Realistic Assessment of Research Publications by Neurosurgery Residency Applicants.

OBJECTIVE: Neurosurgical residency applicants' prior research experience can amplify their ability to stand out to prospective neurosurgery programs. We attempted to accurately quantify the number of research publications coauthored by applicants by analyzing the publications of applicants who matched into neurosurgery in the 2021 Match. METHODS: Scopus, a peer-reviewed literature database, was queried for publications by applicants who matched into neurosurgery in the 2021 Match before the finalization of rank lists. Conference papers, abstracts, and book chapters were excluded to determine an accurate average of actual publications. Descriptive statistics for resident publication data were used, with a Mann-Whitney U test used to compare research productivity between male and female residents. RESULTS: There were 234 positions filled by the 2021 Match, and 233 neurosurgical residents were identifiable in this study. A total of 187 residents matching from U.S. Doctor of Medicine and Doctor of Osteopathic Medicine programs were identified with 946 total publications-an average of 5.1 publications per resident. Analysis of descriptive statistics revealed type of research conducted, authorship information, most published journals, and citation data. Significant differences were found in the number of publications between male and female applicants with averages of 5.6 and 3.8 publications, respectively. CONCLUSIONS: Students matriculating to neurosurgery residency programs display a wide range of research productivity. Typical U.S. Doctor of Medicine and Doctor of Osteopathic Medicine applicants have coauthored a mean of 5.1 and a median of 4.0 publications. This information may assist program directors in weighing applicants' research background and give medical students interested in the field reasonable research expectations.

Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID-19 Infections.

Background In multisystem inflammatory syndrome in children, there is paucity of longitudinal data on cardiac outcomes. We analyzed cardiac outcomes 3 to 4 months after initial presentation using echocardiography and cardiac magnetic resonance imaging. Methods and Results We included 60 controls and 60 cases of multisystem inflammatory syndrome in children. Conventional echocardiograms and deformation parameters were analyzed at 4 time points: (1) acute phase (n=60), (2) subacute phase (n=50; median, 3 days after initial echocardiography), (3) 1-month follow-up (n=39; median, 22 days), and (4) 3- to 4-month follow-up (n=25; median, 91 days). Fourteen consecutive cardiac magnetic resonance imaging studies were reviewed for myocardial edema or fibrosis during subacute (n=5) and follow-up (n=9) stages. In acute phase, myocardial injury was defined as troponin-I level ≥0.09 ng/mL (>3 times normal) or brain-type natriuretic peptide >800 pg/mL. All deformation parameters, including left ventricular global longitudinal strain, peak left atrial strain, longitudinal early diastolic strain rate, and right ventricular free wall strain, recovered quickly within the first week, followed by continued improvement and complete normalization by 3 months. Median time to normalization of both global longitudinal strain and left atrial strain was 6 days (95% CI, 3-9 days). Myocardial injury at presentation (70% of multisystem inflammatory syndrome in children cases) did not affect short-term outcomes. Four patients (7%) had small coronary aneurysms at presentation, all of which resolved. Only 1 of 9 patients had residual edema but no fibrosis by cardiac magnetic resonance imaging. Conclusions Our short-term study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children. Use of sensitive deformation parameters provides further reassurance that there is no persistent subclinical dysfunction after 3 months.

Clinical and cost implications of using immediate MRI in the management of patients with a suspected scaphoid fracture and negative radiographs results from the SMaRT trial.

AIMS: The aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs. PATIENTS AND METHODS: Patients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants' self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors. RESULTS: The mean cost up to three months post-recruitment per participant was £542.40 (sd £855.20, n = 65) for the control group and £368.40 (sd £338.60, n = 67) for the intervention group, leading to an estimated cost difference of £174 (95% confidence interval (CI) -£30 to £378; p = 0.094). The cost difference per participant increased to £266 (95% CI £3.30 to £528; p = 0.047) at six months. Overall, 6.2% of participants (4/65, control group) and 10.4% of participants (7/67, intervention group) had sustained a fracture of the scaphoid (p = 0.37). In addition, 7.7% of participants (5/65, control group) and 22.4% of participants (15/67, intervention group) had other fractures diagnosed (p = 0.019). The use of MRI was associated with higher diagnostic accuracy both in the diagnosis of a fracture of the scaphoid (100.0% vs 93.8%) and of any other fracture (98.5% vs 84.6%). CONCLUSION: The use of immediate MRI in the management of participants with a suspected fracture of the scaphoid and negative radiographs led to cost savings while improving the pathway's diagnostic accuracy and patient satisfaction. Cite this article: Bone Joint J 2019;101-B:984-994.

Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial.

Barbed suture has been associated with improved closure efficiency and safety in TKA in prior studies. We performed a multicenter randomized controlled trial to determine the efficiency and safety of this technology in TKA. We prospectively randomized 411 patients undergoing primary TKA to either barbed running (n=191) or knotted interrupted suture closure (n=203). Closure time was measured intra-operatively. Cost analysis was based on suture and OR time costs. Closure time was shorter with barbed suture (9.8 vs. 14.5 min, p<0.001). Total closure cost was less with barbed suture ($324 vs. $419, p<0.001). Early complications and outcomes were similar between groups. The use of barbed suture in TKA is associated with shorter closure time, lower cost and similar outcomes and complications when compared with standard sutures.

Conserving large carnivores: dollars and fence.

Conservationists often advocate for landscape approaches to wildlife management while others argue for physical separation between protected species and human communities, but direct empirical comparisons of these alternatives are scarce. We relate African lion population densities and population trends to contrasting management practices across 42 sites in 11 countries. Lion populations in fenced reserves are significantly closer to their estimated carrying capacities than unfenced populations. Whereas fenced reserves can maintain lions at 80% of their potential densities on annual management budgets of $500 km(-2) , unfenced populations require budgets in excess of $2000 km(-2) to attain half their potential densities. Lions in fenced reserves are primarily limited by density dependence, but lions in unfenced reserves are highly sensitive to human population densities in surrounding communities, and unfenced populations are frequently subjected to density-independent factors. Nearly half the unfenced lion populations may decline to near extinction over the next 20-40 years.

Lawn soil carbon storage in abandoned residential properties: an examination of ecosystem structure and function following partial human-natural decoupling.

Residential abandonment is on the rise in many urban areas, with unknown implications for ecosystem structure and function on land slated for partial or full restoration to native habitat. Partial decoupling of human and natural systems could reduce disturbance (e.g., trampling, recreational traffic) and modify vegetation structure in a way that alters soil carbon storage, an ecosystem function that many municipalities consider a management objective of growing importance. We quantified soil carbon percent and mass to 10 cm depth and examined vegetation structure in 50 vacant and 10 occupied residential lawns located in Richmond, VA, with the principal objective of determining whether occupancy status alters trajectories of soil carbon storage or its correspondence with household economic/demographic indicators and vegetation cover. Abandoned residential lawns supported significantly less grass cover, but these declines were largely offset by increases in emergent overstory (>1 m height) vegetation cover. Soil carbon percent and mass did not differ between lawns of occupied and abandoned residences, even though significant, but highly uncertain, increases in soil carbon mass occurred in the first decade following vacancy. Instead, all residential lawns exhibited similar significant increases in soil carbon percent and mass with increasing residence age and neighborhood affluence, the former indicating annual carbon accretion rates of 20 g m(-2). We conclude that in this early stage of vacancy, soil carbon storage is already subtly responding to declines in human intervention, with reduced soil disturbance and sustained vegetation cover in abandoned lawns playing likely roles in emerging soil carbon storage trajectories.

The cost of walking downhill: is the preferred gait energetically optimal?

Humans tend to prefer walking patterns that minimize energetic cost, but must also maintain stability to avoid falling over. The relative importance of these two goals in determining the preferred gait pattern is not currently clear. We investigated the relationship between energetic cost and stability during downhill walking, a context in which gravitational energy will assist propulsion but may also reduce stability. We hypothesized that humans will not minimize energetic cost when walking downhill, but will instead prefer a gait pattern that increases stability. Simulations of a dynamic walking model were used to determine whether stable downhill gaits could be achieved using a simple control strategy. Experimentally, twelve healthy subjects walked downhill at 1.25 m/s (0, 0.05, 0.10, and 0.15 gradients). For each slope, subjects performed normal and relaxed trials, in which they were instructed to reduce muscle activity and allow gravity to maximally assist their gait. We quantified energetic cost, stride timing, and leg muscle activity. In our model simulations, increase in slope reduced the required actuation but also decreased stability. Experimental subjects behaved more like the model when using the relaxed rather than the normal walking strategy; the relaxed strategy decreased energetic cost at the steeper slopes but increased stride period variability, an indicator of instability. These results indicate that subjects do not take optimal advantage of the propulsion provided by gravity to decrease energetic cost, but instead prefer a more stable and more costly gait pattern.

Attitudes of general dental practitioners in Wales towards employing dental hygienist-therapists.

AIM: To examine the attitudes of general dental practitioners in Wales with regard to the employment of dually-qualified hygienist-therapists. DESIGN: Questionnaire. RESULTS: Responses were received from the principals of 332 of the 550 practices surveyed, a response rate of 60.4%. Fifty-four percent of responding principals currently employed a hygienist and 9% a dually-qualified hygienist-therapist; 43% considered that they were likely to employ hygienist-therapists in the future. Lack of surgery space to accommodate a hygienist-therapist was a problem facing many principals. Disappointingly, respondents demonstrated a clear lack of knowledge in relation to the cost effectiveness of hygienist-therapists, with 39% of principals admitting that this individual would be expected to spend more than half their working time on hygiene treatment. Sixty percent of principals placed an associate among their first three preferences to fill spare capacity, while only 28% selected a hygienist-therapist. CONCLUSION: This study has provided local evidence to inform workforce planning and identified a need to ensure that all members of the dental team understand the roles and responsibilities of colleagues.

Outreach to the homeless: craft, science, and future implications.

Outreach is a treatment modality for engaging underserved populations in health care. Nowhere is outreach more relevant than in delivering services to homeless persons with mental illness. Programs providing outreach to homeless people have been in existence for at least two decades and a craft has developed naturalistically. However, there has been insufficient formal examination of factors that influence the effectiveness of outreach and how it is actually performed. The authors present an in-depth examination of issues related to outreach to the homeless. They review different outreach modalities, the role of the individual clinician, and the art of teamwork. They also discuss external issues such as financing, access to housing, interactions with other professions, and working conditions. The authors conclude with a brief discussion concerning the application of outreach to populations other than homeless individuals with psychiatric disorders and suggest future directions for improving our understanding of this important modality.

Psychotic ideation and receipt of government entitlements among homeless persons in New York City.

OBJECTIVE: This study compared changes in receipt of government entitlements by homeless persons with and without psychotic ideation in New York City between January 1997 and July 1998, a period characterized by changing state government policies and greater bureaucratic monitoring of eligibility. METHODS: In conjunction with an experimental study of the efficacy of social work services provided to homeless persons in Manhattan by a mobile medical van, 25 persons who were assessed as having experienced psychotic ideation in the previous year and 134 nonpsychotic persons were followed up after four months to identify changes in their receipt of Medicaid benefits, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), food stamps, and home relief (state welfare for single persons). The social work intervention was designed to help eligible clients gain access to entitlements and substance abuse treatment. RESULTS: The proportion of clients with psychotic ideation who received Medicaid, food stamps, or home relief decreased during the study period, while the proportion of nonpsychotic clients who received these entitlements increased. Little change was observed in receipt of SSI or SSDI by either group. CONCLUSIONS: Psychotic ideation among homeless persons may be a significant factor in access to and maintenance of government entitlements. In the context of an increasingly restrictive and bureaucratic welfare system, providing assistance to homeless persons who have severe psychopathology presents new challenges to service providers.

Partnership insurance: an innovation to meet long-term care financing needs in an era of federal minimalism.

In the case of long-term care financing, federal minimalism is not new news. Long-term care has long played a weak "third fiddle" to national health reform concerns about the uninsured and catastrophic expenditures on prescription drugs. The states have been left to struggle with the issue of long-term financing as part of their responsibilities in funding and administering the means-tested Medicaid program. Recently, the environment has become even more challenging. Much of what is on the national agenda for health and welfare reform has been delegated to the states. This "devolution" of responsibilities has created many competing priorities for both the attention and resources of states. This context of evolving federal minimalism calls for creative solutions that balance competing points of view. In this article, we provide some background and insights from one such effort: a collaboration between state governments and private insurers to put into operation an insurance-based approach to long-term care financing that uses Medicaid as an incentive to encourage potential purchasers.

Identifying indicators of laboratory management performance: a multiple constituency approach.

The challenges for laboratory management posed by cost control, managed care, organizational restructuring, information networking and health system integration call for new measures to evaluate how effectively laboratories manage emerging performance expectations. This study identifies the Delphi panel method in achieving consensus on measures of effectiveness and considers a specific application, the identification of indicators of laboratory performance, from the perspective of key constituencies.