Avalanche Education Is Associated with Increased Avalanche Safety Practices in the New Hampshire Backcountry.

INTRODUCTION: Avalanche risk can be mitigated by adhering to certain safety practices. Previous studies of these practices have focused on western United States and European cohorts. We conducted a survey of backcountry users in the White Mountains of New Hampshire to determine local adherence to 5 previously studied avalanche safety practices. We assessed whether participants were carrying transceiver, probe, and shovel (TPS); had formal avalanche education; had awareness of the day's avalanche danger level; had a route plan; and were traveling in a group. METHODS: Backcountry users in the White Mountains were directed to an online survey from December 2020 to June 2021. The survey was completed individually and queried demographics and avalanche safety practices. RESULTS: A total of 133 users participated. Not all surveyed participants answered all questions. Avalanche training was reported by 87% of users, 86% checked the avalanche forecast prior to recreating, 93% had a travel plan, 87% traveled in a group, and 59% carried TPS. All 3 items were carried by all group members only 48% of the time. Only 28% of users met all 5 safety practices. CONCLUSIONS: White Mountains backcountry users are less likely to meet avalanche safety practices than users in previous studies. There is an association between meeting these defined safety practices and formal avalanche education.

Learning by drawing and modeling: Teaching modalities for spinal anatomy in medical students.

Ongoing research has attempted to discern the optimal way to teach surgical anatomy. This study investigated the relative effectiveness of drawing and clay modeling on learning spinal anatomy among medical students. Participants were recruited from a first-year medical school class to participate in an optional educational session in their regular course schedule. Seventy-eight students participated, and 62 completed pre- and post-session tests. Participants were randomized to one of three groups, either learning spinal anatomy by (1) drawing, (2) clay modeling, or (3) reviewing a 3D anatomy application (control). All groups referenced the anatomy application; the control group had no additional learning modality. Students had 15 min to learn major anatomical structures in the lumbar spine according to their assigned modality. Learning was evaluated in terms of score differential on pre- and post-session anatomy tests, with questions focused on anatomy applied in different contexts such as pathophysiology and radiology. Improved pre- to posttest scores were expected for the drawing and modeling groups compared to control. On average, the drawing group's scores significantly improved by 11% from pre- to posttest. Scores in the clay and control groups did not significantly improve. Drawing is thus an effective strategy for learning basic and applied spinal anatomy, and drawing and clay modeling (with adequate time) may be useful for teaching medical students to apply surgical anatomical knowledge in various contexts. These modalities are generalizable to any surgical anatomical education, and should be further explored among surgical residents given their efficacy, feasibility, and minimal use of resources.

Determining an Appropriate Outcome Measure in Neurosurgical Research: Investigating Meaningful, Valid, and Practical Metrics.

Given the rapidly evolving pace of research and technology in the neurosurgical field, it is critical to consider the parameters of valid, practical, and meaningful study outcome measures. Here we review fundamental aspects of selecting outcome measures in the context of neurosurgical research. Exemplifying work in meningiomas and high-grade gliomas, we delineate a proposed framework for identifying an appropriate outcome measure. Four fundamental components of an outcome measure are defined and characterized: understanding characteristics of a good outcome measure; developing a research question to address an outcome measure; defining the outcome measure, and considering limitations of an outcome measure. This four-part framework enhances and promotes the methodology for determining if an outcome measure is valid, practical, and ultimately meaningful.

Type I split cord malformation and tethered cord syndrome in an adult patient: A case report and literature review.

BACKGROUND: In a split cord malformation (SCM), the spinal cord is divided longitudinally into two distinct hemicords that later rejoin. This can result in a tethered cord syndrome (TCS). Rarely, TCS secondary to SCM presents in adulthood. Here, we present an adult female with Type I SCM resulting in TCS and a review of literature. CASE DESCRIPTION: A 57-year-old female with a history of spina bifida occulta presented with a 2-year history of worsening back and left leg pain, difficulty with ambulation, and intermittent urinary incontinence; she had not responded to conservative therapy. Magnetic resonance imaging (MRI) revealed a tethered cord secondary to lumbar type I SCM. The patient underwent an L1-S1 laminectomy for resection of the bony septum with cord detethering. At 2-month follow-up, the patient had improvement in her motor symptoms and less pain. In literature, 25 cases of adult-onset surgically managed SCM with TCS were identified (between 1936 and 2018). Patients averaged 37 years of age at the time of diagnosis, and 56% were female. CONCLUSION: TCS can present secondary to SCM in adulthood and is characterized predominantly by back and leg pain.

Deep Brain Stimulation for Memory Modulation: A New Frontier.

BACKGROUND: In the coming years the number of patients with cognitive disorders, such as Alzheimer disease and traumatic brain injury, is expected to dramatically increase, leading to an ever-increasing societal cost. Unfortunately, few medical and pharmacologic treatments have shown tangible benefit in the treatment of these diseases. Deep brain stimulation (DBS) is an established surgical technique to address multiple conditions, including Parkinson disease and essential tremor. Data from patients being treated with DBS, as well as those being monitored for seizures with depth electrodes, have suggested improvement in memory with electrical neuromodulation. METHODS: MEDLINE was searched from inception through March 2018 using the keywords "DBS," "Deep Brain Stimulation," "Memory," "Memory Modulation," and "Cognition." Studies evaluating the effect of DBS on memory and learning were shortlisted and reviewed. RESULTS: Efforts to stimulate various nodes within the memory circuitry suggest that the variable effects may result from different mechanisms, including alteration of neural firing patterns, increased activity across several regions, and amplification of neural plasticity. Some of these targets, such as the entorhinal cortex, hippocampus, and nucleus basalis of Meynert, have shown promising results with regards to modulation of memory. CONCLUSIONS: Given the aging population and increasing numbers of patients with memory impairment from neurodegenerative diseases, interest in neuromodulation for memory enhancement will likely expand. Further work should employ more sophisticated responsive stimulation parameters and precise spatial targeting that may lead to an effective stimulation strategy for memory enhancement.

Pheromone exposure influences preoptic arginine vasotocin gene expression and inhibits social approach behavior in response to rivals but not potential mates.

The nonapeptides arginine vasotocin (AVT) and vasopressin mediate a variety of social behaviors in vertebrates. However, the effects of these peptides on behavior can vary considerably both between and within species. AVT, in particular, stimulates aggressive and courtship responses typical of dominant males in several species, although it can also inhibit social interactions in some cases. Such differential effects may depend upon AVT influences within brain circuits that differ among species or between males that adopt alternative reproductive phenotypes and/or upon the differential activation of those circuits in different social contexts. However, to date, very little is known about how social stimuli that promote alternative behavioral responses influence AVT circuits within the brain. To address this issue, we exposed adult male goldfish to androstenedione (AD), a pheromonal signal that is released by both males and females during the breeding season, and measured social approach responses of males towards same- and other-sex individuals before and after AD exposure. In a second experiment, we measured AD-induced AVT gene expression using in situ hybridization. We found that brief exposure to AD induces social avoidance in response to rival males, but does not affect the level of sociality exhibited in response to sexually receptive females. Exposure to AD also increases AVT gene expression in the preoptic area of male goldfish, particularly in the parvocellular population of the preoptic nucleus. Together, these data suggest that AD is part of a social signaling system that induces social withdrawal specifically during male-male interactions by activating AVT neurons.