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Abstract Background Current definitions of professionalism for healthcare trainees often lack equity, diversity and inclusion (EDI) in the expectations and assessment of professionalism. While professionalism teaching is incorporated in healthcare training, equity-deserving groups still experience discrimination. This scoping review investigates the literature to understand how EDI and associated domains of cultural humility, and advocacy can be incorporated in healthcare trainees’ education and assessment of professionalism. Methods The Arksey and O’Malley framework was applied to this scoping review. MEDLINE, Embase & PsychINFO were searched up to March 2023, with terms surrounding health professionals, professionalism, EDI, cultural humility, and advocacy. Titles and abstracts (n = 3870) and full-texts (n = 140) were independently screened by two reviewers. Articles were included if they focused on EDI, cultural humility, or advocacy among healthcare students/trainees, and had outcomes related to professionalism. Articles lacking discussion of professionalism as an outcome were excluded. Themes were generated by mutual discussion. Risk of bias was assessed using the Cote et al. and Medical Education Research Study Quality Instrument (MERSQI) tools. Results 48 articles underwent thematic analysis. Studies investigated the disciplines of medicine, nursing, social work, physiotherapy, and dentistry. Most studies were qualitative in methodology (n = 23). Three themes emerged: (1) EDI-related interventions are associated with improved professionalism of healthcare trainees/workers (n = 21). Interventions employed were either an EDI-associated educational course (n = 8) or an exchange program to promote EDI competencies among trainees (n = 13). (2) Trainee definitions and perceptions of professionalism include themes related to EDI and cultural humility (n = 12). (3) Current standards of professionalism are perceived as non-inclusive towards historically-marginalized populations (n = 15). Literature investigating advocacy as it relates to professionalism is limited. Conclusion This review identified that core EDI principles and its associated domains of cultural humility and advocacy are often viewed as integral to professionalism. These findings create a strong impetus to incorporate EDI principles within professionalism frameworks in healthcare education. Future research should employ standardized tools for professionalism assessment to provide more conclusive evidence. Incorporating patient perspectives of professionalism can inform actionable recommendations for fostering inclusive healthcare environments.

Background: Intraoperative middle cerebral artery injury during cranial neurosurgery is a harrowing complication; the overall outcome depends on the nature of the injury and the steps taken to handle it. If direct repair is unsuccessful, traditionally either the expected stroke must be accepted or a bypass must be performed to prevent it, which is often challenging or not feasible if not planned prior to the procedure. Case presentation: A 57 year-old woman with necrotizing neurosarcoidosis presented with headaches and left hemiparesis and was found to have a large right frontotemporal intra-axial mass, progressive in spite of steroids. During surgical resection, the inferior M2 middle cerebral artery (MCA) division was injured. In spite of microsurgical repair of the vessel, the patient emerged from anesthesia with complete left hemiplegia. Emergent cerebral angiography confirmed complete occlusion of the inferior M2 MCA division. Mechanical thrombectomy with a stent-retriever was performed twice, each time resulting in transient recanalization of the vessel followed by re-occlusion. An LVIS Jr. stent was then deployed across the injured segment, intravenous eptifibatide drip initiated, and dual antiplatelet therapy commenced. The patient improved immediately on the table, moving her left side against gravity. Angiography six months later showed continued patency of the injured vessel. At 1-year postoperatively, the patient was back to work with minimal deficits and good control of her sarcoidosis on immunotherapy. Conclusion: This report highlights a rare case of necrotizing neurosarcoidosis, treated surgically, with intraoperative MCA injury salvaged by microsurgical and subsequent endovascular repair with an intracranial stent. Key aspects of complication management are highlighted.

Abstract Efficient degradation of hazardous contaminants from contaminated water is the major challenge for researchers, wherein heavy metals are the prominent contaminants. Consequently, the assessment of multimetal removal is necessary using efficient biosorbant. In this work, the capability of Phanerochaete chrysosporium is evaluated for the individual and simultaneous removal of heavy metals. Individual and simultaneous removal of As, Cd, and Cr is optimized using response surface methodology based on the central composite design by changing the variables, i.e., pH, fungal biomass, and metal concentration. Optimization of the individual metal removal study reveals that fungus effectively absorbs As (29.95 mg L−1), Cd (18.1 mg L−1), and Cr (26.34 mg L−1) at 6.1, 5.64, and 4.15 of pH, respectively. Similarly, As (14.18 mg L−1), Cd (4.53 mg L−1), and Cr (9.28 mg L−1) are absorbed by fungal hyphae simultaneously within 1 h. Changes in the morphology of fungal hyphae are detected in metal absorbed samples as compared to the control hyphae. Interaction of metal‐absorbed fungal hyphae is analyzed using FTIR spectroscopy, revealing that the proteins, carbohydrates, and fatty acids present in the fungal cell are interacted with metals. The model white rot fungi used in the present study can be applied efficiently for the multimetal removal in effluent treatment plants.

The debate surrounding the integration of value in healthcare delivery and reimbursement reform has centered around integrating quality metrics into the current fee-for-service relative value units (RVU) payment model. Although a great amount of literature has been published on the creation and utilization of the RVU, there remains a dearth of information on how clinicians from various specialties view RVU and the quality-of-care metric in the compensation formula. The aim of this review is to analyze and consolidate existing theories on the RVU payment model in neurosurgery. Google and PubMed were searched for English-language literature describing opinions on the RVU in neurosurgery. Commentary was noted to be primary opinions if it was mentioned at least twice in the eight articles included in this review. Overall, seven primary opinions on the RVU were identified across the analyzed articles. Integration of quality into the RVU is viewed favorably by neurosurgeons with a few caveats and opportunities for further improvement.