Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan

Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.

Acute arterial haemodynamics activation of endothelial to mesenchymal transition in long saphenous veins. Impact on vein graft disease

Introduction

The long saphenous vein (LSV) is frequently used in cardiac surgery; however, its use is complicated by late stenosis or occlusion due to the development of intimal hyperplasia (IH). TGF-β has been implicated in the process of IH however the impact of acute haemodynamic changes on the activation of TGF-β endothelial-to mesenchymal transition (EndMT) has not been assessed and it's the focus of this study.

Purpose

To assess the role of acute haemodynamics changes in veins implanted into arterial circulation on EndMT.

Methods

Surplus LSV were exposed to acute arterial haemodynamics using a perfusion bioreactor. Changes in EndMT markers at the RNA and protein level evaluated by quantitative real time PCR, RNAScope and immunofluorescence.

Results

The acute exposure of veins to arterial haemodynamics ex-vivo induced significant increase in inflammatory marker IL-8 expression and transcription factor TWIST1 in LSV (both p≤0.01, Figure 1A) endothelium. Furthermore, immunostaining demonstrated the activation of pSMAD (p≤0.01, Figure 1B) acutely in endothelium after 45 minutes of exposure to arterial haemodynamics. This was followed by significant increase of SMC related markers (Vimentin and α-SMA; Figure 1C, both p≤0.001) and the suppression of endothelial cell related marker CD31 after 4 hours of LSV exposure to acute arterial haemodynamics. RNAScope and IHC results showed localisation of TWIST1 RNA and protein in CD31+ (p≤0.001) and VECAD+ (p≤0.001) cells respectively following exposure to acute arterial haemodynamics (Figure 1D). Furthermore, TGF-β pathway phosphorylation array identified the activation of Smad1 (p≤0.05) but not TAK1 in LSV endothelial cells indicating that acute arterial haemodynamics activates the TGF-β–SMAD pathway specifically (Figure 1E).

Conclusion

The exposure of LSV to acute arterial haemodynamics is associated with the activation of TGF-β–SMAD pathway leading to EndMT changes in the endothelium of vein grafts ex-vivo. This contributes to our understanding of the changes that occur in veins after implantation into arterial circulation and that the acute changes in the endothelium and suggests that strategies to modulate TGF-β–SMAD can be utilised to modulate IH in vein grafts.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Van Geest Foundation Heart and Cardiovascular Diseases Research Fund

The impact of the COVID-19 pandemic on the career choice of medicine: A cross-sectional study amongst pre-medical students in Pakistan

Background

The COVID-19 pandemic has significantly affected the lives of healthcare workers due to the frontline nature of their work. Their hard work and sacrifice have forged new perceptions of healthcare workers. These changes may potentially influence students' interest in medicine. This study explores how the COVID-19 pandemic has affected premedical students’ decisions to pursue medicine as a career.

Methods

A cross-sectional study using a self-designed online questionnaire was carried out amongst pre-medical students across Pakistan.

Results

A total of 1695 students from 93 public and private schools filled in the survey. After the onset of the COVID-19 pandemic, significantly more pre-medical students want to pursue medicine (60.7%–62.9%) and less are unsure (20.2%–17%). Students are significantly more likely to be motivated to pursue medicine due to altruistic benefits to society (57% vs. 62.7%) and be deterred by the risk of contracting infections on duty (10%–14.6%). There is a minor but significant increase in the popularity of internal medicine (17.1%–18.9%), public health (4.1% vs. 5.7%), emergency medicine (3.8% vs. 5.7%), pediatrics (3.8% vs. 4.7%), and radiology (2.1% vs. 2.9%). Most pre-medical students felt that doctors routinely undergo physical and emotional turmoil (84%).

Conclusions

Although awareness of hardships faced by medical professionals has increased, motivation to pursue medicine has grown. Through understanding trends in the motivations of students to pursue medicine, medical schools can accommodate the expectations of incoming students and reach out to potential applicants.

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More pre-medical students want to pursue medicine since the onset of the pandemic.

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The major motivation to pursue medicine remains altruistic.

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Since the pandemic, students are more likely to be deterred by occupational risks.

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Some specialties have become more popular choices since the pandemic.

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These include pediatrics, public health, and internal medicine.

Factors Influencing the Intention to Pursue Surgery among Female Pre-Medical Students: A Cross-Sectional Study in Pakistan

BACKGROUND

While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision.

METHODS

An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery.

RESULTS

Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cutting-edge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239).

CONCLUSION

Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.

The 2021 Magnonics Roadmap

Magnonics is a budding research field in nanomagnetism and nanoscience that addresses the use of spin waves (magnons) to transmit, store, and process information. The rapid advancements of this field during last one decade in terms of upsurge in research papers, review articles, citations, proposals of devices as well as introduction of new sub-topics prompted us to present the first roadmap on magnonics. This is a collection of 22 sections written by leading experts in this field who review and discuss the current status besides presenting their vision of future perspectives. Today, the principal challenges in applied magnonics are the excitation of sub-100 nm wavelength magnons, their manipulation on the nanoscale and the creation of sub-micrometre devices using low-Gilbert damping magnetic materials and its interconnections to standard electronics. To this end, magnonics offers lower energy consumption, easier integrability and compatibility with CMOS structure, reprogrammability, shorter wavelength, smaller device features, anisotropic properties, negative group velocity, non-reciprocity and efficient tunability by various external stimuli to name a few. Hence, despite being a young research field, magnonics has come a long way since its early inception. This roadmap asserts a milestone for future emerging research directions in magnonics, and hopefully, it will inspire a series of exciting new articles on the same topic in the coming years.

Magnetic charge propagation upon a 3D artificial spin-ice

Magnetic charge propagation in spin-ice materials has yielded a paradigm-shift in science, allowing the symmetry between electricity and magnetism to be studied. Recent work is now suggesting the spin-ice surface may be important in mediating the ordering and associated phase space in such materials. Here, we detail a 3D artificial spin-ice, which captures the exact geometry of bulk systems, allowing magnetic charge dynamics to be directly visualized upon the surface. Using magnetic force microscopy, we observe vastly different magnetic charge dynamics along two principal directions. For a field applied along the surface termination, local energetics force magnetic charges to nucleate over a larger characteristic distance, reducing their magnetic Coulomb interaction and producing uncorrelated monopoles. In contrast, applying a field transverse to the surface termination yields highly correlated monopole-antimonopole pairs. Detailed simulations suggest it is the difference in effective chemical potential as well as the energy landscape experienced during dynamics that yields the striking differences in monopole transport.

Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation

OBJECTIVES

Postoperative stump pain after major lower limb amputation is a significant impediment to the recovery of amputees. The vast majority of patients require opioid analgesics following surgery, which are associated with opioid-related side-effects. Here, we investigate whether intraoperative placement of a peripheral nerve stump catheter followed by continuous infusion of local anesthetic is as effective at pain control as current analgesic practices. If beneficial, this procedure could potentially reduce post-amputation opioid consumption and opioid-related adverse effects.

METHODS

A retrospective chart review was conducted of 198 patients over a 4-year period who had undergone a major lower limb amputation for indications related to peripheral vascular disease. Postoperatively, 102 patients received a perineural catheter were compared to 96 patients who did not. The primary outcomes of this study were the amount of morphine equivalents used in the first 72 hours postoperatively and postoperative pain intensity in the first 24 hours.

RESULTS

A total of 198 lower-limb amputations were selected for analyses. Multiple regression analyses indicated that perineural catheter use was associated with a lower cumulative postoperative opioid consumption over the first 72 hours but not postoperative pain scores at 24 hours. Perineural catheter use led to a 40% reduction in opioid use during the first 72 hours postoperatively. Mixed model repeated measures analysis demonstrated that this opioid reduction was consistent over time. Other variables related to total opioid use included age, pre-surgical chronic pain, pre-surgical opioid use, patient-controlled analgesia.

CONCLUSIONS

Continuous perineural infusions of local anesthetic are a safe and effective method for reducing post-amputation opioid analgesic medications after major lower limp amputation.

Emerging chirality in artificial spin ice

Artificial spin ice, made up of planar nanostructured arrays of simple ferromagnetic bars, is a playground for rich physics associated with the spin alignment of the bars and spin texture associated with the magnetic frustration at the bar vertices. The phase diagram is exotic, showing magnetic monopole-like defects and liquid and solid phases of spins arranged in loop states with predicted chiral order. We show that magnetotransport measurements in connected honeycomb structures yield the onset of an anomalous Hall signal at 50 kelvin. The temperature scale can be attributed to the long-range dipolar ice phase. The topological Hall signal arises because chiral loops form at the sample edges, indicating a generic route to exotic states via nanoarray edge structure.

Sub-100-nm negative bend resistance ballistic sensors for high spatial resolution magnetic field detection

We report the magnetic field detection properties of ballistic sensors utilizing the negative bend resistance of InSb∕In(1-x)Al(x)Sb quantum well cross junctions as a function of temperature and geometric size. We demonstrate that the maximum responsivity to magnetic field and its linearity increase as the critical device dimension is reduced. This observation deviates from the predictions of the classical billiard ball model unless significant diffuse boundary scattering is included. The smallest device studied has an active sensor area of 35×35 nm(2), with a maximum responsivity of 20 kΩ∕T, and a noise-equivalent field of 0.87μT∕Hz at 100 K.

Defect trajectories and domain-wall loop dynamics during two-frequency switching in a bistable azimuthal nematic device

Bistable azimuthal nematic alignment textures have been created in micrometer-scale channels for which one sidewall is smooth and straight and the other possesses a symmetric sawtooth morphology. The optical textures have been observed during dynamic switching between the two stable states in response to dual frequency ac waveform driving of a highly dispersive nematic liquid crystal. The switching processes involves collapsing of filamentlike director reorientation (tilt-wall) loops and the associated motion and annihilation of surface defects along and close to the edge at the sawtooth sidewall. The predictions from both the n-director-based Ericksen-Leslie theory and the Q-tensor theory are in good agreement with the experimental observations.

Stereotactic radiotherapy in the treatment of ocular melanoma: a noninvasive eye fixation aid and tracking system

Ocular melanoma is frequently treated using brachytherapy implants (such as 125I and 60Co plaques or 184Ta wire), surgery, or external beam radiotherapy using small 60Co beams, high energy x-rays, or proton therapy. The last technique, though very expensive, provides improved dose distributions and dose localizations in the treatment of tumours adjacent to critical normal tissues. The technique of fractionated stereotactic radiotherapy is now being used at an increasingly large number of centers in the treatment of lesions in the brain, and the head and neck. This article describes the successful extension of the stereotactic technique to the treatment of ocular melanoma: an eye fixation aid is attached to a noninvasive, relocatable Gill-Thomas-Cosman head frame together with a simple eye-movement tracking system.

Management of family and workplace stress experienced by women of colour from various cultural backgrounds

Minority women identify finances and maintaining cultural values as their most commonly experienced stressors at home and in the work-place. A before and after study of ethnic minority women in focus group sessions led by a trained ethnic minority facilitator examined how social and workplace supports, or lack thereof, impact on the individuals' ability to manage daily life. Creative, effective solutions to stressors were identified by the participants. Outcomes were evaluated in terms of the impact of changes on the participants' coping styles in family and work life. Results indicate that a large percentage of women in this study felt discriminated against based on their culture/race, however, this perceived discrimination decreased after the focus groups. The predominant stress management techniques were prayer and music. Family support was the most influential factor in decreasing stress. The family is a major source of support for the working women, acting as a buffer to workplace pressures.