Search

BackgroundIn Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. MethodsBetween 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. ResultsOne hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36–72, 9–48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). ConclusionsDespite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts.

Objectives: To examine the relationship between masticatory muscle activity (MMA), self-reported oral behaviours (OBs) and overall physical activity (PA) in adult women. Materials and methods: MMA and PA were assessed by a wearable electromyography (EMG) device and accelerometer respectively, worn over 2 non-consecutive days by 53 women (mean age 27.5 ± 6.4 years). Following the second recording day, self-reported OBs were assessed. MMA was assessed by the number, amplitude and duration of masseter contraction episodes. Masseter muscle EMG outcome measures were number of contraction episodes per hour (CEs/h) and the relative contraction time (RCT%). PA was assessed by time accumulated in moderate to vigorous physical activity (MVPA) and 10-min bouts of MVPA per hour. Data were analysed using mixed model analysis. Results: MMA in free-living conditions consisted mostly of low-amplitude (

Objectives The study investigated effects of electrode material, inter-electrode distance (IED), and conductive gel on electromyographic (EMG) activity recorded from the masseter muscle. Materials and methods EMG was recorded unilaterally, as ten volunteers performed standardized oral tasks. Ag/AgCl and Ag coated with Au were the gel-based; Ag alloy coated with graphene, pure Ag coated with graphene and silver nanowire embedded electrodes were the gel-free materials tested. Ag/AgCl electrodes were tested at three different IEDs (i.e. 15 mm, 20 mm, 25 mm). An electrode relative performance index (ERPI) was defined and calculated for each of the standardized oral tasks that the volunteers performed. ERPI values obtained for the different oral tasks with different electrode materials and IEDs were compared using two-way repeated-measures ANOVA. Results ERPI values were not significantly influenced by IED. However, for the electrode materials statistically significant differences were found in ERPI values for all oral tasks. Of the gel-free electrode materials tested, pure silver electrodes coated with graphene had the highest ERPI values followed by Ag alloy electrodes coated with graphene and silver nanowire embedded electrodes. Conclusions Within the limitations of the study, IED between 15 and 25 mm has a negligible effect on masseter muscle EMG. Graphene coated and silver nanowire embedded electrodes show promise as gel-free alternatives.

Objectives: To test a smartphone-assisted wireless device for assessing electromyographic (EMG) activity of the masseter muscle in freely moving individuals undertaking routine activities. Materials and Methods: EMG activity was detected unilaterally from the masseter muscle in 12 volunteers using surface electrodes connected to both a smartphone-assisted wireless EMG device and a fixed-wired EMG equipment (reference standard). After performing a series of standardized tasks in the laboratory, participants wore the wireless device for 8 h while performing their normal routine. Results: The wireless device reliably detected masseter muscle contraction episodes under both laboratory and natural environment conditions. The intraclass correlation coefficients for the muscle contraction episode amplitude and duration detected by the wireless and the wired equipment ranged from 0.94–1.00 to 0.82–1.00, respectively. Most masseter contraction episodes during normal routine were of low amplitude (< 10% MVC) and short duration (< 10 s), with no significant differences between sexes or facial side. Conclusions: Within the limitations of the study, smartphone-assisted monitoring of the jaw muscles represents a promising tool to investigate oral behavior patterns in free moving individuals. Clinical relevance: Smartphone-assisted monitoring of masticatory muscle activity may enable possible associations between excessive muscle activity, bruxism, dysfunction, and pain to be investigated, and managed via biofeedback.