Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures.

Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 ± 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 ± 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 ± 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 ± 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 ± 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 ± 6.36 in 4 th postoperstive month, and of 92.35 ± 5.48 in the 8 th postoperative month, which was statistically significant. The mean DASH score was of 9.94 ± 1.55 in the 4 th postoperative month, and of 5.29 ± 1.85 in the 8 th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.

Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures / Osteossíntese minimamente invasiva com placa para fraturas de clavícula

Abstract Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 6.36 in 4th postoperstive month, and of 92.35 5.48 in the 8th postoperative month, which was statistically significant. The mean DASH score was of 9.94 1.55 in the 4th postoperative month, and of 5.29 1.85 in the 8th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.

Resumo Objetivo Analisar o resultado radiológico, clínico e funcional das fraturas da clavícula, tratadas pela técnica de osteossíntese com placa minimamente invasiva (MIPO). Métodos De junho de 2018 a julho de 2019, um total de 17 casos de fraturas claviculares foram tratadas com a técnica de osteossíntese com placa minimamente invasiva (MIPO), sob fluoroscopia com o braço em C. Os resultados funcionais foram avaliados por meio do escore de Constant-Murley e pelo escore de incapacidade do braço, ombro e mão (DASH). Foram analisados os resultados clínicos de consolidação, complicações, tempo cirúrgico, permanência hospitalar e infecção. Resultados O tempo médio de acompanhamento neste estudo foi de 10,41 1,75 meses (variação, 8 a 14 meses). Havia 11 pacientes do sexo masculino e seis do feminino, com média de idade de 39,05 10,76 anos (variação de 22 a 57 anos). Todas as fraturas se consolidaram no tempo médio de 15,35 3,08 semanas (variação, 12 a 20 semanas). O tempo cirúrgico médio foi de 98,11 13,83 minutos (variação, 70 a 130), sendo a permanência hospitalar média de 4,7 1,12 dias (variação de 3 a 7). O escore de Constant-Murley médio foi de 74,82 6,36 no 4° mês e 92,35 5,48 no 8° mês do pós-operatório, o que foi estatisticamente significativo. O escore DASH médio foi de 9,94 1,55 no 4° mês e 5,29 1,85 na 8ª semana do pós-operatório, também sendo estatisticamente significativo. Um paciente apresentou infecção cutânea superficial no local da incisão. Conclusões A técnica MIPO é um método alternativo para a fixação de fraturas da clavícula, porém é tecnicamente mais desafiador, já que necessita de instalações cirúrgicas mais bem equipadas.

Optimization and scale-up of α-amylase production by Aspergillus oryzae using solid-state fermentation of edible oil cakes.

BACKGROUND: Amylases produced by fungi during solid-state fermentation are the most widely used commercial enzymes to meet the ever-increasing demands of the global enzyme market. The use of low-cost substrates to curtail the production cost and reuse solid wastes are seen as viable options for the commercial production of many enzymes. Applications of α-amylases in food, feed, and industrial sectors have increased over the years. Additionally, the demand for processed and ready-to-eat food has increased because of the rapid growth of food-processing industries in developing economies. These factors significantly contribute to the global enzyme market. It is estimated that by the end of 2024, the global α-amylase market would reach USD 320.1 million (Grand View Research Inc., 2016). We produced α-amylase using Aspergillus oryzae and low-cost substrates obtained from edible oil cake, such as groundnut oil cake (GOC), coconut oil cake (COC), sesame oil cake (SOC) by solid-state fermentation. We cultivated the fungus using these nutrient-rich substrates to produce the enzyme. The enzyme was extracted, partially purified, and tested for pH and temperature stability. The effect of pH, incubation period and temperature on α-amylase production using A. oryzae was optimized. Box-Behnken design (BBD) of response surface methodology (RSM) was used to optimize and determine the effects of all process parameters on α-amylase production. The overall cost economics of α-amylase production using a pilot-scale fermenter was also studied. RESULTS: The substrate optimization for α-amylase production by the Box-Behnken design of RSM showed GOC as the most suitable substrate for A. oryzae, as evident from its maximum α-amylase production of 9868.12 U/gds. Further optimization of process parameters showed that the initial moisture content of 64%, pH of 4.5, incubation period of 108 h, and temperature of 32.5 °C are optimum conditions for α-amylase production. The production increased by 11.4% (10,994.74 U/gds) by up-scaling and using optimized conditions in a pilot-scale fermenter. The partially purified α-amylase exhibited maximum stability at a pH of 6.0 and a temperature of 55 °C. The overall cost economic studies showed that the partially purified α-amylase could be produced at the rate of Rs. 622/L. CONCLUSIONS: The process parameters for enhanced α-amylase secretion were analyzed using 3D contour plots by RSM, which showed that contour lines were more oriented toward incubation temperature and pH, having a significant effect (p < 0.05) on the α-amylase activity. The optimized parameters were subsequently employed in a 600 L-pilot-scale fermenter for the α-amylase production. The substrates were rich in nutrients, and supplementation of nutrients was not required. Thus, we have suggested an economically viable process of α-amylase production using a pilot-scale fermenter.

Perception of Students and Faculty on Problem Based Learning in Proficiency Certificate Level Nursing Program.

BACKGROUND: Patan Academy of Health Sciences intended to implement problem based learning in proficiency certificate level nursing program who have just completed grade 10. Presently in Nepal, the available literature on use of problem based learning as teaching learning methods is limited to undergraduate medicine who have passed 10+2 or equivalent. It was conducted to measure the perception of students and faculty on problem based learning in nursing program. METHODS: Nursing faculty who have been involved in teaching learning of nursing curriculum were trained to conduct problem based learning and write problem based learning case. Prior to run problem based learning case, students were also oriented for the problem based learning process. A 44 students and seven faculty returned the filled data collection tool. RESULTS: Both the students and tutors perceived that the problem based learning is an effective teaching learning method. They also found that the attributes of problem based learning such as self-directed learning, collaborative learning, team work and fun learning. Students were eager to have more problem based learning session in their curriculum. Faculty also perceived that problem based learning can be a better teaching learning methods and it can be implemented in proficiency certificate level nursing. CONCLUSIONS: This study shows the acceptance of problem based learning as a teaching learning methods in proficiency certificate level nursing program by both the students and faculty.

Standardizing the approach to late onset sepsis in neonates through antimicrobial stewardship: a quality improvement initiative.

BACKGROUND: Antibiotics are the most prescribed medication in the neonatal intensive care unit (NICU) and there is marked variation in their use. While they are vital for treatment of infections, they put infants at risk for infections with drug resistant organisms, alteration in their microbiome and several other morbidities. Specific guidelines for neonates are often lacking and our NICU is not compliant with late onset sepsis (LOS) guidelines. OBJECTIVE: By January 2019, there will be >75% compliance with our LOS bundle for any infant admitted to Tampa General Hospital's (TGH) NICU undergoing a LOS evaluation at >72 h of life. The bundle includes documented reason for LOS evaluation, appropriate initial antibiotic selection, appropriate initial evaluation considered, and appropriate de-escalation of antibiotics. STUDY DESIGN: The project was implemented in the NICU at TGH, the academic medical center affiliated with the University of South Florida in Tampa, FL. The multidisciplinary antimicrobial stewardship (ASP) team responsible for the project consists of a neonatology attending, three neonatology fellows, a pediatric infectious disease attending, and two NICU pharmacists. The project was started in January 2017 and all data were collected prospectively. We implemented multiple Plan-Do-Study-Act cycles in a stepwise manner; outcome measures included compliance with the LOS bundle and ASP team recommendations. Our process measures were the documented reason for sepsis evaluation, appropriate initial evaluation considered, appropriate antibiotic selection and appropriate antibiotic de-escalation. Patient length of stay was the balancing measure studied. RESULTS: During this 20-month initiative, there were 232 infants who underwent LOS evaluation and there were 98 true positive cultures from blood (28%), urine (35%), and cerebrospinal fluid (3%). Commonly documented rationales for treatment of culture negative sepsis were clinical pneumonia (38%) and necrotizing enterocolitis (38%). Common indications for LOS evaluations were increased respiratory support (51%) and abdominal distension (17%). There was improvement in appropriate initial antibiotic selection (70% vs. 94%); appropriate consideration of initial evaluation (63% vs. 94%, respectively); appropriate de-escalation of antibiotics (86% vs. 100%, respectively) and increase in LOS bundle compliance (44% vs. 87%, respectively). The overall antibiotic utilization rate and length of treatment did not change significantly. CONCLUSIONS: Developing and engaging a NICU ASP team improves compliance with late onset sepsis guidelines through the implementation of a LOS bundle of care.

Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children.

Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing. Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6-12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome. Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail ( n = 2), superficial nail insertion site infection ( n = 2), and backing out of the ulnar nail ( n = 1), requiring early removal. Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications.

Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children / Fixação intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças

Abstract Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing. Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6-12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome. Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail (n = 2), superficial nail insertion site infection (n = 2), and backing out of the ulnar nail (n = 1), requiring early removal. Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications.

Resumo Objetivos A maioria das fraturas dos ossos do antebraço em crianças é tratada com sucesso de forma conservadora com redução fechada e imobilização gessada. No entanto, alguns pacientes podem necessitar de manipulação adicional da fratura ou intervenção cirúrgica devido a angulações residuais. O presente estudo avalia o resultado clinico e radiológico do tratamento de fraturas com desvio do antebraço em crianças fixadas com haste elástica intramedular de titânio. Métodos Um total de 31 pacientes com idades entre 7 e 15 anos com fraturas com desvio do antebraço foram submetidos a haste elástica de titânio flexível. Os pacientes foram acompanhados por um período médio de 8,51 meses (variação: 6-12 meses) e avaliados quanto aos resultados funcionais pelos critérios de Price e radiológicos. Resultados Dos 31 pacientes, 21 foram submetidos a redução fechada e 10 necessitaram de abertura mínima do local da fratura durante a redução. Um total de 29 pacientes tiveram excelentes resultados com arco de movimento normal, e 2 pacientes apresentaram bons resultados. Em todos os pacientes, a consolidação ocorreu em um tempo médio de 7,9 semanas. Cinco pacientes tiveram complicações menores, como irritação da pele sobre a haste proeminente (n = 2), infecção superficial do local de inserção no rádio (n = 2) e recuo da haste ulnar (n = 1), que exigiu remoção precoce. Conclusão A haste flexível é um método eficiente para tratamento da fratura do antebraço em crianças, permitindo mobilização precoce e retorno às atividades normais dos pacientes, com baixas e tratáveis complicações.

Bilateral symmetrical synovial chondromatosis of shoulder: a case report / Condromatose sinovial simétrica bilateral do ombro: relato de caso

ABSTRACT Synovial chondromatosis is a benign arthropathy rarely seen in diarthrodial joints. Extra-articular bilateral symmetrical synovial chondromatosis of shoulder is the rarest variety. The diagnosis is established with the help of imaging modalities and histopathological examinations. This report describes a case of a 39-year-old woman who presented with symmetrical, progressively increasing swelling over the bilateral shoulder region, of 12-18 months duration, with dull ache and restricted movements of the shoulder joints. Magnetic resonance imaging (MRI) and ultrasonography (USG) revealed large bilateral subacromial-subdeltoid bursal swelling with loose floating bodies. Surgical excision of extensive bilateral bursa was performed at four weeks of interval. Histopathological examination revealed synovial chondromatosis on either side. Postoperative recovery occurred without complications.

RESUMO A condromatose sinovial é uma artropatia benigna raramente vista em articulações diartrodiais. A condromatose sinovial simétrica bilateral extra-articular do ombro é a variedade mais rara. O diagnóstico é estabelecido com a ajuda de exames de imagem e histopatológicos. Este relato descreve o caso de uma paciente de 39 anos, com aumento de volume progressivo simétrico sobre a região bilateral do ombro com 12-18 meses de duração com dor entorpecido e limitação dos movimentos das articulações do ombro. A ressonância magnética e a ultrassonografia revelaram um grande aumento de volume da bursa subacromial subdeltoidea bilateral com corpos livres flutuantes. A excisão cirúrgica extensa da bursa bilateral foi feita com quatro semanas de intervalo. O exame histopatológico revelou condromatose sinovial em ambos os lados. A recuperação pós-operatória transcorreu sem complicações.

Bilateral symmetrical synovial chondromatosis of shoulder: a case report.

Synovial chondromatosis is a benign arthropathy rarely seen in diarthrodial joints. Extra-articular bilateral symmetrical synovial chondromatosis of shoulder is the rarest variety. The diagnosis is established with the help of imaging modalities and histopathological examinations. This report describes a case of a 39-year-old woman who presented with symmetrical, progressively increasing swelling over the bilateral shoulder region, of 12-18 months duration, with dull ache and restricted movements of the shoulder joints. Magnetic resonance imaging (MRI) and ultrasonography (USG) revealed large bilateral subacromial-subdeltoid bursal swelling with loose floating bodies. Surgical excision of extensive bilateral bursa was performed at four weeks of interval. Histopathological examination revealed synovial chondromatosis on either side. Postoperative recovery occurred without complications.

A condromatose sinovial é uma artropatia benigna raramente vista em articulações diartrodiais. A condromatose sinovial simétrica bilateral extra-articular do ombro é a variedade mais rara. O diagnóstico é estabelecido com a ajuda de exames de imagem e histopatológicos. Este relato descreve o caso de uma paciente de 39 anos de idade, com aumento de volume progressivo simétrico sobre a região bilateral do ombro com 12-18 meses de duração com dor entorpecido e limitação dos movimentos das articulações do ombro. A ressonância magnética e a ultrassonografia revelaram um grande aumento de volume da bursa subacromial subdeltoidea bilateral com corpos livres flutuantes. A excisão cirúrgica extensa da bursa bilateral foi realizada com quatro semanas de intervalo. O exame histopatológico revelou condromatose sinovial em ambos os lados. A recuperação pós-operatória transcorreu sem complicações.

Demonstration of acid and water recovery systems: Applicability and operational challenges in Indian metal finishing SMEs.

Diffusion dialysis, acid retardation and nanofiltration plants were acquired from Europe and demonstrated in several Indian metal finishing companies over a three year period. These companies are primarily small and medium enterprises (SMEs). Free acid recovery rate from spent pickling baths using diffusion dialysis and retardation was in the range of 78-86% and 30-70% respectively. With nanofiltration, 80% recovery rate of rinse water was obtained. The demonstrations created awareness among the metal finishing companies to reuse resources (acid/water) from the effluent streams. However, lack of efficient oil separators, reliable chemical analysis and trained personnel as well as high investment cost limit the application of these technologies. Local manufacturing, plant customization and centralized treatment are likely to encourage the uptake of such technologies in the Indian metal finishing sector.

Concentrating molasses distillery wastewater using biomimetic forward osmosis (FO) membranes.

Treatment of sugarcane molasses distillery wastewater is challenging due to the presence of complex phenolic compounds (melanoidins and polyphenols) having antioxidant properties. Due to zero liquid discharge regulations, Indian distilleries continue to explore effective treatment options. This work examines the concentration of distillery wastewater by forward osmosis (FO) using aquaporin biomimetic membranes and magnesium chloride hexahydrate (MgCl2.6H2O) as draw solution. The operational parameters viz. feed solution and draw solution flow rate and draw solution concentration were optimized using 10% v/v melanoidins model feed solution. This was followed by trials with distillery wastewater. Under the conditions of this work, feed and draw flow rates of 1 L/min and draw solution concentration of 2M MgCl2.6H2O for melanoidins model solution and 3M MgCl2.6H2O for distillery wastewater were optimal for maximum rejection. Rejection of 90% melanoidins, 96% antioxidant activity and 84% COD was obtained with melanoidins model feed, with a corresponding water flux of 6.3 L/m2h. With as-received distillery wastewater, the rejection was similar (85-90%) to the melanoidins solution, but the water flux was lower (2.8 L/m2h). Water recovery from distillery wastewater over 24 h study period was higher with FO (70%) than reported for RO (35-45%). Repeated use of the FO membrane over five consecutive 24 h cycles with fresh feed and draw solutions and periodic cleaning showed consistent average water flux and rejection of the feed constituents.

Assessment of Total Antioxidant Capacity and Antimicrobial Activity of Glycyrrhiza glabra in Saliva of HIV-Infected Patients.

OBJECTIVES: The objectives of this study were to evaluate the antimicrobial activity and total antioxidant capacity (TAC) of licorice in Saliva of HIV/AIDS patients. MATERIALS AND METHODS: Saliva specimens were collected from 20 people living with HIV infection, with CD4 count <500 cells/mm3 from people infected with HIV/AIDS in Mangalore city, India. A combination of amoxicillin-clavulanic acid and nystatin was taken as the positive control and normal saline as negative control. Results were compared using one-way analysis of variance followed by Tukey's post hoc analysis in SPSS 19. RESULTS: The TAC was evaluated spectrophotometrically at 695nm using the phosphomolybdenum method. Glycyrrhiza glabra showed a statistically significant reduction (P < 0.05) in total Candida count. The TAC of G. glabra was found to be 4.467 mM/L. CONCLUSIONS: G. glabra extracts showed good anticandidal activity and also high antioxidant property which reduces the oxidative stress of HIV-infected people.

Activated carbon from sugarcane bagasse ash for melanoidins recovery.

This work investigates the value added utilization of two sugar-distillery wastes: (i) melanoidins, which are complex Maillard reaction products in molasses distillery wastewater, and (ii) unburnt carbon in sugarcane bagasse ash. Activated unburnt carbon (AUC), prepared by deashing and steam activation, had properties comparable to commercial activated carbon (CAC). Both carbons are suitable for melanoidins adsorption followed by desorption using 25% pyridine solution. For AUC, the equilibrium adsorption data is well described by Langmuir isotherm up to 35 °C while Freundlich model fits better at higher temperature. Adsorption using CAC followed Freundlich isotherm at all temperatures. Both carbons followed pseudo second order kinetics and displayed endothermic physisorption. Recovery of melanoidins from AUC (78%) was close to that observed with CAC (80%).

Promoting teamwork may improve infant care processes during delivery room management: Florida perinatal quality collaborative's approach.

BACKGROUND: LOCAL PROBLEM: Inadequate understanding of compliance with standardized evidence-based DR management. INTERVENTIONS: Promote inter-professional teamwork and a bundle of interventions focusing on resuscitation team roles, equipment check, and debriefing using QI methodology. Optimize delivery room (DR) management to achieve 10-min SPO2 targets, delayed-cord clamping (DCC), team role assignment and debriefings in >50% of deliveries, and achieve normothermia in >75% of infants. METHODS: Over 15 months (Epoch 1 to 5), nine Florida hospitals implemented a DR management plan for infants <31 weeks gestational age or <1500 g (N=814) using quality improvement methodology. RESULTS: There was increased compliance of DCC (36 to 66%), role assignment (53 to 98%), debriefing rates (33 to 76%) and having all seven pre-delivery preparedness components fulfilled (34 to 75%). There were no significant improvements in admission temperatures or SPO2 targeting. When 7 vs 0 items of pre-delivery preparedness were completed, we saw improvements in thermoregulation (57% vs 72%), SPO2 targeting (60% vs 78%) and DCC compliance (43 to 67%). CONCLUSION: Promoting teamwork by increasing pre-delivery preparedness is associated with improvement of thermoregulation, SPO2 targeting and DCC compliance.

Assistive technology solutions for aiding travel of pedestrians with visual impairment.

This work systematically reviews the assistive technology solutions for pedestrians with visual impairment and reveals that most of the existing solutions address a specific part of the travel problem. Technology-centered approach with limited focus on the user needs is one of the major concerns in the design of most of the systems. State-of-the-art sensor technology and processing techniques are being used to capture details of the surrounding environment. The real challenge is in conveying this information in a simplified and understandable form especially when the alternate senses of hearing, touch, and smell have much lesser perception bandwidth than that of vision. A lot of systems are at prototyping stages and need to be evaluated and validated by the real users. Conveying the required information promptly through the preferred interface to ensure safety, orientation, and independent mobility is still an unresolved problem. Based on observations and detailed review of available literature, the authors proposed that holistic solutions need to be developed with the close involvement of users from the initial to the final validation stages. Analysis reveals that several factors need serious consideration in the design of such assistive technology solutions.

Vaccine Safety and Pharmacovigilance in the African Region

In recent years the WHO African Region has seen a growth in clinical development of new vaccines as well as their introduction into the national immunization programmes of many countries. Recognizing the critical need for vaccine safety and pharmacovigilance; WHO has been supporting individual and institutional capacity building in the Region to strengthen the monitoring and response to adverse events following immunization through implementation of the Global Vaccine Safety Blueprint. This framework is discussed along with general points about the importance of ensuring vaccine safety and the system needed to enable this. The article ends with a brief overview of the status of vaccine safety and pharmacovigilance and the key priorities for countries in the Region for the immediate future