On the Cover: Showcasing China's On-the-Job Training in Rural Africa.

The cover of this issue of Technology and Culture illustrates how China implemented-and promoted-on-the-job training in Africa. The image shows a Tanzanian dentist practicing dentistry under the supervision of a Chinese doctor in rural Tanzania, probably in the 1970s. Despite the ineffectiveness of the on-the-job training model, the photograph attempts to project the success of the dental surgery techniques exchanged between China and Tanzania, using simple medical equipment rather than sophisticated medical knowledge. The rural setting reflects the ideological struggle of the Cold War era, when Chinese doctors and rural mobile clinics sought to save lives in the countryside, while doctors from other countries engaged in Cold War competition worked primarily in cities. This essay argues that images were essential propaganda tools during the Cold War and urges historians of technology to use images critically by considering the contexts that influenced their creation.

Lead, Follow, or Get out of the Way-How Bold Young Surgeons Brought Vascular Surgery into Clinical Practice from the Korean War Battlefield.

The maturation of vascular surgery into widespread clinical practice was accelerated by events that took place in Korea during the conflict of 1950-1953. Early research and anecdotal clinical trials were just then resulting in publication of cases of the successful vascular repairs and replacements. Noncrushing vascular clamps were being developed and limited manufacture begun. The stage was set for a major advance in the treatment of arterial injury, just as war commenced in Korea, which provided a clinical laboratory. When the war on the Korean Peninsula erupted in June 1950, the policy of the Army Medical department was to ligate all arterial injuries unless a simple transverse or end-to-end anastomosis could be performed, and repair was "contrary to policy and orders." Despite pressure and threats of "courts martial for vascular repairs" from the senior military medicine leaders-clinical experiments in arterial repair were carried out at Mobile Army Surgical Hospital facilities at battlefield locations across Korea. The young surgeons, mostly draftees and reservists, resisted rigid doctrine and orders to desist, and in the face of threatened punishment, were committed to do the right thing, and ultimately went on to change military medicine and vascular surgery. The "on-the-job" training in vascular surgery that was carried out in Korea by military surgeons who demonstrated substantially higher limb salvage rates energized the field from the battlefield laboratory. Many wounded soldiers had limbs saved by the new techniques in vascular repair pioneered by surgeons in the Korean War, and countless thousands who entered civilian hospitals for emergency vascular surgery in subsequent years also ultimately benefited from their work.

An Historical Examination of the Development of Emergency Medical Services Education in the US through Key Reports (1966-2014).

INTRODUCTION: The Emergency Medical Services (EMS) approach to emergency prehospital care in the United States (US) has global influence. As the 50-year anniversary of modern US EMS approaches, there is value in examining US EMS education development over this period. This report describes US EMS education milestones and identifies themes that provide context to readers outside the US. METHOD: As US EMS education is described mainly in publications of federal US EMS agencies and associations, a Google search and hand searching of documents identified publications in the public domain. MEDLINE and CINAHL Plus were searched for peer reviewed publications. Documents were reviewed using both a chronological and thematic approach. RESULTS: Seventy-eight documents and 685 articles were screened, the full texts of 175 were reviewed, and 41 were selected for full review. Four historical periods in US EMS education became apparent: EMS education development (1966-1980); EMS education consolidation and review (1981-1989); EMS education reflection and change (1990-1999); and EMS education for the future (2000-2014). Four major themes emerged: legislative authority, physician direction, quality, and development of the profession. CONCLUSION: Documents produced through broad interprofessional consultations, with support from federal and US EMS authorities, reflect the catalysts for US EMS education development. The current model of US EMS education provides a structure to enhance educational quality into the future. Implementation evaluation of this model would be a valuable addition to the US EMS literature. The themes emerging from this review assist the understanding of the characteristics of US EMS education.

Gelatin model for training ultrasound-guided puncture / Treinamento de punção ecoguiada em modelo de gelatina

It is indispensable that members of the medical profession receive the technical training needed to enable them to rapidly obtain effective vascular access. Training procedures should be used judiciously to familiarize students with the technique. However, existing models are expensive or ineffective, and models need to be developed that are similar to what will be encountered in real patients.OBJECTIVES: To demonstrate creation and application of a gelatin model for training ultrasound-guided puncture.METHOS: The model was made using a mixture of colorless gelatin and water in a transparent plastic receptacle with two pairs of orifices of different diameters, through which two plastic tubes were inserted, to simulate blood vessels.RESULTS: The model was a close approximation to the real medical procedure in several aspects, since gelatin has a similar consistency to human tissues, providing a more faithful reproduction of the tactile sensation at the moment when the needle reaches the interior of a vessel and its contents are aspirated.CONCLUSIONS: The method proposed here can be used to easily construct a low-cost model using everyday materials that is suitable for large-scale training of ultrasound-guided puncture.

É imprescindível a capacitação técnica da classe médica para a obtenção de um acesso vascular rápido e eficiente, sendo que os procedimentos de treinamento devem ser usados sabiamente como forma de familiarizar o aluno à técnica. Os modelos comerciais existentes são de alto custo ou não são eficientes, devendo ser criados novos modelos semelhantes ao que será visto num paciente.OBJETIVOS: Demonstrar a criação e a utilização de um modelo de gelatina para o treinamento da punção ecoguiada por ultrassom.MÉTODOS: Modelo criado através da mistura de água com gelatina incolor num recipiente plástico transparente com dois orifícios de diferentes diâmetros, nos quais foram colocados dois canos plásticos simulando os vasos sanguíneos.RESULTADOS: O modelo proposto se aproxima da realidade do procedimento médico em vários aspectos, pois a consistência da gelatina é próxima aos tecidos humanos, promovendo a preservação da sensação tátil ao atingir o interior do vaso e durante a aspiração do conteúdo.CONCLUSÕES: O método proposto permite criar um modelo de baixo custo e fácil confecção utilizando-se materiais de uso cotidiano para treino de punção ecoguiada em larga escala.

La Neonatología, primera Área de Capacitación Específica de la Pediatría en Espana / Neonatology, the First Specific Training Area of Paediatrics in Spain

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Parish apprenticeship and the old poor law in London.

This article offers an examination of the patterns and motivations behind parish apprenticeship in late eighteenth- and early nineteenth-century London. It stresses continuity in outlook from parish officials binding children, which involved placements in both the traditional and industrializing sectors of the economy. Evidence on the ages, employment types, and locations of 3,285 pauper apprentices bound from different parts of London between 1767 and 1833 indicates a variety of local patterns. The analysis reveals a pattern of youthful age at binding, a range of employment experiences, and parish-specific links to particular trades and manufactures.

Strengthening Indonesia's Field Epidemiology Training Programme to address International Health Regulations requirements.

PROBLEM: According to the International Health Regulations (IHR), countries need to strengthen core capacity for disease surveillance and response systems. Many countries are establishing or enhancing their field epidemiology training programmes (FETPs) to meet human resource needs but face challenges in sustainability and training quality. Indonesia is facing these challenges, which include limited resources for field training and limited coordination in a newly decentralized health system. APPROACH: A national FETP workplan was developed based on an evaluation of the existing programme and projected human resource needs. A Ministry of Health Secretariat linking universities, national and international partners was established to oversee revision and implementation of the FETP. LOCAL SETTING: The FETP is integrated into the curriculum of Indonesian universities and field training is conducted in district and provincial health offices under the coordination of the universities and the FETP Secretariat. RELEVANT CHANGES: The FETP was included in the Ministry of Health workforce development strategy through governmental decree. Curricula have been enhanced and field placements strengthened to provide trainees with better learning experiences. To improve sustainability of the FETP, links were established with the Indonesian Epidemiologists' Association, local governments and donors to cultivate future FETP champions and maintain funding. Courses, competitions and discussion forums were established for field supervisors and alumni. These changes have increased the geographic distribution of students, intersectoral and international participation and the quality of student performance. LESSONS LEARNT: The main lesson learnt is that linkages with universities, ministries and international agencies such as the World Health Organization are critical for building a sustainable high-quality programme. The most critical factors were development of trusting relationships and clear definitions of the responsibilities of each stakeholder.

Generalized public health and industrial nurses work together. 1949.

Occupational health has been considered a subset of public health nursing for years. The first industrial or occupational health nurses were employed by large companies in the 1890s but the role evolved quickly in the early 20(th) century. By mid-century, many large companies employed a physician and nurse(s) to provide examinations, screenings, episodic care, and trauma intervention for workers. Occupational health nurses faced different problems than community-based public health nurses in generalized nursing service. The intersection of public health and employee health was apparent, though, because large industries often constituted the main workplace for a smaller community and sickness could spread throughout a town if the occupational health nurse was not well-prepared in principles of infection control and health promotion. Excerpts from this July 1949 article about building relationship between public health and industrial nurses illustrate the benefits hoped for when they were formally connected to one another through cross-training and in-service education. The author, Margaret Schwem, was a supervisor at the Rensselaer County Department of Health in Troy, New York. In the original article, Schwem included a list of reference materials for those interested in public health and industrial nursing.

Poverty alleviation in Nigeria: lessons from socioeconomic thoughts of the Yoruba.

Nigeria is the 13th largest oil producer in the world. Yet about 56 per cent of the total population lives in absolute poverty. This article confronts conventional theories of poverty with the indigenous thoughts of the Yoruba (one of the three major ethnic groups in Nigeria). Darwinian, individualistic, cultural, situational and structural theories of poverty associate it either with individual-case or economy-wide factors. Approaching anti-poverty strategy through individual-related factors (such as training the unskilled poor) without due consideration to the economy-wide factors (such as job creation for the poor) ends up redistributing rather than actually reducing aggregate poverty. The analysis of poverty-related proverbs of the Yoruba reveals a consistency between the conventional theories and what the Yoruba think about poverty. The Yoruba believe in chronic (osi) versus transitory (ise) poverty, associated with suffering. They believe that poor people can escape the poverty trap through their own personal efforts (such as by developing a positive work attitude, working hard and reducing their family size) along with the help of support systems (such as job creation and food security). The Yoruba believe that job creation is the best anti-poverty strategy. They further believe that by removing hunger, poverty becomes insignificant. Based on these two axioms, this article suggests that attention be paid to job creation and food security for the poor. It also recommends that studies of the socioeconomic thought of the other major Nigerian tribes with respect to poverty be undertaken, so as to arrive at nationally and culturally derived anti-poverty strategies in Nigeria.

A brief history. Heading for a half century.

The history of NHS management can be viewed as five milestones of reorganisation. The trend of managers being more concerned with patient care started with the 1983 Griffiths inquiry. Leaders from other industries came into the NHS but many underestimated the job and failed. Stress makes many current chief executive posts hard to fill.

[Culture and nutrition. Dietetics in hospital nursing during the 17 century]. / Cultura y alimentación. Dietética en la enfermería hospitalaria en el siglo XVII.

Starting from the important role which feeding and dietetics play in our culture and specifically in activities such as medicine and nursing, this article analyzes aspects like 1., the place of dietetics and feeding found in two manuals, "Instructions for nurses to apply remedies to all kinds of illnesses" and "To attend to many accidents which in the absence of Doctors"; 2., the importance of diets in hospitals throughout the 17th century; 3., the work by nurses related to diets and alimentation during that epoch and the professional training received by these professionals in this regard.