bluuebunny/crossref_metadata_2025 huggingface dataset:
Pengaruh Konsentrasi Lumpur Pada Accelator Terhadap Efisiensi Penurunan Kekeruhan Air Instalasi Pengolahan Air Minum
Authors: Febriona Anggun
Published: February 2024

Kekeruhan air adalah salah satu parameter penting dalam menentukan kualitas air. Kekeruhan dapat disebabkan oleh adanya partikel tersuspensi yang ada di dalam air. Penelitian ini bertujuan untuk mengenalisis pengaruh konsentrasi lumpur pada accelator terhadap efisiensi penurunan kekeruhan air. Penelitian ini menggunakan metode uji laboratorium dengan menggunakan konsentrasi lumpur pada accelator. Hasil penelitian menunjukkan bahwa semakin tinggi konsentrasi lumpur pada accelator, maka semakin tinggi pula efisiensi penurunan kekeruhan air. Konsentrasi lumpur yang paling efektif dalam menurunkan kekeruhan air adalah pada rentang 9,53% dengan konsentrasi PAC 3,33% dan menghasilkan efisiensi penurunan kekeruhan sebesar 99,61%. Namun, kestabilan konsentrasi lumpur harus dijaga pada rentang 4-8% agar tetap menghasilkan efisiensi penurunan kekeruhan yang optimal.
Pengaruh Kekeruhan Air Baku Terhadap Waktu Pengurasan Bak Sedimentasi di IPA 1A Dan 1B PDAM Kota X
Authors: Suriyani Nurlaili
Published: February 2024

Ruang lumpur pada bak sedimentasi perlu dilakukan pengurasan secara berkala untuk mencegah peluapan lumpur ke unit pengolahan selanjutnya. Pada IPA 1A dan 1B Kota X masih menerapkan sistem pengurasan bak sedimentasi secara manual, dimana operator akan membuka pipa outlet lumpur jika dirasa ruang lumpur sudah penuh, dengan penentuan waktu pengurasan didasarkan pada pengalaman lapangan yang sudah lama dijalani. Penelitian ini dilakukan untuk mengetahui waktu pemenuhan ruang lumpur yang tepat pada bak sedimentasi sesuai dengan tingkat kekeruhan air baku yang terjadi, dengan maksud agar operator yang bekerja dapat mengetahui kapan seharusnya melakukan pengurasan ruang lumpur. Perhitungan waktu pengurasan pada ruang lumpur dilakukan dengan beberapa tahap, diantaranya: mengukur tingkat kekeruhan air baku; menentukan dosis optimum PAC; menghitung volume lumpur yang dihasilkan; menghitung volume ruang lumpur bak sedimentasi; menghitung waktu pemenuhan ruang lumpur bak sedimentasi; menghitung durasi pengurasan bak sedimentasi. Setelah dilakukan perhitungan didapatkan waktu pemenuhan bak sedimentasi pada tingkat kekeruhan air baku rendah akan penuh dalam waktu 4,5 hari, pada tingkat kekeruhan air baku sedang akan penuh selama 1,6 hari, serta pada tingkat kekeruhan air baku tinggi akan penuh setelah 0,3 hari, dengan durasi pengurasan ruang lumpur selama 22,6 detik.
Fünf Jahre AUSSDA: Reflexionen über den Aufbau einer sozialwissenschaftlichen Forschungsinfrastruktur
Authors: Kernecker Theresa , Prandner Dimitri , Kaczmirek Lars
Published: February 2024

Das Austrian Social Science Data Archive (AUSSDA) wurde im Jahr 2017 als Infrastruktur für die Sozialwissenschaften in Österreich ins Leben gerufen. Im Mittelpunkt dieses Artikels wird die Rolle des Archivs innerhalb der österreichischen sozialwissenschaftlichen Community beschrieben. Es werden die bedeutendsten Meilensteine des Archivs in seiner Rolle als Datenarchiv zusammengefasst und potenzielle Schwerpunkte für die zukünftige Entwicklung von AUSSDA aus Sicht der Community skizziert. Der Artikel betont außerdem die Mitwirkung und das Engagement der Community als essenzielle Schritte für eine Weiterentwicklung des Archivs.
PITORESCA PELO SERTÃO NO SEU PRIMEIRO DIA
Authors:   Geólogo Consultor´, autônomo, Lima Luiz
Published: February 2024

Eu, Luiz Claudio Lima, geólogo formado na UFRJ em 1982, casado e pai de 2 filhos, residente em uma casa muito sólida em Nova Lima, Minas Gerais, deixei tudo para trás no afã de conhecer e entender o que há no Sertão Nordestino de pitoresco. Pouco entendido de nordeste brasileiro busquei refúgio nas páginas de “O Quinze” de Raquel de Queiroz, escritora e ex-membro da Academia Brasileira de Letras, para preparar-me para os desafios da viagem. Raquel de Queiroz escreveu e publicou o romance “O quinze” pela primeira vez em 1930, retratando a seca ocorrida em 1915 no Nordeste brasileiro. Os fatos expostos estão relacionados ao início do século XX, no contexto da República Velha. A escritora participou do grupo conhecido como “regionalista”, haja vista que, em suas obras, enfocam-se temas como a seca do nordeste, a miséria, a opressão e a vilania dos poderosos diante do sofrimento dos mais pobres.
RELEMBRANDO A VIAGEM PITORESCA PELO SERTÃO
Authors:   Agência Nacional de Mineração – ANM-RS, Porto Alegre, Kautzmann Rubens
Published: February 2024

Em novembro de 2023 tive o prazer de compor o grupo da viagem Pitoresca pelo Sertão. Éramos cinco participantes com um itinerário cuidadosamente planejada pelo líder, Geol. Milson Xavier, que conseguimos respeitar com alguns ajustes. Na verdade, a Pitoresca nos levou durante uma semana por muitos Sertões Nordestinos. Cada Sertão, revelou seu relevo, geologia, natureza, cidade e história, e nos permitiu, por onde passamos, absorver algo, inclusive de seus habitantes, aqueles que nos atenderam e serviram com gentileza e sorriso, nos hotéis, restaurantes e em toda parte, sobretudo nos locais de visita em cada Sertão: minas, áreas de pesquisa, museus e locais históricos e turísticos; fomos brindados com a receptividade dos profissionais: professores, técnicos, monitores e garimpeiros, que nos privilegiaram com sua sabedoria e conhecimento.
How to be the Best Influencer: The Impact of Personality, Audience Perceptions, and Narcissism on Social Media Influencing
Authors: Saroya Japkaran
Published: February 2024

Social media influencers (influencers) are individuals who have built followings on social media platforms by sharing content with their audience and can be paid to do so through promotional posts and partnerships with brands and businesses. Social media influencing has grown into a lucrative career for people worldwide. But which factors are essential to optimize your social media growth online? This paper reviews how specific personality characteristics, audience perceptions, and narcissism play a role in the success of social media influencers and how to utilize social media to create success in social media influencing.
Application of biohumate and optimization of alternative energy sources by solar energy for pumping on sloping and rocky land in West Bacukiki District, Parepare City
Authors: Rahim Iradhatullah , Jasman Jasman , Nurhaeda Nurhaeda , Fatmawati Fatmawati
Published: February 2024

West Bacukiki District is a food source-producing area in Parepare City, South Sulawesi. However, this area is located on rocky hills and has a slope of up to 25°. It was quite difficult for the management of water and soil because the water at a height of discharge is very little. The condition was felt by the Barangan Farmers Group who cultivate shallots. Water has to be pumped and it costs a lot to buy fuel for the pumping machine. One solution that can be done is a pumping system with abundant alternative energy sources and the provision of organic fertilizer products to having nutrient needs. This activity was carried out in 4 stages, namely socialization of activities, optimizing solar panels, repairing water pumps, and bio-humic application. This activity really helps KT Barangan in agricultural cultivation activities by increasing the discharge of pumpable water and increasing the organic matter of rocky and sloping soils on their land.
Recycling household waste as a solution to the scarcity of subsidized fertilizer in Jetis Hamlet
Authors: Ferichani Minar , Darsono Darsono , Marwanti Sri , Rahayu Wiwit , Barokah Umi , Antriyandarti Ernoiz
Published: February 2024

Jetis Hamlet, Karanganyar Regency, is currently facing two urgent problems simultaneously: river pollution and fertilizer scarcity. The aim of the RG-EPP community service is to provide education on processing household waste into liquid organic fertilizer (LOF). Methods employed to achieve this goal include socialization, counseling, technical direction, creating video tutorials, training, practicing LOF-making skills, and conducting LOF laboratory tests. The results of this community service activity, besides addressing the issues of river pollution and fertilizer scarcity, indicate that the community has acquired knowledge and skills to produce high-quality liquid organic fertilizer. This fertilizer can be applied in rice farming using household waste as a raw material.
Empowerment of Aisyiyah cadres in preventing and handling of stroke
Authors: Hudiyawati Dian , Muhlisin Abi , Agustina Tri , Yuniartika Wachidah , Oktaviana Wita , Faozi Ekan , Marfu'ah Siti , Anjarsari Rizki
Published: February 2024

Stroke is among the priority health issues frequently reported by the people of Gemolong, Sragen. Strokes do not only affect the elderly; individuals of productive age can also experience them. Strokes can be prevented by reducing risk factors and providing proper treatment for stroke attacks. This community service activity aims to enhance the knowledge and skills of Aisyiyah administrators in promoting stroke prevention and appropriately handling stroke attacks. The methods used in the service activities include training and simulations, encompassing socialization, education on stroke prevention and treatment, as well as stress management using Al-Quran recitations (murottals). The outcome of the service is an increased knowledge and skills of participants in prevention and treatment. This also includes cadre skills in handling stroke sequelae through bed transfer and Range of Motion (RoM), as well as implementing murottal therapy for stress management.
Training on making processed beef for residents of the Batujajar Transit Apartment, West Bandung Regency
Authors: Harlina Putri Widyanti , Irawan Arif Nanda , Indiarto Rossi , Fetriyuna Fetriyuna
Published: February 2024

Meat is a nutrient-rich animal food essential for maintaining good health. Given its perishable nature, appropriate processing techniques are crucial to enhance its nutritional value and extend its shelf life. Recognizing the potential of animal-origin food processing and the entrepreneurial opportunities it presents for the community is vital. This community service program aims to educate the community, particularly residents of Batujajar Transit Apartments (Aptrans), on the production of processed meat such as shredded meat, jerky, beef sei, and beef tongue sei. The implementation method of this service includes training, mentoring, and in-depth monitoring to raise awareness about the importance of quality meat as a significant protein source for families. Additionally, it fosters independence and creativity in animal food processing, paving the way for the formation of entrepreneurial partnerships and preparing individuals to initiate businesses. This community service program is executed in collaboration with the Housing and Settlement Service and the West Java Province Housing Management and Services UPTD. The outcomes of this service include heightened creativity and independence in processed meat food preparation, as well as an improved ability to maintain nutritional intake for enhanced nutritional completeness.
Education and training on preparing complementary feeding (MP-ASI) from local ingredients to prevent stunting
Authors: Fitriahadi Enny , Herfanda Esitra
Published: February 2024

Stunting can occur during fetal development and becomes apparent when the child reaches two years of age. Without proper intervention, such as balanced catch-up growth, stunting can lead to decreased overall growth. This issue is a significant public health concern, associated with an elevated risk of morbidity, mortality, and impediments to both motor and mental development. One proactive approach to address stunting involves education and training in the preparation of Complementary Feeding (MP-ASI) using locally sourced snakehead fish and Moringa leaves. Our observations, conducted until September 2022, revealed that out of 109 children in Sidoarum Village, 34 were identified as stunted. Our initiative commenced with socialization efforts and progressed to educational sessions and practical training in MP-ASI preparation using local ingredients. Participants in these sessions included 40 mothers of toddlers. Notably, 75% of the participants demonstrating high knowledge following the stunting education and MP-ASI preparation training. In addition to enhancing maternal understanding of stunting prevention, our service providers conducted assessments of toddlers' growth and development.
Education on the benefits of Indonesian plants as raw materials for herbal cosmetics
Authors: Apriani Elsa Fitria , Ahmadi Adik , Agustiarini Vitri , Hardestyariki Dwi , Alawiyah Kamila
Published: February 2024

Empowering Tanjung Pering Village people to use local natural resources for herbal cosmetics is important. Cosmetics are now essential, thus their safety from harmful substances must be examined. Using Indonesian herbs may avoid unexpected adverse effects. This program educates Tanjung Pering Village people on using Indonesian herbs for cosmetics using digital books. Implementation involves pre-test, material-provided and post-test. This program gathered 35 Tanjung Pering Village people. Participants receive personal guidance and digital materials to use. Participants' understanding of Indonesian herbs as cosmetic raw materials improved from 51.8% to 94.6% between pretest and posttest. These data show that the program was successful and that public knowledge increased following education.
Promotion of dental and oral health for school dental health program teachers at elementary school level in the Sukoharjo Regency
Authors: Murdiyanto Dendy , Faizah Ariyani , Suparno Nilasary Rochmanita , Kaswindiarti Septriyani , Ningsih Juwita Raditya , Kurniawati Dwi
Published: February 2024

The role of teachers is crucial for the success of oral health promotion because schools are environments equipped with resources to teach how to maintain healthy teeth and mouth. This activity aims to enhance the knowledge and skills of UKGS teachers in the Sukoharjo Regency area. The methods employed include lectures, discussions, and demonstrations by the facilitator, followed by re-demonstrations by the participants for evaluation. Knowledge was assessed using a questionnaire administered before and after the training. The evaluation results indicate a t-test significance value of 0.000 with p ≤ 0.05, suggesting an improvement in the understanding and knowledge of elementary school UKGS teachers after attending the training.
Empowerment of MIM Surodadi 1, Magelang Regency to create disaster resilient schools
Authors: Oktradiksa Ahwy , Haq Akhmad Liana Amrul , Imanuddin Helmi
Published: February 2024

Madrasah Ibtidaiyah Muhammadiyah (MIM) Surodadi 1 is situated in Surodadi Hamlet, Gondowangi Village, Sawangan District, and falls within the Disaster Risk Area (KRB-2) with a radius of 17 km from the surface of Mount Merapi. However, MIM Surodadi-1 has yet to implement the disaster education policy and adopt SMAB. Activities include Focus Group Discussions (FGDs), simulations, and games. The outcome of these activities involves fortifying the concept of disaster preparedness in schools, employing organizational formats within the school, and enhancing skills to mitigate disaster risks, particularly from a psychological perspective.
Empowering Medan MSMEs through digital marketing training
Authors: Afandi Ahmad , Lubis Muhammad Arifin , Hayati Isra
Published: February 2024

This article examines the implementation of community service programs aimed at improving the digital marketing capabilities of Micro, Small and Medium Enterprises (MSMEs) in Medan City. Focusing on collaboration with Lazismu Kota Medan, this study uses a three-stage approach: partner problem identification, training implementation and evaluation. Through meetings and surveys, the service team determines the training needs of MSMEs, which cover important aspects of digital marketing. The training was held at the Muhammadiyah Da'wah Building with interactive lecture methods, Kahoot application-based quizzes, and group discussions. Evaluation of the effectiveness of the training was carried out through pre-test and post-test, resulting in a significant increase in participants' digital marketing understanding. These results show that digital marketing training is effective in increasing the ability and confidence of MSMEs in digital marketing, providing important implications for the development of MSMEs and the local economy of Medan City.
Counseling on the use of the herbal plant red ginger (Zingiber officinale Rosc. var. rubrum) to make instant granules
Authors: Hamdani Ayu Gita , Taryadi Lia Hawangi Sukma , Prayogo Iqbal Bagus , Sulastri Lela , Ahidin Didin
Published: February 2024

Romangloe Village is situated in the Bontomarannu District, Gowa Regency. With its hilly terrain and expansive areas, the majority of the population earns their livelihood through farming and plantations. Consequently, a group of women known as the Women Farmers Group (KWT) has been formed, dedicated to cultivating and preserving Green Houses for growing various vegetables commonly consumed on a daily basis. Among the crops cultivated is red ginger, yet the community has not fully tapped into its potential for achieving a higher market value. The goal of this empowerment initiative is to enhance the insight of the KWT, enabling them to produce processed ginger with an extended shelf life and increased market value. The methodology involves providing assistance in the production of instant ginger granules and counseling on the benefits of both ginger and instant ginger granules. The outcome of this empowerment effort is a heightened understanding of red ginger and the ability to produce processed red ginger.
Assistance in repackaging and digital marketing for shrimp floss businesses to expand market reach
Authors: Nisa Sayyidah Ilman , Anita Nur , Kurniasih Fitria , Nugraheni Fanny , Puspitasari Windy , Ranti Karmila Aliani , Akbar Ali , Ramdani Al Ahfaz Reza , Kamal Abdul , Fatmawati Fatmawati , Syafutra Randi
Published: February 2024

The aim of this community service is to enhance the marketing quality of shrimp floss through repackaging and the utilization of e-commerce. This program employs a persuasive approach with partners involved in shredded meat production, assisting in the transformation of shrimp into shrimp floss. The outcomes of this initiative include new packaging designs and the digitalization of shrimp floss marketing through e-commerce, along with the dissemination of links on social media. The 2023 Rambat Village KKN MAs activities are expected to bolster the implementation of digital villages by integrating technology to support the economy in Rambat Village.
Pedagogic content knowledge (PCK) in teacher competence development
Authors: Abidin Zaenal , Hindriana Anna Fitri , Arip Asep Ginanjar
Published: February 2024

The teacher competency needed when carrying out professional duties in front of the class is Pedagogical Content Knowledge (PCK). One of the PCK competencies needed by teachers today is to have learning strategies according to the topic and students' conditions. In connection with this, the Kuningan University Postgraduate School, in collaboration with the Kuningan Regency Science Subject Teachers' Conference, held a Teacher Competency Improvement Workshop. The methods used in this workshop are lectures, question and answer sessions, and assignment methods. The results obtained from holding this workshop were an increase in participants' competence in packaging learning material that was easy for students to understand and appropriate for the students' conditions. This can be seen from the increase in pre-test results (mean = 0.61) to post-test PCK (mean = 61.38), indicating a rise of 40.49. Participants also increasingly understand how to package teaching materials so that they are easily understood by students and suitable for the students' conditions. This is evident when participants are given the task of completing several case examples, including those related to choosing learning strategies according to variations in topics and student conditions. Based on this, PCK training through workshops can be a solution for teacher professional development.
Empowerment of pregnant women and mothers of toddlers in increasing stunting knowledge
Authors: Zakaria Muhamad Abi , Amalindah Dia , Zamroni Asroful Hulam , Agustia Dilma’aarij
Published: February 2024

Stunting is a health problem that threatens the quality of human resources. The incidence of stunting in Indonesia is still above the target set by the World Health Organization. This is reflected in the creation of a policy to accelerate stunting reduction through Presidential Decree number 72 of 2021. Gunungkidul is the district with the highest number of stunting incidents in the Special Region of Yogyakarta Province. One of the factors that influences the incidence of stunting is the mother's knowledge about stunting. The aim of this service is to increase mothers' knowledge regarding stunting as an effort to prevent stunting incidents. The method used in this service is the lecture method using modules and discussion media. The results of this activity were attended by 26 pregnant women and mothers with children aged 0-5 years. As a result of this activity, participants experienced an increase in knowledge of 28.07. It is hoped that this increase in knowledge will enhance maternal participation in providing nutrition for babies to prevent stunting.
Mekanisme Terjadinya Kanker Kulit Akibat Radiasi Sinar Ultraviolet
Authors: Fauziah Najma Zahiroh , Sudarti Sudarti , Yushardi Yushardi
Published: February 2024

Matahari adalah titik pusat tata surya yang berupa bola berisi gas. Sinar matahari dapat menghasilkan sinar ultraviolet yang memiliki dampak positif dan dampak negative bagi tubuh manusia. Sinar ultraviolet dapat menyebabkan kanker kulit yang merupakan salah satu faktor kematian terbesar di dunia. Kanker kulit dapat terjadi karena terkena paparan sinar ultraviolet yang berlebih yang mengakibatkan sel kulit berkembang secara abnormal dan merusak DNA yang merupakan penyusun gen. Untuk itu, masyarakat perlu mengetahui pentingnya menjaga kulit dari paparan sinar ultraviolet serta mengetahui mekanisme terjadinya kanker kulit akibat radiasi sinar ultraviolet. Penelitian dilakukan dengan metode studi pustaka dengan mengumpulkan beberapa jurnal dan buku untuk mengumpulkan informasi.
Headache as the leading syndrome of intoxication due to environmental pollution. Ways to solve the problem
Authors: Lototska O , Dnistryanska M
Published: February 2024

Headache is the leading syndrome of many diseases caused by a polluted environment. Processing of human waste reduces the negative impact of landfills of human health. The conducted survey of residents of Vinnytsia and Ternopil found that the vast majority (99 %) of respondents understand that environmental pollution poses a threat to health, causes many diseases accompanied by headaches and requires a solution to waste disposal. Almost all respondents (93 %) are ready to sort garbage, provided the appropriate conditions are provided, which are improve the environment and help reduce the prevalence of headache syndrome in the human population
Sport-related concussion in 8- to 12-year-olds: an understudied population
Authors: Zargari Michael , Jo Jacob , Williams Kristen , Yengo-Kahn Aaron M. , Vance E. Haley , Bonfield Christopher M. , Terry Douglas P. , Zuckerman Scott L.
Published: February 2024

OBJECTIVE

Most studies regarding sport-related concussion (SRC) focus on high school and collegiate athletes; however, little has been published on children younger than 12 years of age. In a cohort of children aged 8–12 years with SRC, the authors sought to describe demographics, initial presentation, and recovery in this understudied population.

METHODS

A retrospective cohort study of children aged 8–12 years who sustained an SRC between November 2017 and April 2022 and were treated at a regional sports concussion center was conducted. Demographic information, injury characteristics, traditional Sport Concussion Assessment Tool 5 (SCAT5) and Child/Parent SCAT5 scores, and outcomes, defined as days to return to learn (RTL), symptom resolution, and return to play (RTP), were reported. Outcomes in boys and girls were compared using effect size analyses given sample size constraints.

RESULTS

Forty-seven athletes were included. The mean age was 11.0 ± 0.8 years, and the majority were male (34, 72.3%). A sizable proportion of patients visited an emergency department (19, 40.4%), and many received head imaging (16, 34.0%), mostly via CT (n = 13). The most common sport for boys was football (15, 44.1%), and the most common sports for girls were soccer (4, 30.8%) and cheerleading (4, 30.8%). These athletes reported a variety of symptoms on presentation. It took a mean of 8.8 ± 10.8 days to RTL, 27.3 ± 38.3 days to reach symptom resolution, and 35.4 ± 41.9 days to RTP. When comparing boys versus girls, there appeared to be moderate differences in symptom severity scores (Cohen’s d = 0.44 for SCAT5, 0.13 for Child SCAT5, and 0.38 for Parent SCAT5) and minimal differences in recovery (Cohen’s d = 0.11 for RTL, n = 35; 0.22 for symptom resolution, n = 22; and 0.12 for RTP, n = 21).

CONCLUSIONS

In this cohort of concussed athletes aged 8–12 years, a little less than half of the athletes initially presented to the emergency department, and approximately one-third received acute head imaging. Across all athletes, the mean RTL was slightly more than a week and the mean symptom resolution and RTP were both approximately 1 month; however, much of the cohort is missing recovery outcome measures. This study demonstrated a strong positive correlation between Child SCAT5 and Parent SCAT5 symptom reporting. Future efforts are needed to evaluate differences in clinical presentation and outcomes following SRC between children and older populations.
Gender parity in neurosurgery residencies: an analysis
Authors: Kabangu Jean-Luc , Lei Catherine , Yekzaman Bailey , Minchew Heather , Birney Jalee , Heskett Cody , Lundy Paige , Miller Christopher
Published: February 2024

OBJECTIVE

The number of women graduating from United States medical schools has reached parity with that of men. However, persistent inequalities and barriers have slowed the pace toward equity in application and representation in neurosurgery residency despite initiatives to increase female representation. The objective of the present study was to assess the advancement of gender parity within neurosurgery residency programs. Additionally, the study aimed to analyze the pipeline dynamics by investigating the effects of attrition on women in neurosurgery, as well as exploring the patterns of female applications to neurosurgery residency programs versus other surgical specialties.

METHODS

Data on the number of active female neurosurgery residents and female applicants to neurosurgery were collected from the Accreditation Council for Graduate Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022. Linear regression analysis was used to predict the percent of active female residents based on academic year (AY). A Pearson chi-square test was used to determine the odds of a female applying to neurosurgery.

RESULTS

The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as a predictor of the percent of active females showed a statistically significant correlation. On average, the percent of active female residents increased by 0.65% per year. If trends persist, parity for females in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of the percent of active female residents revealed that for every 1% increase in the rate of attrition, the percent of active female residents decreased by 2.91% (p = 0.001). The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022 (p = 0.009), yet the odds of a female applying to neurosurgery remain low.

CONCLUSIONS

Neurosurgery continues to struggle with the recruitment of female medical students even as parity has been reached for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.
Safety of the immediate use of nonsteroidal anti-inflammatory drugs after adult craniotomy for tumor
Authors: Perez Jennifer L. , Naylor Ryan M. , Bauman Megan M. J. , Harrison Daniel Jeremiah , Knowles Kyelin , Burns Terry C. , Lanzino Giuseppe , Link Michael J. , Peris Celda Maria , Meyer Fredric B. , Van Gompel Jamie , Parney Ian F.
Published: February 2024

OBJECTIVE

Poor pain control has a negative impact on postoperative recovery and patient satisfaction. However, overzealous pain management, particularly with opioids, can confound serial neurological assessments, increase morbidity, and predispose patients to long-term dependence. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating postoperative pain and can limit opioid intake, but their use has been limited in patients undergoing craniotomy for brain tumor resection due to concerns of an increased hemorrhage risk. Herein, the authors aim to 1) address the safety of NSAID use in the immediate postoperative setting and 2) determine whether NSAID administration decreases opioid use following craniotomy for tumor resection in adult patients.

METHODS

The authors conducted a retrospective cohort study of patients 18 years and older with an estimated glomerular filtration rate ≥ 60 ml/min/body surface area who had undergone craniotomy for tumor resection at their institution between 2019 and 2021. NSAID use in the first 48 hours following surgery was recorded. Primary outcomes were postoperative hemorrhage requiring a return to the operating room before hospital discharge and within 30 days of surgery. Secondary outcomes were more-than-minimal hemorrhage that did not require reoperation, acute kidney injury, and total opioid use within 48 hours after craniotomy.

RESULTS

Among 1765 reviewed patient records, 1182 were eligible for inclusion in this analysis. Amid these records were 114 patients (9.6%) who had received at least one dose of an NSAID within 48 hours of their craniotomy. Four (0.3%) patients experienced bleeding requiring a return to operating room, one of whom was from the NSAID-treated group (RR 3.12, 95% CI 0.33–29.77, p = 0.30). No significant difference in nonoperative intracranial hemorrhage (RR 1.34, 95% CI 0.54–3.35, p = 0.53), postoperative acute kidney injury, or clinically significant extracranial bleeding was found between the NSAID and no-NSAID groups. Patients in the NSAID group had significantly higher oral morphine equivalent use (median 68 vs 30, p < 0.001).

CONCLUSIONS

Postoperative NSAID use following craniotomy for tumor resection was not associated with an increased risk of hemorrhage requiring a return to the operating room. The authors noted higher opioid use in the patients treated with NSAIDs, which may reflect underlying reasons for the decision to treat patients with NSAIDs in the immediate postoperative period. These data warrant further investigation of NSAIDs as a safe, opioid-sparing postoperative pain management strategy in patients with normal kidney function who are undergoing intracranial tumor resection.
Risk factors for postoperative urinary retention after deep brain stimulation surgery: the role of the subthalamic nucleus
Authors: Porche Ken , Peart Rodeania , Silva Victor , Mampre David , Chandra Vyshak , Zakare-Fagbamila Rasheedat , Foote Kelly , Hilliard Justin D. , Robicsek Steven
Published: February 2024

OBJECTIVE

Deep brain stimulation (DBS) is a common procedure in neurosurgery used for the treatment of Parkinson’s disease (PD) and essential tremor (ET) among other disorders. Lower urinary tract dysfunction is a common complication in PD, and this study aimed to evaluate the risk factors of postoperative urinary retention (POUR) after DBS surgery in patients with PD compared with patients with ET. Understanding the risk factors associated with this complication may help in the development of strategies to minimize its occurrence and improve patient outcomes.

METHODS

The study was a retrospective analysis of patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. The surgical technique used has been described in previous articles and included a two-stage procedure, with stage 1 involving burr hole placement, microelectrode recording, and electrode implantation and stage 2 involving the placement of an implantable pulse generator (IPG). Data were collected on patient characteristics and surgical details and analyzed using univariate and mixed-linear models. Post hoc propensity score matching was used to confirm the association between subthalamic nucleus (STN)–DBS and POUR.

RESULTS

The study included 350 patients (153 with PD and 197 with ET) who underwent 1086 DBS surgeries (lead implantations, IPG placement, and IPG replacements). The POUR rates were 16.6% (79/477), 5.2% (19/363), and 0.4% (1/246) for stage 1, stage 2, and IPG replacement procedures, respectively. Optimal mixed-effects logistic modeling revealed history of urinary retention (OR 9.3, p = 0.004), male sex (OR 2.7, p = 0.011), having an electrode placed or connected for the first time (OR 2.2, p = 0.014), anesthesia time (OR 1.5 for each 30-minute increase, p < 0.0001), preoperative opioid use (OR 1.4 for each additional 10 morphine milligram equivalents, p = 0.032), and Charlson Comorbidity Index (OR 1.4 per comorbidity, p = 0.017) to be significant risk factors for POUR. Having an electrode in the STN was found to be protective of POUR (propensity score–matched analysis: OR 0.2, p = 0.010).

CONCLUSIONS

Most risk factors found to increase the risk of POUR in DBS are not modifiable but are still important to consider in preoperative planning. Opioid use reduction and shorter anesthesia time may be modifiable risk factors to weigh against their alternative. Targeting the STN during DBS may result in decreased rates of POUR. This highlights the potential for STN-targeted DBS in reducing POUR risk in PD and ET patients.
Effectiveness and safety of MR-guided focused ultrasound thalamotomy in patients with essential tremor and low skull density ratio: a study of 101 cases
Authors: Hino Sakae , Maki Futaba , Yamaguchi Toshio , Kaburagi Mayumi , Nakano Masayuki , Iwamuro Hirokazu , Takasaki Masahito , Iijima Ken , Kanouchi Masashi , Sasanuma Jinichi , Watanabe Kazuo , Hasegawa Yasuhiro , Yamano Yoshihisa
Published: February 2024

OBJECTIVE

The objective was to investigate the effectiveness and safety of MR-guided focused ultrasound (MRgFUS) treatment in patients with essential tremor, particularly those with low skull density ratio (SDR) and including those with very low SDR, and to identify the factors influencing treatment effectiveness and to provide insights into therapeutic approaches for patients with lower SDR.

METHODS

Real-world data from 101 patients who underwent MRgFUS between July 2019 and March 2022 at a single institution were analyzed. Tremor severity was assessed using the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (CRST). The patients were categorized into quartile groups based on their mean SDR, and the characteristics, treatment effectiveness, treatment parameters, and adverse events were evaluated among these subgroups.

RESULTS

Patients were classified into 4 quartiles based on the mean SDR: quartile 1 (Q1) (SDR 0.26–0.37), Q2 (SDR 0.38–0.42), Q3 (SDR 0.43–0.49), and Q4 (SDR 0.50–0.75). MRgFUS significantly improved total CRST and tremor score across all SDR subgroups. Additionally, there were no significant differences in the improvement rates among the 4 subgroups. Analysis of the treatment parameters revealed that lower mean SDR was associated with lower target maximum temperature and smaller coagulation volume after focused ultrasound (FUS). Regarding adverse events, headache and nausea during FUS and facial and head edema on the day after surgery were more frequent in the Q1 subgroup (very low-SDR group). In contrast, numbness was more common in the Q4 subgroup. However, all these adverse events had resolved by the 3-month follow-up except numbness.

CONCLUSIONS

This study suggested that MRgFUS is effective and safe for patients with medication-resistant essential tremor, including those with very low mean SDR. However, the very low-SDR group had insufficient temperature elevation at the target site compared with the high-SDR group, suggesting the need for a different strategy. Notably, with careful adjustments and considerations, positive outcomes can still be achieved in patients with very low SDR. Therefore, very low SDR should not be considered an absolute exclusion criterion because it is expected to increase the number of patients who benefit from MRgFUS.
The Lenticular
Authors: Ganz Jeremy C.
Published: February 2024

OBJECTIVE

The lenticular was an instrument introduced by Galen to facilitate cutting the bone of the cranium. Illustrations of the instrument first appeared in the 16th century during the Renaissance. These illustrations have been widely used, but the instrument’s shape seems ill-adapted to its function. Archaeological research in Rimini, Italy, unearthed a similar instrument with a shape that seems more suitable for the function of cutting cranial bone. The object of this study was to evaluate the efficacy of these two instruments for cutting the bone of the cranium.

METHODS

Replicas of the two instruments were obtained. Trepanation was performed in the left parietal region of a sheep’s head. In addition, the application of the instruments in the literature was analyzed.

RESULTS

The Roman lenticular cut the cranium with ease. The Renaissance instrument failed to cut the bone and only separated the dura mater from the bone. The lenticular had been used to cut bone up to the 13th century. In contrast, the Renaissance instrument was not used to cut bone but to smooth roughened bony surfaces and to remove spicules of bone that were in contact with the dura.

CONCLUSIONS

Analysis of illustrations in medical publications should be undertaken with the same rigor as applied to analysis of text.
Intraoperative neuromonitoring potentials and evidence of preserved neuronal circuitry below the anatomical and functional level in patients with complex spinal dysraphism undergoing detethering reoperations
Authors: McGrath Margaret , Sivakanthan Sananthan , Durfy Sharon , Lee Amy , Browd Samuel , Hauptman Jason S. , Ellenbogen Richard G. , Kinney Gregory A. , Ojemann Jeffrey G. , Goldstein Hannah E.
Published: February 2024

OBJECTIVE

Spina bifida represents one of the most common birth defects, occurring in approximately 1–2 children per 1000 live births worldwide. The functional level of patients with spina bifida is highly variable and believed to be correlated with the anatomical level of the lesion. The variable clinical picture is well established, but the correlation with anatomical level and intraoperative neuromonitoring (IONM) data has not been investigated. Furthermore, the potential for preserving function beyond the apparent clinical level has also not been investigated. The objective of this research was to determine the presence and level of intraoperative transcranial motor evoked potential (tcMEP) and triggered electromyography (tEMG) responses, and the association of these responses with preoperative clinical function and radiographic data in pediatric cases of complex tethered cord release reoperations.

METHODS

A single-center retrospective review of pediatric patients with complex spinal dysraphism undergoing detethering reoperations was conducted. Preoperative demographic and clinical data, including the radiographic and clinical level of dysraphism, were collected. IONM, including tcMEPs and tEMG responses, were obtained and compared with preoperative clinical data. Descriptive analysis was performed, by patient for demographics and by case for surgeries performed.

RESULTS

In 100% of 21 cases of complex detethering reoperations, representing 20 patients, intraoperative tcMEPs could be generated at (4.8%) or below (95.2%) the level of clinical function. Compared with the preoperative clinical examination, 5 cases (23.8%) demonstrated tcMEP responses that were 1 level below the clinical function level, 11 cases (52.4%) were 2 levels below, and 4 cases (19.0%) were 3 levels below. Overall, 18 of 21 cases showed tEMG responses at or below the level of clinical function; of these, 7 cases (33%) were 1 level below and 3 (14%) were ≥ 2 levels below the clinical function level.

CONCLUSIONS

The presence of positive stimulation potentials below the level of clinical function in patients with complex spinal dysraphism undergoing detethering reoperations indicates a degree of preserved neuronal connectivity. These findings suggest novel future treatment approaches for these patients, including using devices targeted to stimulation of these neurological pathways.
Is it necessary to extend fusion to L4 when correcting pediatric L5–S1 spondylolisthesis?
Authors: Jiao Jiahao , Ye Xiaohan , Guo Dong , Cao Jun , Zhang Xuejun , Wang Shengru , Zhang Jianguo , Yao Ziming
Published: February 2024

OBJECTIVE

The objective of this study was to investigate whether extending fusion to L4 is imperative in the surgical treatment of pediatric L5–S1 spondylolisthesis.

METHODS

This retrospective analysis encompassed 68 pediatric cases of dysplastic L5–S1 spondylolisthesis who underwent posterior lumbar interbody fusion surgery at two hospitals. Patients were categorized into two groups based on the upper instrumented vertebra (group L4 and group L5). Data were collected from medical records and radiological images obtained preoperatively and at last follow-up. Radiographic parameters including slip percentage (SP), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), Spinal Deformity Study Group dysplastic lumbosacral angle (SDSG-LSA), pelvic tilt (PT), Dubousset’s lumbosacral angle (Dub-LSA), sacral slope (SS), and severity index (SI) were measured. Surgery-related data and complication data were also collected. The incidence rates of complications were compared, including those of neurological deficit, adjacent-segment instability (ASI), and other complications. ASI was defined as progression of slippage > 3 mm or posterior opening > 5° in the adjacent segment. Clinical outcomes were assessed with the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores. The follow-up period for all patients lasted a minimum of 2 years.

RESULTS

Among all 68 patients, group L4 consisted of 15 patients and group L5 comprised 53 patients. The patients included in both groups had comparable baseline demographic characteristics and radiographic parameters. Postoperative SP and SDSG-LSA were significantly lower in group L5 (p < 0.05). No other postoperative radiographic differences were observed between groups. One patient in group L4 and 3 patients in group L5 experienced transient neurological deficits (p > 0.05). There were 13 cases of ASI in group L5 compared with none in group L4 (24.5% vs 0%, p > 0.05). Of the 13 patients with ASI, 4 underwent revision surgery due to L4–5 level instability and clinical symptoms. The remaining individuals exhibited no symptoms, and regular annual follow-up assessments are being conducted for all patients. The NRS and ODI scores at final follow-up did not exhibit any significant differences between the two groups.

CONCLUSIONS

Fusion to L5 could achieve comparable satisfactory results to fixation to L4, albeit with increased likelihood of ASI. Extension of fusion to L4 may not be necessary for most patients with pediatric L5–S1 spondylolisthesis.
Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery
Authors: Ridolfi Dominic , Oyekan Anthony A. , Tang Melissa Yunting , Chen Stephen R. , Como Christopher J. , Dalton Jonathan , Gannon Emmett J. , Jackson Keith L. , Bible Jesse E. , Kowalski Christopher , de Groot S. Joseph , Donaldson William F. , Lee Joon Y. , Shaw Jeremy D.
Published: February 2024

OBJECTIVE

Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery.

METHODS

The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss’ and Cohen’s kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively.

RESULTS

Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785–0.908) and 0.852 (95% CI 0.791–0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644–0.912), 0.698 for grade II (95% CI 0.564–0.832), 0.861 for grade III (95% CI 0.727–0.996), 0.845 for grade IV-A (95% CI 0.711–0.979), 0.962 for grade IV-B (95% CI 0.828–1.097), and 0.960 for grade V (95% CI 0.826–1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944–0.999) for rater 1, 0.963 (95% CI 0.926–1.001) for rater 2, and 0.926 (95% CI 0.869–0.982) for rater 3.

CONCLUSIONS

The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.