Background: Neurosurgery is a long and arduous training program, and the demands of neurosurgical training have led to resident burnout prevalence ranging from 11-67%, attrition, and suicide. We aimed to assess whether implementation of a weekly self-assessment tool with optional psychological counselling improves neurosurgical resident quality of life. Methods: We performed a one year prospective cohort study including 14 Calgary (intervention group) and 12 Toronto/Winnipeg residents (control group). Calgary residents utilized a mobile application (“HONE”) weekly, and all residents responded to questionnaires at baseline, midpoint and endpoint: EQ-5D-5L, Maslach Burnout Inventory (MBI), and Mayo Clinic Well-being Index (WBI). Between and within group results were compared using two-tailed t-tests. Results: Pooled baseline scores were comparable to population norms, with increased mean MBI depersonalization scores (10.28 versus 7.12, p=0.033), and more WBI “at risk” scores compared to normative data. There were no baseline differences between cohorts. EQ-5D-5L, MBI, and WBI scores were comparable between and within cohorts at all three time points. Three intervention group residents accessed psychological counselling, totalling ten sessions. Conclusions: Weekly use of the HONE application did not impact resident quality of life, although multiple residents displayed help-seeking behaviours. HONE provided tangible data for the program director to track trends in team well-being.

Background: This scoping review investigates factors influencing local control in patients with metastatic brain disease undergoing adjuvant stereotactic radiosurgery (SRS) to surgical cavities. Methods: Seven databases (Ovid Medline, PubMed, Web of Science, EMBASE, BIOSIS, Scopus, Global Health, Cochrane) were searched up to August 2, 2021, using terms related to radiosurgery and brain metastasis. A three-level screening identified relevant studies. Data extraction included study type, population, SRS details, and outcomes. Variables recorded were histopathology, resection degree, number of metastases, SRS platform, dose parameters, cavity volume, margin, time to SRS, local control at 12/24 months, overall, and progression-free survival. Significant predictors were noted. Results: From 10,633 articles, 22 studies with 1,749 cavities. Local control at 12 months was 50–100% (median 82%, IQR 73–84.4%). Distant progression at 12 months was 36–64% (median 45.5%, IQR 38–51%) and at 24 months 39–76% (median 53%, IQR 46–55%). Histology, radiation dose, tumor size, extent of resection, treatment timing, tumor depth, and dural/pial attachment impacted local control, whereas primary disease status, surgical corridor coverage, and tumor location did not. Conclusions: Modifiable SRS treatment and patient selection factors need further investigation. This review emphasizes the necessity for consensus and guides future trials and guidelines to enhance metastatic brain disease management outcomes.

Background: Hemifacial spasm (HFS) is a disorder of unilateral facial myoclonus that can be psychosocially debilitating. It is generally caused by microvascular compression of the facial nerve and is amenable to potentially curative surgery. Unfortunately, many patients receive delayed surgical referrals and are instead managed with injections of botulinum toxin to varying benefit. The reason behind late referrals is unclear, but one factor may be misleading diagnostic information; specifically, MRI reports that indicate incorrect or absent neurovascular conflict. The goal of this study was to explore the association between MRI reports and operative findings in HFS patients, with the hopes of identifying opportunities for improved diagnosis and treatment. Methods: We performed a single-center, retrospective chart review of 30 consecutive patients who underwent surgery for HFS between January 2019 and January 2020. Descriptive data were extracted from pre-operative MRI reports and operative notes, then coded for statistical analysis. Results: Pre-operative MRIs were reported by radiologists from 6 provinces. Across all MRIs (n = 45), a positive finding was only identified in 51.1%. All 30 patients had clear neurovascular conflict noted in surgery. Conclusions: There is a need for improved diagnostic accuracy in HFS, with the goal of expediting surgical referrals and possible cure.

The last 50 years have seen an increasing dependence on academic institutions to develop and commercialize new biomedical innovations, a responsibility for which many universities are ill-equipped. To address this need, we created LEAP, an asset development and gap fund program at Washington University in St. Louis (WUSTL). Beyond awarding funds to promising projects, this program aimed to promote a culture of academic entrepreneurship, and thus improve WUSTL technology transfer, by providing university inventors with individualized consulting and industry expert feedback. The purpose of this work is to document the structure of the LEAP program and evaluate its impact on the WUSTL entrepreneurial ecosystem. Our analysis utilizes program data, participant surveys, and WUSTL technology transfer office records to demonstrate that LEAP consistently attracted new investigators and that the training provided by the program was both impactful and highly valued by participants. We also show that an increase in annual WUSTL start-up formation during the years after LEAP was established and implicate the program in this increase. Taken together, our results illustrate that programs like LEAP could serve as a model for other institutions that seek to support academic entrepreneurship initiatives.

This article presents a new multiscale modeling approach proposed to predict the impact response of a biomedical niobium–zirconium alloy by incorporating both geometric and microstructural aspects. Specifically, the roles of both anisotropy and geometry-based distribution of stresses and strains upon loading were successfully taken into account by incorporating a proper multiaxial material flow rule obtained from crystal plasticity simulations into the finite element (FE) analysis. The simulation results demonstrate that the current approach, which defines a hardening rule based on the location-dependent equivalent stresses and strains, yields more reliable results as compared with the classical FE approach, where the hardening rule is based on the experimental uniaxial deformation response of the material. This emphasizes the need for proper coupling of crystal plasticity and FE analysis for the sake of reliable predictions, and the approach presented herein constitutes an efficient guideline for the design process of dental and orthopedic implants that are subject to impact loading in service.