Gender Equity of Promoting Practices in Academic Neurosurgery in the United States.

BACKGROUND: Women have historically been underrepresented in academic medicine, particularly in surgical subspecialties. This study investigated potential associations between gender and promoting practices in academic neurosurgery. METHODS: Faculty data, including time from residency, professorship, specialty, and h-index, were obtained from websites of the institutions listed in the American Association of Neurological Surgeons Neurosurgical Residency Training Program Directory. Demographics, training, and appointments were compared between male and female neurosurgeons. Predictors of professorship, chair, directorship, and division leadership were identified using multivariable models. RESULTS: The study examined 1629 faculty members. Women were more likely to be assistant professors (P < 0.0001), while men were more likely to be full professors (P < 0.0001), hold chair positions (P = 0.007), lead subspecialty divisions (P = 0.008), and have a higher Scopus h-index (P < 0.0001). In a multivariable analysis, years from training (P < 0.001), fellowship (P = 0.009), h-index (P < 0.001), and chair/program director/division leadership position (P < 0.001) were significant positive predictors of full professorship. Holding additional advanced degrees (P = 0.010), leading a subspecialty division (P = 0.005), and having a higher h-index (P = 0.002) positively predicted chair position. However, when accounting for all other factors, gender was not a significant predictor of full professorship, division leadership, chair, or program directorship. CONCLUSIONS: While significantly more men hold leadership positions in U.S. academic institutions, after controlling for contributing variables, there did not appear to be an association between gender and full professorship, division leadership, chair, or program directorship in academic neurosurgery. While the field still has significant work to do to achieve gender equity, these results may serve as encouragement to women who are looking to advance their careers in academic neurosurgery.

Gender-Pay Equity in Academic Neurosurgery at United States Public Universities.

Background Compensation has historically been unequal for men versus women in medical fields, particularly in surgical subspecialties.  Objective We analyzed associations between gender and compensation and identified factors associated with compensation among male and female academic neurosurgeons in the United States (US) public institutions. Methods This is a cross-sectional study of available data for the 2016-2017 fiscal years associated with male and female neurosurgical faculty from public, academic institutions within the US. The data used for analysis included total annual salary, which consisted of the base salary and additional compensation. Other gleaned data included faculty demographics, training, and academic appointments. The male and female neurosurgeons' data were separated into two respective gender groups and then were compared. Predictors of compensation were identified using univariable and non-imputed and multiply-imputed multivariable statistical models. Results The cohort was comprised of 460 neurosurgery faculty members (female n=34; male n=426). Total annual salaries were comparable between the genders. Females were more likely to be younger (p=0.001), to have completed neurosurgery training recently (p=0.003), to have had fellowship training (p=0.011), and to have lower h--indices (p=0.003) compared to males. Males and females differed in academic ranks (p=0.035) and neurosurgical subspecialties (p=0.038). Midwest (a[Formula: see text])=-US$337,516.7, p=0.002), South (a[Formula: see text]=-US$302,500.5, p=0.003), and West (a[Formula: see text]=-US$276,848.8, p=0.005) practices were independent predictors of lower annual compensation. Chair position (a[Formula: see text]=US$174,180.3, p=0.019) and associate professorship (a[Formula: see text]=US$126,633.4, p=0.037) were independent predictors of higher annual compensation. Gender was not a significant predictor of total annual compensation. Conclusions Total salaries were not different between male and female neurosurgeons in public, academic institutions in the US. Gender was not a significant predictor of total annual compensation. This study is applicable to public institutions in states with Freedom of Information Act reporting requirements.

Emerging Technologies in Flow Diverters and Stents for Cerebrovascular Diseases.

PURPOSE OF REVIEW: Stents and flow diverters have revolutionized the treatment of cerebrovascular disease. Guglielmi coils, flexible microcatheters, and first-generation intracranial stents, such as Neuroform (Stryker Neurovascular) and Enterprise stents (Codman/DePuy-Synthes), have paved the way for the development of the Pipeline Embolization Device (PED) (ev3/Covidien/Medtronic) and other endovascular approaches. RECENT FINDINGS: This review discusses the historical development of flow diverter technologies from the PED to similar devices, such as the Surpass stent (Stryker Neurovascular), the Flow-Redirection Endoluminal Device (FRED; MicroVention, Inc.), the SILK stent (Balt Extrusion), and the p64 Flow Modulation Device (Phenox). In addition, the potential use of drug-eluting stents and various bioresorbable scaffolds (e.g., poly-L-lactic acid, magnesium), new developments in stent material (e.g., thin-film nitinol), design (e.g., biocompatible polymers, embedded microcircuitry, flow models), and potential applications for flow diverters will be considered. Endovascular treatment of cerebrovascular disease is rapidly advancing via continued development of new technology.

Use of conditioned medium for efficient transformation and cost-effective cultivation of Nannochloropsis salina.

The oleaginous microalga Nannochloropsis sp. has been spotlighted as a promising candidate in genetic engineering research for biodiesel production. However, one of the major bottlenecks in the genetic manipulation against Nannochloropsis sp. is low transformation efficiency. Based on the idea that they grow rapidly in broth culture, the effect of conditioned medium on colonization and transformation efficiency of Nannochloropsis salina was investigated. Cells grown on agar plates with 20-40% conditioned medium produced colonies that were approximately 2.3-fold larger than cells grown without conditioned medium. More importantly, the transformation efficiency was about 2-fold greater on plates with 30% conditioned medium relative to those without conditioned medium. In addition, FAME productivity in liquid cultures with 100% conditioned medium increased up to 20% compared with cultures of control medium. These results suggest that conditioned medium can be applied for efficient transformation and cost-effective cultivation of N. salina for biodiesel production.

Critical assessment of complications associated with use of the Pipeline Embolization Device.

BACKGROUND: The Pipeline Embolization Device (PED) has become an important tool in the treatment of complex cerebrovascular pathology since it was approved by the Food and Drug Administration in April 2011. OBJECTIVE: To determine the overall complication rate (permanent and transient) associated with the use of this new device from a single institution. METHODS: We retrospectively examined a prospectively maintained database of our patients treated with the PED since its availability to the current time. 126 patients (24 men, 102 women; age range 14-83 years, mean 59.8 years) were treated for a total of 137 intracranial aneurysms, one cervical internal carotid artery dissection, one cervical vertebral artery dissection, and one carotid-cavernous fistula with a total of 217 PEDs (1.72 PED/patient). RESULTS: A total of 40 complications were experienced by 33 patients in our cohort. Four complications (4/126, 3.2%) in four patients were permanent, resulting in three deaths and one permanent disability. The other 36 complications (28.6%) occurred in 29 patients, all of whom went on to recover completely. The total complication rate associated with the use of the PED was 31.7% (40/126). CONCLUSIONS: Despite a low rate of permanent complications associated with the PED in this series, the total complication rate was high. This finding supports the conclusion that this device should be reserved for the most challenging aneurysms. Patients should be advised of this higher rate of transient periprocedural complications. TRIAL REGISTRATION NUMBER: IRB#:14BN027 Q7.

Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model.

Solitary fibrous tumor represents a spectrum of mesenchymal tumors, encompassing tumors previously termed hemangiopericytoma, which are classified as having intermediate biological potential (rarely metastasizing) in the 2002 World Health Organization classification scheme. Few series have reported on clinicopathological predictors with outcome data and formal statistical analysis in a large series of primary tumors as a single unified entity. Institutional pathology records were reviewed to identify primary solitary fibrous tumor cases, and histological sections and clinical records reviewed for canonical prognostic indicators, including patient age, tumor size, mitotic index, tumor cellularity, nuclear pleomorphism, and tumor necrosis. Patients (n=103) with resected primary solitary fibrous tumor were identified (excluding meningeal tumors). The most common sites of occurrence were abdomen and pleura; these tumors were larger than those occurring in the extremities, head and neck or trunk, but did not demonstrate significant outcome differences. Overall 5- and 10-year metastasis-free rates were 74 and 55%, respectively, while 5- and 10-year disease-specific survival rates were 89 and 73%. Patient age, tumor size, and mitotic index predicted both time to metastasis and disease-specific mortality, while necrosis predicted metastasis only. A risk stratification model based on age, size, and mitotic index clearly delineated patients at high risk for poor outcomes. While small tumors with low mitotic rates are highly unlikely to metastasize, large tumors ≥ 15 cm, which occur in patients ≥ 55 years, with mitotic figures ≥ 4/10 high-power fields require close follow-up and have a high risk of both metastasis and death.

Contraceptive decision-making in military women.

The purpose of this study was to explore the experiences of women in the military related to the prevention of pregnancy. Ten single women, ages 19 to 24, volunteered to be participants. They were interviewed over a 12-week period in a private setting at a military clinic. The results of the study were that their decision to use contraception was influenced by their personal goals, family values, perceived support system, and effectiveness of the birth control. These women used contraceptive methods that they felt were right for them. The conclusion of the study was that women in active military duty are in need of reproductive health education, career counseling, and support. Nurses are in a good position to provide these needed services.