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Regional reanalyses provide a dynamically consistent recreation of past weather observations at scales useful for local-scale environmental applications. The development of convection-permitting models (CPMs) in numerical weather prediction has facilitated the creation of kilometre-scale (1–4 km) regional reanalysis and climate projections. The Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA) also aims to realize the benefits of these high-resolution models over Australian sub-regions for applications such as fire danger research by nesting them in BARRA's 12 km regional reanalysis (BARRA-R). Four midlatitude sub-regions are centred on Perth in Western Australia, Adelaide in South Australia, Sydney in New South Wales (NSW), and Tasmania. The resulting 29-year 1.5 km downscaled reanalyses (BARRA-C) are assessed for their added skill over BARRA-R and global reanalyses for near-surface parameters (temperature, wind, and precipitation) at observation locations and against independent 5 km gridded analyses. BARRA-C demonstrates better agreement with point observations for temperature and wind, particularly in topographically complex regions and coastal regions. BARRA-C also improves upon BARRA-R in terms of the intensity and timing of precipitation during the thunderstorm seasons in NSW and spatial patterns of sub-daily rain fields during storm events. BARRA-C reflects known issues of CPMs: overestimation of heavy rain rates and rain cells, as well as underestimation of light rain occurrence. As a hindcast-only system, BARRA-C largely inherits the domain-averaged bias pattern from BARRA-R but does produce different climatological extremes for temperature and precipitation. An added-value analysis of temperature and precipitation extremes shows that BARRA-C provides additional skill over BARRA-R when compared to gridded observations. The spatial patterns of BARRA-C warm temperature extremes and wet precipitation extremes are more highly correlated with observations. BARRA-C adds value in the representation of the spatial pattern of cold extremes over coastal regions but remains biased in terms of magnitude.

The high spatio-temporal variability of precipitation is often difficult to characterise due to limited measurements. The available low-resolution global reanalysis datasets inadequately represent the spatio-temporal variability of precipitation relevant to catchment hydrology. The Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA) provides a high-resolution atmospheric reanalysis dataset across the Australasian region. For hydrometeorological applications, however, it is essential to properly evaluate the sub-daily precipitation from this reanalysis. In this regard, this paper evaluates the sub-daily precipitation from BARRA for a period of 6 years (2010–2015) over Australia against point observations and blended radar products. We utilise a range of existing and bespoke metrics for evaluation at point and spatial scales. We examine bias in quantile estimates and spatial displacement of sub-daily rainfall at a point scale. At a spatial scale, we use the fractions skill score as a spatial evaluation metric. The results show that the performance of BARRA precipitation depends on spatial location, with poorer performance in tropical relative to temperate regions. A possible spatial displacement during large rainfall is also found at point locations. This displacement, evaluated by comparing the distribution of rainfall within a day, could be quantified by considering the neighbourhood grids. On spatial evaluation, hourly precipitation from BARRA is found to be skilful at a spatial scale of less than 100 km (150 km) for a threshold of 75th percentile (90th percentile) at most of the locations. The performance across all the metrics improves significantly at time resolutions higher than 3 h. Our evaluations illustrate that the BARRA precipitation, despite discernible spatial displacements, serves as a useful dataset for Australia, especially at sub-daily resolutions. Users of BARRA are recommended to properly account for possible spatio-temporal displacement errors, especially for applications where the spatial and temporal characteristics of rainfall are deemed very important.

An accurate representation of spatio-temporal characteristics of precipitation fields is fundamental for many hydro-meteorological analyses but is often limited by the paucity of gauges. Reanalysis models provide systematic methods of representing atmospheric processes to produce datasets of spatio-temporal precipitation estimates. The precipitation from the reanalysis datasets should, however, be evaluated thoroughly before use because it is inferred from physical parameterization. In this paper, we evaluated the precipitation dataset from the Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA) and compared it against (a) gauged point observations, (b) an interpolated gridded dataset based on gauged point observations (AWAP – Australian Water Availability Project), and (c) a global reanalysis dataset (ERA-Interim). We utilized a range of evaluation metrics such as continuous metrics (correlation, bias, variability, and modified Kling–Gupta efficiency), categorical metrics, and other statistics (wet-day frequency, transition probabilities, and quantiles) to ascertain the quality of the dataset. BARRA, in comparison with ERA-Interim, shows a better representation of rainfall of larger magnitude at both the point and grid scale of 5 km. BARRA also more closely reproduces the distribution of wet days and transition probabilities. The performance of BARRA varies spatially, with better performance in the temperate zone than in the arid and tropical zones. A point-to-grid evaluation based on correlation, bias, and modified Kling–Gupta efficiency (KGE′) indicates that ERA-Interim performs on par or better than BARRA. However, on a spatial scale, BARRA outperforms ERA-Interim in terms of the KGE′ score and the components of the KGE′ score. Our evaluation illustrates that BARRA, with richer spatial variations in climatology of daily precipitation, provides an improved representation of precipitation compared with the coarser ERA-Interim. It is a useful complement to existing precipitation datasets for Australia, especially in sparsely gauged regions.

The Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA) is the first atmospheric regional reanalysis over a large region covering Australia, New Zealand, and Southeast Asia. The production of the reanalysis with approximately 12 km horizontal resolution – BARRA-R – is well underway with completion expected in 2019. This paper describes the numerical weather forecast model, the data assimilation methods, the forcing and observational data used to produce BARRA-R, and analyses results from the 2003–2016 reanalysis. BARRA-R provides a realistic depiction of the meteorology at and near the surface over land as diagnosed by temperature, wind speed, surface pressure, and precipitation. Comparing against the global reanalyses ERA-Interim and MERRA-2, BARRA-R scores lower root mean square errors when evaluated against (point-scale) 2 m temperature, 10 m wind speed, and surface pressure observations. It also shows reduced biases in daily 2 m temperature maximum and minimum at 5 km resolution and a higher frequency of very heavy precipitation days at 5 and 25 km resolution when compared to gridded satellite and gauge analyses. Some issues with BARRA-R are also identified: biases in 10 m wind, lower precipitation than observed over the tropical oceans, and higher precipitation over regions with higher elevations in south Asia and New Zealand. Some of these issues could be improved through dynamical downscaling of BARRA-R fields using convective-scale ( km) models.

Optimisation methods were successfully used to calibrate parameters in an atmospheric component of a climate model using two variants of the Gauss–Newton line-search algorithm: (1) a standard Gauss–Newton algorithm in which, in each iteration, all parameters were perturbed and (2) a randomised block-coordinate variant in which, in each iteration, a random sub-set of parameters was perturbed. The cost function to be minimised used multiple large-scale multi-annual average observations and was constrained to produce net radiative fluxes close to those observed. These algorithms were used to calibrate the HadAM3 (third Hadley Centre Atmospheric Model) model at N48 resolution and the HadAM3P model at N96 resolution.For the HadAM3 model, cases with 7 and 14 parameters were tried. All ten 7-parameter cases using HadAM3 converged to cost function values similar to that of the standard configuration. For the 14-parameter cases several failed to converge, with the random variant in which 6 parameters were perturbed being most successful. Multiple sets of parameter values were found that produced multiple models very similar to the standard configuration. HadAM3 cases that converged were coupled to an ocean model and run for 20 years starting from a pre-industrial HadCM3 (3rd Hadley Centre Coupled model) state resulting in several models whose global-average temperatures were consistent with pre-industrial estimates. For the 7-parameter cases the Gauss–Newton algorithm converged in about 70 evaluations. For the 14-parameter algorithm, with 6 parameters being randomly perturbed, about 80 evaluations were needed for convergence. However, when 8 parameters were randomly perturbed, algorithm performance was poor. Our results suggest the computational cost for the Gauss–Newton algorithm scales between P and P2, where P is the number of parameters being calibrated.For the HadAM3P model three algorithms were tested. Algorithms in which seven parameters were perturbed and three out of seven parameters randomly perturbed produced final configurations comparable to the standard hand-tuned configuration. An algorithm in which 6 out of 13 parameters were randomly perturbed failed to converge.These results suggest that automatic parameter calibration using atmospheric models is feasible and that the resulting coupled models are stable. Thus, automatic calibration could replace human-driven trial and error. However, convergence and costs are likely sensitive to details of the algorithm.

Background: The fibularis longus (FL) muscle is larger in volume than fibularis brevis (FB) and is therefore claimed to be the stronger evertor of the two. Clinical observation of FL and FB tendon rupture show that injury to the FB has a serious negative effect on hindfoot eversion. This implies that the FB is the stronger and more important evertor. The strength of a muscle is not purely based on its volume, and the observed discrepancy between the FB and FL may be due to differences in muscle architecture. This study compares the muscle architecture of FL with FB., Methods: Sixteen legs from eight formaldehyde-fixed human specimens, mean age 83 (range 72-89) years, were dissected. The volume, fibre lengths and fibre pennation angles for both muscles were measured and the physiological cross-sectional area (PCSA) was calculated., Results: The FL was always larger than the FB, with an individual difference in volume that varied from 1.4 to 4.6 times larger with a mean difference of 17 ml (95% CI 14-20; p < 0.001). Mean fibre lengths were 9 mm (95% CI 2-16; p = 0.015) longer in FL than in FB. The mean pennation angle was 9.6 degrees in FL and 8.8 degrees in FB, this difference was not significant (p = 0.32). The mean PCSA for FL was 3 cm 2 (95% CI 2-4) larger than for FB (p < 0.001)., Conclusions: With our sample set, the hypothesis that the muscle architecture can explain the clinical discrepancy between the FL and FB, was not supported. The difference in hindfoot eversion might instead depend on the different moment arms of FL and FB and the effect forefoot abduction has on hindfoot eversion., (© 2024. The Author(s).)

Background: Contention exists amongst anatomists, clinicians and surgeons about how much anatomical knowledge medical students need, although what is taught should be aligned with current surgical practice. The aim of this study was to explore the scope of recent advances in applied anatomy as highlighted in the ANZ Journal of Surgery in each of the surgical specialties., Methods: The 2018 volume of the ANZ Journal of Surgery was narrowed to 254 articles by applying the search term 'anatomy'. The main topic was extracted from each paper. The content of the paper was assessed for 'novel description' or 'novel application' of anatomical knowledge and classified accordingly., Results: Most papers with an anatomical focus were from general surgery, which focused on surgical techniques, outcomes and management. Vascular surgery had the highest percentage of papers with a novel description and application of anatomy. Although cardiothoracic and paediatric surgery had no papers with a novel description of anatomy, novel applications of anatomy were a focus in each speciality., Conclusion: The trend towards novel applications of anatomical knowledge in all surgical specialties should encourage medical schools to shape their anatomy curricula in tandem with such advances as they evolve. The high proportion of novel applications and descriptions of anatomy in general surgery indicates continued growth as a benchmark of anatomical understanding. Vascular surgery's proportion of novel application and description of anatomy may change the way students will learn vascular anatomy to incorporate endovascular, radiologically based approaches., (© 2021 Royal Australasian College of Surgeons.)

Objective: To evaluate outcomes of congenital solitary functioning kidney (SFK) in early childhood., Study Design: A retrospective study of 32 children diagnosed in utero with SFK owing to unilateral renal agenesis or multicystic dysplastic kidney and followed for 1 to 11.5 years., Results: SFK length was in the compensatory hypertrophy range in 45% of fetal sonographic evaluations from mid-pregnancy, and in 85% on postnatal follow-up. Glomerular filtration rate was below normal range in 44.4%, 12.5% and 0% at <1 year, age 1 to 3 years and thereafter, respectively. Hyperfiltration was detected in 18.5% and 82.6% at <1 year and >3 years, respectively. Hypertension was documented in 35% at age 1 to 3 years but in none at an older age. Proteinuria was absent in all children., Conclusion: Congenital SFK is apparently associated with little or no renal damage in infancy or childhood. Compensatory enlargement of the functioning kidney begins in utero and might serve as a prognostic indicator for normal renal function after birth.

Embryo implantation requires a reciprocal interaction between the blastocyst and endometrium and is associated with complex regulatory mechanisms. Since their discovery, microRNAs have become prominent regulatory candidates, providing missing links for many biological pathways. In recent years, microRNAs have been implicated as one of the important players in the regulation of multiple physiological functions of the endometrium. This review aims to present recent knowledge pertaining to the diverse aspects of microRNAs in the embryo-endometrial cross talk. We will focus on the role of microRNAs in decidualization. Next, we will review recent studies investigating the role of microRNAs in recurrent pregnancy loss. Finally, we will discuss the role of microRNAs in the tissue invasion of implantation and compare that with tissue invasion in cancers., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Lengthening of the conjoined tendon of the gastrocnemius aponeurosis and soleus fascia is frequently used in the treatment of equinus deformities in children and adults. The Vulpius procedure as described in most orthopaedic texts is a division of the conjoined tendon in the shape of an inverted V. However, transverse division was also described by Vulpius and Stoffel, and has been reported in some clinical studies. We studied the anatomy and biomechanics of transverse division of the conjoined tendon in 12 human cadavers (24 legs). Transverse division of the conjoined tendon resulted in predictable, controlled lengthening of the gastrocsoleus muscle-tendon unit. The lengthening achieved was dependent both on the level of the cut in the conjoined tendon and division of the midline raphé. Division at a proximal level resulted in a mean lengthening of 15.2 mm (sd 2.0, (12 to 19), which increased to 17.1 mm (sd 1.8, (14 to 20) after division of the midline raphé. Division at a distal level resulted in a mean lengthening of 21.0 mm (sd 2.0, (18 to 25), which increased to 26.4 mm (sd 1.4, (24 to 29) after division of the raphé. These differences were significant (p < 0.001)., (©2014 The British Editorial Society of Bone & Joint Surgery.)

Background: Lengthening of the gastrocnemius-soleus complex is frequently performed for equinus deformity. Many techniques have been described, but there is uncertainty regarding the precise details of some surgical procedures., Methods: The surgical anatomy of the gastrocnemius-soleus complex was investigated, and standardized approaches were developed for the procedures described by Baumann, Strayer, Vulpius, Baker, Hoke, and White. The biomechanical characteristics of these six procedures were then compared in three randomized trials involving formaldehyde-preserved human cadaveric lower limbs. After one of the lengthening procedures was performed, a measured dorsiflexion force was applied across the metatarsal heads with use of a torque dynamometer. Lengthening of the gastrocnemius-soleus complex was measured directly, by measuring the gap between the ends of the fascia or tendon., Results: The gastrocnemius-soleus musculotendinous unit was subdivided into three zones. In Zone 1, it was possible to lengthen the gastrocnemius-soleus complex in either a selective or a differential manner-i.e., to lengthen the gastrocnemius alone or to lengthen the gastrocnemius and soleus by different amounts. The procedures performed in this zone (Baumann and Strayer procedures) were very stable but were limited with regard to the amount of lengthening achieved. Zone-2 lengthenings of the conjoined gastrocnemius aponeurosis and soleus fascia (Vulpius and Baker procedures) were not selective but were stable and resulted in significantly greater lengthening than Zone-1 procedures (p < 0.001). In Zone 3 (Hoke and White procedures), lengthenings of the Achilles tendon were neither selective nor stable but resulted in significantly greater lengthening than Zone-1 or 2 procedures (p < 0.001)., Conclusions: Surgical procedures for the correction of equinus deformity by lengthening of the gastrocnemius-soleus complex vary in terms of selectivity, stability, and range of correction. Procedures for the correction of equinus deformity have different anatomical and biomechanical characteristics. Clinical trials are needed to determine whether these differences are of clinical importance. It may be appropriate for surgeons to select a procedure involving the zone best suited to the clinical needs of a specific patient.

Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. The parietal pleura has a more significant role in pleural fluid homeostasis. Its vessels are closer to the pleural space compared with its visceral counterpart; it contains lymphatic stomata, absent on visceral pleura, which are responsible for a bulk clearance of fluid. The diagnosis and successful treatment of pleural effusions requires a mixture of imaging techniques and pleural fluid analysis., (Copyright © 2013. Published by Elsevier Inc.)

Background: Medial hamstring lengthening is frequently used to correct contractures in neuromuscular conditions such as cerebral palsy. Surgical techniques vary considerably and little is known about the lengthening characteristics of muscle-tendon-units after surgical intervention., Methods: A randomized trial was performed on paired cadaver medial hamstring muscle-tendon-units comparing 'High' (proximal) versus 'Low' (distal) lengthening procedures. The paired muscle-tendon-units were subjected to tensile testing utilizing an Instron® (Instron Corporation, Canton, MA, USA) machine under controlled conditions. Prior to tensile testing, the paired semitendinosus and paired gracilis received either high or low intramuscular tenotomy. Load (N) versus displacement (mm) was recorded continuously for each test. The difference in lengthening and load at failure for intact and surgical simulation muscle-tendon-units was recorded and compared with paired t-tests., Results: Both low and high lengthenings increased the amount of lengthening achieved compared with intact controls and the lengthening was achieved at lower applied load. Low intramuscular tenotomy of the semitendinosus resulted in a 30% greater lengthening when compared with high intramuscular tenotomy. For the gracilis muscle, the low intramuscular tenotomy achieved 39% greater lengthening than the high intramuscular tenotomy and these differences were significant., Conclusion: Biomechanical testing of formalin-preserved human cadaveric medial hamstring muscle-tendon-units confirms that it is possible to achieve lengthening in continuity following an intramuscular tenotomy or fascial striping procedure. The site of the surgical procedure (high versus low) results in a different effect on the lengthening characteristics, dictated by the anatomy of the particular muscle-tendon-unit., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

Introduction: Trial of vaginal birth after caesarean is considered acceptable after one caesarean section. However, trial of vaginal birth after more than one caesarean section is still unaccepted by most clinicians. Birth rates in Israel are within the highest in the western world and many women are interested in a trial of labor after two previous caesarean sections. Therefore, it is crucial to establish evidence based guidelines for this issue., Objective: To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections and to present our experience in trial of labor after two caesarean sections., Methods: We searched MEDLINE, using search terms "Caesarean section", "caesarian", "C*rean", "C*rian", "Vaginal birth after caesarean section", "Trial of labor"., Results: The literature revealed a success rate of 60-80%. The main complication is rupture of the uterus and its rate is 0-3%. During the years 2006-2009, 67 trials of labor after two caesarean sections were performed in our medical center. Our success rate is 88%. There were no cases of rupture of the uterus., Conclusion: A trial of labor after two caesarean sections is possible for carefully selected women and when appropriate medical resources are available.

Background: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle-tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics., Methods: We performed a randomized trial on paired cadaver tibialis posterior muscle-tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron(®) machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests., Results: We found 48% greater lengthening for low IMT compared to high IMT for a given load (P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome., Conclusions: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical "dose" by altering the position of the intramuscular tenotomy within the muscle-tendon-unit.

Flexor carpi ulnaris (FCU) is an ever-present muscle of the anterior flexor compartment of the forearm. Variations of FCU are uncommon, with additional slips or heads of muscles described, and only one reported case of an accessory muscle. We describe a unique clinical case report in which an accessory FCU was identified and describe the findings of 5,000 cadaveric dissections of the forearm, performed as part of an ongoing institutional study of anatomical variations. An aberrant accessory forearm flexor muscle was identified incidentally at the wrist during surgery for an anterior interosseous to ulnar nerve transfer for management of ulnar nerve palsy. This muscle was seen running superficial to the ulnar nerve and radial to the FCU proper, arising from the common flexor origin and inserting at the triquetral carpal bone. This was therefore suitably acknowledged as an "accessory FCU". The anomaly was identified as bilateral using ultrasound imaging, and was found to be anomalously innervated by the median nerve with nerve conduction studies. A subsequent review of 5,000 cadaveric dissections of the forearm did not identify any such variations related to FCU, despite identifying a range of variations of the other forearm flexor musculature. While the scarcity of this anomaly is thus highlighted, consideration of an accessory FCU, and its aberrant innervation is important in a range of surgical approaches., (2010 Wiley-Liss, Inc.)

Purpose: The purpose of this narrative review is to describe an anatomical approach for residents-in-training and anesthesiologists who are learning techniques of ultrasound-guided regional anesthesia of the neck and upper limb., Sources: Relevant articles relating anatomy and anatomical variation to the emerging practice of ultrasound-guided regional anesthesia for the neck and upper limb were sourced via both Medline and PubMed databases. Also, our approach to teaching ultrasound technique has developed from using anatomical resources and cadaveric workshops. This approach emphasizes precise image acquisition, a detailed knowledge of anatomy and anatomical variations, and, importantly, visual interpretation of sonographic landmarks based on pattern recognition when interpreting sonograms., Principal Findings: Typical sonographic patterns orient the examiner to nerve position, which is necessary for executing successful regional anesthesia of the neck and upper limb. Only by understanding the typical anatomical arrangement can the examiner then visually interpret any individual anatomical variation that may occur., Conclusion: Simple sonographic anatomical patterns can provide a strategy to correctly locate nerves when performing ultrasound-guided cervical and brachial plexus anesthesia.

This Guide, a combined work by three authors from different countries, provides perspectives into the history of teaching gross anatomy, briefly, from the earliest of times, through to a detailed examination of curricula in both traditional didactic approaches and Problem-Based Learning (PBL) curricula. The delivery of a module within a curriculum in tertiary education is interplay between the content (knowledge and skills) of a subject, the teaching staff involved, the students and their approaches to learning, and the philosophy underpinning the delivery of the learning material. The work is divided into sections that deal with approaches to learning anatomy from the perspective of students, to delivery of the content of the curriculum by lecturers, including the assessment of knowledge, and itemises the topics that could be considered important for an appropriate anatomy module in an integrated course, delivered in a way that emphasises clinical application. The work concludes by looking to the future, and considering what measures may need to be addressed to ensure the continued development of anatomy as a clinically relevant subject in any medical curriculum.

Introduction: Factual presentations of sexual anatomy are required for educational purposes, for clinical and more general communication about sexual matters. To date, unambiguous, accurate and objective images with appropriate labeling to enhance specificity in communication have been lacking., Aim: The aim of this presentation is to provide a comprehensive overview of anatomy of the distal vagina. We aim to simplify the anatomy to reduce the confusion of historical descriptions. In doing so, we aim to avoid sacrificing any of the specific detail. This would aid communication between clinicians, researchers, and the nonclinician regarding this anatomy. OUTCOME MEASURES AND METHODS: This article reviews the historical and current anatomical literature. Systematic dissection and photography, histological study, and magnetic resonance imaging have been used as the basis for this presentation. Digital technology has been used to label, color, and highlight photography to provide clarity and permit diagramatization of photography. No distortion has otherwise been used in presenting images from cadavers or anatomical research., Results: The anatomy of the distal vagina and surrounding structures is shown and described in detailed. The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit though the responses are not uniform., Conclusions: Significant progress has been made in the field of female sexual anatomy and its pictorial representation. This may facilitate further progress in the related fields of female sexual health and education.

Background: The introduction of a problem-based learning (PBL) curriculum at the School of Medicine of the University of Melbourne has necessitated a reduction in the number of lectures and limited the use of dissection in teaching anatomy. In the new curriculum, students learn the anatomy of different body systems using PBL tutorials, practical classes, pre-dissected specimens, computer-aided learning multimedia and a few dissection classes. The aims of this study are: (1) to assess the views of first- and second-year medical students on the importance of dissection in learning about the anatomy, (2) to assess if students' views have been affected by demographic variables such as gender, academic background and being a local or an international student, and (3) to assess which educational tools helped them most in learning the anatomy and whether dissection sessions have helped them in better understanding anatomy., Methods: First- and second-year students enrolled in the medical course participated in this study. Students were asked to fill out a 5-point Likert scale questionnaire. Data was analysed using Mann-Whitney's U test, Wilcoxon's signed-ranks or the calculation of the Chi-square value., Results: The response rates were 89% for both first- and second-year students. Compared to second-year students, first-year students perceived dissection to be important for deep understanding of anatomy (P < 0.001), making learning interesting (P < 0.001) and introducing them to emergency procedures (P < 0.001). Further, they preferred dissection over any other approach (P < 0.001). First-year students ranked dissection (44%), textbooks (23%), computer-aided learning (CAL), multimedia (10%), self-directed learning (6%) and lectures (5%) as the most valuable resources for learning anatomy, whereas second-year students found textbooks (38%), dissection (18%), pre-dissected specimens (11%), self-directed learning (9%), lectures (7%) and CAL programs (7%) as most useful. Neither of the groups showed a significant preference for pre-dissected specimens, CAL multimedia or lectures over dissection., Conclusions: Both first- and second-year students, regardless of their gender, academic background, or citizenship felt that the time devoted to dissection classes were not adequate. Students agreed that dissection deepened their understanding of anatomical structures, provided them with a three-dimensional perspective of structures and helped them recall what they learnt. Although their perception about the importance of dissection changed as they progressed in the course, good anatomy textbooks were perceived as an excellent resource for learning anatomy. Interestingly, innovations used in teaching anatomy, such as interactive multimedia resources, have not replaced students' perceptions about the importance of dissection.

The biphalangeal little toe is an anatomical anomaly that has been previously well described in the early anatomical literature. But, as is the case with many anomalies, there is a lack of awareness of it amongst current clinicians. We report the case of a fracture through the distal phalanx of the little toe, with a delay in the diagnosis due to confusion over the X-ray findings. X-rays revealed a biphalangeal toe with a fracture through the distal phalanx, which mimicked the usual triphalangeal toe. This is the first reported case of clinical confusion over this anatomical variation. A review of 102 human skeletal feet at the Department of Anatomy, University of Melbourne, was performed to evaluate the frequency of the biphalangeal little toe variant, revealing an incidence of 26%.

A venographic cryptic stenosis at the junction of middle and lateral third of the transverse sinus has been observed in patients suffering from idiopathic intracranial hypertension. After reviewing the anatomical and embryological literature of the transverse sinus, 20 transverse sinuses were explored (in a pilot study of 10 human cadavers) in order to determine the anatomical basis of this stenosis. The presence of septa of varying sizes was observed. We conclude that the presence of a large septum is one of the causes of venographic cryptic stenosis observed in these patients and might be one of the aetiological factors involved in idiopathic intracranial hypertension.

The traditional pulse generator implantation site lies subcutaneous on the fascia of the pectoralis major muscle. This article describes a subpectoral pocket approach, which on anatomic investigation is actually "intrapectoral" and offers a much improved cosmetic result with the potential advantage of less erosion. In the authors' experience with over 1000 initial pacemaker implants and pulse generator replacements, the potential concerns of neurovascular and muscular damage have not been realized. There has been no pulse generator damage from the ribs, serious loculated hematomas, or unusual postoperative or chronic pain. From experience with pulse generator recalls, the replacement procedure has not been significantly more difficult than with the subcutaneous approach. The intrapectoral approach has now become the authors' routine in patients without significant adipose tissue overlying the pectoralis major muscle.

Background: This study documents the anatomy of the pudendal nerve, which has a major role in maintaining faecal continence. Unexpected faecal incontinence can develop following perineal surgery even when the anal sphincters are not damaged. In addition, injury to the pudendal nerve might be encountered during pelvic procedures such as a sacrospinous colpopexy., Methods: An anatomical study on 28 cadavers was conducted to examine the course of the pudendal nerve and its branches in the perineum., Results: In five of the 28 cadavers dissected (four male, one female), a nerve plexus was found within the ischiorectal fossa in close proximity to the anal sphincters. The plexus received contributions from interconnecting branches of the inferior rectal and perineal nerves to innervate the external anal sphincter. In 11 of the 28 cadavers (five female, six male) an additional nerve arose from the medial aspect of the pudendal nerve at the level of the sacrotuberous and sacrospinous ligaments. This nerve continued distally and gave several branches to the perineum and the levator ani muscle., Conclusion: A sound knowledge of the anatomical variations of the pudendal nerve and its branches is essential for all surgeons operating in the perineal region.

Unlabelled: The lateral recovery position is widely used for the positioning of unconscious patients. Ideally, in the setting of trauma it is avoided because of concerns about spinal cord injury. However, unconscious individuals with unsuspected trauma or trauma victims attended by partially trained first-aiders may be placed in the recovery position, potentially endangering the cord. Excessive movement of the spine in the recovery position may increase the risk of spinal cord injury in these situations. A new recovery position, termed the modified HAINES position, is described and the position of the spine in this position is compared with the lateral recovery position., Hypothesis: That the modified HAINES position results in less distortion of the position of the spine than the lateral recovery position., Methods: Thirty-eight healthy volunteers were imaged in the two different positions. Measurements of rotation, flexion and lateral flexion of the cervical and thoraco-lumbar spine were made. Two tailed paired t-tests were employed to compare measurements of the two positions and a McNemar test was used to compare the subjects' subjective experiences., Results: The modified HAINES position resulted in 13.0 degrees (99% CI: 7.5-18.5) less lateral flexion and 12.6 degrees (99% CI: 9.4-15.9) less extension of the cervical spine while the position of the thoraco-lumbar spine was similar in both positions. Nineteen of 28 subjects found the modified HAINES position more comfortable (not significant)., Conclusion: The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients when trauma may have occurred. Further research is required to ensure that the recovery positions in use today are the best possible.

Objectives: One of the risks associated with harvesting the radial artery is hand ischemia. Accordingly, this study investigated the variations of the hand collateral circulation., Methods: Fifty hands of cadavers were examined. Variations of the palmar arches were recorded. A classic superficial palmar arch was defined as direct continuity between the ulnar artery and the superficial palmar branch of the radial artery. A classic complete deep palmar arch was defined as direct continuity between the radial artery and the deep branch of the ulnar artery., Results: A classic superficial palmar arch was found in 10% (5/50) of hands, and a classic complete deep palmar arch was found in 90% (45/50) of hands. The superficial palmar branch of the ulnar artery supplied blood to all fingers in 66% (33/50) of hands. Although the superficial palmar branch of the ulnar artery was continuous with the radial artery in only 34% (17/50) of hands (including the classic type of superficial palmar arch), every hand had at least one major branch connecting the radial and ulnar arteries., Conclusions: Variations in the terminations of the radial and ulnar arteries are common. Although the classic type of superficial palmar arch occurs relatively infrequently, there is always a significant anastomosis between the radial and the ulnar artery in the hand. This anatomic study confirms the presence of a collateral supply in the hand. In the absence of vascular disease, harvesting the radial artery should be regarded as a safe procedure.

Background: The injection of depot corticosteroid preparations into soft tissues and joints has been used for some time to alleviate pain in a variety of musculoskeletal conditions. However the evidence, supporting the efficacy for these procedures, until recently, has been poor., Objectives: To review the recent literature on the efficacy and toxicity of commonly used corticosteroid injections in musculoskeletal medicine and to illustrate the key anatomy of the injection sites., Discussion: Injections of corticosteroid into the lateral epicondyle, subacromial bursa, carpal tunnel, knee and plantar fascia all result in short term (weeks to months) alleviation of pain and other symptoms in the studies reviewed. The natural history of these conditions, however, is that the majority of patients improve over longer periods (months to a year) whether or not an injection has been given.

Background: The ulnar artery has been used as a coronary bypass graft in 8 patients when it was deemed unsafe to harvest the radial artery after evaluation of the arterial circulation in the forearm and hand., Methods: The ulnar artery was removed from the lower three quarters of the forearm, along with its satellite veins. Dissection was commenced distally near the wrist and extended proximally to where the ulnar artery passed between the two heads of origin of the flexor digitorum superficialis. The artery was divided distally above the wrist joint and proximally at a point immediately below the origin of the common interosseus artery., Results: Ten ulnar arteries were removed for use as coronary artery bypass grafts; two were rejected, one because of severe calcification and the other because of atherosclerotic occlusion. The remaining eight ulnar arteries were grafted successfully to coronary arteries other than the left anterior descending. No early hand or cardiac complications were observed., Conclusions: The ulnar artery is an alternative coronary artery bypass graft that may be used when the radial artery is dominant and cannot be removed without risk. The ulnar artery is in close proximity to the ulnar nerve and harvesting has the potential to injure the nerve. Therefore, until the use of the ulnar artery has been more fully evaluated it should be used only when other options have been exhausted.

Introduction: Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the "lateral recovery position," coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance., Hypothesis: It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the "HAINES modified recovery position." HAINES is an acronym for High Arm IN Endangered Spine., Methods: Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position., Results: For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each)., Conclusion: An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.

In recent years, the curriculae of some Australian medical schools have been extensively revised. However, being revisions, as distinct from reconstructions, new subjects were only added if they were thought of at the time; for example, electives. Still more recently, there have been cries for undergraduate medical education to involve itself more with the common problems typically facing the family physician. This has paralleled the wave of verbal opinion by medical students, doctors, and allied health professionals, that the field of "Human sexuality" should be included in the medical curriculum as an integrated but distinct entity. The survey presented in this article was carried out to document this opinion on paper, and to obtain information which may be relevant in proposals for establishing such a formal teaching programme.