We report on an ytterbium-free, erbium-doped single-mode all-fiber laser reaching a record output power of 107 W at 1598 nm, with a slope efficiency of 38.6% according to the absorbed pump power at 981 nm. The erbium-doped gain fiber, co-doped with cerium, aluminum, and phosphorus, was fabricated in-house with adjusted doping concentrations to reduce erbium ions clustering, thereby increasing efficiency while keeping the numerical aperture low to ensure a single-mode laser operation. The addition of cerium co-dopant in the core glass of an erbium system is used for the first time, to the best of our knowledge, in order to adjust the fiber’s numerical aperture without increasing the erbium concentration. Numerical modeling, validated by the experimental results, demonstrates that adding aluminum and phosphorus at high concentration mitigates erbium ions clustering, with an estimated erbium paired ions of only 5.0% in the reported gain fiber.

OBJECTIVEAlthough the past decades have seen a steady increase of women in medicine in general, women continue to represent a minority of the physician-training staff and workforce in neurosurgery in Canada and worldwide. As such, the aim of this study was to analyze the experiences of women faculty practicing neurosurgery across Canada to better understand and address the factors contributing to this disparity.METHODSA historical, cross-sectional, and mixed-method analysis of survey responses was performed using survey results obtained from women attending neurosurgeons across Canada. A web-based survey platform was utilized to collect responses. Quantitative analyses were performed on the responses from the study questionnaire, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding.RESULTSA total of 19 of 31 respondents (61.3%) completed the survey. Positive enabling factors for career success included supportive colleagues and work environment (52.6%); academic accomplishments, including publications and advanced degrees (36.8%); and advanced fellowship training (47.4%). Perceived barriers reported included inequalities with regard to career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Quantitative analyses demonstrated emerging themes of an increased need for women mentors as well as support and recognition of the contributions to career advancement of personal and family-related factors.CONCLUSIONSThis study represents, to the authors’ knowledge, the first analysis of factors influencing career success and satisfaction in women neurosurgeons across Canada. This study highlights several key factors contributing to the low representation of women in neurosurgery and identifies specific actionable items that can be addressed by training programs and institutions. In particular, female mentorship, opportunities for career advancement, and increased recognition and integration of personal and professional roles were highlighted as areas for future intervention. These findings will provide a framework for addressing these factors and improving the recruitment and retention of females in this specialty.

Implicit bias held by health care providers can adversely affect the care provided to vulnerable populations and contribute to existing healthcare inequities. Few reports exist on the health of incarcerated individuals. We herein aimed to report how implicit bias affects the care of incarcerated and detained individuals, especially for those experiencing neurological diseases. We frame our review by providing an overview of the organization of the Canadian correctional system and of its population. We highlight the flagrant overrepresentation of Indigenous people and racialized groups in Canadian prisons, which is germane to the healthcare in this population, particularly when viewed through the lens of intersectionality. We also discuss health disparities between incarcerated individuals and the general population, whether it be in terms of neurological, psychiatric, or infectious diseases. Factors other than implicit bias found to affect medical care for these individuals include the perception of safety issues for both healthcare providers and patients in hospital and clinic settings, as well as resource limitations, confounding psychiatric comorbidities and non-organic disorders, and systemic barriers to adequate followup in this population. Using illustrative cases from our institution's experience, paired with findings from our review of the literature, we demonstrate that incarcerated or detained individuals represent a vulnerable group disadvantaged through a series of inequitable policies and actions, which put this group at higher risk of poor general and neurological health. Data specific to neurological diseases in this population are lacking, especially pertaining to long-term healthcare experiences and outcomes. In addition to highlighting literature gaps in this population, we propose ways in which barriers to care can be addressed, such as the development of multidisciplinary care teams to facilitate care and follow-up in these populations. Healthcare providers should make use of opportunities presented to diagnose and treat diseases in this population. Follow-up by specializing nursing and physician teams, as well as care during incarceration by medical and rehabilitation team members including occupational and physiotherapists may help build bridges between healthcare and carceral institutions. Education to raise awareness of implicit bias and mitigation strategies amongst health care providers is another way in which care provided to incarcerated individuals can be improved.

BACKGROUND: Trigeminal autonomic cephalalgias (TACs) are a group of highly disabling primary headache disorders. Although pharmacological treatments exist, they are not always effective or well tolerated. Occipital nerve stimulation (ONS) is a potentially effective surgical treatment. OBJECTIVE: To perform a systematic review of the efficacy of ONS in treating TACs. METHODS: A systematic review was performed using Medline, Embase, and Cochrane databases. Primary outcomes were reduction in headache intensity, duration, and frequency. Secondary outcomes included adverse event rate and reduction in medication use. Because of large differences in outcome measures, data for patients suffering from short-lasting, unilateral, and neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and cranial autonomic symptoms (SUNA) were reported separately. Risk of bias was assessed using the NIH Quality Assessment Tools. RESULTS: A total of 417 patients from 14 published papers were included in the analysis, of which 15 patients were in the SUNCT/SUNA cohort. The mean reduction in headache intensity and duration was 26.2% and 31.4%, respectively. There was a mean reduction in headache frequency of 50%, as well as a 61.2% reduction in the use of abortive medications and a 31.1% reduction in the use of prophylactic medications. In the SUNCT/SUNA cohort, the mean decrease in headache intensity and duration was 56.8% and 42.8%. The overall responder rate, defined as a >50% reduction in attack frequency, was 60.8% for the non-SUNCT/non-SUNA cohort and 66.7% for the SUNCT/SUNA cohort. Adverse events requiring repeat surgery were reported in 33% of cases. Risk of bias assessment suggests that articles included in this review had reasonable internal validity. CONCLUSION: ONS may be an effective surgical treatment for approximately two thirds of patients with medically refractory TACs.

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