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Schmidt-hammer exposure-age dating (SHD) of boulders on cryoplanation terrace treads and associated bedrock cliff faces revealed Holocene ages ranging from 0 ± 825 to 8890 ± 1185 yr. The cliffs were significantly younger than the inner treads, which tended to be younger than the outer treads. Radiocarbon dates from the regolith of 3854 to 4821 cal yr BP (2σ range) indicated maximum rates of cliff recession of ~0.1 mm/yr, which suggests the onset of terrace formation before the last glacial maximum. Age, angularity, and size of clasts, together with planation across bedrock structures and the seepage of groundwater from the cliff foot, all support a process-based conceptual model of cryoplanation terrace development in which frost weathering leads to parallel cliff recession and, hence, terrace extension. The availability of groundwater during autumn freezeback is viewed as critical for frost wedging and/or the growth of segregation ice during prolonged winter frost penetration. Permafrost promotes cryoplanation by providing an impermeable frost table beneath the active layer, focusing groundwater flow, and supplying water for sediment transport by solifluction across the tread. Snow beds are considered an effect rather than a cause of cryoplanation terraces, and cryoplanation is seen as distinct from nivation.
We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability.
We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability.
In our sample of 3 306 participants,21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%,2.9%, and1.5%respectively. Alcoholdependencewasidentifiedin6.6%,andmajordepressionin4.0%of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non- alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4).
People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.
Background: External ventricular drain (EVD) insertion is a common neurosurgical procedure performed in patients with life-threatening conditions, but can be associated with complications. The objectives of this study are to evaluate data on national practice patterns and complications rates in order to optimize clinical care Methods: The Canadian Neurosurgery Research Collaborative conducted a prospective multi-centre registry of patients undergoing EVD insertions at Canadian residency programs Results: In this interim analysis, 4 sites had recruited 46 patients (mean age: 53.9 years, male:female 2:1). Most EVD insertions occurred outside of the operating theatre, using free-hand technique, and performed by junior neurosurgery residents (R1-R3). The catheter tip was in the ipsilateral frontal horn or body of the lateral ventricle in 76% of cases. Suboptimally placed catheters did not have higher rates of short-term occlusion. EVD-related hemorrhage occurred in 6.5% (3/45) with only 1 symptomatic patient. EVD-related infection occurred in 13% (6/46) at a mean of 6 days and was associated with longer duration of CSF drainage (P=0.039; OR: 1.13) Conclusions: Interim results indicate rates of EVD-related complications may be higher than previously thought. This study will continue to recruit patients to confirm these findings and determine specific risk factors associated with them
Timoniella spp. are cryptogonimid flukes (Digenea: Cryptogonimidae) that parasitize the guts of fish in brackish waters. Timoniella imbutiforme, a species from the Mediterranean Sea, is recorded in the Black Sea, while T. balthica has been described from the Baltic Sea. In this paper, we clarify the taxonomic status of Timoniella populations in the Baltic and Black seas. Adults and metacercariae of Timoniella spp. were sampled from localities in the Mediterranean Sea (France), Black Sea (Ukraine) and Baltic Sea (Germany) and subjected to molecular and morphological analysis, including Bayesian phylogenetic reconstruction based on concatenated sequences of ITS1–ITS2–28S. This allowed us to construct a new key to species of the genus Timoniella. Our results suggest that T. balthica forms part of the Boreal–Atlantic relict fauna of the Black Sea and should now be considered a junior synonym of T. imbutiforme.
Background: No standardized method of resident operative-case logging exists. Our study sought to develop a standardized form used by residents to log operative-cases. Methods: Members of the Canadian Neurosurgery Research Collaborative (CNRC), a national resident-led research organization have created a standardized document based on the current Royal College objectives for operative procedures (section 5). Modifications to structure and content will be guided via consensus from Canadian neurosurgery program-directors. Results: Program directors in each CNRC collaborative institution will be asked to modify the standardized form. The CNRC currently involves thirteen of the fourteen Canadian neurosurgery residency programs. Additional consensus, if necessary, can be reached at the Royal College meeting for program directors of neurosurgery March 20th 2017. Conclusions: A standardized operative-case log represents the first step in a prospective study towards compiling operative volume of all Canadian neurosurgical residents over one academic year. Such data will be essential to guide informed decisions with regard to Royal College requirements as Canadian neurosurgical programs transition to a competency based framework.
Background: Communicating with senior neurosurgical colleagues during residency necessitates a reliable and versatile smartphone. Smartphones and their apps are commonplace. They enhance communication with colleagues, provide the ability to access patient information and results, and allow access to medical reference applications. Patient data safety and compliance with the Personal Health Information Protection Act (PHIPA, 2004) in Canada remain a public concern that can significantly impact the way in which mobile smartphones are utilized by resident physicians Methods: Through the Canadian Neurosurgery Research Collaborative (CNRC), an online survey characterizing smartphone ownership and utilization of apps among Canadian neurosurgery residents and fellows was completed in April 2016. Results: Our study had a 47% response rate (80 surveys completed out of 171 eligible residents and fellows). Smartphone ownership was almost universal with a high rate of app utilization for learning and facilitating the care of patients. Utilization of smartphones to communicate and transfer urgent imaging with senior colleagues was common. Conclusions: Smartphone and app utilization is an essential part of neurosurgery resident workflow. In this study we characterize the smartphone and app usage within a specialized cohort of residents and suggest potential solutions to facilitate greater PHIPA adherence
Background: The Canadian Neurosurgery Research Collaborative (CNRC) was founded in November 2015 as a resident-led national network for multicentre research. We present an annual report of our activities. Methods: CNRC meetings and publications were reviewed and summarized. The status of ongoing and future studies was collected from project leaders. Results: In its first year, the CNRC produced two papers accepted for publication in the Canadian Journal of Neurological Sciences: A CNRC launch letter and a study of operative volume at Canadian neurosurgery residency programs. Three manuscripts are in preparation: 1) a study of the demographics of Canadian neurosurgery residents, 2) an assessment of mobile devices usage patterns and 3) a validation study of the most utilized neurosurgery mobile apps. In addition, protocols for two multi-centre studies are currently undergoing national Research Ethics Board review: A retrospective study of the incidence and predictors of cerebellar mutism and a prospective registry of external ventricular drain procedures and complications. The network is now a registered not-for-profit organization endorsed by the Canadian Neurosurgical Society. Conclusions: The CNRC is a feasibile, relevant and productive resident-led national research network. As the CNRC matures, we look forward to expanding the scope and impact of its projects.
Video is considered to be an effective, easy to use tool employed in anti-stigma interventions among young people. Mass media has been shown to be effective for reducing stigma; however, there is insufficient evidence to determine the destigmatization effects of videos specifically. This article systematically reviews the effectiveness of video intervention in reducing stigma among young people between 13 and 25 years. We searched 13 electronic databases including randomized controlled trials, cluster randomized controlled trials, and controlled before and after studies. Of the 1426 abstracts identified, 23 studies (reported in 22 papers) met the inclusion criteria. Video interventions led to improvements in stigmatising attitudes. Video was found to be more effective than other interventions, such as classical face-to-face educational sessions or simulation of hallucinations. According to results of two studies, social contact delivered via video achieved similar destigmatization effect to that delivered via a live intervention. Although the quality of studies as well as the form of video interventions varied, the findings suggest that video is a promising destigmatization tool among young people; however, more studies in this area are needed. There was a lack of evidence for interventions outside of school environments, in low- and middle-income countries, and studies, which looked at long-term outcomes or measured impact on actual behaviour and implicit attitudes. The review generates recommendations for video interventions targeted at young people.
Background: The Canadian Neurosurgery Research Collaborative (CNRC) is a new consortium of neurosurgery residency programs set-up to facilitate the planning and implementation of multi-center studies. As a trainee-led organization, it will focus on resident-initiated, resident-driven projects. The goal of this study is to assess the demographics of Canadian neurosurgery residents, with particular focus on their academic and subspecialty interests. Methods: After approval by the CNRC, an online survey will be sent to all Canadian neurosurgery residents and fellows with reminders at 2, 4 and 6 weeks. Anonymous, basic demographic data will be collected. Specific interest towards the various subspecialties, research and academic vs community practice will be measured. The data will be crossed with the ongoing Canadian Neurosurgery Operative Landscape study to assess the impact of case volume on academic and subspecialty interests. Results: This is the first study providing a snapshot of Canadian neurosurgery residents at all levels of training. The study is ongoing and the official results will be presented at the meeting. As one of the first CNRC studies, it will also demonstrate the effectiveness of the collaborative. Conclusions: Understanding the demographics and interests of Canadian neurosurgery residents will allow the CNRC to better fulfill its mission.
Background: The Canadian Neurosurgery Research Collaborative (CNRC) is a trainee-led multi-centre collaboration made up of representatives from 12 of 14 neurosurgical centres with residency programs. To demonstrate the potential of this collaborative network, we gathered administrative operative data from each centre in order to provide a snapshot of the operative landscape in Canadian neurosurgery. Methods: Residents from each training program provided adult neurosurgical operative data for the 2014 calendar year, including the number of surgeries in the subcategories cranial, spinal, and peripheral nerve. Because some residency programs have surgeries distributed among more than one hospital, we calculated mean case load per residency program and per hospital. Results: Interim results from 6 neurosurgery residency programs are presented (with data from other programs forthcoming). Overall, there were on average 2,352 operative cases per residency program (n=6) and 1,176 operative cases per adult hospital (n=12). Among 5 programs with more detailed operative data, the mean numbers of cranial, spinal, peripheral nerve, and miscellaneous surgeries per residency program were 757 (47%), 487 (30%), 47 (3%), and 319 (20%) respectively. Conclusions: We show as a proof-of-concept that a trainee-led nation-wide research collaborative can generate meaningful data in a Canadian context.
Background: The goals of evidence-based neurosurgery are to improve surgical outcomes, reduce complications, and provide an objective basis for altering practice. The need for higher quality studies, typically prospective and multicentre, has been growing especially in light of the evolving complexity of neurosurgical interventions and heterogeneity of patient populations. In the United Kingdom (UK), trainee-led research collaboratives have been established to tackle this problem. Therefore, we sought to evaluate the potential role for a resident-led research collaborative in neurosurgery in Canada based on the UK experience. Methods: A literature review of trainee-led collaboratives was conducted utilizing PubMed and Medline. Identified articles were reviewed for study quality and clinical relevance to explore the potential benefits of collaboratives. Results: In the UK, 27 collaboratives have been established in various specialties by trainees. Some published high quality trials with implications on their clinical fields. Evidence suggests that such endeavors improves trainees’ research skills and may help cultivate a research culture tailored towards clinical trials. Conclusions: Given the growing evidence for research collaboratives in the UK, we propose launching the Canadian Neurosurgery Research Collaborative (CNRC) which currently represents 12 out of 14 neurosurgery programs in Canada, and planning its first multicenter prospective study.
Background: Current selection methods for neurosurgical residents lack objective measurements of psychomotor performance. This pilot study was designed to answer three questions: 1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using the NeuroVR (formerly NeuroTouch) neurosurgical simulator? 2) Are there exceptionally skilled medical student applicants? 3) Does previous surgical exposure influence surgical performance? Methods: Medical students attending neurosurgery residency interviews at McGill University were asked to participate. Participants were instructed to remove 3 simulated brain tumors. Validated tier 1, tier 2, and advanced tier 2 metrics were utilized to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure. Results: Sixteen of 17 neurosurgical applicants (94%) participated. Performances clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increase applicant self-evaluated technical skills, high self-ratings of confidence and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increase blood loss was seen in multivariate analysis. Conclusions: Simulation technology identifies neurosurgical residency applicants at the extremes of technical ability and extrinsic and intrinsic applicant factors appear to influence performance.
Seasonal affective disorder (SAD) is a subtype of recurrent depressive or bipolar disorder that is characterized by regular onset and remission of affective episodes at the same time of the year. The aim of the present study was to provide epidemiological data and data on the socioeconomic impact of SAD in the general population of Austria.
We conducted a computer-assisted telephone interview in 910 randomly selected subjects (577 females and 333 males) using the Seasonal Health Questionnaire (SHQ), the Seasonal Pattern Assessment Questionnaire (SPAQ), and the Sheehan Disability Scale (SDS). Telephone numbers were randomly drawn from all Austrian telephone books and transformed using the random last digits method. The last birthday method was employed to choose the target person for the interviews.
Out of our subjects, 2.5% fulfilled criteria for the seasonal pattern specifier according to DSM-5 and 2.4% (95% CI = 1.4–3.5%) were diagnosed with SAD. When applying the ICD-10 criteria 1.9% (95% CI = 0.9–2.8%) fulfilled SAD diagnostic criteria. The prevalence of fall-winter depression according to the Kasper-Rosenthal criteria was determined to be 3.5%. The criteria was fulfilled by 15.1% for subsyndromal SAD (s-SAD). We did not find any statistically significant gender differences in prevalence rates. When using the DSM-5 as a gold standard for the diagnosis of SAD, diagnosis derived from the SPAQ yielded a sensitivity of 31.8% and a specificity of 97.2%. Subjects with SAD had significantly higher scores on the SDS and higher rates of sick leave and days with reduced productivity than healthy subjects.
Prevalence estimates for SAD with the SHQ are lower than with the SPAQ. Our data are indicative of the substantial burden of disease and the socioeconomic impact of SAD. This epidemiological data shows a lack of gender differences in SAD prevalence. The higher rates of females in clinical SAD samples might, at least in part, be explained by lower help seeking behaviour in males.
Background: Objective methods to assess the influence of significant stress on neurosurgical bimanual psychomotor performance have not been developed. We utilized NeuroTouch, a virtual reality simulator, to answer two questions: 1) What is the impact of significant stress on bimanual psychomotor performance during the resection of a simulated tumor? 2) Does stress influence performance immediately following the stressful episode? Methods: Uncontrollable ‘intraoperative’ bleeding during one of the tumor resections resulting in simulated patient cardiac arrest served as the acute stressor. Six neurosurgeons, 6 senior and 6 junior neurosurgical residents and 6 senior medical students were studied. The evaluated advanced tier 2 metrics were efficiency index, ultrasonic aspirator path length index, suction coordination index and ultrasonic aspirator bimanual forces ratio. Results: The stress scenario significantly decreased the efficiency index of all groups and significantly decreased performance for many groups for suction coordination index and ultrasonic aspirator path length index. Performance in all advanced tier 2 metrics returned to pre-stress levels in post stress resection scenarios. Conclusions: Our results are consistent with the concept that acute stress initiated by severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute episode but had no significant influence on immediate post stress operative performance.
Background: The availability of virtual reality (VR) surgical simulators affords the opportunity to assess the influence of stress on neurosurgical operative performance in a controlled laboratory environment. This study sought to examine the effect of a stressful VR neurosurgical task on the subjective anxiety ratings of participants with varying levels of surgical expertise. Methods: Twenty four participants comprised of six staff neurosurgeons, six senior neurosurgical residents (PGY4-6), six junior neurosurgical residents (PGY1-3), and six senior medical students took part in a bimanual VR tumor removal task with a component of sudden uncontrollable intra-operative bleeding. State Trait Anxiety Inventory (STAI) questionnaires were completed immediately pre and post the stress stimulus. The STAI questionnaire consisted of six items (calm, tense, upset, relaxed, content and worried) measured on a Likert scale. Results: Significant increases in subjective anxiety ratings were noted in junior residents (p=0.005) and medical students (p=0.025) while no significant changes were observed for staff and senior neurosurgical residents. Conclusions: Staff and senior residents more effectively mitigate stress compared to junior colleagues in a VR operative environment. Further physiological correlates are needed to determine whether this increased anxiety is paralleled by physiological arousal and altered surgical performance.