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ObjectivesVocal fold (VF) stiffness and geometry are determinant variables in voice production. Type 1 medialization thyroplasty (MT), the primary surgical treatment for glottic insufficiency, changes both of these variables. Understanding the cause and effect relationship between these variables and acoustic output might improve voice outcomes after MT. In this study, the effects of thyroplasty implants with variable stiffness on glottal shape and acoustics were investigated.MethodsIn an ex vivo human larynx phonation model, bilateral MT with implants of four stiffness levels (1386, 21.6, 9.3, and 5.5 kPa) were performed. Resulting acoustics and aerodynamics were measured across multiple airflow levels. A vertical partial hemilaryngectomy was performed and stereoscopic images of the VF medial surface taken to reconstruct its three-dimensional (3D) surface contour. The results were compared across implants.ResultsThe effects of implant stiffness on acoustics varied by airflow. Softer implants resulted in improved acoustics, as measured by cepstral peak prominence (CPP), at lower airflow levels compared to stiffer implants but this relationship reversed at high airflow levels. Stiffer implants generally required less airflow to generate a given subglottal pressure. Stiffer implants resulted in greater medialized surface area and maximal medialization, but all implants had similar effects on overall VF medial surface contour.ConclusionSofter implants result in less medialization but better acoustics at low airflow rates. Stiffer implants provide better acoustics and more stable pressure-flow relationships at higher airflow rates. This highlights a potential role for patient-specific customized thyroplasty implants of various stiffness levels.Level of evidenceNA.

Rhabdomyomas are benign tumors composed of mesenchymal tissue and having a histologic appearance similar to skeletal muscle. Extracardiac rhabdomyomas are rare, and the majority of the adult subtype occur in the head and neck (H&N) region. Diagnosis can be challenging due to fine-needle aspiration (FNA) and core needle biopsy being suspicious for sampling error from surrounding muscle or concerning for rhabdomyosarcoma. We present a case of a slowly enlarging left neck mass in the strap musculature of a 45-year-old Hispanic male. Multiple FNA and core biopsies failed to establish a diagnosis, and excisional biopsy was pursued revealing a hypertrophied left inferior belly of the omohyoid muscle. Histological analysis was diagnostic of an adult-type extracardiac rhabdomyoma, with complete surgical excision being the gold standard treatment for these tumors. The patient had an uneventful recovery. Skeletal muscle tumors of the H&N are uncommon, and benign extracardiac rhabdomyoma must be considered in the differential diagnosis to prevent unnecessarily aggressive intervention and appropriate patient counseling before and after surgery.

With the ceaseless development of new and more advanced technologies, along with their growing influence and control over business and commerce, it is no surprise that the educational community is struggling to come up with programs to educate students to adequately handle these developments. Textbooks are becoming a thing of the past, for information and standards are changing faster than any publisher is willing to re-publish. Instead, a student of advancing business technologies must be able to adapt and learn from the 'here and now' while efficiently filtering out any antiquated information. These students must also be able to handle the myriad technologies currently in use and solve complex problems. This paper investigates innovations in experiential learning and their application to enterprise systems integration education.

Background: Like many developing countries, Guyana has a severe shortage of surgeons. Rather than rely on overseas training, Guyana developed its own Diploma in Surgery and asked for assistance from the Canadian Association of General Surgeons (CAGS). This paper reviews the initial results of Guyana's first postgraduate training program. Methods: We assisted with program prerequisites, including needs assessment, proposed curriculum, University of Guyana and Ministry of Health approval, external partnership and funding. We determined the outputs and outcomes of the program after 2 years, and we evaluated the impact of the program through a quantitative/ qualitative questionnaire administered to all program participants. Results: Five residents successfully completed the 2-year program and are working in regional hospitals. Another 9 residents are in the training program. Twenty-four modules or short courses have been facilitated, alternating Guyanese with visiting Canadian surgical faculty members coordinated through CAGS. A postgraduate structure, including an Institute for Health Sciences Education and Surgical Postgraduate Education Committee, has been developed at the Georgetown Public Hospital Corporation (GPHC). An examination structure similar to Canada's has been established. Hospital staff morale is greater, surgical care is more standardized and academic opportunities have been enhanced at GPHC. Four regional hospitals have welcomed the new graduates, and surgical services have already improved. Canadian surgeons have a greater understanding of and commitment to surgical development in low-income countries. Conclusion: Guyana has proven that, with visiting faculty assistance, it can mount its own postgraduate training suitable to national needs and will provide a career path to encourage its own doctors to remain and serve their country. Contexte : A l'instar d'un grand nombre de pays en developpement, la Guyana connait une grave penurie de chirurgiens. Plutot que de compter sur l'enseignement qui se donne dans d'autres pays, elle a etabli son propre diplome en chirurgie et sollicite l'aide de l'Association canadienne des chirurgiens generaux (ACCG). Le present rapport expose les resultats initiaux du premier programme de formation superieure de la Guyana. Methodes : L'aide que nous avons apportee visait les prealables du programme avec l'evaluation des besoins, le programme pedagogique propose, l'obtention du feu vert de l'Universite de la Guyana et du ministere de la Sante, ainsi que la collaboration et le financement exterieurs. Nous avons jauge les produits et les resultats du programme apres 2 ans et evalue son incidence par un questionnaire quantitatif et qualitatif auquel ont repondu tous les participants. Resultats : Cinq residents qui ont mene a bien le programme de 2 ans et travaillent dans des hopitaux regionaux; 9 autres suivent le programme de formation. On a presente 24 cours de courte duree ou modules <> avec des enseignants guyaniens en alternance avec des enseignants canadiens en chirurgie, le tout etant coordonne par l'ACCG. Une structure de formation superieure avec notamment un Institute for Health Sciences Education et un Surgical Postgraduate Education Committee ont vu le jour a la Georgetown Public Hospital Corporation (GPHC). Une structure d'examen semblable a celle qui existe au Canada a ete mise en place. Grace a la GPHC, le moral est meilleur chez les membres du personnel hospitalier; les soins chirurgicaux sont plus uniformes et les possibilites de formation, plus riches. Quatre hopitaux regionaux ont accueilli les nouveaux diplomes et les services chirurgicaux se sont deja ameliores. Les chirurgiens canadiens comprennent mieux et appuient davantage le developpement de la chirurgie dans les pays a faible revenu. Conclusion : La Guyana a prouve que, avec l'aide d'enseignants de l'exterieur, elle peut organiser sa propre formation superieure en fonction des besoins nationaux et tracer un parcours de carriere qui encouragera les medecins guyaniens a rester au service de leur pays., Guyana and its population of 739 000 (1) is nestled between Venezuela, Suriname and Brazil on the Caribbean coast of South America. Over the past 4 decades, political instability and [...]

Background: This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malformations (ARM) in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS) and the Association of Paediatric Surgeons of Nigeria (APSON). Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97). Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05) and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05). Experience with transanal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%). CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05). The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care. [ABSTRACT FROM AUTHOR]

One of the greatest challenges facing information technology (IT) managers is adapting to change. IT managers must cope with frequent changes in programming languages and technology platforms, all the while implementing new applications within their organizations (Straub & Watson, 2001). There are many indicators that this constant change is a challenge for IT professionals and managers. Benemati and Lederer (2001) documented a series of problems that IT professionals experience when attempting to cope with the rapid changes of the field, namely "realizing the potential of new IT while avoiding the associated risks." This study investigates one particular method for dealing with change and skill set maintenance among IT professionals: technology discussion groups. The study also investigates gender differences in the use of discussion groups. Two hundred and fourteen IT professionals were surveyed on what sort of IT-related activities they devote time to, how much problem-solving they attempt via technology discussion groups with respect to those activities, and their perceived community and organizational benefits to participating in such discussion groups. The study found significant gender differences in perceived value of technology discussion groups. [ABSTRACT FROM AUTHOR]

Background: Eyal and Hurst proposed that locally relevant medical education can offset the prevalence of physician "brain drain" in resource-poor regions of the world, and presented a framework of the ethical and pragmatic benefits and concerns posed by these initiatives. The present study explored the framework's utility through a case study of the University of Guyana Diploma in Surgery (UGDS) program., Methods: The framework's utility was evaluated using a case study design that included review and analysis of documents and semi-structured interviews with graduates, trainees, faculty members, and policy makers associated with the UGDS program. Data were analyzed from constructivist and interpretivist perspectives, and compared against the benefits and concerns described by Eyal and Hurst., Results: The framework is a useful template for capturing the breadth of experience of locally relevant training in the Guyanese setting. However, the results suggest that delineating the framework factors as either beneficial or concerning may constrict its applicability. The case study design also provided specific insights about the UGDS program, which indicate that the Program has promoted the retention of graduates and a sustainable culture of postgraduate medical education in Guyana., Conclusion: It is suggested that the framework be modified so as to represent the benefits and concerns of locally relevant training along a continuum of advantage. These approaches may help us understand retention within a resource-poor country, but also within particularly remote areas and public health care systems generally., Competing Interests: Conflicts of Interest: Co-author MR is the Director of the UGDS Program. Co-author BHC was formerly involved in the UGDS Program as a visiting CAGS surgeon. Neither MR nor BHC participated in the collection, analysis, or interpretation of data. The authors declare that they have no other competing interests.

Background: International medical electives (IMEs) are unique learning opportunities; however, trainees can risk patient safety. Returning medical students often express concern about doing procedures beyond their level of training. The Canadian Federation of Medical Students has developed guidelines for pre-departure training (PDT), which do not address procedural skills. The purpose of this research is to determine which procedural skills to include in future PDT., Methods: Twenty-six medical students who returned from IMEs completed surveys to assess PDT. Using a Likert scale, we compared procedures performed by students before departing on IME to those performed while abroad. We used a similar scale to assess which procedures students feel ought to be included in future PDT., Results: There was no significant increase in number of procedures performed while on IME. Skills deemed most important to include in future PDT were intravenous line insertion, suturing of lacerations, surgical assisting and post-operative wound care., Conclusions: Pre-departure training is new and lacks instruction in procedural skills. Over half the students rated several procedural skills such as IV line insertion, suturing, assisting in surgery, post operative wound management and foley catheterization as important assets for future PDT.

Background: Like many developing countries, Guyana has a severe shortage of surgeons. Rather than rely on overseas training, Guyana developed its own Diploma in Surgery and asked for assistance from the Canadian Association of General Surgeons (CAGS). This paper reviews the initial results of Guyana's first postgraduate training program., Methods: We assisted with program prerequisites, including needs assessment, proposed curriculum, University of Guyana and Ministry of Health approval, external partnership and funding. We determined the outputs and outcomes of the program after 2 years, and we evaluated the impact of the program through a quantitative/qualitative questionnaire administered to all program participants., Results: Five residents successfully completed the 2-year program and are working in regional hospitals. Another 9 residents are in the training program. Twenty-four modules or short courses have been facilitated, alternating Guyanese with visiting Canadian surgical faculty members coordinated through CAGS. A postgraduate structure, including an Institute for Health Sciences Education and Surgical Postgraduate Education Committee, has been developed at the Georgetown Public Hospital Corporation (GPHC). An examination structure similar to Canada's has been established. Hospital staff morale is greater, surgical care is more standardized and academic opportunities have been enhanced at GPHC. Four regional hospitals have welcomed the new graduates, and surgical services have already improved. Canadian surgeons have a greater understanding of and commitment to surgical development in low-income countries., Conclusion: Guyana has proven that, with visiting faculty assistance, it can mount its own postgraduate training suitable to national needs and will provide a career path to encourage its own doctors to remain and serve their country.