BACKGROUND AND OBJECTIVES: In low- and middle-income countries (LMICs), approximately 5 million essential neurosurgical operations per year remain unaddressed. When compared with high-income countries, one of the reasons for this disparity is the lack of microsurgery training laboratories and neurosurgeons trained in microsurgical techniques. In 2020, we founded the Madison Microneurosurgery Initiative to provide no-cost, accessible, and sustainable microsurgery training opportunities to health care professionals from LMICs in their respective countries. METHODS: We initially focused on enhancing our expertise in microsurgery laboratory training requirements. Subsequently, we procured a wide range of stereo microscopes, light sources, and surgical instrument sets, aiming to develop affordable, high-quality, and long-lasting microsurgery training kits. We then donated those kits to neurosurgeons across LMICs. After successfully delivering the kits to designated locations in LMICs, we have planned to initiate microsurgery laboratory training in these centers by providing a combination of live-streamed, offline, and in-person training assistance in their institutions. RESULTS: We established basic microsurgery laboratory training centers in 28 institutions across 18 LMICs. This was made possible through donations of 57 microsurgery training kits, including 57 stereo microscopes, 2 surgical microscopes, and several advanced surgical instrument sets. Thereafter, we organized 10 live-streamed microanastomosis training sessions in 4 countries: Lebanon, Paraguay, Türkiye, and Bangladesh. Along with distributing the recordings from our live-streamed training sessions with these centers, we also granted them access to our microsurgery training resource library. We thus equipped these institutions with the necessary resources to enable continued learning and hands-on training. Moreover, we organized 7 in-person no-cost hands-on microanastomosis courses in different institutions across Türkiye, Georgia, Azerbaijan, and Paraguay. A total of 113 surgical specialists successfully completed these courses. CONCLUSION: Our novel approach of providing microsurgery training kits in combination with live-streamed, offline, and in-person training assistance enables sustainable microsurgery laboratory training in LMICs.

A Novel Approach for Free, Affordable, and Sustainable Microsurgery Laboratory Training for Low- and Middle-Income Countries: University of Wisconsin-Madison Microneurosurgery Laboratory Experience.

Establishing Microsurgery Skills Laboratories in Low- and Middle-income Countries with Integrated Remote Teaching

Network Dynamics in Later Life

Objective: The authors asked whether social support and depression are independently associated with functional disability and examined the potential role of social support as a moderator in the depression-junctional disability association. Methods: Subjects were 305 patients age 60 years and over Predictor variables were social support, depressive symptoms, and depression diagnosis. Dependent variables were the Instrumental Activities of Daily Living Scale, the Physical Self-Maintenance Scale, and the Physical Functioning subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey Authors used multiple-regression analyses. Results: Depressive symptoms and all dimensions of social support were independently associated with junctional disability the specifics of these relationships varied among types of social support and functional disability Depression diagnosis was not independently associated with any functional disability measure. Social support (more instrumental help, more perceived satisfaction) moderated some depression diagnosis-functional disability associations, and one depressive symptom-functional disability association. Conclusions: The study hypotheses were partially confirmed. Different dimensions of social support have important and varied roles in the depression-functional disability dynamic. Future research is needed to further specify the complex relationships among depression, social support, and functional disability.

Social Support, Depression, and Functional Disability in Older Adult Primary-Care Patients.

Although the concept of everyday competence has theoretical roots in different traditions in psychology and gerontology, in its broadest sense it refers to individuals’ capacity to interact effectively with their environment (Bandura, 1997; White, 1959). This definition emphasizes that competence is shown in persons’ transactions with their physical-spatial and social-interpersonal surroundings and that an examination of competent behavior needs to focus on at least two major factors. The first factor is the person with his or her skills, abilities, beliefs, developmental history, and other personal resources. The second factor is the environment, which can facilitate or impede the application of the person’s skills, abilities, and resources. Thus, competent behavior in everyday life always reflects the confluence, or interaction, of personal and environmental factors and focuses on individuals’ abilities to adapt to the challenges of different environmental conditions (Diehl, 1998; Lawton, 1989a; Lewin, 1935; Willis, 1991, 2000). This chapter has several objectives:

Everyday Competence and Everyday Problem Solving in Aging Adults: The Role of Physical and Social Context

Great Hospitals: The History of Neurosurgery at the University of Vermont Medical Center, A Macroscopic Examination of Microscope-Savvy Pioneers.

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Great Hospitals: The History of Neurosurgery at the University of Vermont Medical Center, A Macroscopic Examination of Microscope-Savvy Pioneers.