Age-related changes in inguinal region anatomy from 0 to 19 years of age.

Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019. © 2019 Wiley Periodicals, Inc.

Understanding the current anatomical competence landscape: Comparing perceptions of program directors, residents, and fourth-year medical students.

A mixed methods survey of fourth-year medical students, resident physicians, and residency program directors at the Indiana University School of Medicine gathered perceptions of anatomical competence-defined as the anatomical education necessary for effective clinical practice. The survey items explored numerous aspects of anatomical competence, including the most effective modes of instruction, perceptions of readiness for clinical practice, and specific suggestions for improving anatomical education during medical school and residency. The response rate was 46% for fourth-year medical students, 47% for residents (as graduates from 137 medical schools), and 71% for program directors. A majority of students and residents reported that their course in Gross Anatomy prepared them well for clinical practice; that cadaveric dissection was important in the early development of their anatomical competence; and that placing a greater emphasis on clinical relevance in medical school would have improved their anatomical competence even further. However, in terms of anatomical preparedness upon entering residency, the program directors rated their residents less prepared than the residents rated themselves. All three groups agreed that there is need for additional opportunities for anatomical educational during medical school and residency. Suggestions for improving anatomical education included the following: providing more opportunities for cadaveric dissection during medical school and residency; more consistent teaching of anatomy for clinical practice; more workshops that review anatomy; and better integration of anatomy with the teaching of other subjects during medical school. Anat Sci Educ 9: 307-318. © 2015 American Association of Anatomists.

After the waters receded: a qualitative study of university officials' disaster experiences during the Great Iowa Flood of 2008.

When the Great Flood of 2008 hit towns across Eastern Iowa, officials from the University of Iowa shut its operations for a week, relocated and evacuated students and community residents, and suffered damage to over a dozen buildings. This study is a qualitative assessment of the experiences and perceptions of twelve university officials involved in the response and management of the disaster. Major themes are presented according to phases of the Disaster Management Cycle. During the preparedness phase, an established all-hazards plan as well as specific annexes for flooding and pandemic influenza proved to enhance community response to the flood. However, training university clientele across a large organization to execute these plans and respond to future disasters is not an easy task. The content and effective means for delivering these trainings are areas for further research. During the response phase of the flood, officials swiftly expedited a business continuity plan to assure that personnel were paid during the university closure. However, enforcing a policy to avoid coming to work during the closure was challenging. Thus, future work must be done to determine and implement effective disaster communications that relay clear messages about roles and responsibilities. Now, in recovery, the university must rebuild its infrastructure and consider potential mental health issues. Lessons learned from the Great Flood of 2008 provide the opportunity to self-assess and prepare universities for disasters in the future.