Special Series Of Articles Research Articles

Progress in stratified stroke characterization-associated with better diagnosis, accurate prognosis and improved treatment strategies.

In this special issue, focussed on novel stroke biomarkers, we invited world-leading researchers to submit novel findings from work originating from the Asian provinces of China. As we move towards an era of stratified and personalised medicine with a significant input from large data sets and artificial intelligence (AI) algorithms, a complete understanding of the clinical background, risk factors, genetics and epigenetic markers and pathophysiological biomarkers that inform and therefore predict response to treatment and ultimately, outcome, are still needed [1]. Therefore, here, are included several articles that provide further novel insight into this complex disease process, and which will contribute to the synthesis of data resulting in our transcendence to optimized treatment and rehabilitation with associated reduced morbidity and mortality. The contribution of inflammation and the neuroinflammatory response to stroke volume, neuronal cell death and outcome is undeniable [2], with activation of local microglia stimulating and pre-empting the arrival of an ‘army’ of inflammatory M2-polarised monocytes/macrophages through the damaged blood–brain barrier secreting damaging cytokines such as interleukins 1-β/6/8, as well as tumour necrosis factor-α, and others including the more recently identified plasma-borne monomeric C-reactive protein [3, 4]. In this series, Zhang et al. [5], provided a comprehensive review of the role of the mononuclear phagocyte system in ischaemic stroke, summarizing that the effects are time dependent and influence the processes of stroke volume development, angiogenesis and remodelling and plasticity, as well as being potential markers of long-term prognosis and outcome. Hence as recently described by Monsour et al. [6], targeting critical early inflammatory pathways such as pro-inflammatory IL-6 but protecting the inactive IL-6-soluble IL-6 receptor 130 complex might form part of a future combinational therapeutic effort. Within this series, and in an original and more translational study, Han-Yu et al. [7], analysed the impact of reactive astrogliosis following transient global cerebral perfusion using a rat model of stroke. They showed that conditional knockout of the lysosomal-associated membrane protein 2A (LAMP-2A), protected CA1 hippocampal neurones from death also ameliorating spatial learning and memory deficits, by inhibiting astrocyte activation. They proposed this as a potential novel neuroprotective strategy. Whilst additional protective mechanisms include the prevention of apoptotic protein translocation (Bax/Bad), both the previous findings that LAMPs are involved in mediating proper autophagy that could protect the brain against toxic plaque build up-also associated with the medium to long-term consequences after stroke, as well as the known limitations in translation of rodent models to the human condition [8]. Nevertheless this work represents an important finding within the field. As mentioned earlier, AI algorithms and deep-learning predictive big-data-derived technology will be essential to improve our understanding of how to manage stroke at the individual level, for example, by providing MRI-lesion segmentation datasets that will help in treatment decision-making and evaluating outcome. In this series, Jiang et al. [9] showed that a multiparameter model using deep-learning automated processes, measuring datasets of the volume of interest and segment slices, together, significantly better predicted haemorrhagic transformation in patients following endovascular thrombectomy after ischaemic stroke, compared with single parameter models. One of the less common causes of cerebral infarction is susceptibility due to vertebrobasilar dolichoectasia (VBD), where abnormalities in the basilar artery predispose to premature development of atherosclerosis. Mortality rates are high due to the non-specific symptoms and delay in diagnosis. Here, Tao et al. (2023), used high-resolution MRI (HR-MRI), to fully characterise the arterial structure and function in 24 patients and concluded that risk of stroke was associated with bifurcation height and arterial turbulence and inferior diameters [10]. This work should help to enable more effective stratified risk assessment following larger-scale clinical studies. In conclusion, this special series of articles reflects the broad and extremely complex nature of stroke pathophysiology. Importantly, it indicates how a series of small advances could eventually support an optimised programme of stratification and personalised approach to understanding risk, diagnosis prognosis and outcome. This would probably be achieved using a combination of data-driven deep learning AI together with point-of-care rapid testing, through advanced imaging and likely a combinational approach to targeting early tissue damage regulating inflammation and apoptosis and eliciting neuroprotective pathways thereby maintaining patency of neurovascular units. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

The Beginning of the American Thyroid Association Centennial Year

The Beginning of the American Thyroid Association Centennial Year

Investigative algorithms for disorders affecting acidosis: a narrative review

Background and Objective: The following article forms part of a special series of articles designed to aid the reader to diagnose the cause of various electrolyte imbalances. By the end of the article, the reader will be able to request and interpret appropriate investigations when faced with an acidotic patient.

Presenter: Werner Paulus, University Hospital Muenster, Muenster. Publishing A High-quality, Non-commercial Neuropathology Journal Without a Publisher: The First Nine Months

Scholarly communication faces increasing economical and ethical challenges, including pricing policies and overbearing behavior of commercial publishing houses. Based on the hypothesis that a diamond open access neuropathology journal of a high scientific and technical quality can be run entirely by neuropathologists, we launched Free Neuropathology (FNP; freeneuropathology.org) in January 2020. Classical publisher activities, such as copyediting, layout, website maintenance, and journal promotion, are undertaken by neuropathologists and neuroscientists using free open access software. The journal is free for both readers and authors, and papers are published under a Creative Commons BY SA licence, where copyright remains with the authors. Based on 26 articles published by August 2020, it takes FNP 11.1 days from submission to first, and 19.9 days to final, decision. High-quality copyediting, layout, and online publishing in the final format is accomplished in only 8 days. Absence of a commercial publisher enables prioritization of democratic and scientifically-driven decisions on editorial structure, website design, journal promotion, paper formatting, special article series, and number of accepted papers. This new model of journal publishing, which returns the control of scholarly communication to scientists, will be of interest to neuropathologists and wider scientific community alike.Learning ObjectivesSummarize the current state and driving forces behind commercial and non-commercial scientific publishing in neuropathology.Describe the advantages and challenges of a non-commercial publishing platform for neuropathology.

Introduction

Introduction

Introduction to a New Special Series for the Journal of Pain and Symptom Management—Science in Action: Evidence and Opportunities for Palliative Care Across Diverse Populations and Care Settings

Practices to optimize palliative care delivery and new opportunities in which to integrate palliative care vary across populations and care settings. Systematic reviews are an efficient and methodologically rigorous approach to summarize existing research to identify both evidence-based best practices and new areas for future research and clinical practice. This is the introduction to a special series of articles in which members of the American Academy of Hospice and Palliative Medicine Research Committee report the results of circumscribed systematic reviews, which in a specific population or care setting seek to 1) summarize existing evidence for optimal palliative care practices or 2) identify opportunities where better palliative care delivery could improve patient and/or family outcomes.

The Implementation of Measuring What Matters in Research and Practice: Series Commentary

The Measuring What Matters (MWM) initiative identified 10 indicators of high-quality palliative and hospice care. Members of the AAHPM Research Committee, through a special series of articles, examined applications of the MWM quality indicators in research and practice settings. Many themes were present in these articles, including the important role of electronic health records in quality measurement, challenges and strategies for implementing and tracking measures over time, and the importance of identifying new measures. This article is the final commentary of the series and includes recommendations for next steps in quality measurement.

Functional and structural plasticity in the primary somatosensory cortex associated with chronic pain.

Tissue or nerve injury induces widespread plastic changes from the periphery and spinal cord up to the cortex, resulting in chronic pain. Although many clinicians and researchers have extensively studied altered nociceptive signaling and neural circuit plasticity at the spinal cord level, effective treatments to ameliorate chronic pain are still insufficient. For about the last two decades, the rapid development in macroscopic brain imaging studies on humans and animal models have revealed maladaptive plastic changes in the 'pain matrix' brain regions, which may subsequently contribute to chronic pain. Among these brain regions, our group has concentrated for many years on the primary somatosensory (S1) cortex with a help of advanced imaging techniques and has found the functional and structural changes in neurons/glia as well as individual synapses in the S1 cortex during chronic pain. Taken together, it is now believed that such S1 plasticity is one of the causes for chronic pain, not a simple and passive epiphenomenon following tissue/nerve injury as previously thought. In this small review, we discuss the relation of plasticity in the S1 cortex with chronic pain, based on clinical trials and experimental studies conducted on this field. This article is part of the special article series "Pain".

Neuronal and microglial mechanisms for neuropathic pain in the spinal dorsal horn and anterior cingulate cortex.

Neuropathic pain is a debilitating chronic pain condition occurring after damage in the nervous system and is refractory to the currently available treatments. Major challenges include elucidating its mechanisms and developing new medications to treat it. Nerve injury-induced pain hypersensitivity involves aberrant excitability in spinal dorsal horn (SDH) neurons as a consequence of dysfunction of inhibitory interneurons and of hyperactivity of glial cells, especially microglia, the immune cells of the central nervous system. Evidence of this is found using animal models to investigate the molecular and cellular mechanisms of neuropathic pain. The pathologically altered somatosensory signals in the SDH then convey to the brain regions, including the anterior cingulate cortex (ACC). In these regions, nerve injury produces pre- and postsynaptic long-term plasticity, which contributes to negative emotions and anxiety associated with chronic pain conditions. Furthermore, recent evidence also indicates that the descending projection pathways from the ACC directly and indirectly to the SDH (the top-down corticospinal network) regulate nociceptive sensory transmission in the SDH. Thus, understanding a possible connection between the SDH and ACC, including a neuron-microglia interaction, may provide us with insights into the mechanisms used to amplify pain signals related to neuropathic pain and clues to aid the development of new therapeutic agents for the management of chronic pain. This article is part of the special article series "Pain".

New mechanisms for pain: From neurons to glia; from spinal cord to cortex.

This is the Preface for the special article series "Pain". Cover Image for this issue: doi: 10.1111/jnc.13799.

The therapeutic potential of targeting chemokine signalling in the treatment of chronic pain.

Chronic pain is a distressing condition, which is experienced even when the painful stimulus, whether surgery or disease related, has subsided. Current treatments for chronic pain show limited efficacy and come with a host of undesirable side‐effects, and thus there is a need for new, more effective therapies to be developed. The mechanisms underlying chronic pain are not fully understood at present, although pre‐clinical models have facilitated the progress of this understanding considerably in the last decade. The mechanisms underlying chronic pain were initially thought to be neurocentric. However, we now appreciate that non‐neuronal cells play a significant role in nociceptive signalling through their communication with neurons. One of the major signalling pathways, which mediates neuron/non‐neuronal communication, is chemokine signalling. In this review, we discuss selected chemokines that have been reported to play a pivotal role in the mechanisms underlying chronic pain in a variety of pre‐clinical models. Approaches that target each of the chemokines discussed in this review come with their advantages and disadvantages; however, the inhibition of chemokine actions is emerging as an innovative therapeutic strategy, which is now reaching the clinic, with the chemokine Fractalkine and its CX 3 CR 1 receptor leading the way. This article is part of the special article series “Pain”.

Effects of cold temperatures on the excitability ofrat trigeminal ganglion neurons that are not forcold sensing.

Aside from a small population of primary afferent neurons for sensing cold, which generate sensations of innocuous and noxious cold, it is generally believed that cold temperatures suppress the excitability of primary afferent neurons not responsible for cold sensing. These not-for-cold-sensing neurons include the majority of non-nociceptive and nociceptive afferent neurons. In this study we have found that the not-for-cold-sensing neurons of rat trigeminal ganglia (TG) change their excitability in several ways at cooling temperatures. In nearly 70% of not-for-cold-sensing TG neurons, a cooling temperature of 15°C increases their membrane excitability. We regard these neurons as cold-active neurons. For the remaining 30% of not-for-cold-sensing TG neurons, the cooling temperature of 15°C either has no effect (cold-ineffective neurons) or suppress their membrane excitability (cold-suppressive neurons). For cold-active neurons, the cold temperature of 15°C increases their excitability as is evidenced by increases in action potential (AP) firing numbers and/or the reduction in AP rheobase when these neurons are depolarized electrically. The cold temperature of 15°C significantly inhibits M-currents and increases membrane input resistance of cold-active neurons. Retigabine, an M-current activator, abolishes the effect of cold temperatures on AP firing, but not the effect of cold temperature on AP rheobase levels. The inhibition of M-currents and the increases of membrane input resistance are likely two mechanisms by which cooling temperatures increase the excitability of not-for-cold-sensing TG neurons. This article is part of the special article series "Pain".

Nociception modulation by supraspinal group III metabotropic glutamate receptors

The modulatory actions of glutamate, the main excitatory neurotransmitter in the central nervous system (CNS), are exerted through the activation of metabotropic glutamate receptors (mGluRs). Of the eight known mGluRs (mGluR1-8), group III mGluRs (mGluR4, mGluR6, mGluR7, and mGluR8) are less understood because of the lack of selective ligands. Except for mGluR6, group III mGluRs are widely distributed throughout the CNS. They are mainly located on presynaptic terminals where they inhibit neurotransmitter release at glutamatergic and γ-aminobutyric acid (GABA)ergic synapses. Their location at certain synapses is considered critical for normal CNS function, which makes them potential targets in neurological and psychiatric treatments. Novel ligands that are selective for group III mGluR subtypes have recently been developed. These compounds, which mainly targetallosteric sites and act as positive or negative allosteric modulators (PAMs or NAMs) of glutamate transmission, are contributing to the understanding of the functional roles of group III mGluRs in a number of pathological conditions, such as epilepsy, anxiety, neurodegenerative diseases, and chronic pain. Moreover, the presence of group III mGluRs throughout the entire pain neuraxis and particularly in the descending system suggests that these endogenous substrates that extend from the cortex to the first spinal synapse are candidates for pain control. Recent data on chronic pain alleviation by group III mGluR ligands encourage further studies as pathological pain is one of the most troublesome diseases because of the current lack of satisfactory therapy. This review summarizes recent studies on group III mGluRs in animal models of chronic pain, which evidence an opposite modulation of mGluR7 and mGluR8 on pain responses and their capability to affect pain responses only in pathological states. This article is part of the special article series "Pain".

Transcriptional repressor DREAM regulates trigeminal noxious perception.

Expression of the downstream regulatory element antagonist modulator (DREAM) protein in dorsal root ganglia and spinal cord is related to endogenous control mechanisms of acute and chronic pain. In primary sensory trigeminal neurons, high levels of endogenous DREAM protein are preferentially localized in the nucleus, suggesting a major transcriptional role. Here, we show that transgenic mice expressing a dominant active mutant of DREAM in trigeminal neurons show increased responses following orofacial sensory stimulation, which correlates with a decreased expression of prodynorphin and brain-derived neurotrophic factor in trigeminal ganglia. Genome-wide analysis of trigeminal neurons in daDREAM transgenic mice identified cathepsin L and the monoglyceride lipase as two new DREAM transcriptional targets related to pain. Our results suggest a role for DREAM in the regulation of trigeminal nociception. This article is part of the special article series "Pain".

Special Article Series on Signal Processing Education via Hands-On and Design Projects [From the Guest Editors

As professionals in the signal and information processing field, we build on the tools and theories we learned in our undergraduate studies, adding knowledge and skills over the years. For many of us, it has been a while since our undergraduate studies, yet we can probably recall some of these “Ahha” moments when a full meaning of some fundamental theory sank in. As educators and mentors, we seize on these moments and our own experiences to implement new successful teaching methods that advance effective learning and skill development.

Stepping OUT in Educational Research: Pediatric Physical Therapy Education has Learned to Walk

It is our pleasure introduce special series of articles that will appear in each of the next 3 issues of this journal highlighting key areas of educational research specific pediatric physical therapy education. The purpose of this special series, as stated in the initial call for proposals in 2014, is to focus on identifying the curricular elements and instructional changes that will be necessary ensure the provision of high quality physical therapy services for pediatric patients and adults with lifelong developmental disabilities. To this end, we found it was both necessary enhance our collective understanding of best practice in pediatric physical therapy education and share that more broadly with the physical therapy education community. While the literature on the scholarship of teaching and learning (SoTL) in physical therapy education continues expand in both breadth and depth, the variability of educational practices relative the education of pediatric physical therapy knowledge, skills, and abilities is highly variable across professional physical therapy curriculum. In fact, many of the concerns first identified in 1993 by Cherry and Knutson1 and by Martin2 regarding the limited amount of time spent and the variability in teaching pediatric content as part of the entry-level physical therapy curriculum are still unresolved. More recently, pediatric physical therapy educators have begun strive towards more systematic approach the SoTL using an increasingly broader array of educational research methods answer some of these same questions. To this end, the special series will expand the current literature base.The happenstance of several separate, yet overlapping, key events led this special series. The words and actions of Journal of Physical Therapy Education coeditors, Hack and Gwyer, have demonstrated their support for publishing special series highlight specific topic. In addition, and perhaps more notable, has been the encouragement of the coeditors, through editorials and their own contributions the literature, acknowledging that research of physical therapy education needs be supported by evidence and sound methodology.3-4 In her 2011 McMillan lecture, Dr Jensen spoke directly the need for educational research that will provide evidence on best practices in physical therapist education.5 And more recently, Jensen et al proposed a compelling rationale for building much needed foundation for education research in physical therapy6 The foundations for our work on this series began around the same time.This special series is one of several key outcomes from the first (2012) Pediatric Education Summit sponsored by the Section on Pediatrics (now known as the Academy on Pediatric Physical Therapy, or APPT). This was in part result of the findings of Schreiber et al, as they identified that variability across educational practices among professional physical therapy education programs had not changed much from 1993 compared with their 2010 survey.7 The Education Summit brought together 20 individuals affiliated with pediatric physical therapy education (academic and clinical components), and together, they reached consensus on 5 essential core competencies in pediatric physical therapy education: (1) Human Development, (2) Age-Appropriate Patient/Client Management, (3) Family-centered Care, (4) Health Promotion and Safety, and (5) Legislation, Policy and Systems.8 (Readers who are not familiar with the competencies are encouraged review that work before delving into this special series.) Several additional manuscripts stemmed from that first Summit,9-10 and the formation of the Academic and Clinical Educator (ACE) Special Interest Group (SIG) of the APPT was also born. These efforts helped better describe expectations of pediatric physical therapy education, while both academicians and clinicians tried better understand the best ways teach pediatric physical therapy in the classroom, lab, and clinic. …

Advanced Optical Materials is Making its Way Up

It has been an eventful year for the optics research community and the optical industry sector, not least because 2015 was the UNESCO International Year of Light. Light technologies are the basis of a multi-billion dollar industry as well as an integral part of our everyday lives. Optical research is a motor for innovation and its application areas are numerous. This variety is reflected by the broad spectrum of high quality work published in Advanced Optical Materials. Let's have a look back on some of the high points of 2015. One highlight was definitely the special issue on “Optical Materials for Spectral Management” guest-edited by Ralf Wehrspohn and Stefan Schweizer. This compilation included review articles on different spectral converters as fluoride hosts and methods to tune the fluorescence of phosphors and their applications in photovoltaics, scintillator materials, and solid-state lighting. Furthermore, many new results on materials for up- and down-conversion were published, three examples being novel energy-transfer materials presented by Andries Meijerink et al., an innovative topotactic transformation synthetic route from Hongpeng You and colleagues, and persistent and photostimulated red emission in nanophosphors presented by John Capobianco. The whole issue can be found here. We were also very proud to be able to present a very special article series dedicated to celebrate the International Year of Light. The topics of the featured review articles, written by experts in their fields, span carbon nanotube photodetectors and photonic structures for light harvesting to micro-transfer printing and plasmonic nanoparticles. You can find all of the contributions in the table below or online at www.advopticalmat.de/IYL. In the past two years the Best of Advanced Optical Materials editions were very well received by the community. Therefore, this year we also selected some of the most outstanding articles from all original articles published in the twelve issues of 2015. The collection can be found at www.best-of-advanced-optical-materials-2015.com and gives you a good impression of the high quality and broad scope of the content published in Advanced Optical Materials. The excellent research published in Advanced Optical Materials has contributed to the journal's first one-year impact factor of 4.062, which is a very promising result underlining the position among the top optics journals. Citations and impact factors are not the only measures of a journal's performance and the quality of the presented research; but this inaugural value, together with our 2015 Immediacy Index of 1.132, provides a solid foundation on which to build in future years. We would like to take this opportunity to thank our Editorial Advisory Board members for their help and advice over the last year, all authors who submitted to the journal, and last but certainly not least all of the more than 1200 reviewers who help to maintain the standards of the journal. We would especially like to mention our most frequent reviewers—Hongbing Fu, Jianfang Wang, Dai-Sik Kim, Hirohiko Fukagawa, Paul Braun, Yong Sheng Zhao, Timothy Bunning, and He Tian—for their generous contributions to the success of the journal. Thank you very much! For the coming year of 2016 we wish you great success and hope that we can contribute to it through our continuous publishing efforts and dedication to good customer service. P.S.: For any kind of feedback please contact us at advopticalmat@wiley-vch.de.

Improving Access to Maternity Care for Women with Opioid Use Disorders: Colocation of Midwifery Services at an Addiction Treatment Program.

Perinatal drug and alcohol use is associated with serious medical and psychiatric morbidity for pregnant and postpartum women and their newborns. Participation in prenatal care has been shown to improve outcomes, even in the absence of treatment for substance use disorders. Unfortunately, women with substance use disorders often do not receive adequate prenatal care. Barriers to accessing care for pregnant women with substance use disorders include medical and psychiatric comorbidities, transportation, caring for existing children, housing and food insecurity, and overall lack of resources. In a health care system where care is delivered by each discipline separately, lack of communication between providers causes poorly coordinated services and missed opportunities. The integration of mental health and substance use treatment services in medical settings is a goal of health care reform. However, this approach has not been widely promoted in the context of maternity care. The Dartmouth-Hitchcock Medical Center Perinatal Addiction Treatment Program provides an integrated model of care for pregnant and postpartum women with substance use disorders, including the colocation of midwifery services in the context of a dedicated addiction treatment program. A structured approach to screening and intervention for drug and alcohol use in the outpatient prenatal clinic facilitates referral to treatment at the appropriate level. Providing midwifery care within the context of a substance use treatment program improves access to prenatal care, continuity of care throughout pregnancy and the postpartum, and availability of family planning services. The evolution of this innovative approach is described. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program.

This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.