Global neurotrauma: A systematic review and summary of the current state of registries around the world.

Neurotrauma registries (NTR) collect data on traumatic brain injuries (TBI) to advance knowledge, shape policies, and improve outcomes. This study reviews global NTRs from High-Income (HICs) and Low- and Middle-Income countries (LMICs). A systematic review was conducted using PubMed, Google Scholar, Embase, and Web of Science following PRISMA guidelines to identify relevant NTRs. Twenty-six articles were included, revealing ten different NTRs from Europe, North America, Latin America, the Middle East, and Asia. North America had the most registries at four, followed by Europe and Asia with two each, and Latin America and the Middle East with one each. The median database size was 1,734 patients (Range: 65-25,000), with the largest registry from the United States (FITBIR DB) and the smallest from Iran (NSCIR-IR). The longest data collection period was 32 years, with a mean age of 43.1 years (Range: 9.07-60.0). Males comprised 70 % of patients. Sixty-six percent of articles emphasized outcomes such as functionality, length of stay, and mortality. Key challenges identified included issues with missing data and incomplete records (n = 4), lack of standardization in data collection procedures (n = 3), staffing shortages (n = 5), lack of IT infrastructure (n = 3), and problems with reproducibility, particularly in high-income countries (n = 4). Our review highlights the need for a large-scale global NTR, addressing LMIC barriers through private-public partnerships with organized neurosurgery members.

An Infralimbic Cortex Neuronal Ensemble Encoded During Learning Attenuates Fear Generalization Expression.

Generalization allows for experience to flexibly guide behavior when conditions change. A basic physical unit of memory storage and expression in the brain are sparse, distributed groups of neurons known as ensembles (i.e., the engram). The infralimbic (IL) subregion of the ventral medial prefrontal cortex plays a key role in modulating conditioned defensive responses. How IL neuronal ensembles established during learning contribute to generalized responses is unknown. In this set of experiments, generalization was tested in male and female mice by presenting a novel, ambiguous, tone generalization stimulus following Pavlovian defensive (fear) conditioning. The first experiment was designed to test a role for IL in generalization using chemogenetic manipulations. Results show IL bidirectionally regulates defensive behavior. IL silencing promotes a switch in defensive state from vigilant scanning to generalized freezing, while IL stimulation reduces freezing in favor of scanning. Leveraging activity-dependent tagging technology (ArcCreERT2 x eYFP system), a neuronal ensemble, preferentially located in IL superficial layer 2/3, was associated with the generalization stimulus. Remarkably, in the identical discrete location, fewer reactivated neurons were associated with the generalization stimulus at the remote timepoint (30 days) following learning. When an IL neuronal ensemble established during learning was selectively chemogenetically silenced, generalization increased. Conversely, IL neuronal ensemble stimulation reduced generalization. Overall, these data identify a crucial role for IL in suppressing generalized responses. Further, we uncover an IL neuronal ensemble, formed during learning, functions to later attenuate the expression of generalization in the presence of ambiguous threat stimuli.

The creation of a global neurotrauma registry.

The authors propose the generation of a multi-institutional TBI registry. Barriers to registry implementation include: (1) difficulties in acquiring ethical approval; (2) incomplete clinical data available; (3) lack of information and insufficient technology (IT) support; (4) limited available resources; (5) time constraints involving understaffing yet managing high patient volumes; (6) time constraints associated with entering patient data into the registry tool. The authors detail the current state of affairs on neurotrauma registries worldwide and propose the creation of a multi-institutional, global neurotrauma registries. This private-public partnership will enable appropriate balance among stakeholders while offering care to the largest number of citizens. This initiative will require coordinated efforts involving vetted members of organized neurosurgery. Support from these entities, such as fellowship program creation, provided funding through travel vouchers to LMICs, secured housing and transportation costs in LMI nations, facilitated meetings with global local stakeholders, and promotion of key developments via social media, will accelerate the creation of this global neurotrauma registry. We propose the creation of a global TBI registry, in partnership with large, academic medical centers. Several proposed limitations of registry implementation can be addressed with support from local stakeholders, including government officials and administrative members at key institutions. Several American institutions have well-established global health programs to support this initiative. Further, at Harvard Medical School, the program in Global Surgery and Social Change offers the Paul Farmer Global Surgery Fellowship that trains leaders in policy development and implementation. The fellowship consists of 2 separate tracks: a 2-year research fellow (PGY-5-PGY-6) and 1-year research associate (MD and MBBS, etc.). Funding could be allocated towards creating a year-long fellowship dedicated towards implementing a neurotrauma registry, with this selected scholar granted the resource and connections to network with government officials and healthcare groups in every nation within that jurisdiction. A scholar would be assigned a region of the world with the goal to generate a registry that would later be combined with those generated by peer scholars. In addition, we propose the creation of a fund, controlled by donors, as a funding model.

Mildred Codding (1902-1991): Neurosurgery Medical Illustrator at Harvard Medical School, Peter Bent Brigham Hospital, and Boston's Children Hospital.

BACKGROUND: This historical account reviews the life and times of Mildred Codding (1902-1991) in neurosurgery and medical illustration. METHODS: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Codding, testimony on personal relationships, and viewpoints after comprehensive compilation of information. RESULTS: Mildred Codding learned the carbon dust technique from Max Brödel at the Johns Hopkins Hospital (Baltimore, Maryland USA), and worked at Peter Bent Brigham Hospital, now Brigham and Women's Hospital (Boston, Massachusetts, USA). Codding was Dr. Cushing's medical illustrator, colleague, and friend. She provided photographs, diagrams, and sketches for the majority of Cushing's collection of intracranial tumors from 1929 to 1932. A 1991 interview of Codding was hosted by Brigham and Women's Hospital and Boston Children's Hospital for the permanent collection of the Archives of the American Association of Neurologic Surgeons and provides additional photographs and insignia, drawings with pen and ink method, multistepped layering, and illustration implements. Importantly, the Brigham Surgical Alumni insignia showing a surgeon's hand with scalpel was modeled after Codding's left hand. Outside of the operating room, Codding's interests included Pediatrics, Zoology and Genetics, atlantes of surgical operations, teatime, and paint with watercolor, particularly seascapes, lighthouses and dunes. CONCLUSIONS: This article provides glimpses into the personality and marked influence of Mildred Codding on neurosurgery and medical education and adds to the growing literature on her person.

Exploring Health Inequalities and Presurgical Attitudes on Postsurgical Outcomes in Spine Surgery.

OBJECTIVE: The influence of social determinants of health on health disparities is substantial. However, their impact on postsurgical outcomes in spine can be challenging to ascertain at the community level. This study aims to explore the interplay between presurgical attitudes, area deprivation index (ADI), income, employment status, and body mass index (BMI) on postsurgical outcomes at 3, 6, 9, and 12 months after elective spine surgery. METHODS: The study involved 127 patients who underwent elective spine surgery between August 2021 and August 2022 at a large academic institution. The main objective involved a prospective analysis of presurgical attitudes, coupled with a retrospective assessment of ADI, income, employment status, and BMI over 3, 6, 9, and 12 months following elective spine surgery using a univariate analysis. RESULTS: Utilizing the univariate analyses, ADI displayed a significant correlation with increased Patient-Reported Outcomes Measurement Information System and Visual Analog Scale scores both before surgery and at the 3-, 6-, and 9-month postsurgical intervals (P < 0.05). One year after surgery, patients in the lowest income group (annual income under $25,000) consistently demonstrated the highest Patient-Reported Outcomes Measurement Information System pain (8.00, P = 0.022). Patients who were not employed had significantly lower levels of social support (P = 0.042) and confidence in the health care system (P = 0.009). Individuals who were unemployed were most likely to be readmitted six weeks after surgery (P < 0.001). CONCLUSIONS: Presurgical attitudes, ADI, income, employment status, and BMI were important factors associated with improved surgical outcome measurements, indicating potential focal points for combating health disparities in spinal surgery patients.

Implications for neurosurgery of medical schools leaving the United States News and World Report.

Ranked lists are a highly praised method of assessment in America. Whether it's a list of the top national sports teams, the best restaurants in New York City, or as in this case, the strongest educational institutions, we look to rankings to scrutinize, evaluate, and compare. Unfortunately, not all rankings offer insightful and valuable information. Many use metrics that fall short of an accurate representation of the desired outcome. The U.S. News & World Report (USNWR), one of the most widely regarded rankings of educational institutions, has recently been under the spotlight as several major medical schools have removed themselves from candidate lists. The current USNWR Medical School's rankings are regarded as having a narrow perspective in that the metrics perpetuate a less diverse medical community and fail to recognize worthy institutions that choose to champion a well-rounded student experience. The authors, along with the many others, fear this may deliver a skewed vision of what the USNWR tries to measure: the excellence of a medical education.

Basilar Impression: A Systematic Review and Meta-Analysis of Clinical Features, Operative Strategies, and Outcomes.

OBJECTIVE: Basilar impression (BI) is a rare yet debilitating abnormality of the craniovertebral junction, known to cause life-threatening medullary brainstem compression. Our study analyzes surgical approaches for BI and related outcomes. METHODS: A systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles examining BI. RESULTS: We analyzed 87 patients from 65 articles, mostly female (55.17%) with a mean age of 46.31 ± 17.94 years, commonly presenting with motor (59.77%) and sensory deficits (55.17%). Commonly employed procedures included posterior occipitocervical fusion (24.14%), anterior decompression (20.69%), and combined anterior decompression with posterior fusion (21.84%). Patients who underwent anterior approaches were found to be older (55.38 ± 17.67 vs. 45.49 ± 18.78 years, P < 0.05) and had a longer duration from symptom onset to surgery (57.39 ± 64.33 vs. 26.02 ± 29.60 months, P < 0.05) compared to posterior approaches. Our analysis revealed a significant association between a longer duration from symptom onset to surgery and an increased likelihood of undergoing odontoidectomy and decompression (odds ratio: 1.02, 95% confidence interval: 1.00-1.03, P < 0.05). Furthermore, after adjusting for all other covariates, a history of rheumatoid arthritis and the use of a posterior approach were significantly associated with an elevated risk of postoperative complications (P < 0.05). CONCLUSIONS: The treatment approach to complex craniovertebral junction disease should be tailored to the surgeon's experience and the nature of the compressive pathology.

Stewardship: it's going viral.

Introduction: Historically, antimicrobial stewardship (AMS) has considered the judicious use of antibiotics. AMS is widely adopted across Europe and the US; recently antifungal AMS is gaining momentum but antiviral AMS has been little described. Here we describe the introduction of AMS virology reviews at University Hospitals Birmingham (UHBFT); a novel concept and an opportunity to broaden the beneficial aspects of AMS to virology, termed anti-viral stewardship (AVS). Method: In June 2022, a UK supply issue with aciclovir injection (ACV IV) was announced. In order to review and preserve parenteral ACV for those in greatest need, UHBFT pharmacist and virologists implemented a specialist review for patients prescribed more than 48 hours of treatment. This review initially lasted 10 weeks and data was collected on the advice offered, whether it was accepted, and time required completing the review. Results: AVS rounds halved IV ACV consumption, compared to pre or post intervention levels, with more than half of patients advised to stop or switch to oral therapy. Diagnostics and sampling guidance was offered in one quarter of reviews, whilst the remaining interventions were more stewardship focused. In almost all cases stewardship advice was readily accepted by clinical teams. Due to positive feedback from clinicians and its effective management of supply, the anti-viral stewardship (AVS) programme was re-introduced in June 2023. Conclusions: Antiviral AMS rounds provide an opportunity to optimise sampling, diagnosis and improve patient management. Introduction of regular AVS at UHBFT are now well established and plan to be implemented in other hospitals.

Technical note: utilization of various allotment strategies to evaluate variation and replications required to detect statistical significance in nursery pig research.

A total of 720 barrows (line 200 × 400, DNA genetics) were used in two 42-d nursery trials (initially 6.20 ±â€…0.12 kg and 5.63 ±â€…0.16 kg, respectively) to evaluate strategies for allotting pigs to pens in randomized controlled trials. At placement, the population was split into three cohorts with similar average weight and standard deviation and randomly assigned to one of the three allotment strategies. Strategy 1 (random) utilized a simple randomization strategy with each pig randomized to pens independent of all other pigs. Strategy 2 (body weight [BW] distribution) sorted each pig within the cohort into one of the five BW groups. One pig from each weight group was then randomly assigned to a pen such that distribution of BW within pen was uniform across pens. Strategy 3 (BW grouping) sorted pigs within the cohort into 3 BW categories: light, medium, and heavy. Within each BW category, pigs were randomized to pen to create pens of pigs from each BW category. Within each experiment, there were 72 pens with five pigs per pen and 24 pens per allotment strategy. For all strategies, once pigs were allotted to pens, pens were allotted to one of the two treatments for a concurrent trial. In experiment 1, environmental enrichment using ropes tied near the pan of the feeder was compared to a control with no enrichment. In experiment 2, treatment diets consisted of basal levels of Zn and Cu from the trace mineral premix for the duration of the study (110 and 17 mg/kg, respectively; control), or diets (supplemented control) with carbadox (50 g/ton; Mecadox, Phibro Animal Health, Teaneck, NJ) fed in phase 1 (days 0 to 22) and 2 (days 22 to 43), pharmacological levels of Zn and Cu (2,414 mg/kg Zn from ZnO; 168 mg/kg Cu from CuSO4) fed in phase 1, and only pharmacological levels of Cu (168 mg/kg Cu from CuSO4) fed in phase 2. These treatment designs were used to determine the impact on coefficient of variation (CV) and to estimate the number of replications required to find significant treatment differences based on allotment strategy. There were no meaningful allotment strategy × treatment interactions for either study. For between-pen CV, pigs allotted using BW distribution and BW grouping strategies had the lowest CV at allotment and final weight in both trials. For overall average daily gain in experiments 1 and 2 in experiment 2, the BW distribution strategy required the fewest replications to detect differences in performance. However, there is no meaningful difference between allotment strategies in replications required to detect significant differences for gain:feed ratio.

Decreasing variation between experimental units increases the likelihood of finding a statistically significant difference if one exists. Assignment of animals to experimental units (pens) may contribute to that variation. Therefore, the purpose of this trial was to investigate the effect that different methods of allotting pigs to pens (experimental unit) have on variation and in turn, the number of replications required to detect a significant difference of a given amount between treatments. The random strategy assigned pigs to pens in a completely random fashion. The body weight (BW) distribution strategy ordered pigs from lightest to heaviest and created five groups based on BW. Each pen was randomly assigned one pig from each of the five groups. The BW grouping strategy again ordered pigs from lightest to heaviest but split pigs into three groups based on BW and each pen was randomly assigned pigs from only one BW group such that there were pens of light pigs, pens of medium pigs, and pens of heavy pigs. Ultimately, the best allotment strategy depends on the parameter of interest. For final BW and overall ADG, the BW grouping method required the fewest pens to detect statistically significant differences.

Madeline Earle Stanton (1898-1980): Librarian and Consultant of the Medical Historical Library at Yale University, Research Assistant in Bibliography in the Yale Department of the History of Medicine, Associate Editor of the Journal of the History of Medicine and Allied Sciences, and Secretary and Protégé of Harvey Cushing.

BACKGROUND: This historical account reviews the course and lasting impact of Madeline Earle Stanton (1898-1980) in neurosurgery. METHODS: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Stanton. It is a thorough review of literature on Stanton and reflects the scope and depth of these prior works. RESULTS: Beginning with Madeline Stanton's venture with Dr. Harvey Cushing at Harvard and Peter Bent Brigham Hospital in Boston, this project follows the transformation of her role as Cushing's secretary to the secretary of the Medical Historical Library at Yale. Stanton played an integral role in the development of the Yale Medical Historical Library, becoming the librarian of the Historical Collections and remaining a historical consultant after retirement. Stanton served as an assistant and associate editor for the Journal of the History of Medicine and Allied Sciences. Stanton's work created an access point to valuable medical literature for the furthering of medical education and development. CONCLUSIONS: Our article provides glimpses into the personality of Madeline Stanton and her marked impact on neurosurgery.

The persistent homology of genealogical networks.

Genealogical networks (i.e. family trees) are of growing interest, with the largest known data sets now including well over one billion individuals. Interest in family history also supports an 8.5 billion dollar industry whose size is projected to double within 7 years [FutureWise report HC-1137]. Yet little mathematical attention has been paid to the complex network properties of genealogical networks, especially at large scales. The structure of genealogical networks is of particular interest due to the practice of forming unions, e.g. marriages, that are typically well outside one's immediate family. In most other networks, including other social networks, no equivalent restriction exists on the distance at which relationships form. To study the effect this has on genealogical networks we use persistent homology to identify and compare the structure of 101 genealogical and 31 other social networks. Specifically, we introduce the notion of a network's persistence curve, which encodes the network's set of persistence intervals. We find that the persistence curves of genealogical networks have a distinct structure when compared to other social networks. This difference in structure also extends to subnetworks of genealogical and social networks suggesting that, even with incomplete data, persistent homology can be used to meaningfully analyze genealogical networks. Here we also describe how concepts from genealogical networks, such as common ancestor cycles, are represented using persistent homology. We expect that persistent homology tools will become increasingly important in genealogical exploration as popular interest in ancestry research continues to expand.

Generating segmentation masks of herbarium specimens and a data set for training segmentation models using deep learning.

PREMISE: Digitized images of herbarium specimens are highly diverse with many potential sources of visual noise and bias. The systematic removal of noise and minimization of bias must be achieved in order to generate biological insights based on the plants rather than the digitization and mounting practices involved. Here, we develop a workflow and data set of high-resolution image masks to segment plant tissues in herbarium specimen images and remove background pixels using deep learning. METHODS AND RESULTS: We generated 400 curated, high-resolution masks of ferns using a combination of automatic and manual tools for image manipulation. We used those images to train a U-Net-style deep learning model for image segmentation, achieving a final Sørensen-Dice coefficient of 0.96. The resulting model can automatically, efficiently, and accurately segment massive data sets of digitized herbarium specimens, particularly for ferns. CONCLUSIONS: The application of deep learning in herbarium sciences requires transparent and systematic protocols for generating training data so that these labor-intensive resources can be generalized to other deep learning applications. Segmentation ground-truth masks are hard-won data, and we share these data and the model openly in the hopes of furthering model training and transfer learning opportunities for broader herbarium applications.

Perceived Parental Monitoring and Sexual Orientation Moderate Lifetime Acts of Non-Suicidal Self-Injury.

Being non-heterosexual, particularly bisexual, is associated with high rates of engagement in NSSI amongst young adults. The goal of the present study was to determine if parenting practices, specifically parental monitoring, and sexual orientation moderate engagement with NSSI. Undergraduates (N = 1,353) completed a survey on sexual orientation, non-suicidal self-injury (NSSI) acts, and multiple aspects of perceived parental monitoring during high school. Moderation analyses revealed that most facets of parental monitoring were similarly negatively correlated with NSSI for both individuals whose sexual orientation where nearly, or entirely, gay and heterosexual youth. Youth who were neither exclusively heterosexual nor exclusively gay (mixed sexual orientation) reported the most NSSI acts, and no facet of parental monitoring predicted reduced NSSI acts for this group. While previous literature shows that many aspects of parental monitoring may be protective against engagement in health risk behaviors, the present study adds to these findings that similar aspects are negatively associated with self-injurious behavior for some, but not all, individuals. More research is needed to better understand the causes of increased NSSI for individuals with a mixed sexual orientation.

Forms of non-suicidal self-injury as a function of trait aggression.

To date, the considerable body of research on predictors of non-suicidal self-injury (NSSI) has conceptualized NSSI as a unitary construct despite the fact that NSSI can exist in many forms (e.g., hitting, cutting, burning). The goal of the present study is to examine differential prediction of forms of NSSI. Specifically, we examined trait aggression as a predictor of more aggressive forms of NSSI (i.e., hitting). We hypothesized that higher trait aggression would differentiate those who engaged in hitting forms of NSSI from those who did not, whereas other factors (i.e., emotion regulation and trait anger) would serve as a non-specific predictor of NSSI. We also hypothesized that higher trait aggression would be related to lifetime frequency of hitting NSSI, but not other forms of NSSI, whereas emotion regulation and anger would act as predictors of other forms of NSSI. To test these hypotheses, a large sample of young adults completed measures of trait aggression, trait anger, emotion regulation, and NSSI behaviors. Results were generally in line with our hypotheses. Higher levels of trait aggression differentiated those who engaged in hitting NSSI from those who did not and was also associated with greater frequency of hitting NSSI. These results imply that different factors predict different forms of NSSI and that NSSI may be best examined as a multi-faceted construct.

Self-harm behavior among individuals with intermittent explosive disorder and personality disorders.

Self-harm behaviors are a major public health concern across the lifespan, particularly among individuals with psychiatric disorders. Little research, however, has examined these behaviors among individuals with a diagnosis characterized by recurrent acts of impulsive aggression, Intermittent Explosive Disorder (IED). Furthermore, extant research has not examined variables that might mediate the relationship between IED and self-harm. The current study examined the rates of non-suicidal self-injury (NSSI) and suicide attempts among individuals with IED as compared to healthy controls, individuals with personality disorders (PDs; which are highly comorbid with IED), and individuals with comorbid IED and PD. The study also examined the indirect effects of aggression, impulsivity, and affective lability in the relationship between diagnosis and self-harm. Participants were 1079 community individuals and prevalence rates among the total sample were 18% for NSSI and 13.2% for suicide attempts. Scores on measures aggression, impulsivity, and affect lability showed significant indirect effects on the relationships between IED + PD and NSSI; scores on aggression showed a significant indirect effect on the relationship between PD and NSSI; scores on impulsivity showed a significant indirect effect on the relationship between IED + PD and suicide attempt. These results suggest that individuals with PDs, and particularly those with comorbid IED and PD, are at increased risk for engagement in self-harm behaviors. Furthermore, traits of aggression, impulsivity, and affect lability significantly accounted for the relationship between diagnostic status and self-harm, particularly in regards to NSSI.

The interaction of affective states and cognitive vulnerabilities in the prediction of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is a serious public health concern and remains poorly understood. This study sought to identify both cognitive and affective vulnerabilities to NSSI and examine their interaction in the prediction of NSSI. A series of regressions indicated that low levels of positive affect (PA) moderated the relationships between self-criticism and brooding and NSSI. The associations of self-criticism and brooding with greater frequency of NSSI were attenuated by higher levels of PA. The interaction of cognitive and affective vulnerabilities is discussed within the context of current NSSI theory.

Risk for suicidal ideation and attempt among a primary care sample of adolescents engaging in nonsuicidal self-injury.

One in five adolescents in the United States has engaged in nonsuicidal self-injury (NSSI), one in eight have had serious thoughts of suicide, and one in 25 have attempted suicide. Research suggests that NSSI may increase risk for suicide attempt, yet little is known about the relationship between NSSI and suicidal ideation or attempts. In a primary care setting, 1,561 youth aged 14-24 years completed a brief, comprehensive, mental health screen as part of a routine well visit to determine which factors were most likely to predict suicidal ideation and attempt among youth engaging in NSSI. Results of recursive partitioning revealed that current depression and history of alcohol use best differentiated youth engaging in NSSI with low versus high risk for suicidal ideation and attempts. This simple algorithm is presented as a clinical screening tool that might aid medical providers in determining which youth would benefit from more intensive assessment and intervention.

Vulnerability-specific stress generation: an examination of depressogenic cognitive vulnerability across multiple domains.

BACKGROUND AND OBJECTIVES: Although there is supporting evidence for the stress generation hypothesis (i.e., the tendency for depression-prone individuals to experience more negative dependent events influenced by their behaviors and characteristics), additional research is required to advance current understanding of the specific types of dependent events relevant to this effect. The present study elaborated on the stress generation hypothesis, in which the content of negative dependent events experienced by individuals is contingent upon, and matches, the nature of their particular vulnerabilities. This extension was tested within the context of Cole's competency-based model of depression. DESIGN: Participants (n=185) were assessed at two time-points separated by a four-month interval. METHODS: Self-perceived competence in academic, social, and appearance domains at the initial time-point were examined in relation to negative life events prospectively occurring over the four-month follow-up period, assessed using the "contextual threat" method. RESULTS: Partial support was obtained for vulnerability-specific stress generation. Stress-generation specificity was found for self-perceived competence in appearance and academic domains, but not for self-perceived social competence. CONCLUSIONS: The current findings are consistent with the possibility of a more complex relation between self-perceived social competence and domain-congruent stress generation. Individuals may be more likely to experience negative dependent events in domains matching their specific vulnerabilities.