and 2016, there was a significantly decreasing trend in the age-standardized incidence and DALYs rate of animal injury, and obvious decline could be seen in the incidence of non-venomous animal injury, compared with venomous animal injury. The incidence and DALYs rate of animal injury declined in both males and females and in different age groups. The obvious decline of incidence and DALYs rate could be found in children aged 5-14 years and aged <5 years. Conclusions: Between 1990 and 2016, there was a significant alleviation of the disease burden of animal injury in China. Young children were most prone to animal injury, resulting in serious disability and death, indicating more attention should be paid to this population at high risk and in animal injury prevention and control programs.

[Burn-related burden among Chinese population from 1990 to 2013].

Objective: To analyze the burden and changes caused by burns among Chinese population, from 1990 to 2013. Methods: Using the G20 data and the China national and subnational data from GBD2013, this study deemed to comprehensively show the burden caused by burns and the change from 1990 to 2013, using the indicators of death and DALY. Results: In 2013, the standardized mortality of burns in Chinese was 0.88/100 000, with the standardized DALY rate of burn as 30.58/100 000. The ratio of DALY between males and females was 1.85 ∶ 1. Among the G20 countries, China ranked 16 for the standardized DALY rate, according to the top down order. The highest death rate was seen in the age group of 70 and over, followed by age group of 5, which had the highest DALY rate and followed by the 70 or older age group. In different provinces, Guizhou presented the highest DALY rate (50.24/100 000), with Aomen area the lowest (6.16/100 000). From 1990 to 2013, the burden of burn reduced generally. Both the standardized rates on death and DALY reduced by 68.10% and 76.95% respectively, more in females than in males. Standardized rates on death and DALY reduced among all the age groups, with the rates of reduction increasing by age. From 1990 to 2013, the DALY rate decreased in all the provinces. Conclusions: The burden of burn decreased in Chinese population during 1990-2013. However, the burden of burn among children, elderly and males were still relatively high that called for closer attention.

The epidemiology of HIV infection in Zambia.

Population surveys of health and fertility are an important source of information about demographic trends and their likely impact on the HIV/AIDS epidemic. In contrast to groups sampled at health facilities they can provide nationally and regionally representative estimates of a range of variables. Data on HIV-sero-status were collected in the 2001 Zambia Demographic and Health Survey (ZDHS) and made available in a separate data file in which HIV status was linked to a very limited set of demographic variables. We utilized this data set to examine associations between HIV prevalence, gender, age and geographical location. We applied the generalized geo-additive semi-parametric model as an alternative to the common linear model, in the context of analyzing the prevalence of HIV infection. This model enabled us to account for spatial auto-correlation, non-linear, location effects on the prevalence of HIV infection at the disaggregated provincial level (nine provinces) and assess temporal and geographical variation in the prevalence of HIV infection, while simultaneously controlling for important risk factors. Of the overall sample of 3950, 54% was female. The overall HIV-positivity rate was 565 (14.3%). The mean age at HIV diagnosis for male was 30.3 (SD=11.2) and 27.7 (SD=9.3) for female respectively. Lusaka and Copperbelt have the first and second highest prevalence of AIDS/HIV (marginal odds ratios of 3.24 and 2.88, respectively) but when the younger age of the urban population and the spatial auto-correlation was taken into account, Lusaka and Copperbelt were no longer among the areas with the highest prevalence. Non-linear effects of age at HIV diagnosis are also discussed and the importance of spatial residual effects and control of confounders on the prevalence of HIV infection. The study was conducted to assess the spatial pattern and the effect of confounding risk factors on AIDS/HIV prevalence and to develop a means of adjusting estimates of AIDS/HIV prevalence on the important risk factors. Controlling for important risk factors, such as geographical location (spatial auto-correlation), age structure of the population and gender, gave estimates of prevalence that are statistically robust. Researchers should be encouraged to use all available information in the data to account for important risk factors when reporting AIDS/HIV prevalence. Where this is not possible, correction factors should be applied, particularly where estimates of AIDS/HIV prevalence are pooled in systematic reviews. Our maps can be used for policy planning and management of AIDS/HIV in Zambia.

Implications for prediction and hazard assessment from the 2004 Parkfield earthquake.

Obtaining high-quality measurements close to a large earthquake is not easy: one has to be in the right place at the right time with the right instruments. Such a convergence happened, for the first time, when the 28 September 2004 Parkfield, California, earthquake occurred on the San Andreas fault in the middle of a dense network of instruments designed to record it. The resulting data reveal aspects of the earthquake process never before seen. Here we show what these data, when combined with data from earlier Parkfield earthquakes, tell us about earthquake physics and earthquake prediction. The 2004 Parkfield earthquake, with its lack of obvious precursors, demonstrates that reliable short-term earthquake prediction still is not achievable. To reduce the societal impact of earthquakes now, we should focus on developing the next generation of models that can provide better predictions of the strength and location of damaging ground shaking.

Age at spermarche and comparison of growth and performance of pre- and post-spermarcheal Chinese boys.

The prevalence of first ejaculation emission (spermarche) in Chinese Han boys in 1995 was considered. The subjects were 86,744 Han boys 9 through 18 years randomly selected from 28 provinces. Median spermarcheal ages (MSAs) were 14.4 and 14.6 years for urban and rural boys, respectively, and 14.3, 14.6, and 14.7 years for the boys of 1st, 2nd, and 3rd socioeconomic classes, respectively. Two environmental factors, ecological and socioeconomic, had strong influence upon MSAs. Eight indicators of somatic growth and motor ability were compared between pre- and post-spermarcheal boys of the same age. Post-spermarcheal boys were advanced in body size, shape, and physiological function during early and middle puberty, but most of the difference disappeared by 16 years. Pre-spermarcheal boys in a given age group were more linear and had more potential for increasing leg length into late adolescence. Within an age group, post-spermarcheal boys had advanced performances in several tasks requiring endurance, strength, and power around the age of maximum growth, 13-15 years. At older ages, the groups did not differ.

The geographic clustering of body size of Chinese children aged 7 years.

We studied the morphological differences and similarities among Chinese Han children aged 7 years by using PCA-Q mode cluster analysis. The data were drawn from 17,119 boys and 17,084 girls who came from 28 provinces and participated in the 1985 National Survey on Students Constitution and Health. The children were divided into urban and rural subgroups in each province. First, the values of six measures of body size (stature, sitting height, body weight, chest girth, biacromial diameter and biiliocristal diameter) were normalized into principal component scores; and then clustering was performed among subgroups according to the distances determined by the component scores. The results show significant variations in children's body size exist not only between north and south China, but also between developed and under-developed districts and between urban and rural areas. The geographic and socio-economic factors causing these variations were investigated. The practical use of PCA-Q cluster analysis and its merits in studying Chinese children's growth variations are discussed.