Various terms are used to describe the regions of the brain and central nervous system. The specific sites used in this report are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List. 19 See Table 1 for an overview of CBTRUS primary site groupings. The CBTRUS Site/Validation List can be found on the CBTRUS website (http://www.cbtrus.org). Measurement MethodsCounts, means, rates, ratios, proportions, and other relevant statistics were calculated using R 3.1.2 statistical software 20 and/or SEER*Stat 8.2.1. 21 Statistics are suppressed when counts are fewer than 16 within a cell but included in totals except when data from only one cell are suppressed within a category to prevent identification of the number in the suppressed cell. Note that reported percentages may not add up to 100% due to rounding.Population data for each geographic region were obtained from the SEER program website 22 for the purpose of rate calculation.Age-adjusted incidence rates and 95% confidence intervals 23 for malignant and non-malignant tumors and for selected histology groupings by gender, race, Hispanic ethnicity, and pediatric, young adult, and adult age groups were estimated per 100,000 population. Age-adjustment was based on oneyear age groupings and standardized to the 2000 US standard population. The age distribution of the 2000 US standard population is shown in Appendix A. Combined populations for the regions included in this report are shown in Appendix B and Appendix C.CBTRUS presents statistics on the pediatric and adolescent age group 0-19 years for clinical relevance and in order to Ostrom et al: CBTRUS Statistical Report Neuro-Oncology iv3The overall average annual age-adjusted incidence rates by age, behavior and CCR, are presented in Table 5, Figures 7a -c. † There is less variation by region for malignant tumor incidence rates as compared to incidence rates for nonmalignant tumors. CCR and regional variations likely reflect differences in reporting and case ascertainment practices. † A slight majority of non-malignant brain and CNS tumors are histologically confirmed (50.4%) (Table 6). † The overall average annual age-adjusted incidence rates of all tumors (malignant and non-malignant) for each individual CCR ranged from 16.30 to 28.06 per 100,000 population. † Average annual age-adjusted incidence rates of all primary malignant tumors ranged from 4.79 to 8.48 per 100,000 population, and average annual age-adjusted incidence rates of all primary non-malignant tumors ranged from 9.41 to 20.04 per 100,000 population. † Among adults 20 years of age and older, CCR-specific incidence rates ranged from 5.63 to 10.27 per 100,000 population for malignant tumors and from 13.02 to 27.30 per 100,000 population for non-malignant tumors. † In those less than 20 years of age, incidence rates listed ranged from 2.27 to 4.81 per 100,000 population for malignant tumors and from 1.02 to 3.65 per 100,000 population for non-malignant tumors.

General population-based survival statistics for primary malignant brain or other central nervous system (CNS) tumors do not provide accurate estimations of prognosis for individuals who have survived for a significant period of time. For these persons, the use of conditional survival percentages provides more accurate information to estimate potential outcomes. Using information from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program from 1995 to 2012, conditional survival percentages were calculated for 1 or 5 years of additional survival for all primary malignant brain and CNS tumors overall and by gender, race, ethnicity and age. Rates were calculated to include 1, 2, 3, 4, 5, 10 and 15 years post diagnosis. Conditional survival was also calculated in intervals from 1995-2004 to 2005-2012, to examine the potential effect that the introduction of new treatment protocols may have had on survival rates. The percentage of patients surviving one or five additional years varied by histology, age at diagnosis, gender, race and ethnicity. Younger persons (age <15 years at diagnosis) had higher conditional survival percentages for all histologies as compared to all histologies in older patients (age ≥15 years at diagnosis). The longer the amount of time post-diagnosis of a malignant brain or other CNS tumor, the higher the conditional survival. Younger persons at diagnosis had the highest conditional survival irrespective of histology. Use of conditional survival rates provides relevant additional information for patients and their families, as well as for clinicians and researchers, and helps with understanding prognosis.

IntroductionEstablishing a boot camp curriculum is pertinent for emergency medicine (EM) residents in order to develop proficiency in a large scope of procedures and leadership skills. In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey.MethodsWe designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing.ResultsTwelve EM interns entered residency with an overall confidence score of 3.2 (1–5 scale) across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3) and genitourinary exams (3.9). The lowest pre-survey confidence score was in thoracostomy (2.4). Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of “moderately confident/need guidance at times to perform procedure.”ConclusionAt the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency.

Introduction: Interns are often unprepared to effectively communicate in the acute trauma setting. Despite the many strengths of the Advanced Trauma Life Support (ATLS) program, the main shortcoming within the course is the deficiency of teamwork and leadership training. In this study, we describe the creation of an interdisciplinary boot camp in which interns' basic trauma knowledge, level of confidence, and teamwork skills are assessed.Methods: We designed a one-day, boot camp curriculum for interns of various specialties with the purpose of improving communication and teamwork skills for effective management of acute trauma patients. Our curriculum consisted of a one-day, twelve-hour experience, which included trauma patient simulations, content expert lectures, group discussion of video demonstrations, and skill development workstations. Baseline and acquired knowledge were assessed through the use of confidence surveys, cognitive questionnaires, and a validated evaluation tool of teamwork and leadership skills for traumaResults: Fifteen interns entered the boot camp with an overall confidence score of 3.2 (1-5 scale) in the management of trauma cases. At the culmination of the study, there was a significant increase in the overall confidence level of interns in role delegation, leadership, Crisis Resource Management (CRM) principles, and in the performance of primary and secondary surveys. No significant changes were seen in determining and effectively using the Glasgow Coma Scale, Orthopedic splinting/reduction skills, and effective use of closed-loop communication.Conclusion: An intensive one-day trauma boot camp demonstrated significant improvement in self-reported confidence of CRM concepts, role delegation, leadership, and performance of primary and secondary surveys. Despite the intensive curriculum, there was no significant improvement in overall teamwork and leadership performance during simulated cases. Our boot camp curriculum offers educators a unique framework to which they can apply to their own training program as a foundation for effective leadership and teamwork training for interns.

Primary malignant brain and other central nervous system tumors (BT) are a rare cancer that causes morbidity and mortality disproportionate to their incidence. This study presents the most up-to-date mortality data for malignant BT in the United States (US) by histology groupings, age, race, and sex. Mortality rates for malignant BT were generated using the Center for Disease Control's National Vital Statistics Systems (NVSS, ~100% of US) data from 1975 to 2012. Histology-specific incidence-based mortality rates were calculated using the National Cancer Institute's Surveillance, Epidemiology, and End-Results 9 (SEER9, ~9.4% of US) data from 1975 to 2012. Joinpoint modeling was used to estimate trends. Mortality was similar in both the NVSS and SEER9 datasets. Overall, mortality from 1975 to 2012 was higher among men, higher in older individuals, and higher in Whites compared to other races. Persons age 65+ years had significant increases in mortality for all malignant tumors overall and for glioma histologies, while persons age <20 years had no significant changes in mortality. This study reports up-to-date mortality rates by histology groupings, age, race, and sex for malignant BT. There have been no significant changes in overall mortality due to these tumors from 1975 to 2012. There have been significant increases in mortality in the elderly (age 65+ years), especially those age 75-84 years, mirroring the effect of overall population aging. Examining age-, race-, sex-, and histology-specific morality at the population level can provide important information for clinicians, researchers, and public health planning.