bluuebunny/crossref_metadata_2025 huggingface dataset:
UM PROJETO DE APROXIMAÇÃO DA HISTÓRIA E DA SOCIOLINGUÍSTICA RUMO AO ENTENDIMENTO DAS DISSIMETRIAS HUMANAS. A BOM ENTENDEDOR, MEIA PALAVRA BASTA?
Authors: Legrady Suzanne Maria
Published: March 2020

O presente artigo apresenta um projeto de construção de uma estrutura metodológica de análise de entrevistas no campo da História Oral enriquecida por propostas da Sociolinguística Interacional. Visa, portanto, descobrir novos caminhos que (re)significam as histórias de “corpos e almas em movimento”, bem como sinaliza proposições de entendimento das diversidades por meio do reconhecimento e da aceitação das dissimetrias humanas. A ideia central é a de fazer valer a articulação “língua(gem)-comunicação-história”, trazendo à tona múltiplos elementos (implícitos e explícitos) que compõem o vasto oceano das pluralidades de expressões humanas.
An Analysis of Students’ Reviews of Expository Text A Study at English Department of UNP
Authors: Rani Yati Aisya , Kher Dinovia Fannil
Published: March 2020

This article describes the result of analysis of expository text reviews made by English Department students at UniversitasNegeri Padang. The review quality was seen from the applications of review components. This article is aimed at analyzing how far English Department students used the components in their reviews of expository text.The research design was descriptive by using reviewing task as the instrument. The population of the research was the third-year students at English Department of UniversitasNegeri Padang who had passed the Extensive Reading and Academic Writing subjects. The sample consisted of 18 students. They were asked to review an expository text with the topic of parents’ efforts to prevent their children from becoming smokers. From the result of analysis, it was found that three components were successfully applied by the students in their reviews which were the identification of premise and supporting points, the writing mechanics, and the organization. Meanwhile, other three components; the application of analysis, the critical evaluation, and the review format, were not properly applied in the reviews made by the students.

Artikel ini mengkaji hasil analisis dari review teks eksposisi yang ditulis oleh mahasiswa bahasa Inggris Universitas Negeri Padang. Kualitas review yang dihasilkan oleh mahasiswa dilihat dari pengaplikasian komponen review didalamnya. Oleh karena itu, artikel ini bertujuan untuk menganalisis sejauh mana masing-masing komponen review ditemukan dalam review teks eksposisi yang ditulis mahasiswa bahasa Inggris Universitas Negeri Padang.Jenis penelitian yang digunakan pada artikel ini adalah penelitian deskriptif dengan menggunakan reviewing task sebagai instrumennya.Populasi dalam penelitian ini adalah mahasiswa tahun ketiga Jurusan Bahasa Inggris UNP yang sudah selesai mengambil mata kuliah Extensive Reading dan Academic Writing.Sampel penelitian terdiri dari 18 orang mahasiswa yang dipilih dengan menggunakan teknik random sampling.Para mahasiswa tersebut diminta untuk me-review sebuah teks eksposisi dengan topik yang berkaitan dengan usaha orang tua untuk mencegah anak mereka merokok. Dari hasil analisis review mahasiswa, ditemukan bahwa tiga komponen review terkandung didalamnya yaitu identifikasi ide utama dan pendukung dalam teks, mekanika penulisan review, dan penyusunan ide dalam review. Sementara itu, tiga komponen review lain yaitu komponen analisis, evaluasi kritis, dan format review belum tergambar dengan baik. Disarankan kepada para dosen untuk memasukkan komponen review kedalam pengajaran dan menyediakan latihan yang bisa merangsang kemampuan mereview mahasiswa..

KataKunci: Review, TeksEksposisi, Mahasiswa Jurusan Bahasa dan Sastra Inggris
Supporting Emergent Bilingual Professional Development through Supervisor Feedback
Authors: Guise Megan , Hegg Sarah , Ronan Briana , Flushman Tanya , Grant Billie-Jo
Published: March 2020

This study examines the effects of professional development on the content and frequency of university supervisor (n=6) written feedback related to supporting emergent bilinguals in order to improve the quality of observational evaluations provided to elementary and secondary pre-service teachers. Findings reveal supervisors’ post-intervention feedback more frequently addressed the needs of language learners and provided a greater breadth of issues related to emergent bilinguals. Interview data reveal key factors explain how the professional development addressed gaps in knowledge and affected confidence levels of university supervisors. Implications highlight the importance of supporting supervisors with targeted professional development opportunities around supporting emergent bilinguals to allow for critical reflection of feedback provided to pre-service teachers.
Two new species of the Peronospora belbahrii species complex, Pe. choii sp. nov. and Pe. salviae-pratensis sp. nov., and a new host for Pe. salviae-officinalis
Authors: Hoffmeister M. , Ashrafi S. , Thines M. , Maier W.
Published: March 2020

The downy mildew species parasitic to Mentheae are of particular interest, as this tribe of Lamiaceae contains a variety of important medicinal plants and culinary herbs. Over the past two decades, two pathogens, Peronospora belbahrii and Pe. salviae-officinalis
have spread globally, impacting basil and common sage production, respectively. In the original circumscription of Pe. belbahrii, the downy mildew of coleus (Plectranthus scutellarioides) was ascribed to this species in the broader sense, but subtle differences in morphological
and molecular phylogenetic analyses using two genes suggested that this pathogen would potentially need to be assigned to a species of its own. In the present study, Peronospora species causing downy mildew on members of the Mentheae, including clary sage (Salvia sclarea),
meadow sage (S. pratensis), basil (Ocimum basilicum), ground ivy (Glechoma hederacea) and coleus (Plectranthus scutellarioides) were studied using light microscopy and molecular phylogenetic analyses based on six loci (ITS rDNA, cox 1, cox 2, ef1a,
hsp 90 and β-tubulin) to clarify the species boundaries in the Pe. belbahrii species complex. The downy mildew on Salvia pratensis is shown to be distinct from Pe. salviae-officinalis and closely related to Pe. glechomae, and is herein described
as a new species, Pe. salviae-pratensis. The downy mildew on S. sclarea was found to be caused by Pe. salviae-officinalis. This is of phytopathological importance, because meadow sage thus does not play a role as inoculum source for common sage in the natural habitat of
the former in Europe and Asia, while clary sage probably does. The multi-gene phylogeny revealed that the causal agent of downy mildew on coleus is distinct from Pe. belbahrii on basil, and is herein described as a new taxon, Pe. choii.
Kontekstualisasi dalam Penyebaran Islam: Analisis Pola Pembentukan Islam di Nusantara (Contextualization in the Spread of Islam: Analysis on the Pattern of the Spreading of Islam in Nusantara)
Authors: Rumahuru Yance Zadrak
Published: March 2020

This article analyzes the pattern of the spread of Islam in Nusantara, especially in Maluku islands. It aims to develop the thought of spread of Islam as proposed by Taufik Abdullah and Djoko Suryo. It is constructed based on the writer’s research findings in Ternate and Tidore North Maluku, also in Ambon island and Haruku island, Central Maluku. Besides field data, literature study on the spread of Islam in Indonesia and Southeast Asia is used as well. Referring to the macro context proposed by Taufik Abdullah and Djoko Suryo, the writer examines the micro context of Maluku islands, and it is found that: First, the spread of Islam in Maluku takes place through a contextualization pattern. Second, the presence of Islam in Maluku islands is a momentum for the development of society in the past and influenced the existence of Islam until now. Through Islam, the local communities are able to realize the outside world and build a wider communication that allows them to experienced modernization. Furthermore, this article can be placed as part of the historical and religious identity studies undertaken to assert the existence of Islam that has contributed to build the civilization of society, either in Maluku or in Indonesia and Southeast Asia. Keywords: contextualization, Indonesia, Islam in Southeast Asia, Maluku, Nusantara
Signifikansi Pemimpin Kristen Yang Berintegritas di Era-Postmodern Dalam Menumbuhkan Pemahaman Integritas Hidup Dalam Kepemimpinan Kristen
Authors: Pasaribu Ferdinan
Published: March 2020

Signifikansi Pemimpin Kristen Yang Berintegritas di Era-PostmodernDalam Menumbuhkan Pemahaman Integritas Hidup Dalam Kepemimpinan Kristen adalah sebuah kebutuhan yang sangat dinantikan oleh gereja dan seluruh komunitas dalam kehidupan sosial. Kepemimpinan yang berintegritas akan melahirkan sebuah kemajuan yang berdampak pada lahirnya kehidupan yang memuliakan Tuhan. Jika integritas seorang pemimpin tidak kuat, maka kala badai tekanan datang, runtuhlah kepemimpinan yang sudah dibangun. Tetapi jika seorang pemimpin memiliki integritas, maka sekuat apa pun badai tekanan datang, ia tetap menjadi seorang pemimpin yang dapat diandalkan.Seorang pemimpin harus mempunyai kemampuan menangani kerumitan dari setiap permasalahan yang ada berdasarkan integritas. Integritas terlihat katika ada tantangan yang melanggar kode etik dan cara menyelesaikan kerumitan persoalan yang sedang dihadapi. Melalui pengamatan dari penulis, integritas ini sangat penting sehingga dalam paper ini penulis ingin memaparkan apa itu kepemimpinan, dan bagaimana integritas kepemimpinan Kristen.
Aspek Yuridis Dan Implikasi Hak Guna Ruang Atas Dan Bawah Tanah
Authors: Sakti Trie
Published: March 2020

Perkembangan pembangunan di perkotaan menunjukkan bahwa pemanfaatan ruang di perkotaan tidak terbatas pada bidang tanah saja tetapi termasuk juga ruang atas dan bawah tanah. Permasalahan timbul ketika terjadi pembangunan mall di bawah tanah, MRT, underpass, flyover, terkait status hak yang akan diberikan mengingat hak atas tanah diartikan hanya sebatas yang ada di permukaan bumi, kemudian seberapa jauh batas ketinggian yang boleh dipergunakan pihak lain dan seberapa jauh batas kedalaman yang dapat dipergunakan pihak lain. Peraturan perundangan yang ada belum secara spesifik mengatur mengenai penggunaan pemanfaatan Hak Guna Ruang Atas dan Bawah Tanah (HGRBT) sehingga timbul berbagai penafsiran terhadap ketentuan yang ada. Mengingat perkembangan teknologi yang semakin maju dan terbatasnya tanah yang tersedia maka perlu segera disusun peraturan perundang-undangan mengenai Hak Guna Ruang Atas dan Bawah Tanah dan harmonisasinya dengan peraturan lain di tingkat pusat dan daerah terkait penataan ruang, lingkungan hidup, pertambangan, Rencana Tata Ruang Wilayah (RTRW) dan Rencana Detail Tata Ruang (RDTR). Kajian ini menelaah dan menganalisis data sekunder sebagai sumber utama. Pendekatan yang dipergunakan dalam pendekatan ini adalah pendekatan perundang-undangan, pendekatan konseptual, serta pendekatan historis. Pendekatan terhadap peraturan perundangan dilakukan dengan cara menganalisis terhadap ketentuan hukum yang terkait.
Intrinsic Religiosity Attenuates the Negative Relationship Between Social Disconnection and Meaning in Life
Authors: Reynolds Caleb Joshua , Spencer  , Conway Paul
Published: March 2020

Positive social connections are integral to people’s experience of meaning in their lives. As such, social isolation can make life seem meaningless. Chan, Michalak, and Ybarra (2019, Journal of Personality) provided evidence that religious beliefs (not just participation in corporate religious life) can provide an alternative source of meaning for people who feel socially isolated. We tested whether this phenomenon was specific to (a) intrinsic vs. extrinsic orientations toward religion, and (b) experiencing meaning in one’s life at present vs. actively searching for meaning. In a sample of undergraduates, high levels of intrinsic—but not extrinsic—religiosity attenuated the relationship between social disconnection and decreased meaning in life. Moreover, this attenuation was specific to felt presence of meaning in life, rather than active search for meaning. These results corroborate and expand Chan et al.’s findings and suggest that future research should explore mechanisms by which religious beliefs themselves serve meaning-making functions.
Modelling a Multi-Dimensional Model of Memory Performance in Obsessive-Compulsive Disorder: A Multi-Level Meta-Analytic Review.
Authors: Harkin Ben , Kessler Klaus , Persson Sofia , Yates Alan
Published: March 2020

Even though memory performance is a commonly researched aspect of Obsessive-Compulsive Disorder (OCD), a coherent and unified explanation of the role of specific cognitive factors has remained elusive. To address this, the present meta-analysis examined the predictive validity of Harkin and Kessler’s (2011) Executive Function (E), Binding Complexity (B) and Memory Load (L) Classification System with regards to affected vs. unaffected memory performance in OCD. We employed a multi-level meta-analytic approach (Viechtbauer, 2010) to accommodate the interdependent nature of the EBL model and interdependency of effect sizes (305 effect sizes from 144 studies, including 4424 OCD patients). Results revealed that the EBL model predicted memory performance, i.e., as EBL demand increases, those with OCD performed progressively worse on memory tasks. Executive function was the driving mechanism behind the EBL’s impact on OCD memory performance and negated effect size differences between visual and verbal tasks in those with OCD. Comparisons of sub-task effect sizes were also generally in accord with the cognitive parameters of the EBL taxonomy. We conclude that standardised coding of tasks along individual cognitive dimensions and multi-level meta-analyses provides a new approach to examine multi-dimensional models of memory and cognitive performance in OCD and other disorders.
The effect of bilingualism on brain development from early childhood to young adulthood
Authors: Pliatsikas Christos , Meteyard Lotte , Veríssimo João , Deluca Vincent , Shattuck Kyle , Ullman Michael
Published: March 2020

Bilingualism affects the structure of the brain in adults. This is indicated by experience-dependent gray and white matter changes in brain structures implicated in language learning, processing, or control. However, limited evidence exists on how bilingualism may influence brain development. We examined the developmental trajectories of both grey and white matter structures in a cross-sectional study of a large sample (N=711 for grey matter, N=637 for white matter) of bilingual and monolingual participants, aged 3-21 years. Metrics of grey matter (thickness, volume, surface area) and white matter (fractional anisotropy, mean diffusivity) were examined across 41 cortical and subcortical brain structures and 20 tracts, respectively. We used generalised additive modelling to analyse whether, how, and where the developmental trajectories of bilinguals and monolinguals might differ. Bilingual and monolingual participants manifested distinct developmental trajectories in both gray and white matter structures. As compared to monolinguals, bilinguals showed: a) more gray matter (less developmental loss) starting during late childhood and adolescence, mainly in frontal and parietal regions (particularly in inferior frontal gyrus pars opercularis, superior frontal cortex, inferior and superior parietal cortex, and the precuneus); and b) higher white matter integrity (greater developmental increase) starting during mid-late adolescence, specifically in striatal-inferior frontal fibers. The data suggest that there may be a developmental basis to the well-documented structural differences in the brain between bilingual and monolingual adults.
Experience with research paradigms relates to infants' direction of preference
Authors: Santolin Chiara , Garcia-Castro Gonzalo , Zettersten Martin , Sebastian-Galles Nuria , Saffran Jenny
Published: March 2020

Interpreting and predicting direction of preference in infant behavioral research has been a thorny issue for decades. Several factors have been proposed to account for familiarity and novelty preferences in habituation and familiarization studies, including infant age, length of exposure and task complexity. The current study explores an additional dimension that may affect direction of preference: amount of experience with the experimental task. To test this hypothesis, we re-analyzed the data from 4 experiments on artificial grammar learning in 12-month-old infants run using the Head- turn Preference Procedure (HPP). The participants in these studies varied substantially in their number of laboratory visits. Linear mixed-effects results show that the number of HPP studies in which infants had previously participated is related to infants’ direction of preference: infants who had no (or limited) experience with the HPP setting were more likely to show familiarity preferences than infants who had amassed more experience with this task in prior study visits. Interestingly, the effect is driven by a significant decrease in looking time for familiar trials. These results have important implications for the interpretation of experimental results: infants’ experience with a given paradigm or, more broadly, with the lab environment, may affect their patterns of preferences.
Puberty and social brain development
Authors: Barendse Marjolein , Pfeifer Jennifer H
Published: March 2020

Puberty is characterized by substantial change in many areas of development, including hormonal, physical, neuronal, psychological and social. In this chapter, we outline how puberty, and its underlying hormonal and physical changes, might elicit a sensitive period for the development of the social brain. The literature to date suggests that pubertal development is relevant for the structural development of the social brain, partly in interaction with sex. Functionally, puberty might render the brain more sensitive to social information. However, methodological issues relating to sample size, study design and analysis, limit the possibility of drawing more specific conclusions. Apart from overcoming these methodological problems, future research should focus on individual differences in pubertal processes and their relevance to social brain development, as well as examining the mechanisms from pubertal processes through social brain functioning to social behavior.
Asking about Sexual Orientation and Gender Identity in Social Surveys in Japan: Findings from the Osaka City Residents’ Survey and Related Preparatory Studies
Authors: Hiramori Daiki , Kamano Saori
Published: March 2020

Most studies on the measurement of sexual orientation and gender identity (SOGI) in representative surveys are conducted in Western countries. Whether the findings from these studies are applicable to countries with legal, religious, and cultural contexts regarding sexual and gender minorities distinct from Western societies is yet to be explored. To fill this gap, this paper summarizes the findings from focus groups and a pilot survey conducted to develop SOGI questions in the Japanese context. For sexual orientation identity, a six-category question that includes definition of each category, and for transgender status, a three-step method, are suggested for general use. The paper also reports on percentage distributions of SOGI by assigned sex at birth and by age group based on the Osaka City Residents' Survey, one of the first population-based surveys in Japan with SOGI questions. Overall, our findings illustrate the significance of examining the measurement of SOGI beyond Western societies.
Huge Dual Ectopic Retroternal Thyroid Masses within a Single Capsule: A Case Report
Authors: Mogahed Mona , Shafik Elkahwagy Mohamed , Mogahed Mona , Saeid Basalama Salim , M Alnomani Taha Saad
Published: March 2020

Background: Goiter sometimes has retrosternal extension in the mediastinum. And may present with compressive symptoms such as dyspnea, dysphagia, dysphonia or sleep apnea. Treatment of choice is total thyroidectomy and removal of the intrathoracic portion of thyroid. However, these cervicomediastinal masses may be separately encapsulated, and a sternotomy may be required for complete and safe excision of the mediastinal mass to achieve decompression of the surrounding structures and preventing the hemorrhagic complications if attempted from cervical incision
Pengaruh Lokasi Toko dan Citra Merek terhadap Minat Beli Konsumen pada Ayam Gepuk Pak Gembus Padang
Authors: Susanti Febsri , Zakaria Zaky
Published: March 2020

The current development of business competition in Indonesia is very tight, which makes companies do various ways to attract consumers to buy their products. This study aims to determine whether the location of the store and brand image influence consumer buying interest in the Ayam Gepuk Pak Gembus, by using data collection methods in the form of a questionnaire of 160 respondents. In analyzing the data using validity, reliability, and classic assumption tests, namely normality, multicollinearity and heteroscedasticity. The analytical method used is multiple linear regression analysis. While for testing the hypothesis, namely the F test, T test, R2 determinant coefficient using SPSS tools. The results of the tests conducted found that the location of the store had a positive and significant effect on consumer buying interest and the brand image also had a positive and significant effect on consumer buying interest.
Variación del Puntaje Z Peso-edad en lactantes hospitalizados, características de su alimentación y percepción de los padres
Authors: Morel Zuny Alejandra , Godoy Laura
Published: March 2020

Introducción: La desnutrición en pacientes pediátricos hospitalizados continúa siendo un hallazgo común y una causa frecuente de aumento de la morbimortalidad en niños. Objetivo: Describir la Variación del Puntaje Z del peso-edad en lactantes hospitalizados en sala de internados en el periodo de Septiembre a Diciembre del 2018. Materiales y Métodos: Estudio observacional, descriptivo, transversal, prospectivo con componente analítico. Población: pacientes de 0 a 24 meses hospitalizados en el periodo de septiembre a diciembre del 2018. Variables: edad, sexo, procedencia, tiempo de lactancia materna exclusiva, alimentación actual, alimentación complementaria, comorbilidades, ayuno, peso al ingreso Puntaje Z, peso al egreso Puntaje Z, diagnóstico nutricional al ingreso, diagnóstico nutricional al egreso, diagnóstico de egreso, percepción de los padres. Análisis de datos: sistema SSPPv21, estadística descriptiva. El protocolo fue aceptado por el comité de ética de la institución con consentimiento informado. Resultados: la mediana de edad fue de 7 meses, predominó el sexo masculino 52%, la mayoría proceden del área central 87%, la mediana del tiempo de lactancia materna exclusiva fue 5 meses, la mediana del inicio de alimentación complementaria fue 6 meses, siendo la mediana de días de internación 4 (mínimo 3 y máximo de 6), la alimentación actual corresponde a LME en 40%,el diagnostico nutricional del ingreso: eutrófico en 65% y al egreso 66%, el Pz al ingreso fue 0,29±0,94 y al egreso fue 0,42±0,87. Considerando como punto de corte 5 días de hospitalización, y analizando la variación del Pz (P/E) en relación a los mismos no hubo variación. La percepción de los padres sobre la alimentación de sus hijos durante la hospitalización fue que comen en igual proporción que habitualmente en un 74,3%. Conclusión: No hubo variación estadísticamente significativa en el Puntaje Z de los pacientes hospitalizados y no se encontró variación del estado nutricional durante hospitalización de los lactantes. La mayoría de los pacientes tuvieron corta estancia hospitalaria y no fueron sometidos a ayuno durante la misma.

Conflicto de interés: Los autores declaran no poseer conflicto de interés

Recibido: 20/12/2019 Aceptado: 18/02/2020
Contenido de grasas, sodio, azúcares y edulcorantes declarados en etiquetado nutricional de golosinas, snacks salados y en bebidas dulces no alcohólicas seleccionadas
Authors: Hermosilla Soria Romy Beatriz , Sánchez Bernal Susana F. , Burgos Rodrigo
Published: March 2020

Introducción: La obesidad en niños se asocia también a ingesta de alimentos ricos en grasas, azúcares y sodio, por ello es importante conocer sus niveles en golosinas y las bebidas dulces. Objetivos: Evaluar contenido de nutrientes críticos acorde al Perfil de Nutrientes de OPS en golosinas dulces, snacks salados y bebidas dulces no alcohólicas envasadas, según información del etiquetado nutricional.

Materiales y Métodos: Estudio transversal, descriptivo, exploratorios. Se evaluó contenido por porción de grasas totales(GT), saturadas(GS) y trans(GTr), sodio, azúcares libres(AL) y edulcorantes artificiales(EA) en golosinas dulces, saladas, y bebidas dulces no alcohólicas (BDNA) según etiquetado nutricional. Niveles excesivos fueron considerados según "Perfil de nutrientes de OPS". Muestra fue por conveniencia obtenida en 2 bocas de expendio. Se excluyeron postres envasados y golosinas con información poco visible. Resultados: Fueron evaluados 104 alimentos agrupados en: confitería (alfajor, magdalenas), chocolates, snacks salados (queso, maíz, galletitas saladas, papas fritas), galletitas dulces, bebidas dulces (jugos/gaseosas/bebidadeportistas). En confitería, 8/13 tenían exceso de GT, 10/13 de GS, 4/13 de GTr, 11/13, de AL, ninguno exceso de sodio, 11/13 tenían EA. Entre chocolates, todos tenían exceso de GT y GS, 2/10 en GTr, ninguno sodio, 9/10 altos en AL, 2/10 contenían EA. Snacks:, 14/17 eran altos en GT, 7/17 en GS, 1/17 en GTr, 15/17 en sodio, 4/17 en AL, 6/17 contenían EA. Galletitas dulces tenían exceso de GT 14/20, de GS 17/20, 6/20 de GTr, de sodio 1/20, todos con AL,17/20 contenían EA. En BDH (n=44), todas tenían exceso de sodio, 36/44 exceso de AL, 21/44 tenían EA. Conclusión: Alimentos de confitería son altos en grasas, azúcares libres y edulcorantes.. Los chocolates son altos en grasas y azucares. Los snacks son altos en sodio y grasas. Las galletitas tienen exceso de azúcares y grasas saturadas, 2/3 contienen edulcorantes artificiales. Las bebidas dulces son altas en sodio y azucares, la mitad tiene edulcorantes artificiales.

Conflicto de interés: Los autores declaran no poseer conflicto de interés

Recibido: 08/02/2019 Aceptado: 20/02/2020
Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects
Authors: Gandy Kellen , Castillo Heidi , Rocque Brandon G. , Bradko Viachaslau , Whitehead William , Castillo Jonathan
Published: March 2020

OBJECTIVE

The recognition that neurosurgeons harbor great potential to advocate for the care of individuals with neural tube defects (NTDs) globally has sounded as a clear call to action; however, neurosurgical care and training in low- and middle-income countries (LMICs) present unique challenges that must be considered. The objective of this study was to systematically review publications that describe the challenges and benefits of participating in neurosurgery-related training programs in LMICs in the service of individuals with NTDs.

METHODS

Using MEDLINE (PubMed), the authors conducted a systematic review of English- and Spanish-language articles published from 1974 to 2019 that describe the experiences of in-country neurosurgery-related training programs in LMICs. The inclusion criteria were as follows—1) population/exposure: US residents, US neurosurgeons, and local in-country medical staff participating in neurosurgical training programs aimed at improving healthcare for individuals with NTDs; 2) comparison: qualitative studies; and 3) outcome: description of the challenges and benefits of neurosurgical training programs. Articles meeting these criteria were assessed within a global health education conceptual framework.

RESULTS

Nine articles met the inclusion criteria, with the majority of the in-country neurosurgical training programs being seen in subregions of Africa (8/9 [89%]) and one in South/Central America. US-based residents and neurosurgeons who participated in global health neurosurgical training had increased exposure to rare diseases not common in the US, were given the opportunity to work with a collaborative team to educate local healthcare professionals, and had increased exposure to neurosurgical procedures involved in treating NTDs. US neurosurgeons agreed that participating in international training improved their own clinical practices but also recognized that identifying international partners, travel expenses, and interference with their current practice are major barriers to participating in global health education. In contrast, the local medical personnel learned surgical techniques from visiting neurosurgeons, had increased exposure to intraoperative decision-making, and were given guidance to improve postoperative care. The most significant challenges identified were difficulties in local long-term retention of trained fellows and staff, deficient infrastructure, and lower compensation offered for pediatric neurosurgery in comparison to adult care.

CONCLUSIONS

The challenges and benefits of international neurosurgical training programs need to be considered to effectively promote the development of neurosurgical care for individuals with NTDs in LMICs. In this global health paradigm, future work needs to investigate further the in-country professionals’ perspective, as well as the related outcomes.
Reaching the horizon and looking beyond: neurosurgery education in Kazakhstan
Authors: Akshulakov Serik , Makhambetov Yerbol , Bralov Askhat , Pazylbekov Talgat , Tursynov Nurtas , Menlibayeva Karashash
Published: March 2020

Neurosurgery education in Kazakhstan has 55 years of history. The first neurosurgery department was established in 1964 in the city of Almaty, South Kazakhstan (the former capital of Kazakhstan). The department was headed by the pioneer of Kazakhstani neurosurgeons, Prof. Yevgeniya Azarova. A new neurosurgery education system was adopted after a while. To date, 4 medical universities and 1 neurosurgical center in Kazakhstan have a neurosurgery department that prepares around 10 neurosurgeons annually. The country’s populations are currently served by more than 300 neurosurgeons. However, isolated regions lack neurosurgical services and a specialized medical workforce. Urbanization results in inequality of receiving medical care among rural and regional inhabitants.

To develop and strengthen the neurosurgery services, the National Center for Neurosurgery was opened in the heart of the country. The center has placed great importance on the development of neurosurgery and neurosurgical education in Kazakhstan. The World Federation of Neurosurgical Societies, European Association of Neurosurgical Societies, Asian Congress of Neurosurgeons, and International Society for Pediatric Neurosurgery have held many international meaningful events on neurosurgery at the center. Opened in 2008, the neurosurgery center has prepared 41 neurosurgeons in the residency program. This article seeks to provide readers with an understanding of the state of neurosurgery education in Kazakhstan and its development history.
Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery
Authors: Lundy Paige , Miller Christopher , Woodrow Sarah
Published: March 2020

OBJECTIVE

It is estimated that nearly 47 million preventable deaths occur annually due the current worldwide deficit in surgical care; subsequently, the World Health Organization resolved unanimously to endorse a decree to address this deficit. Neurosurgeons from industrialized nations can help address the needs of underserved regions. Exposure during training is critical for young neurosurgeons to gain experience in international work and to cultivate career-long interest. Here, the authors explore the opinions of current residents and interest in global neurosurgery as well as the current state of international involvement, opportunities, and barriers in North American residency training.

METHODS

An internet-based questionnaire was developed using the authors’ university’s REDCap database and distributed to neurosurgical residents from US ACGME (Accreditation Council for Graduate Medical Education)–approved programs. Questions focused on the resident’s program’s involvement and logistics regarding international rotations and the resident’s interest level in pursuing these opportunities.

RESULTS

A 15% response rate was obtained from a broad range of training locations. Twenty-nine percent of respondents reported that their residency program offered elective training opportunities in developing countries, and 7.6% reported having participated in these programs. This cohort unanimously felt that the international rotation was a beneficial experience and agreed that they would do it again. Of those who had not participated, 81.3% reported interest or strong interest in international rotations.

CONCLUSIONS

The authors’ results indicate that, despite a high level of desire for involvement in international rotations, there is limited opportunity for residents to become involved. Barriers such as funding and rotation approval were recognized. It is the authors’ hope that governing organizations and residency programs will work to break down these barriers and help establish rotations for trainees to learn abroad and begin to join the cause of meeting global surgical needs. To meet overarching international neurosurgical needs, neurosurgeons of the future must be trained in global neurosurgery.
The state of neurosurgical training and education in East Asia: analysis and strategy development for this frontier of the world
Authors: Ferraris Kevin Paul , Matsumura Hideaki , Wardhana Dewa Putu Wisnu , Vesagas Theodor , Seng Kenny , Mohd Ali Mohd Raffiz , Ishikawa Eiichi , Matsumura Akira , Rosyidi Rohadi Muhammad , Mahadewa Tjokorda , Kuo Meng-Fai
Published: March 2020

OBJECTIVE

The authors, who are from Indonesia, Japan, Malaysia, the Philippines, and Taiwan, sought to illustrate the processes of training neurosurgeons in their respective settings by presenting data and analyses of the current state of neurosurgical education across the East Asian region.

METHODS

The authors obtained quantitative data as key indicators of the neurosurgical workforce from each country. Qualitative data analysis was also done to provide a description of the current state of neurosurgical training and education in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was also done to identify strategies for improvement.

RESULTS

The number of neurosurgeons in each country is as follows: 370 in Indonesia, 10,014 in Japan, 152 in Malaysia, 134 in the Philippines, and 639 in Taiwan. With a large neurosurgical workforce, the high-income countries Japan and Taiwan have relatively high neurosurgeon to population ratios of 1 per 13,000 and 1 per 37,000, respectively. In contrast, the low- to middle-income countries Indonesia, Malaysia, and the Philippines have low neurosurgeon to population ratios of 1 per 731,000, 1 per 210,000, and 1 per 807,000, respectively. In terms of the number of training centers, Japan has 857, Taiwan 30, Indonesia 7, Malaysia 5, and the Philippines 10. In terms of the number of neurosurgical residents, Japan has 1000, Taiwan 170, Indonesia 199, Malaysia 53, and the Philippines 51. The average number of yearly additions to the neurosurgical workforce is as follows: Japan 180, Taiwan 27, Indonesia 10, Malaysia 4, and the Philippines 3. The different countries included in this report have many similarities and differences in their models and systems of neurosurgical education. Certain important strategies have been formulated in order for the system to be responsive to the needs of the catchment population: 1) establishment of a robust network of international collaboration for reciprocal certification, skills sharing, and subspecialty training; 2) incorporation of in-service residency and fellowship training within the framework of improving access to neurosurgical care; and 3) strengthening health systems, increasing funding, and developing related policies for infrastructure development.

CONCLUSIONS

The varied situations of neurosurgical education in the East Asian region require strategies that take into account the different contexts in which programs are structured. Improving the education of current and future neurosurgeons becomes an important consideration in addressing the health inequalities in terms of access and quality of care afflicting the growing population in this region of the world.
Academic performance after neurosurgery residency training in Turkey: a national survey
Authors: Yakar Fatih , Hanalioglu Sahin , Sahin Balkan , Egemen Emrah , Dere Umit A. , Kiraz İlker , Coskun M. Erdal , Kahilogullari Gokmen
Published: March 2020

OBJECTIVE

Neurosurgery training programs aim to train specialists. In addition, they are expected to equip the residents with necessary knowledge and skills for academic development. This study aims to gain insights into academic productivity after neurosurgeons graduated from residency training in Turkey.

METHODS

An electronic survey was sent to all Turkish Neurosurgical Society members (n = 1662 neurosurgeons) between September and November 2019. The number of participants was 289 (17.4%). Participants were divided into subgroups based on three main factors: training institution type (university hospital [UH] vs training and research hospital [TRH]), training institution annual case volume (low [< 1000 or inadequate cranial/spinal case numbers] vs high [> 1000 and adequate cranial/spinal case numbers]), and training program accreditation status (accredited vs nonaccredited).

RESULTS

The majority of the participants (64.7%) graduated from the UHs. Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index–Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. In addition, graduates of accredited programs reported more PhD degrees than those of nonaccredited programs.

CONCLUSIONS

Neurosurgeons trained in higher-case-volume, accredited programs, mostly in the UHs, performed better in terms of scientific activities and productivity in Turkey. Strong research emphasis and supportive measures should be instituted to increase academic performance during and after residency training.
Job satisfaction, engagement, and burnout in the population of orthopedic surgeon and neurosurgeon trainees in mainland China
Authors: Yu Jinli , Zou Fei , Sun Yirui
Published: March 2020

OBJECTIVE

In China, orthopedics and neurosurgery are among the most desired majors for medical students. However, little is known about the working and living status of specialists in these two fields. This study was aimed at evaluating job satisfaction, engagement, and burnout in the population of Chinese orthopedist and neurosurgeon trainees.

METHODS

A nationwide online survey was administered in mainland China. Questionnaires were answered anonymously. Job satisfaction, engagement, and burnout were assessed using the Job Descriptive Index, the Utrecht Work Engagement Scale, and the Maslach Burnout Inventory, respectively.

RESULTS

Data were collected from 643 orthopedist trainees and 690 neurosurgeon trainees. Orthopedists and neurosurgeons showed no statistical difference in terms of age, sex, job titles, and preference for working in tertiary hospitals. Orthopedists had a higher marriage rate (p < 0.01), a lower divorce rate (p = 0.017), relatively shorter working hours (p < 0.01), and a higher annual income (p = 0.023) than neurosurgeons. Approximately 40% of respondents experienced workplace violence in the last 5 years. Less than 10% of respondents were satisfied with their pay, and over 70% would not encourage their offspring to become a doctor. Orthopedists were more satisfied with their careers than neurosurgeons (p < 0.01) and had a higher level of work engagement (p < 0.01). In addition, a higher proportion of orthopedists were burnt out (p < 0.01) than neurosurgeons, though the difference between the two groups was not significant (p = 0.088). Multivariate regressions suggested that younger age (≤ 25 years old), being a senior trainee, getting divorced, working in a regional hospital, long working hours (≥ 71 hrs/wk), a low annual income (<¥100,000), sleeping < 6 hrs/day, and experience with workplace violence were significantly related to burnout for both groups.

CONCLUSIONS

Chinese orthopedic surgical and neurosurgical trainees are under significant stress. Orthopedic surgeons showed relatively optimistic data in their assessments of job satisfaction, engagement, and burnout. This study may provide valuable information for orthopedic and neurosurgical candidates considering either specialty as a career.
Development and validation of a synthetic 3D-printed simulator for training in neuroendoscopic ventricular lesion removal
Authors: Licci Maria , Thieringer Florian M. , Guzman Raphael , Soleman Jehuda
Published: March 2020

OBJECTIVE

Neuroendoscopic surgery using an ultrasonic aspirator represents a valid tool with which to perform the safe resection of deep-seated ventricular lesions, but the handling of neuroendoscopic instruments is technically challenging, requiring extensive training to achieve a steep learning curve. Simulation-based methods are increasingly used to improve surgical skills, allowing neurosurgical trainees to practice in a risk-free, reproducible environment. The authors introduce a synthetic, patient-specific simulator that enables trainees to develop skills for endoscopic ventricular tumor removal, and they evaluate the model’s validity as a training instrument with regard to realism, mechanical proprieties, procedural content, and handling.

METHODS

The authors developed a synthetic simulator based on a patient-specific CT data set. The anatomical features were segmented, and several realistic 1:1 skull models with all relevant ventricular structures were fabricated by a 3D printer. Vascular structures and the choroid plexus were included. A tumor model, composed of polyvinyl alcohol, mimicking a soft-consistency lesion, was secured in different spots of the frontal horn and within the third ventricle. Neurosurgical trainees participating in a neuroendoscopic workshop qualitatively assessed, by means of a feedback survey, the properties of the simulator as a training model that teaches neuroendoscopic ultrasonic ventricular tumor surgery; the trainees rated 10 items according to a 5-point Likert scale.

RESULTS

Participants appreciated the model as a valid hands-on training tool for neuroendoscopic ultrasonic aspirator tumor removal, highly rating the procedural content. Furthermore, they mostly agreed on its comparably realistic anatomical and mechanical properties. By the model’s first application, the authors were able to recognize possible improvement measures, such as the development of different tumor model textures and the possibility, for the user, of creating a realistic surgical skull approach and neuroendoscopic trajectory.

CONCLUSIONS

A low-cost, patient-specific, reusable 3D-printed simulator for the training of neuroendoscopic ultrasonic aspirator tumor removal was successfully developed. The simulator is a useful tool for teaching neuroendoscopic techniques and provides support in the development of the required surgical skills.
Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education
Authors: Deora Harsh , Garg Kanwaljeet , Tripathi Manjul , Mishra Shashwat , Chaurasia Bipin
Published: March 2020

OBJECTIVE

The evolution of the neurosurgical specialty in lower-middle-income countries is uniformly a narrative of continuous struggle for recognition and resource allocation. Therefore, it is not surprising that neurosurgical education and residency training in these countries is relatively nascent. Dr. Harvey Cushing in 1901 declared that he would specialize in neurosurgery and gave his greatest contribution to the advancement of neurosurgical education by laying the foundations of a structured residency training program. Similar efforts in lower-middle-income countries have been impeded by economic instability and the lack of well-established medical education paradigms. The authors sought to evaluate the residency programs in these nations by conducting a survey among the biggest stakeholders in these educational programs: the neurosurgical residents.

METHODS

A questionnaire addressing various aspects of the residency program from a resident’s perspective was prepared with Google Forms and circulated among neurosurgery residents through social media and email groups. Where applicable, a 5-point Likert scale was used to grade the responses to the questions. Responses were collected from May to October 2019 and analyzed using descriptive statistics. Complete anonymity of the respondents was ensured to keep the responses unbiased.

RESULTS

A total of 195 responses were received, with 189 of them from lower-middle-income countries (LMICs). The majority of these were from India (75%), followed by Brazil and Pakistan. An abiding concern among residents was lack of work hour regulations, inadequate exposure to emerging subspecialties, and the need for better hands-on training (> 60% each). Of the training institutions represented, 89% were offering more than 500 major neurosurgical surgeries per year, and 40% of the respondents never got exposure to any subspecialty. The popularity of electronic learning resources was discernible and most residents seemed to be satisfied with the existent system of evaluation. Significant differences (p < 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.

CONCLUSIONS

It is prudent that concerned authorities in LMICs recognize and address the deficiencies perceived by neurosurgery residents in their training programs. A determined effort in this direction would be endorsed and assisted by a host of international neurosurgical societies when it is felt that domestic resources may not be adequate. Quality control and close scrutiny of training programs should ensure that the interests of neurosurgical trainees are best served.