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Item Blood Supply to the Human Spinal Cord. I. Anatomy and Hemodynamics(Wiley, 2015-01) Bosmia, Anand N.; Hogan, Elizabeth; Loukas, Marios; Tubbs, R. Shane; Cohen-Gadol, Aaron A.; Department of Neurological Surgery, IU School of MedicineThe arterial network that supplies the human spinal cord, which was once thought to be similar to that of the brain, is in fact much different and more extensive. In this article, the authors attempt to provide a comprehensive review of the literature regarding the anatomy and known hemodynamics of the blood supply to the human spinal cord. Additionally, as the medical literature often fails to provide accurate terminology for the arteries that supply the cord, the authors attempt to categorize and clarify this nomenclature. A complete understanding of the morphology of the arterial blood supply to the human spinal cord is important to anatomists and clinicians alike.Item A case for using eponyms in anatomy to teach bioethics(American Association for Anatomy, 2021-11) Organ, Jason M.; Mussell, Jason C.; Anatomy and Cell Biology, School of MedicineItem Choroid Plexus of the Fourth Ventricle: Review and Anatomic Study Highlighting Anatomical Variations(Elsevier, 2016-04) Tubbs, R. Shane; Shoja, Mohammadali M.; Aggarwal, Anjali; Gupta, Tulika; Loukas, Marios; Sahni, Daisy; Ansari, Shaheryar F.; Cohen-Gadol, Aaron A.; Department of Neurological Surgery, IU School of MedicineRelatively few studies have been performed that analyze the morphology of the choroid plexus of the fourth ventricle. Due to the importance of this tissue as a landmark on imaging and during surgical intervention of the fourth ventricle, the authors performed a cadaveric study to better characterize this important structure. The choroid plexus of the fourth ventricle of 60 formalin fixed adult human brains was examined and measured. The horizontal distance from the midline to the lateral most point of the protruding tip of the horizontal limbs was measured. In the majority of the 60 brain specimens, right and left horizontal limbs of the choroid plexus were seen extending from the midline and protruding out of their respective lateral apertures of the fourth ventricle and into the subarachnoid space. However, on 3.3% of sides, there was absence of an extension into the foramen of Luschka and in one specimen, this lack of extension into the foramen of Luschka was bilateral. On two sides, there was discontinuity between the midline choroid plexus and the tuft of choroid just outside the foramen of Luschka. For specimens in which the choroid plexus did protrude through the foramen of Luschka (96.7%), these tufts were located anterior to the flocculus and inferolateral to the facial/vestibulocochlear nerve complex and posterosuperior to the glossopharyngeal/vagal/accessory complex. A thorough understanding of the normal and variant anatomy of the fourth ventricular choroid plexus is necessary for those who operate in, or interpret imaging of, this region.Item Cleft Lip and Palate Literature Review Compilation(Office of the Vice Chancellor for Research, 2015-04-17) Khan, Abdul Karim; Yard, MichaelThe purpose of this review is to provide a summary of the cleft lip or palate procedure with a focus on human anatomy and physiology. Cleft lip and palate are the most common facial malformations and occur in 1 newborn in 2500 live births. Through a thorough analysis of journal articles and viable sources one can grasp an introductory understanding of cleft palate including the history, anatomy, causes, procedure, and post-operation lifestyle with cleft palate. Although the problem is genetic and embryological in nature, anatomy is relevant as the complications stem from oropharyngeal muscles inserting on structural bones, impacting neurovascular areas of the mouth, leading to a complex deformity. The topic was subdivided to cover all areas relevant to the review. The sources used were primarily from journal articles such as PubMed, books, and other online published data. Overall the topic is closely related to medicine and dentistry while incorporating basic anatomical concepts.Item Dural Septation on the Inner Surface of the Jugular Foramen: An Anatomical Study(Thieme Publishing Group, 2015-06) Tubbs, R. Shane; Griessenauer, Christoph J.; Bilal, Muhammad; Raborn, Joel; Loukas, Marios; Cohen-Gadol, Aaron A.; Department of Neurological Surgery, IU School of MedicineIntroduction Preserving cranial nerve (CN) function during tumor removal at the jugular foramen is challenging. No anatomical study has better defined the relevant dural septations on the inner surface of the jugular foramen. This study was undertaken to elucidate this anatomy. Methods Fourteen cadaveric heads (28 sides) were dissected, and relationships of the meningeal coverings of the jugular foramen and adjacent CNs documented. A classification scheme was created to better describe the dural septations of the inner surface of the jugular foramen. Results Four types of dural septations were noted. Type I: 10 sides (36%) where a dural septation was seen between CNs IX anteriorly and X and XI posteriorly. Of these, the septum was ossified in 20%. Type II (32%) was defined as a jugular foramen with no dural septation. Type III (7%) was defined as septation between CNs IX and X anteriorly and XI posteriorly. Type IV (7 sides, 25%) or the chaotic form was defined as multiple septations within the jugular foramen that housed and divided CN rootlets. Conclusions The dural septations defined here can be used in future studies to help correlate operative strategy to meningeal morphology within the jugular foramen.Item How are our Undergraduate Students Doing? Exploring the Emotional Impact of Human Donors in Undergraduate Anatomy Education(2024-04-26) Shafer, Anna; Dunham, Stacey M.INTRODUCTION: The use of human cadavers (donors) in anatomy laboratories is a common experience for many future healthcare professionals. For undergraduates taking anatomy, this may be their first introduction to human cadavers, and for many students their first experience viewing a deceased person. Students exhibit a variety of reactions to this experience. Previous research has focused on student experiences in undergraduate medical education. This study explores student reactions to donors in undergraduate education. STUDY OBJECTIVE: The purpose of this study was to ascertain students’ emotions and reactions to the donors in the laboratory classroom setting and to identify coping mechanisms that students used within this learning environment. Understanding these student experiences will provide insight to educators as they work to accommodate student needs and understand the emotional impact of human donor use in undergraduate education. METHODS: The participants of this study included students who completed a 5-credit hour, 200-level human anatomy course between Fall 2021 through Fall 2023. The laboratory uses two prosected donors that the students observe throughout the semester. Students are required to identify structures on the donors for the muscular, nervous, circulatory, respiratory, digestive, urinary, and reproductive systems. Students do not have the opportunity to touch the donors; instead, instructors in the course demonstrate structures to small groups of students, and students can practice identifying structures during open study periods. Three of the four laboratory exams include identification questions on the donors which are approximately 25% of each exam. Students who were currently enrolled in the course, as well as those who were previously enrolled, were invited to participate in the study via the university’s learning management system. Students completed an anonymous survey that asked questions related to their individual experiences in the anatomy laboratory. The survey was hosted on Qualtrics and completed by participants electronically. The study was approved by Indiana University IRB #21296. RESULTS: A total of 326 surveys were completed. For 88% of students, this was their first exposure to human cadavers. Students described feeling excited, nervous, frightened, awed, shocked, and hesitant upon first seeing the donors. Only 22% of students somewhat or strongly agreed with the statement, “I believe using humor is an appropriate coping method for working with the donors.” When asked if they “would have benefitted from knowing more information about the lives of the donors,” 30% of students responded they either somewhat or strongly agreed. Students frequently described reminding themselves the donor was previously a living being as a coping mechanism. Many students also discussed the importance of eating before lab. CONCLUSIONS: While the initial exposure to human donors in the anatomy laboratory can be an unsettling experience for students, anatomy educators can accommodate their students' emotional needs by using appropriate instruction methods. This can provide a positive learning environment and potentially result in an improvement in students’ performances within the course as well as future anatomy education.Item The Intramuscular Course of the Greater Occipital Nerve: Novel Findings with Potential Implications for Operative Interventions and Occipital Neuralgia(2014-10) Tubbs, R. Shane; Watanabe, Koichi; Loukas, Marios; Cohen-Gadol, Aaron A.; Department of Neurology, IU School of MedicineBackground: A better understanding of the etiologies of occipital neuralgia would help the clinician treat patients with this debilitating condition. Since few studies have examined the muscular course of the greater occipital nerve (GON), this study was performed. Methods: Thirty adult cadaveric sides underwent dissection of the posterior occiput with special attention to the intramuscular course of the GON. Nerves were typed based on their muscular course. Results: The GON traveled through the trapezius (type I; n = 5, 16.7%) or its aponeurosis (type II; n = 15, 83.3%) to become subcutaneous. Variations in the subtrapezius muscular course were found in 10 (33%) sides. In two (6.7%) sides, the GON traveled through the lower edge of the inferior capitis oblique muscle (subtype a). On five (16.7%) sides, the GON coursed through a tendinous band of the semispinalis capitis, not through its muscular fibers (subtype b). On three (10%) sides the GON bypassed the semispinalis capitis muscle to travel between its most medial fibers and the nuchal ligament (subtype c). For subtypes, eight were type II courses (through the aponeurosis of the trapezius), and two were type I courses (through the trapezius muscle). The authors identified two type IIa courses, four type IIb courses, and two type IIc courses. Type I courses included one type Ib and one type Ic courses. Conclusions: Variations in the muscular course of the GON were common. Future studies correlating these findings with the anatomy in patients with occipital neuralgia may elucidate nerve courses vulnerable to nerve compression. This enhanced classification scheme describes the morphology in this region and allows more specific communications about GON variations.Item An Investigation of the Metacognitive Awareness of Postbaccalaureate Premedical Students at Indiana University School of Medicine(2021-04-22) Craven, Da'Quan D.; Byram, Jessica N.BACKGROUND AND AIMS: Medical school curriculum is tasked with producing lifelong self-directed learners, a set of characteristics requiring strong metacognitive skills. Metacognitive skills directly impact students’ metacognition, which is their ability to understand and regulate their own thinking and learning. It may then be postulated that metacognition may be key in distinguishing students that require a postbaccalaureate program from those that do not. Metacognition has two critical domains: metacognitive knowledge and metacognitive regulation, each of which contain multiple subprocesses. Metacognitive knowledge includes knowing strategies for learning, when to use those strategies, and knowing oneself as a learner. Metacognitive regulation includes strategies for planning, monitoring, evaluating, and debugging learning strategies. Therefore, the purpose of this study is to investigate: 1) the impact of a graduate TBL course on students’ metacognitive awareness, and 2) the relationship between metacognition and course performance. Methods Students enrolled in a TBL graduate histology course at Indiana University took part in this study. Students completed a 19-item Metacognitive Awareness Inventory (MAI) at the beginning (MAI1) and end of the semester (MAI2). The MAI has two domains, Knowledge (8 items) and Regulation (11 items), where items are rated on a 5-point scale from “not at all typical of me” to “very typical of me.” Free response questions asked about knowledge and study abilities, plans for studying in histology and how study skills and abilities have improved across the semester. Finally, students completed a voluntary reflection about their examination performance after the first unit exam. Differences between MAIs were investigated using a Wilcoxon signed-rank test. Spearman's correlations explored the relationship between MAI and final course grades. MAI free responses and exam reflection were analyzed using thematic analysis. Responses were coded using a conceptual framework of metacognition based on processes of knowledge and regulation. Results Thirty-one (94%) students completed both MAIs. There were no differences between MAI1 and MAI2 scores and there was no relationship between MAI1 or MAI2 and final course grades. The Wilcoxon test demonstrated a significant difference between the Knowledge and Regulation domains for MAI1 (p=0.002) and MAI2 (p=0.001) where students reported the items in the Knowledge domain were more typical of them than items in the Regulation domain. There were no differences across the domains between the two timepoints. Students reported initial hesitation and difficulty with learning histology content in a lecture-free, flipped classroom approach. Students discussed plans for approaching studying, but many reported modifying study strategies throughout the semester. However, few students discussed active learning strategies that would allow them to evaluate and assess their knowledge prior to assessments. Conclusion While the MAI failed to demonstrate any improvement in metacognition, students reported an increase in their ability to adapt their study strategies to the content and learning materials. Differences in knowledge of cognition and regulation suggests educators in TBL classrooms may need to provide students with additional resources and strategies to regulate their learning. Future studies aim to investigate the validity of the MAI for measuring metacognition in anatomy courses.Item Metacognition in the Middle: Mismatch between Anticipated and Actual Exam Grades of Allied Health Anatomy Students(2021-04-22) Cale, Andrew S.; McNulty, Margaret A.INTRODUCTION: Accurate evaluation of one’s knowledge and performance is a key metacognitive skill critical to success in the classroom. Students who lack this skill may over-estimate their knowledge and under-prepare for exams, resulting in poor academic performance. Therefore, the purpose of this study was to assess the ability of allied health students to evaluate their exam performance in an anatomy course to identify which groups, if any, need support with this skill. METHODS: In an IRB-approved study, first-year physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students (n=129) participated in a doctoral-level anatomy course. This course covered human anatomy through asynchronous lectures and synchronous virtual labs (due to COVID). Students’ anatomical knowledge was assessed via four exams throughout the course. Prior to the start of the course and again at the end, students were invited to complete a de-identified pre-survey including the Metacognitive Awareness Inventory (MAI), a 52-item survey that assesses metacognition. Throughout the course, students were asked to reflect on their exam performances (anticipated grade, actual grade, and satisfaction) using a modified Likert scale. For analyses, students were divided into terciles based on their mean combined exam performance. Reflections and MAI scores were then compared across terciles in SPSS using Kruskal-Wallis H test. RESULTS: Average exam scores of high (93%±2.0), middle (86%±2.7), and low-performers (74%±4.6) were significantly different from each other (p<0.01). A total of113 (88%) and 59 (46%) students completed the pre- and post-surveys, respectively, resulting in 52 matched pairs (40%). Overall, students significantly improved their metacognition (p<0.01). Reflection participation ranged from 67% to 97%. When asked how their actual grade measured against their anticipated grade, high- and middle-performers’ anticipated grades were similar to each other but significantly higher than those of low-performers (p<0.01 for three exams). High-performers reported significantly greater exam satisfaction than middle- and low-performers on two exams (p<0.01). The performance terciles scored similarly across all metacognition subcategories in the post-survey except declarative knowledge, the factual knowledge of structures and concepts that provides the foundation for higher-order thinking (p=0.01). CONCLUSION: In this study, middle-performers appear to have the greatest mismatch between their anticipated grade, actual grade, and exam satisfaction when compared to high- and low-performers. These students anticipate strong exam performances, but appear to fall short, leaving them less satisfied. This metacognitive disconnect may be related to how students evaluate their knowledge. Students seem to evaluate their progress based on their declarative knowledge, which may not accurately represent their ability to apply that knowledge. SIGNIFICANCE: Metacognitive activities that improve student self-evaluation skills should be implemented in anatomy courses to minimize the metacognitive disconnect between anticipated and actual exam performance.Item Neural Connections between the Nervus Intermedius and the Facial and Vestibulocochlear Nerves in the Cerebellopontine Angle: An Anatomic Study(Springer, 2015) Tubbs, R. Shane; Hose, Nicole; Loukas, Marios; De Caro, Raffaele; Cohen-Gadol, Aaron A.; Department of Neurological Surgery, IU School of MedicinePurpose Unexpected clinical outcomes following transection of single nerves of the internal acoustic meatus have been reported. Therefore, this study aimed to investigate interneural connections between the nervus intermedius and the adjacent nerves in the cerebellopontine angle. Methods On 100 cadaveric sides, dissections were made of the facial/vestibulocochlear complex in the cerebellopontine angle with special attention to the nervus intermedius and potential connections between this nerve and the adjacent facial or vestibulocochlear nerves. Results A nervus intermedius was identified on all but ten sides. Histologically confirmed neural connections were found between the nervus intermedius and either the facial or vestibulocochlear nerves on 34 % of sides. The mean diameter of these small interconnecting nerves was 0.1 mm. The fiber orientation of these nerves was usually oblique (anteromedial or posterolateral) in nature, but 13 connections traveled anteroposteriorly. Connecting fibers were single on 81 % of sides, doubled on 16 %, and tripled on 3 %, six sides had connections both with the facial nerve anteriorly and the vestibular nerves posteriorly. On 6.5 % of sides, a connection was between the nervus intermedius and cochlear nerve. For vestibular nerve connections with the nervus intermedius, 76 % were with the superior vestibular nerve and 24 % with the inferior vestibular nerve. Conclusions Knowledge of the possible neural interconnections found between the nervus intermedius and surrounding nerves may prove useful to surgeons who operate in these regions so that inadvertent traction or transection is avoided. Additionally, unanticipated clinical presentations and exams following surgery may be due to such neural interconnections.