Development of a professional competency framework for Australian sonographers-perspectives for developing competencies using a Delphi methodology.

BACKGROUND: Professional competencies are important for enhancing alignment between the needs of education, industry and health consumers, whilst describing public expectations around health professionals. The development of competency standards for the sonography profession defines the behaviours, skills and knowledge sonographers should demonstrate for each learning and experience level. OBJECTIVE: The objective of this project was to develop a set of professional competency standards for the sonography profession which described in depth the behaviours, skills and knowledge sonographers should demonstrate across multiple learning and experience levels. METHODS: Representatives of three Australian ultrasound professional associations and seven tertiary institutions involved in entry-level sonographer education in Australia formed a research team (RT). The RT recruited an expert panel that responded to six survey rounds. Using a Delphi methodology, the results and free-text comments from each previous round were fed back to participants in the subsequent survey rounds to achieve a consensus. RESULTS: The project developed a professional competency framework for sonographers, which included four major domains: detailed competency standards, sonographer knowledge, sonographer attitudes and a holistic competency matrix [https://doi.org/10.6084/m9.figshare.17148035.v2.]. CONCLUSION: The Delphi methodology is an effective way to develop professional competency standards. This paper describes the methods and challenges in developing such standards for sonographers which could be translated to other health professionals.

Decreased maternal serum acetate and impaired fetal thymic and regulatory T cell development in preeclampsia.

Maternal immune dysregulation seems to affect fetal or postnatal immune development. Preeclampsia is a pregnancy-associated disorder with an immune basis and is linked to atopic disorders in offspring. Here we show reduction of fetal thymic size, altered thymic architecture and reduced fetal thymic regulatory T (Treg) cell output in preeclamptic pregnancies, which persists up to 4 years of age in human offspring. In germ-free mice, fetal thymic CD4+ T cell and Treg cell development are compromised, but rescued by maternal supplementation with the intestinal bacterial metabolite short chain fatty acid (SCFA) acetate, which induces upregulation of the autoimmune regulator (AIRE), known to contribute to Treg cell generation. In our human cohorts, low maternal serum acetate is associated with subsequent preeclampsia, and correlates with serum acetate in the fetus. These findings suggest a potential role of acetate in the pathogenesis of preeclampsia and immune development in offspring.

Automatic Measurement of Thalamic Diameter in 2-D Fetal Ultrasound Brain Images Using Shape Prior Constrained Regularized Level Sets.

We derived an automated algorithm for accurately measuring the thalamic diameter from 2-D fetal ultrasound (US) brain images. The algorithm overcomes the inherent limitations of the US image modality: nonuniform density; missing boundaries; and strong speckle noise. We introduced a "guitar" structure that represents the negative space surrounding the thalamic regions. The guitar acts as a landmark for deriving the widest points of the thalamus even when its boundaries are not identifiable. We augmented a generalized level-set framework with a shape prior and constraints derived from statistical shape models of the guitars; this framework was used to segment US images and measure the thalamic diameter. Our segmentation method achieved a higher mean Dice similarity coefficient, Hausdorff distance, specificity, and reduced contour leakage when compared to other well-established methods. The automatic thalamic diameter measurement had an interobserver variability of -0.56 ± 2.29 mm compared to manual measurement by an expert sonographer. Our method was capable of automatically estimating the thalamic diameter, with the measurement accuracy on par with clinical assessment. Our method can be used as part of computer-assisted screening tools that automatically measure the biometrics of the fetal thalamus; these biometrics are linked to neurodevelopmental outcomes.