BACKGROUND:In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater ...closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity.
OBJECTIVE:To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model.
METHODS:The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a technical simulation model of dural repair for the lumbar spine.
RESULTS:Didactic pretest scores ranged from 4/11 (36%) to 10/11 (91%). Posttest scores ranged from 8/11 (73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all participants, with a mean improvement between pre- and posttest scores of 1.17 (18.5%; P = .02). The technical component consisted of 11 durotomy closures by 6 participants, where 4 participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P = .66), whereby the median leak rate improved from 14 to 7 (P = .34). There were also demonstrative technical improvements by all.
CONCLUSION:Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development.
ABBREVIATIONS:CNS, Congress of Neurological SurgeonsPGY, postgraduate year
Using the astrometry and integrated photometry from the
Gaia
Early Data Release 3, we map the density variations in the distribution of young upper main sequence (UMS) stars, open clusters, and ...classical Cepheids in the Galactic disc within several kiloparsecs of the Sun. We derive maps of relative over- and under-dense regions for UMS stars in the Galactic disc using both bivariate kernel density estimators and wavelet transformations. The resulting overdensity maps exhibit large-scale arches that extend in a clumpy but coherent way over the entire sampled volume, indicating the location of the spiral arm segments in the vicinity of the Sun. Peaks in the UMS overdensity are well matched by the distribution of young and intrinsically bright open clusters. By applying a wavelet transformation to a sample of classical Cepheids, we find that their overdensities possibly extend the spiral arm segments on a larger scale (≃10 kpc from the Sun). While the resulting map based on the UMS sample is generally consistent with previous models of the Sagittarius-Carina spiral arm, the geometry of the arms in the III quadrant (galactic longitudes 180° <
l
< 270°) differs significantly from that suggested by many previous models. In particular, we find that our maps favour a larger pitch angle for the Perseus arm, and that the Local Arm extends into the III quadrant at least 4 kpc past the position of the Sun, giving it a total length of at least 8 kpc.
This study examined the hypothesis that differences in the cultural norms of Anglo-Americans and three other ethnic groups--Asian, Hispanic, and Black Americans--will result in different behaviors on ...a group task. Student subjects were assigned to ethnically diverse or all-Anglo groups. Individual and group responses were measured using a Prisoner's Dilemma task in which participants could choose to compete or cooperate with another party. We hypothesized that groups composed of people from collectivist cultural traditions would display more cooperative behavior than groups composed of people from individualistic cultural traditions. Results confirmed this hypothesis. Implications for future research and for organizations seeking to manage diversity are discussed.
The Far Ultraviolet Spectroscopic Explorer (FUSE) ultraviolet spectra of eight giant and supergiant stars reveal that high-temperature (3 x 10 super(5) K) atmospheres are common in luminous cool ...stars and extend across the color-magnitude diagram from alpha Car (F0 II) to the cool giant alpha Tau (K5 III). Emission present in these spectra includes chromospheric H Ly beta , Fe II, C I, and transition region lines of C III, O VI, Si III, and Si IV. Emission lines of Fe XVIII and Fe XIX signaling temperatures of similar to 10 super(7) K and coronal material are found in the most active stars, beta Cet and 31 Com. A short-term flux variation, perhaps a flare, was detected in beta Cet during our observation. Stellar surface fluxes of the emission of C III and O VI are correlated and decrease rapidly toward the cooler stars, reminiscent of the decay of magnetically heated atmospheres. Profiles of the C III lambda 977 lines suggest that mass outflow is underway at T similar to 80,000 K and the winds are warm. Indications of outflow at higher temperatures (3 x 10 super(5) K) are revealed by O VI asymmetries and the line widths themselves. High-temperature species are absent in the M supergiant alpha Ori. Narrow fluorescent lines of Fe II appear in the spectra of many giants and supergiants, apparently pumped by H Ly alpha , and formed in extended atmospheres. Instrumental characteristics that affect cool star spectra are discussed.
Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to ...assess resident education from the perspective of readiness to practice.
To assess the efficacy of resident training in preparing young neurosurgeons for practice.
In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available.
The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management.
The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.
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