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Context: In India, COVID-19 pandemic has limited the utilization and access to dental services owing to the risk of infections transmission. In this context, tele-dentistry could be useful but there is paucity of literature which provides guidance on the scope and challenges for using tele-dentistry in India. Aims: To identify challenges, scope and assessment approaches of tele-dentistry from an Indian perspective. Settings and Design: Scoping Review. Methods and Material: Scoping review was conducted using the Arksey and O’Malley framework. Databases were searched in July from April to August 2020. Studies concerning challenges and scope of tele-dentistry in India were included. Additionally, literature about assessment approaches used for tele-dentistry programs were also reviewed Results: A total of 64 studies were reviewed, out of which 26 articles were included in the final review. Scoping review reveled that tele-dentistry can act as a seamless tool for diagnosing, training and screening. Few studies suggested the relevance of smartphone technology for specialist consultations and proper diagnosis. Majority of studies revealed shortage of basic infrastructure as a major challenge for tele-dentistry in India. Assessment studies were mainly focused on economic perspective and cost-effectiveness of the programs. Conclusions: This review provide guidance for using tele-dentistry in India. It is also reflected that there is a need for further research about the assessment of tele-dentistry in terms of safety, clinical outcomes, and patient perception.

This Viewpoint discusses the structure of the National Academy of Medicine’s Scholars in Diagnostic Excellence program and the lessons learned from this national leadership incubator.

Nowadays, digital images have a valuable role in our daily life, and can be used for various of applications like fingerprint recognition, video surveillance etc. Sometimes, images get infected with noise due to many reasons such as defects in camera sensors, transmission in noisy channel, faulty memory locations in the hardware etc. Processing a noisy image is not advisable because usually it yields erroneous outcomes. So, as to improve it for subsequence processing, the noise must be eliminated from the image in advance. Therefore, there is a need of an efficient image denoising technique that helps to deal with noisy image. Image de-noising is a process to realign the original image from the degraded image. In this paper, autoencoders based deep learning model is proposed for image denoising. The autoencoders learns noise from the training images and then try to eliminate the noise for novel image. The experimental outcomes prove that this proposed model for PSNR has achieved higher result compared to the conventional models.

In situ simulation has emerged as a powerful tool for identifying latent safety threats (LSTs). After the first wave of the SARS-CoV-2 pandemic, an urban community emergency department (ED) identified opportunities for improvement surrounding acute airway management and particularly focused on infection control precautions, equipment availability, and interprofessional communication during acute resuscitation. Using the Model for Improvement, a hybrid in situ/quality improvement initiative was implemented using Plan-Do-Study-Act (PDSA) cycles to enhance systems for intubating patients with SARS-CoV-2.Three PDSA cycles consisting of 10 simulations each were conducted from June 2020 through February 2021. Latent safety threats (LST) were identified through an in situ simulation scenario involving a patient with SARS-CoV-2 in acute respiratory failure. LSTs were collected through structured debriefs focused on (1) infection control, (2) equipment availability, and (3) communication. The SAFER-Matrix was used to score LSTs according to frequency and likelihood of harm by members of the ED QI team (SAFER score). The research team worked with the same QI leaders to implement action plans based on scored threats using cause-and-effect and driver diagrams. The Donabedian model was used to conceptually evaluate the quality of interventions upon conclusion of the third PDSA cycle.The median SAFER score decreased from 10.94 in PDSA cycle 1 to 6.77 in PDSA cycle 2 to 4.71 in PDSA cycle 3. Across all identified LSTs, the SAFER score decreased by 3.114 for every additional PDSA cycle (P = 0.0167). When evaluating for threats identified as being primarily structure based, there was a decrease in SAFER score of 1.28 per every additional PDSA cycle (P = 0.001). There was a decrease in total count of LST of 0.20 per additional simulation run (P = 0.02) after controlling for shift type, census, perceived workload, team size, and prior attendance in simulations across all PDSA cycles.This study presents a blueprint for the utilization of in situ simulation through multiple waves of the SARS-CoV-2 pandemic to identify LSTs and use the SAFER score as a surrogate marker to monitor the impact of interventions for a safer environment for both medical staff and patients.

Background: The people living in slums lack the basic civic amenities. Due to deprivation of socioeconomic resources and health care facilities these groups of people are more vulnerable to infectious diseases like HIV/AIDS. Aim& Objective: To assess the knowledge and awareness about HIV/AIDS and to identify related health education needs in urban slums of Jodhpur. Settings and Design: A cross sectional study was conducted during July – Nov 2018 in slums of Jodhpur city. Methods and Material: Two stage cluster sampling strategy was used to collect data from 1200 participants regarding HIV/ AIDS knowledge and awareness to identify health education needs in urban slums. Statistical analysis used: Descriptive statistics, chi-square test and multivariate logistics analysis were used. Results: A total of 1200 participants were surveyed, out of which 48.5 % were males. Among the study population 58% (n=697) has heard about HIV/AIDS and only 17.5% (n=211) have knowledge that the HIV and AIDS are different. Only 17.8% (n=214) have undergone HIV testing. Females were less likely aware about preventive measures of HIV than males (OR=0.09, 95%CI=0.05-0.14, P value45 years). Only 13.9% (n=110) of tobacco consumers and 11.5% (n=78) alcohol consumers have undergone HIV testing. Conclusions: The comprehensive health education program should be designed with focus on different education needs according to age and gender of urban slums.

Systems integration simulations (SIS) and system-focused debriefing (SFDs) are tools to improve the processes and systems of healthcare.1–4 The goal of SIS/SFD is to identify systems issues/gaps, including latent safety threats to reduce preventable harm.1 2 5 6 Kolbe et al underscore the importance of psychological safety for effective learner-focused debriefings (LFD) and how this is built from a strong organisational culture.7 This may be even more prescient during SFD where participants are being asked for feedback about processes/systems that by their nature may reflect poorly on their leaders or organisation. Threats to psychological safety during SFD can inhibit the desire to openly share issues and undermine future improvement efforts.8 Little is published on how to manage psychological safety relative to a SFD. Kolbe et al describe strategies contributing to psychological safety before, during and after a LFD.7 This editorial highlights key considerations for managing psychological safety at each stage of SFD. Our perspective is based on a combined 40 years of experience conducting SIS/SFD. ### The pre-work phase The SIS/SFD early planning and engagement work, also called the pre-work phase is the starting point for establishing psychological safety.8 Inclusion and engagement of all key stakeholders and a clear endorsement from senior leaders help create a foundation for psychological safety.9 10 Threats to individual psychological safety may come from feeling left out, or that their opinion/role/stakeholder group was not held in high regard.11 Table 1 highlights the potential threats and mitigation strategies during all phases of SFD. View this table: Table 1 Potential threats to psychological safety during an SIS/SFD with suggested mitigation strategies/sample statements Pre-work includes a needs assessment to identify and prioritise anticipated highest risk/highest impact changes, which informs scenario design. Ensuring clarity of mission (ie, what types of issues can be mitigated, how they will be resolved, timelines) …

INTRODUCTION The simulation fellowship training community has commenced efforts toward the development of core curricular elements for healthcare simulation fellowships but has not deployed the same effort to create evaluation strategies to monitor fellows' progress. The authors present a current view of simulation fellowship assessment strategies, their relative validity evidence using Kane's theoretical framework, and consider new approaches for defining expertise after training. METHODS Fellowship directors in North America were surveyed to identify what competencies are being used by the simulation fellowship community to monitor fellows' progress. A follow-up survey was sent to further clarify which tools with published validity evidence were being applied by current programs. RESULTS Of the 61 programs contacted, 44 (72.1%) responded and completed the first survey. Of the 44 programs, 32 (72.7%) reported using some formal assessment of their fellows. The most commonly assessed skill was debriefing. Twenty-three (37.7%) of the 61 programs contacted responded to the secondary survey. These reported that the most common published tool used was the Debriefing Assessment for Simulation in Healthcare, with only a few other tools mentioned. CONCLUSIONS There is a paucity of tools with published validity evidence being used to monitor a fellow's progression. The authors agree that further research needs to focus on creating validated assessment tools to assist in refining fellowship training.

Healthcare organizations strive to deliver safe, high-quality, efficient care. These complex systems frequently harbor gaps, which if unmitigated, could result in harm. Systems-focused simulation (SFS) projects, which include systems-focused debriefing (SFD), if well designed and executed, can proactively and comprehensively identify gaps and test and improve systems, enabling institutions to improve safety and quality before patients and staff are placed at risk.The previously published systems-focused debriefing framework, Promoting Excellence and Reflective Learning in Simulation (PEARLS) for Systems Integration (PSI), describes a systematic approach to SFD. It includes an essential “pre-work” phase, encompassing evidence-informed steps that lead up to a SFD. Despite inclusion in the PSI framework, a detailed description of the pre-work phase, and how each component facilitates change management, was limited.The goal of this paper is to elucidate the PSI “Pre-work” phase, everything leading up to the systems-focused simulation and debriefing. It describes how the integration of project and change management principles ensures that a comprehensive collection of safety and quality issues are reliably identified and captured.

Safety science in healthcare has historically focused primarily on reducing risk and minimizing harm by learning everything possible from when things go wrong (Safety-I). Safety-II encourages the study of all events, including the routine and mundane, not only bad outcomes. While debriefing and learning from positive events is not uncommon or new to simulation, many common debriefing strategies are more focused on Safety-I. The lack of inclusion of Safety-II misses out on the powerful analysis of everyday work.A debriefing tool highlighting Safety-II concepts was developed through expert consensus and piloting and is offered as a guide to encourage and facilitate inclusion of Safety-II analysis into debriefings. It allows for debriefing expansion from the focus on error analysis and “what went wrong” or “could have gone better” to now also capture valuable discussion of high yield Safety-II concepts such as capacities, adjustments, variation, and adaptation for successful operations in a complex system. Additionally, debriefing inclusive of Safety-II fosters increased debriefing overall by encouraging debriefing when “things go right”, not historically what is most commonly debriefed.

Background: India contributes for one-third of the total burden of oral cancer worldwide. Lower socioeconomic groups are more affected with oral cancer as they are more attracted towards tobacco consumption and diagnosed in later stages due to lack of health-related awareness and diagnostic tools. Therefore, this study was conducted to assess the knowledge and awareness about oral cancer, its risk factors and to ascertain the distribution of risk factors in the urban slum population. Methods: A cross-sectional survey conducted in the urban-slum population of Jodhpur in 2019 using cluster sampling strategy to collect data from 1200 participants. The semi-structured questionnaire was used to obtain information on knowledge and awareness for oral cancer, its risk factors, signs, symptoms and distribution of different patterns of risk factors for oral cancer. Results: Out of surveyed 1200 participants, 48.5 % were males and 51.4 % were females. 46.6% males and 53.4% females of the study population heard about oral cancer Among study population, 28.9 % reported tobacco, 27.8% smoking, 29.8% alcohol and 27% betel-nut chewing as risk factor of oral cancer. Almost 53% considered oral cancer as a consequence of dental treatment and 49% believed that it can transmitted through close contact. The knowledge about signs or symptoms of oral cancer was quite low in urban-slums. Consumption of various risk factors like tobacco, alcohol, both alcohol and tobacco, arecanut were significantly associated with gender. Conclusion: This study highlights the lack of awareness regarding oral cancer and its risk factors in the urban-slum population. A significant number of the population in the study were tobacco or alcohol users which makes them more vulnerable to oral malignant diseases. This emphasized the need for health education interventions for raising oral cancer awareness in these high-risk groups. Keywords: Awareness, oral cancer, tobacco, urban slum

The rapid migration from rural to urban region results in mushrooming of slums in India. Urban-slums are comparatively poor vulnerable groups which are mostly affected with oral cancer due to higher exposure to risk factors like tobacco use.To assess pattern of tobacco consumption, awareness about oral cancer and related health education needs in urban slums of Jodhpur city.Study was conducted during July 2018Nov 2018 in slum of Jodhpur city. On the basis of cluster sampling strategy data were collected from 1200 participants regarding tobacco use and perception regarding oral cancer to identify health education needs in urban slums. Descriptive statistics, Chi-square test, multivariate logistics analysis were used andA total of 1200 participants were surveyed, out of which 48.5% were males. Among the study population, 58.5% (An effective information, education and communication (IEC) strategy for tobacco cessation should be designed with focus on different education needs according to age, gender, and education status of slum population.

As healthcare professionals, we are poised to train the next generation of healthcare leaders and equip them with agency to catalyze transformation in their local environments. For any complex heal...

In 2013, twenty-two states enacted seventy provisions restricting access to abortion. The legislation restricted access to abortions by instituting more regulations on providers and facilities, by prohibiting abortion prior to viability, by restricting funding available to patients and by requiring patients to wait a mandatory time period before having a procedure. Genetic counselors are trained to provide unbiased, comprehensive information in a non-directive style in order to allow patients to exercise their reproductive freedom. We developed a survey of 37 questions for genetic counselors to gauge the potential impact these provisions will have on their ability to be a patient advocate. A total of 286 individuals completed the survey; however, not all respondents answered all questions. Qualitative questions complemented quantitative survey entries, allowing respondents to input thoughts and examples. Results indicate genetic counselors in all regions share similar professional opinions about the provisions. More genetic counselors in the South and Midwest noticed changes impacting patients since the provisions have been enacted. These regional differences correlate with the location of states that have seem the greatest increase in antiabortion provisions.

New York City became one of the epicentres of the COVID-19 pandemic in 2020. Simulation was used to establish the COVID-19 trained observer programme to mitigate healthcare workers’ infection risk during patient care. The members of the trained observer group consisted of 32 staff members. At the start of the training programme, they were provided donning and doffing guides with a step-by-step description of personal protective equipment (PPE) usage, followed by in-situ PPE simulation training. Later on, as PPE protocols evolved, additional educational modalities were used and included training videos, picture demonstrations of common PPE mistakes and repeated in-situ simulations. The early lessons which emerged from using simulation to train observers during the COVID-19 pandemic were the following: address PPE shortages during presimulation planning, prepare to perform updates for trained observers and use multiple educational modalities to train observers. Adequate amounts of PPE should be available to train observers. Repeated simulations are necessary to update observers on PPE protocols. Multiple learning modalities should educate the trained observers and equip them for their role in COVID-19 units.

Background: Socio-economic status can be an important determinant for patterns of tobacco consumption and its related health risks. Easy availability and affordable price may lead to the indulgence of smokeless tobacco; this deprived the section of society towards addiction of smokeless tobacco. Therefore, this study was conducted to ascertain smokeless tobacco use and its dependence in urban slum population of Jodhpur city.Methods: A cross-sectional survey was conducted in the urban-slum population of Jodhpur in 2019. A cluster sampling strategy was used to collect data from 1200 participants in different slums of Jodhpur city. The semi-structured questionnaire was used to obtain information on tobacco usage and willingness to quit.Results: Out of surveyed 1200 participants, 48.5% were males and 51.4% were females. 65.7% of the tobacco users reported in study population. Among tobacco user’s majority were using smokeless tobacco (75.4%), followed by 14.8% dual tobacco users and 9.8% were smoking tobacco. Out of female and male tobacco users, 95% females and 86.3% males were using smokeless forms of tobacco respectively. The frequency of daily tobacco use, time of tobacco chewing, duration of tobacco use was significantly associated with gender. No significant association was found between willingness to quit and gender.Conclusions: Smokeless tobacco was prevalent as compared to smoking form in urban-slums of Jodhpur city. Younger population and women were more attracted towards smokeless tobacco and willingness to quit tobacco was equally prevalent among males and females. An effective health education strategy for tobacco cessation should be designed according to age and gender of urban-slums.

This statement is designed primarily as an educational resource for clinicians to help them provide quality medical services. Adherence to this statement is completely voluntary and does not necessarily assure a successful medical outcome. This statement should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed toward obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. Clinicians are encouraged to document the reasons for the use of a particular procedure or test, whether or not it is in conformance with this statement. Clinicians also are advised to take notice of the date this statement was adopted and to consider other medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.Noninvasive prenatal screening using cell-free DNA (NIPS) has been rapidly integrated into prenatal care since the initial American College of Medical Genetics and Genomics (ACMG) statement in 2013. New evidence strongly suggests that NIPS can replace conventional screening for Patau, Edwards, and Down syndromes across the maternal age spectrum, for a continuum of gestational age beginning at 9-10 weeks, and for patients who are not significantly obese. This statement sets forth a new framework for NIPS that is supported by information from validation and clinical utility studies. Pretest counseling for NIPS remains crucial; however, it needs to go beyond discussions of Patau, Edwards, and Down syndromes. The use of NIPS to include sex chromosome aneuploidy screening and screening for selected copy-number variants (CNVs) is becoming commonplace because there are no other screening options to identify these conditions. Providers should have a more thorough understanding of patient preferences and be able to educate about the current drawbacks of NIPS across the prenatal screening spectrum. Laboratories are encouraged to meet the needs of providers and their patients by delivering meaningful screening reports and to engage in education. With health-care-provider guidance, the patient should be able to make an educated decision about the current use of NIPS and the ramifications of a positive, negative, or no-call result.Genet Med 18 10, 1056-1065.

In situ simulation is the practice of simulation in the actual clinical environment and has demonstrated utility in the assessment of system processes, identification of latent safety threats, and improvement in teamwork and communication. Nonetheless, performing simulated events in a real patient care setting poses potential risks to patient and staff safety. One integral aspect of a comprehensive approach to ensure the safety of in situ simulation includes the identification and establishment of "no-go considerations," that is, key decision-making considerations under which in situ simulations should be canceled, postponed, moved to another area, or rescheduled. These considerations should be modified and adjusted to specific clinical units. This article provides a framework of key essentials in developing no-go considerations.

The debriefing is an essential component of simulation-based training for healthcare professionals, but learning this complex skill can be challenging for simulation faculty. There are multiple competing priorities for a debriefer’s attention that can contribute to a high mental workload, which may adversely affect debriefer performance and consequently learner outcomes. In this paper, we conceptualize the debriefer as a learner of debriefing skills and we discuss Cognitive Load Theory to categorize the many potential mental loads that can affect the faculty debriefer as learner. We then discuss mitigation strategies that can be considered by faculty development programmes to enhance professional development of debriefing staff.

To date, preconceptual and prenatal patients have been offered gene-by-gene, disorder-by-disorder carrier screening. Newer techniques allow screening of many disorders at one time. The goal of this review is to provide an overview of the current practice and future direction of carrier screening within the preconceptual/prenatal setting.

Background: Building the public health workforce in India along with strengthening the public health systems across the Nation are essential components necessary to achieve the sustainable development goals for India. In the Indian context, there is limited information available for undergraduate public health education. The central aim of this brief study is to elucidate the undergraduate public health education landscape at selected institutions in India.Methods: A mixed methods approach was used in this brief study. First, cross-sectional, scoping review was used. Then, to describe student perceptions and attitude towards undergraduate public health curriculum, primary data were collected by using a questionnaire. A self-administered questionnaire was developed after extensive literature search. Descriptive statistics were used to summarize questionnaire results. Chi-square tests were used to help identify factors that may influence student perceptions and attitudes.Results: Through scoping rapid review and internet search, eight institutions were identified that are offering undergraduate public health courses in India. Most institutes in India have 3 years duration for the undergraduate public health degree courses. Most of students (89%) believed that the undergraduate public health course increased their knowledge in the field of public health. We found an association between student perceptions about community benefits from trained undergraduate public health workforce.Conclusions: The undergraduate public health education initiatives should be promoted and envisioned as a new strategy for public health capacity-building in public health in India.

Noninvasive assessment of the fetal genome is now possible using next-generation sequencing technologies. The isolation of fetal DNA fragments from maternal circulation in sufficient quantity and sizes, together with proprietary bioinformatics tools, now allows patients the option of noninvasive fetal aneuploidy screening. However, obstetric care providers must become familiar with the advantages and disadvantages of the utilization of this approach as analysis of cell-free fetal DNA moves into clinical practice. Once informed, clinicians can provide efficient pretest and posttest counseling with the goal of avoiding patient harm. It is in the public’s best interest that test results contain key elements and that laboratories adhere to established quality control and proficiency testing standards. The analysis of cell-free fetal DNA in maternal circulation for fetal aneuploidy screening is likely the first of major steps toward the eventual application of whole fetal genome/whole fetal exome sequencing. Genet Med advance online publication 00 Month 2013

We describe a novel combination of medical simulation and Lean process improvement methodology applied to improve operating room (OR) turnover time (TOT). Excess OR TOT (time between one patient's exit and next patient's entry) negatively impacts throughput, patient care and revenue generation. Elimination of waste and improvement in efficiency are highly desirable. Lean methodology, applied to healthcare, seeks improvement by eliminating waste, revising processes and identifying/resolving problems at a root-cause level.1–4 Staff are engaged in change through weeklong rapid improvement events (RIE) to redesign, test and implement new work processes. An RIE includes critical assessment of the current state, mapping current processes, identification of the desired state, examination of process gaps, brainstorming improvements and experimentation to develop solutions and improve standard work.1 To address the issue of excess OR TOT, taking an OR out-of-service would be disruptive to patient care and cost-prohibitive. A simulated OR provided a potential opportunity to rapidly and repeatedly recreate the turnover process, develop and practice standard work, experiment without patient harm/disruption of care and engage staff members in designing and implementing improvements by encouraging experimentation with change. To capture this opportunity, the perioperative services, hospital-wide process improvement and simulation centre teams collaborated. ### Setting The Institute for Medical Simulation and Advanced Learning (IMSAL) and Jacobi Medical Center (JMC), a municipal hospital, Bronx, New York, …

Introduction Emergency medicine physicians must have the knowledge and skills to stabilize all life-and-limb-threatening conditions. These skills are especially important considering that the 1989 COBRA act clearly defines active labor as a condition unsuitable to transfer. Given this context, we thought it necessary to create a work that could be used to provide emergency physicians with the necessary skills to assist in deliveries both routine and complex. Methods The total time requirement for the workshop is 4 hours. Before the session begins, learners are asked to fill out a survey. Learners complete two 40-minute small-group sessions on the topics of normal vaginal delivery and shoulder dystocia with hands-on training with birthing manikins. After a short break learners complete a 65-minute small-group session for breech delivery with hands-on training. Each small-group session is preceded by a whole-group demonstration of required skills lasting 15 minutes as well a mini lecture on maternal hemorrhage and estimation of blood loss. Results Our workshop has been shown to successfully educate emergency physicians with a range of obstetric experience and improve their knowledge base and hands-on skills. One hundred percent of our learners felt this workshop was appropriate for them and met its stated goals. Discussion While this is not the first workshop to educate on obstetric deliveries and their possible complications, it is the first to be created with the emergency medicine provider as the intended audience and the first to create a curriculum around uncomplicated delivery, shoulder dystocia, breech delivery, and postpartum hemorrhage.

Background More than a decade ago, researchers described a survey of Maternal Fetal Medicine fellows that showed that chorionic villus sampling training was limited for Maternal Fetal Medicine fellows in the United States. Prenatal screening and diagnosis have rapidly evolved since then and include the introduction of noninvasive aneuploidy screening that uses cell-free fetal DNA. Yet, chorionic villus sampling remains the only method available for first-trimester genetic diagnosis. Objective This study evaluated the chorionic villus sampling training of Maternal Fetal Medicine fellows with respect to availability, competency standards, and education methods. Study Design In November 2015, an electronic survey was sent to Maternal Fetal Medicine fellows and fellowship directors of accredited Maternal Fetal Medicine fellowship programs in the United States. Results Fifty-eight percent of fellows (179/310) and 46% of program directors (35/76) responded. Ninety-five percent of Maternal Fetal Medicine fellows think that invasive diagnostic testing is essential to their training; 100% of fellows have amniocentesis training; and 65% have chorionic villus sampling training. The median number of chorionic villus sampling procedures that are expected during a fellowship in those who trained was 10. Eighty-eight percent of fellows and 89% of program directors state that chorionic villus sampling training could be better; 89% of fellows and 97% of directors would like access to simulated models. Barriers to training included lack of patients (71%) and lack of proficient attending supervisors (43%). Conclusion Since the last survey, >10 years ago, chorionic villus sampling training has declined further. A decrease in the number of procedures that are performed is the leading barrier to this training.

To evaluate the prefrontal space (PFS) ratio of fetuses of African descent without Down syndrome and compare it to the PFS ratio previously established in a homogeneous Caucasian population to determine whether there is a difference in the ratio in these two groups. The PFS ratio was calculated retrospectively from stored 2D images of 100 African, African-American and African-Caribbean fetuses in the second and third trimester performed at the authors’ center. Other data including the maternal age, gestational age, and ethnicity were collected. An unpaired T test was used to compare the previously published Caucasian mean, 0.97 (SD 0.29) with the mean established for the black population 1.37 (SD 0.44). The difference between these two PFS ratios was found to be significant (p < 0.0001). This pilot study suggests a significant difference in the PFS in the non-Caucasian population. In order to use the PFS as a sonographic screening tool for Down syndrome, it will be important to determine normal values in different ethnic populations.

Background: As various dental procedures can transmit HIV, rapid HIV oral testing facilities in dental settings could play a major role in prevention of HIV infection. Being most popular HIV testing methods worldwide, the rapid HIV oral test is not available in India and its level of acceptance in Indian dental settings is unexplored. This study conducted with the objective to assess patient’s knowledge about HIV and their willingness toward rapid HIV oral testing in dental settings.Methods: This cross-sectional study was conducted in two dental clinics selected from two different largest mixed socioeconomic housing societies of Jodhpur respectively. A semi structured questionnaire consisting of demographics, respondent’s general knowledge towards AIDS/HIV infection, willingness towards HIV rapid oral test was developed for data collection. Standard descriptive statistics were calculated and comparisons between demographic data and willingness to get tested in dental setting, awareness for HIV etc. were analyzed.Results: Total of 473 age-eligible patients were surveyed out of which 214 were males. The difference about the knowledge of HIV/AIDS between two groups of education levels (p

This analysis explores how to optimise knowledge transfer in healthcare simulation by applying cognitive load theory to curriculum design and delivery for both novice and expert learners. This is particularly relevant for interprofessional learning which is team-based, as each participant comes to the simulation experience with different levels of expertise. Healthcare simulation can offer opportunities to create complex and dynamic experiences that replicate real clinical situations. Understanding Cognitive Load Theory can foster the acquisition of complex knowledge, skills and abilities required to deliver excellence in patient care without overwhelming a learner's ability to handle new materials due to working memory limitations. The 2 aspects of working memory that will be explored in this paper are intrinsic load and extrinsic load. These will be addressed in terms of the learner's level of expertise and how to consider these elements to enhance the learning environment in simulation scenario development and delivery. By applying the concepts of Cognitive Load Theory, this paper offers educators a method to tailor their curricula to navigate working memory and optimise the opportunity for knowledge transfer.

Noninvasive prenatal screening for fetal aneuploidy analyzes cell-free fetal DNA circulating in the maternal plasma. Because cell-free fetal DNA is mainly of placental trophoblast origin, false-positive and false-negative findings may result from placental mosaicism. The aim of this study was to calculate the potential contribution of placental mosaicism in discordant results of noninvasive prenatal screening.We performed a retrospective audit of 52,673 chorionic villus samples in which cytogenetic analysis of the cytotrophoblast (direct) and villus mesenchyme (culture) was performed, which was followed by confirmatory amniocentesis in chorionic villi mosaic cases. Using cases in which cytogenetic discordance between cytotrophoblast and amniotic fluid samples was identified, we calculated the potential contribution of cell line-specific mosaicism to false-positive and false-negative results of noninvasive prenatal screening.The false-positive rate, secondary to the presence of abnormal cell line with common trisomies in cytotrophoblast and normal amniotic fluid, ranged from 1/1,065 to 1/3,931 at 10% and 100% mosaicism, respectively; the false-negative rate was calculated from cases of true fetal mosaicism, in which a mosaic cell line was absent in cytotrophoblast and present in the fetus; this occurred in 1/107 cases.Despite exciting advances, underlying biologic mechanisms will never allow 100% sensitivity or specificity.