The impact of digital technology in care homes on unplanned secondary care usage and associated costs.

BACKGROUND: A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. METHODS: A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. FINDINGS: Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6-15%], emergency admissions by 25% [20-39%] and length of stay by 11% [3-18%] (with an additional month-by-month decrease of 28% [24-34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. INTERPRETATION: The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents.

Sharing real-world data for public benefit: a qualitative exploration of stakeholder views and perceptions.

BACKGROUND: There has been an increasing interest in the use of "real-world" data to inform care decision making that could lead to public health benefit. Routinely collected service and activity data associated with the administration of care services and service-users (such as electronic health records or electronic social care records), hold potential to better inform effective and responsive decision-making about health and care services provided to national and local populations. This study sought to gain an in-depth understanding regarding the potential to unlock real world data that was held in individual organisations, to better inform public health decision-making. This included sharing data between and within health service providers and local governing authorities, but also with university researchers to inform the evidence base. METHODS: We used qualitative methods and carried out a series of online workshops and interviews with stakeholders (senior-level decision-makers and service leads, researchers, data analysts, those with a legal and governance role, and members of the public). We identified recurring themes in initial workshops, and explored these with participants in subsequent workshops. By this iterative process we further refined the themes identified, compared views and perceptions amongst different stakeholder groups, and developed recommendations for action. RESULTS: Our study identified key elements of context and timing, the need for a different approach, and obstacles including governmental and legal, organisational features, and process factors which adversely affect the sharing of real world data. The findings also highlighted a need for improved communication about data for secondary uses to members of the public. CONCLUSION: The Covid-19 pandemic context and changes to organisational structures in the health service in England have provided opportunities to address data sharing challenges. Change at national and local level is required, within current job roles and generating new jobs roles focused on the use and sharing of real-world data. The study suggests that actions can be taken to unlock the potential of real-world data for public health benefit, and provides a series of recommendations at a national level, for organisational leaders, those in data roles and those in public engagement roles.

A Visual-Vestibular Model to Predict Motion Sickness for Linear and Angular Motion.

OBJECTIVE: This study proposed a model to predict passenger motion sickness under the presence of a visual-vestibular conflict and assessed its performance with respect to previously recorded experimental data. BACKGROUND: While several models have been shown useful to predict motion sickness under repetitive motion, improvements are still desired in terms of predicting motion sickness in realistic driving conditions. There remains a need for a model that considers angular and linear visual-vestibular motion inputs in three dimensions to improve prediction of passenger motion sickness. METHOD: The model combined the subjective vertical conflict theory and human motion perception models. The proposed model integrates visual and vestibular sensed 6 DoF motion signals in a novel architecture. RESULTS: Model prediction results were compared to motion sickness data obtained from studies conducted in motion simulators as well as on-road vehicle testing, yielding trends that are congruent with observed results in both cases. CONCLUSION: The model demonstrated the ability to predict trends in motion sickness response for conditions in which a passenger performs a task on a handheld device versus facing forward looking ahead under realistic driving conditions. However, further analysis across a larger population is necessary to better assess the model's performance. APPLICATION: The proposed model can be used as a tool to predict motion sickness under different levels of visual-vestibular conflict. This can be leveraged to design interventions capable of mitigating passenger motion sickness. Further, this model can provide insights that aid in the development of passenger experiences inside autonomous vehicles.

Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system.

BACKGROUND: COVID-19 pandemic responses impacted behaviour and health services. We estimated the impact on incidence, stage and healthcare pathway to diagnosis for female breast, colorectal and non-small cell lung cancers at population level in Wales. METHODS: Cancer e-record and hospital admission data linkage identified adult cases, stage and healthcare pathway to diagnosis (population ~2.5 million). Using multivariate Poisson regressions, we compared 2019 and 2020 counts and estimated incidence rate ratios (IRR). RESULTS: Cases decreased 15.2% (n = -1011) overall. Female breast annual IRR was 0.81 (95% CI: 0.76-0.86, p < 0.001), colorectal 0.80 (95% CI: 0.79-0.81, p < 0.001) and non-small cell lung 0.91 (95% CI: 0.90-0.92, p < 0.001). Decreases were largest in 50-69 year olds for female breast and 80+ year olds for all cancers. Stage I female breast cancer declined 41.6%, but unknown stage increased 55.8%. Colorectal stages I-IV declined (range 26.6-29.9%), while unknown stage increased 803.6%. Colorectal Q2-2020 GP-urgent suspected cancer diagnoses decreased 50.0%, and 53.9% for non-small cell lung cancer. Annual screen-detected female breast and colorectal cancers fell 47.8% and 13.3%, respectively. Non-smal -cell lung cancer emergency presentation diagnoses increased 9.5% (Q2-2020) and 16.3% (Q3-2020). CONCLUSION: Significantly fewer cases of three common cancers were diagnosed in 2020. Detrimental impacts on outcomes varied between cancers. Ongoing surveillance with health service optimisation will be needed to mitigate impacts.

A parametric modeling of adult body shape in a supported seated posture including effects of age.

Statistical body shape models (SBSM) provide compact, flexible representations of body shape that can be implemented in design software. However, few SBSMs have been created to represent adults in supported seated postures that are relevant for the design of seated environments, and none has incorporated the effects of age. This paper presents an SBSM based on surface laser-scan data from 155 U.S. adults. The data were processed to obtain homologous mesh structure and symmetric geometry, and the processed data were statistically analysed using principal component analysis to obtain a compact representation of the data variance. Regression analysis was conducted to predict body size and shape from stature, body mass index, ratio of sitting height to stature, sex, and age. The resulting model allows rapid generation of realistic body models for applications, including product design, accommodation assessment, and safety system optimisation. The model is publicly accessible at HumanShape.org. Practitioner summary: This paper presents a statistical model that represents adult body shapes in a supported seated posture based on 3 D anthropometric measurements. This model is the first whole-body parametric model known to incorporate age effects based on data extending beyond 65 years of age.

Post-Drive Standing Balance of Vehicle Passengers Using Wearable Sensors: The Effect of On-Road Driving and Task Performance.

Postural sway has been demonstrated to increase following exposure to different types of motion. However, limited prior studies have investigated the relationship between exposure to normative on-road driving conditions and standing balance following the exposure. The purpose of this on-road study was to quantify the effect of vehicle motion and task performance on passengers' post-drive standing balance performance. In this study, trunk-based kinematic data were captured while participants performed a series of balance exercises before and after an on-road driving session in real-time traffic. Postural sway for all balance exercises increased following the driving session. Performing a series of ecologically relevant visual-based tasks led to increases in most post-drive balance metrics such as sway position and velocity. However, the post-drive changes following the driving session with a task were not significantly different compared to changes observed following the driving session without a task. The post-drive standing balance performance changes observed in this study may increase vulnerable users' risk of falling. Wearable sensors offer an opportunity to monitor postural sway following in-vehicle exposures.

Static, Dynamic, and Cognitive Fit of Exosystems for the Human Operator.

OBJECTIVE: To define static, dynamic, and cognitive fit and their interactions as they pertain to exosystems and to document open research needs in using these fit characteristics to inform exosystem design. BACKGROUND: Initial exosystem sizing and fit evaluations are currently based on scalar anthropometric dimensions and subjective assessments. As fit depends on ongoing interactions related to task setting and user, attempts to tailor equipment have limitations when optimizing for this limited fit definition. METHOD: A targeted literature review was conducted to inform a conceptual framework defining three characteristics of exosystem fit: static, dynamic, and cognitive. Details are provided on the importance of differentiating fit characteristics for developing exosystems. RESULTS: Static fit considers alignment between human and equipment and requires understanding anthropometric characteristics of target users and geometric equipment features. Dynamic fit assesses how the human and equipment move and interact with each other, with a focus on the relative alignment between the two systems. Cognitive fit considers the stages of human-information processing, including somatosensation, executive function, and motor selection. Human cognitive capabilities should remain available to process task- and stimulus-related information in the presence of an exosystem. Dynamic and cognitive fit are operationalized in a task-specific manner, while static fit can be considered for predefined postures. CONCLUSION: A deeper understanding of how an exosystem fits an individual is needed to ensure good human-system performance. Development of methods for evaluating different fit characteristics is necessary. APPLICATION: Methods are presented to inform exosystem evaluation across physical and cognitive characteristics.

Anthropometric Dimensions of Individuals With High Body Mass Index.

OBJECTIVE: This study presents anthropometric data for individuals with high body mass index (BMI). Modified anthropometric dimensions were also developed to address the challenges of obtaining accurate and repeatable data for this population segment. BACKGROUND: The prevalence of obesity affects approximately 40% of the U.S. adult population. Anthropometric data are needed to guide product design and safety, but few individuals with high BMI have been measured in available datasets. METHOD: Anthropometric data for a convenience sample of 288 adults with high BMI (≥30 kg/m2) were collected. To increase participation and minimize participant discomfort, measurements were collected at three bariatric weight loss clinics and one academic research institution. RESULTS: The current obese cohort are heavier than the U.S. general population, with a difference in mean body weight of 47 kg for women and 56 kg for men. The obese cohort are also heavier and have a higher BMI compared with the NIOSH (National Institute for Occupational Safety and Health) truck driver population. Waist circumferential measures of the current obese cohort were larger than women or men in either population compared, a result indicative of meaningful body shape differences. CONCLUSION: To our knowledge, this study is the first to collect anthropometric data for the obese population segment and conduct comparisons to the U.S. general population and available occupational databases. The obese cohort differed substantially with respect to the distributions of anthropometric variables. APPLICATION: These data provide insights about the obese population segment that are relevant to product design, and establish a foundation for future data collection efforts.

Motion sickness in passenger vehicles during test track operations.

As automation transforms drivers into passengers, the deployment of automated vehicles (AVs) has the potential to greatly increase the incidence of motion sickness. A study was conducted to quantify motion sickness response of front-seat passengers performing ecologically relevant passenger activities during conditions consistent with driving on public roadways. Fifty-two adults with a large range of self-reported levels of motion sickness susceptibility and age participated in data collection on a closed test track in a passenger sedan. Motion sickness ratings increased with task vs. no-task and moderate vs. low acceleration test conditions. Increased motion sickness susceptibility was associated with higher motion sickness ratings. In comparison to older participants (age > 60), younger participants (age < 60) experienced increased motion sickness. This is the first in-vehicle study that systematically compared normative passenger activities and acceleration magnitudes typical of normative driving conditions on motion sickness response for a large, diverse sample of passengers, enabling the exploration of the effects of covariates. Practitioner summary: The data demonstrate that a relatively large range of motion sickness response can be expected to result from passengers performing visual tasks in passenger vehicles. Measurement and modelling efforts should seek to elucidate relationships among the factors contributing to motion sickness for the purpose of informing and prioritising future countermeasures for automated vehicles (AVs). Abbreviations: AV(S): automated vehicles; BMI: body mass index; BVP: blood volume pulse; EDA: electrodermal activity; FMS: fast motion sickness scale; GPS: global positioning system; IMU: inertial measurement unit; ISO: International Organization for Standardization; MISC: misery scale; MSDV: motion sickness dose value; NDS: naturalistic driving study; SAE: Society of Automotive Engineers International; UMTRI: The University of Michigan Transportation Research Institute Key Aspect of Research: Motion sickness may be an important barrier to widespread adoption of automated vehicles @UMTRI.

Evaluation of the biological activities of the IL-15 superagonist complex, ALT-803, following intravenous versus subcutaneous administration in murine models.

ALT-803 is a fusion protein complex consisting of an interleukin (IL)-15 superagonist and a dimeric IL-15 receptor alpha sushi domain IgG1 Fc fusion protein. When administered to mice, ALT-803 is capable of inducing natural killer (NK) and CD8+ T cell proliferation and activation, and effectively promoting potent anti-tumor responses. Currently, ALT-803 is in clinical trials for treatment of various solid tumors and hematological malignancies. In the initial phase of these clinical studies, intravenous (iv) injection was used according to the route used in pre-clinical efficacy studies. In order to evaluate the possible advantage of subcutaneous (sc) injection versus iv injection, this study compared the biological activity of the two treatment regimens of ALT-803 in pre-clinical in vivo models. The pharmacokinetics, immune stimulation, and anti-tumor efficacy of iv and sc injection routes of ALT-803 in C57BL/6 mice were compared. The half-life of ALT-803 was 7.5 h for iv versus 7.7 h for sc with the maximal detected serum concentration of ALT-803 to be 3926 ng/ml at 0.5 h time-point following iv injection versus 495 ng/ml at 16 h post sc injection. Biodistribution studies indicated that sc ALT-803, similarly to iv ALT-803 as previously reported, has a greater tissue distribution and longer residence time in lymphoid tissues compared to recombinant IL-15. Notably, ALT-803 when administered either iv or sc induced comparable proliferation and activation of CD8+ T and NK cells and resulted in similar reductions of tumor burden. A toxicity study of mice receiving multiple injections of ALT-803 for 4 weeks by iv or sc routes revealed equivalent immune-related changes. The gradual absorbance into the blood stream and lower maximal blood levels of ALT-803 in sc-injected mice, along with similar anti-tumor efficacy support the administration of ALT-803 by sc injection in patients with various malignancies and infectious diseases.

Antigen and lymphopenia-driven donor T cells are differentially diminished by post-transplantation administration of cyclophosphamide after hematopoietic cell transplantation.

Administration of cyclophosphamide after transplantation (post-transplantation cyclophosphamide, PTC) has shown promise in the clinic as a prophylactic agent against graft-versus-host disease (GVHD). An important issue with regard to recipient immune function and reconstitution after PTC is the extent to which, in addition to diminution of antihost allo-reactive donor T cells, the remainder of the nonhost allo-reactive donor T cell pool may be affected. To investigate PTC's effects on nonhost reactive donor CD8 T cells, ova-specific (OT-I) and gp100-specific Pmel-1 T cells were labeled with proliferation dyes and transplanted into syngeneic and allogeneic recipients. Notably, an intermediate dose (66 mg/kg) of PTC, which abrogated GVHD after allogeneic HSCT, did not significantly diminish these peptide-specific donor T cell populations. Analysis of the rate of proliferation after transplantation illustrated that lymphopenic-driven, donor nonhost reactive TCR Tg T cells in syngeneic recipients underwent slow division, resulting in significant sparing of these donor populations. In contrast, after exposure to specific antigens at the time of transplantation, these same T cells were significantly depleted by PTC, demonstrating the global susceptibility of rapidly dividing T cells after an encounter with cognate antigen. In total, our results, employing both syngeneic and allogeneic minor antigen-mismatched T cell replete models of transplantation, demonstrate a concentration of PTC that abrogates GVHD can preserve most cells that are dividing because of the accompanying lymphopenia after exposure. These findings have important implications with regard to immune function and reconstitution in recipients after allogeneic hematopoietic stem cell transplantation.

The effect of bracing availability on one-hand isometric force exertion capability.

Environmental obstructions that workers encounter can kinematically limit the postures that they can achieve. However, such obstructions can also provide an opportunity for additional support by bracing with the hand, thigh or other body part. The reaction forces on bracing surfaces, which are in addition to those acting at the feet and task hand, are hypothesised to improve force exertion capability, and become required inputs to biomechanical analysis of tasks with bracing. The effects of kinematic constraints and associated bracing opportunities on isometric hand force were quantified in a laboratory study of 22 men and women. Analyses of one-hand maximal push, pull and lift tasks demonstrated that bracing surfaces available at the thighs and non-task hand enabled participants to exert an average of 43% more force at the task hand. Task hand force direction deviated significantly from the nominal direction for exertions performed with bracing at both medium and low task hand locations. PRACTITIONER SUMMARY: This study quantifies the effect of bracing on kinematically constrained force exertions. Knowledge that appropriate bracing surfaces can substantially increase hand force is critical to the evaluation of task-oriented strength capability. Force estimates may also involve large off-axis components, which have clear implications for ergonomic analyses of manual tasks.

Navigating data governance associated with real-world data for public benefit: an overview in the UK and future considerations.

Real-world data encompass data primarily captured for the provision or operation of services, for example, electronic health records for direct care purposes, but which may have secondary uses for informing research or commissioning. Public benefit is potentially forfeited by the underutilisation of real-world data for secondary uses, in part due to risk aversion when faced with the prospect of navigating necessary and important data governance processes. Such processes can be perceived as complex, daunting, time-consuming and exposing organisations to risk. By providing an overview description and discussion around the role of six key legal and information governance frameworks and their role regarding responsible data access, linkage and sharing, our intention is to make data governance a less daunting prospect and reduce the perception that it is a barrier to secondary uses, thus enabling public benefit.

Hematopoietic progenitor cell regulation by CD4+CD25+ T cells.

CD4(+)CD25(+)FoxP3(+) regulatory T cells (Tregs) possess the capacity to modulate both adaptive and innate immune responses. We hypothesized that Tregs could regulate hematopoiesis based on cytokine effector molecules they can produce. The studies here demonstrate that Tregs can affect the differentiation of myeloid progenitor cells. In vitro findings demonstrated the ability of Tregs to inhibit the differentiation of interleukin-3 (IL-3)/stem cell factor (colony-forming unit [CFU]-IL3)-driven progenitor cells. Inhibitory effects were mediated by a pathway requiring cell-cell contact, major histocompatibility complex class II expression on marrow cells, and transforming growth factor-beta. Importantly, depletion of Tregs in situ resulted in enhanced CFU-IL3 levels after bone marrow transplantation. Cotransplantation of CD4(+)FoxP3(+)(gfp) Tregs together with bone marrow was found to diminish CFU-IL3 responses after transplantation. To address the consequence of transplanted Tregs on differentiated progeny from these CFU 2 weeks after hematopoietic stem cell transplantation, peripheral blood complete blood counts were performed and examined for polymorphonuclear leukocyte content. Recipients of cotransplanted Tregs exhibited diminished neutrophil counts. Together, these findings illustrate that both recipient and donor Tregs can influence hematopoietic progenitor cell activity after transplantation and that these cells can alter responses outside the adaptive and innate immune systems.

The whore gaze as the world burns: A conversation between PJ Starr, Monica Jones, The Incredible, Edible, Akynos and Bambi Katsura.

This illustrated conversation between The Incredible, Edible, Akynos, Monica Jones, PJ Starr and Bambi Katsura unpacks how we use media to continue our sex worker activism during the multiple pandemics of COVID-19, police violence and environmental disasters. We each bring our histories and theoretical innovations to the table including the framework of the 'Whore Gaze' developed by PJ, Monica's approach to documentary that ensures trans people narrate their own lives, Akynos' scripted film series Chronicles of a Black Heaux that may re-imagine the 'melomentary form' for sex worker representation and Bambi's experience as a filmmaker and curator. In our conversation, we discuss how we use film, photography, film festivals, animation and other forms for our activism to promote social justice. We also describe how we are systematically unlearning the codes of representation of research and human rights documentation, so that we can create materials that are accessible to our communities, to people with disabilities and be freed from the dead-end of respectability politics.

A naturalistic study of passenger seating position, posture, and restraint use in second-row seats.

OBJECTIVE: The objective of the current study was to increase scientific understanding of rear-seat passenger seating position, postures, CRS use, and belt use through a naturalistic study. A secondary objective was to compare data from vehicles used in ride-hailing with data from other vehicles. METHOD: Video cameras were installed in the passenger cabins of the vehicles of 75 drivers near the center of the windshield. The video data were downloaded after the vehicles were operated by their owners for two weeks. Video frames were sampled from near the ends and in the middle of each trip, and at five-minute intervals in trips longer than 15 min. A total of 7,323 frames with second-row passengers were manually coded. RESULTS: A total of 444 unique second-row passengers were identified in video frames from 1,188 trips taken in 65 of the 75 vehicles in the study. Two of the vehicles that were driven for commercial ride-hailing during the study period accounted for 199 (45%) of the passengers. Considering multiple passengers in some trips, a total of 1,899 passenger-trips were identified. For passengers not using child restraint systems (CRS), the belt use rate was 65% in the non-ride-hailing vehicles versus 32% among passengers in the ride-hailing vehicles. No CRS use was observed in the ride-hailing vehicles. Among children using backless boosters, the shoulder belt was lateral to the clavicle or under the arm in 26% of frames. Among belted passengers not using CRS, the belt was lateral to the clavicle or on the neck about 6% of the time. Belted passengers not using CRS were observed leaning to the left or right about 27% of the time, with leaning away from the shoulder belt more common than leaning into the belt. CONCLUSIONS: This study is the first to report seating position, posture, and belt fit observations for a large naturalistic sample of second-row passengers that includes adult occupants. The data suggest that low rear seat belt use rates remain a concern, particularly in ride-hailing vehicles. Non-nominal belt placement and posture may also be common in second-row seating positions.

A parametric head geometry model accounting for variation among adolescent and young adult populations.

BACKGROUND AND OBJECTIVE: Modeling the size and shape of human skull and scalp is essential for head injury assessment, design of helmets and head-borne equipment, and many other safety applications. Finite element (FE) head models are important tools to assess injury risks and design personal protective equipment. However, current FE head models are mainly developed based on the midsize male, failing to account for the significant morphological variation that exists in the skull and brain. The objective of this study was to develop a statistical head geometry model that accounts for size and shape variations among the adolescent and young adult population. METHODS: To represent subject-specific geometry using a homologous mesh, threshold-based segmentation of head CT scans of 101 subjects between 14 and 25 years of age was performed, followed by landmarking, mesh morphing, and projection. Skull and scalp statistical geometry models were then developed as functions of age, sex, stature, BMI, head length, head breadth, and tragion-to-top of head using generalized Procrustes analysis (GPA), principal component analysis (PCA) and multivariate regression analysis. RESULTS: The statistical geometry models account for a high percentage of morphological variations in scalp geometry (R2=0.63), outer skull geometry (R2=0.66), inner skull geometry (R2=0.55), and skull thickness (error < 1 mm) CONCLUSIONS: Skull and scalp statistical geometry models accounts for size and shape variations among the adolescent and young adult population were developed as functions of subject covariates. These models may serve as the geometric basis to develop individualized head FE models for injury assessment and design of head-borne equipment.

Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains.

OBJECTIVE: To explore the effect of personal protective equipment (PPE) fit on functional performance across a range of occupational domains. BACKGROUND: PPE introduces an ergonomic, human systems integration, and mass burden to the wearer, and these factors are thought to be amplified if PPE is ill-fitting. However, few studies have considered the role of fit (static, dynamic, and cognitive) when evaluating PPE-related performance detriments in occupational settings. METHOD: A systematic literature review was conducted to identify relevant studies, which were then critically appraised based on methodological quality and collated to compare key findings and present evidence-based recommendations for future research directions across a range of occupational domains. RESULTS: 16 published studies met the inclusion criteria, 88% of which found that the fit of PPE had a statistically significant effect on occupational performance. Poorly sized PPE resulted in slower or increased reaction time; decreased range of motion or mobility; decreased endurance or tolerance; decreased pulmonary function; and altered muscle activation. Limited research met the inclusion criteria and those that did had risks of bias in methodology quality. CONCLUSION: Future research evaluating the effect of PPE on performance in occupational settings should aim to recruit a more representative population; consider sex as a covariate; quantify and evaluate PPE fit and performance when integrated with all relevant equipment items; include outcome measures related to all three categories of fit (static, dynamic, cognitive); and assess performance of operationally relevant tasks.

Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme.

Introduction: The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Methods: Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Results: Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. Conclusion: There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.