bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro Mitral Valve Model with Unrestricted Ventricular Access: Using Vacuum to Close the Valve and Enable Static Trans-Mitral Pressure
Authors: Stephens Sam E. , Kammien Alexander J. , Paris Jacob C. , Applequist Alexis P. , Ingels Neil B. , Jensen Hanna K. , Rodgers Drew E. , Cole Charles R. , Wenk Jonathan F. , Jensen Morten O.
Published: January 2022

Current in vitro models of the left heart establish the pressure difference required to close the mitral valve by sealing and pressurizing the ventricular side of the valve, limiting important access to the subvalvular apparatus. This paper describes and evaluates a system that establishes physiological pressure differences across the valve using vacuum on the atrial side. The subvalvular apparatus is open to atmospheric pressure and accessible by tools and sensors, establishing a novel technique for experimentation on atrioventricular valves. Porcine mitral valves were excised and closed by vacuum within the atrial chamber. Images were used to document and analyze closure of the leaflets. Papillary muscle force and regurgitant flow rate were measured to be 4.07 N at 120 mmHg and approximately 12.1 ml/s respectively, both of which are within clinically relevant ranges. The relative ease of these measurements demonstrates the usefulness of improved ventricular access at peak pressure/force closure.

Graphical abstract
A systematic review of behaviour change techniques used in interventions to increase physical activity among breast cancer survivors
Authors: Hailey Verity , Rojas-Garcia Antonio , Kassianos Angelos P.
Published: January 2022

Background

Despite evidence that physical activity (PA) can help reduce recurrence and mortality, many breast cancer survivors are less active than recommended levels. The aim of this systematic review is to advance our understanding of which behaviour change techniques (BCTs) have been used in interventions promoting breast cancer survivors’ PA and to evaluate their potential to increase PA.

Methods

A systematic search was conducted in five databases (Medline; PsycInfo; Embase; CINAHL and Scopus) for studies published between 2005 and 2019. Following a rigorous screening process, 27 studies were retained. These were reviewed and analysed for quality, coded for BCTs (k = 0.65) and interventions categorised according to their potential to increase PA using an established methodology.

Results

The majority of studies were moderate quality (64%). Demonstration on how to perform the behaviour was the most commonly used BCT (n = 23). Adding objects to the environment, (pedometer or accelerometer) was the BCT with the highest potential to increase PA. This was followed by, goal setting and self-monitoring of behaviour. A theory-based approach to evaluation was used in only 59% (n = 16) of the studies.

Conclusions

The results of this review inform which BCTs have the potential to increase PA for breast cancer survivors and inform intervention development. Future research, is encouraged to properly report intervention procedures around dose and frequency of intervention components to allow for review and replication.
Combined Effect of a Laser Cladded Coating and Surface Texture on Tribological Performance Under Dry Sliding and Starved Lubrication
Authors: Qiao Chenfeng , Yu Jing , Zhang Shuai , Liu Zhengda , Wang Jinlong
Published: January 2022

Fe-based alloy coating was laser cladded on gray cast iron using Ni-Cu alloy as an intermediate layer. The cross section of the laser cladded coating was characterized by optical microscopy (OM), scanning electron microscopy (SEM) equipped with energy dispersive spectrometry (EDS), X-ray diffraction (XRD), and a Vickers hardness tester. A microdimple texture was created by reciprocating an electrolyte jet with prefabricated mask (REJP) machining on an Fe-based alloy coating. The tribological performances of untextured and textured coatings were examined through interrupted wear tests using an in-house developed reciprocating ball-on-plate tribotester under dry sliding and starved lubricated conditions. The results show that the presence of microdimple edges in the nonconformal contact region has a detrimental effect on the friction performance under dry sliding. However, the microdimples can be beneficial for trapping debris to preserve a smoother contacting surface and thus a lower volume wear track compared to untextured coatings. Due to its role in oil reservoirs and debris entrapment, the microdimple textured coating can maintain a low friction coefficient for a long time period after lubricant oil cutoff and results in a lower volume wear track under starved lubrication.

Graphical abstract
A Survey of the Awareness and Educational Needs of Nurses in Nagasaki Prefecture Regarding Hereditary Breast and Ovarian Cancer
Authors: Matsumoto Megumi , Sasaki Noriko , Tsukigawa Yayoi , Otsubo Ryota , Yano Hiroshi , Nagayasu Takeshi
Published: January 2022

The aim of this study was to evaluate the knowledge and educational needs with regard to hereditary breast and ovarian cancer among nurses working in breast cancer care in the Nagasaki Prefecture. In breast cancer care, the identification of patients at risk for hereditary breast and ovarian cancer is necessary for the implementation of genetic testing and counseling. Nurses should be involved in this process, since they play a crucial role in the care of patients with breast cancer. However, the knowledge regarding hereditary breast and ovarian cancer among nurses working in oncology care in Japan has not been assessed. The design of this study is cross-sectional design. We distributed 597 surveys to nurses working in breast cancer care. The surveys assessed the nurses’ demographic data, their current knowledge and practices regarding cancer genetics and hereditary breast and ovarian cancer, and their attitude and preferences regarding learning about the condition. We received 317 valid replies. Nurses had limited knowledge about hereditary breast and ovarian cancer characteristics: 41.6% reported that they do not know about the condition, whereas less than 10% knew its characteristics. However, nurses were aware of hereditary breast and ovarian cancer significance and were willing to learn about it: 91% wished to learn about the condition, and 88.6% wanted to participate in study group meetings. Further, nurses’ preferences regarding educational programs were clarified. Overall, our results show that educational programs should be implemented to advance nurses’ knowledge of hereditary breast and ovarian cancer characteristics.
Ein pflegegeleitetes Sekundärpräventionsprogramm für Menschen nach einem akuten Koronarsyndrom aus Sicht von Gesundheitsexpertinnen und -experten in Österreich – eine qualitative Studie
Authors: Qin Hong , Bonderman Diana , Brunner Silvia , Großbichler Tamara , Badr Eslam Roza , Mayer Hanna
Published: January 2022

Hintergrund

Menschen nach akutem Koronarsyndrom weisen weiterhin ein hohes kardiovaskuläres Risiko auf. Eine pflegerische Intervention zur Verbesserung der Adhärenz von Betroffenen hinsichtlich der empfohlenen Präventionsmaßnahmen ist erforderlich. In deren Entwicklung sollen alle an der Versorgung beteiligten Personengruppen miteinbezogen werden, u. a. Gesundheitsexpertinnen und -experten.

Ziel

Ziel war es, die Ausrichtung eines dem österreichischen Kontext angepassten pflegegeleiteten Sekundärpräventionsprogramms für Menschen nach akutem Koronarsyndrom aus Sicht von Gesundheitsexpertinnen und -experten zu generieren.

Methodik

Die Entwicklung dieses Programms stützt sich methodisch auf das „intervention mapping“. Um die Inhalte der ersten 3 Schritte des Intervention mapping zu erarbeiten, wurden 2 Fokusgruppeninterviews und 13 Einzelinterviews mit 27 Gesundheitsexpertinnen und -experten durchgeführt. Die Datenanalyse erfolgte anhand der thematischen Analyse nach Braun und Clarke.

Ergebnisse

Die Ausrichtung des Programms bezieht sich auf die Bereiche „personenzentrierter Ansatz“, „Akutkrankenhaus als Initialpunkt“ und „persönliches Gespräch als zentrale Vermittlungsform“. Die erforderlichen strukturellen und personellen Rahmenbedingungen umfassen „Prioritätensetzung für die Patientenedukation im Akutkrankenhaus“, „Einrichtung einer Anlaufstelle“, „interdisziplinäre Zusammenarbeit“ und „gesetzliche Bestimmungen für die Patienteninformation“ sowie die Schaffung der Position einer „cardiac rehabilitation nurse“, welche speziell ausgebildetes Pflegepersonal übernehmen könnte. Ein vertieftes Krankheitsverständnis und ein reduzierter Angstzustand sollen die angestrebten Ergebnisse des Programms sein.

Schlussfolgerung

Das zu entwickelnde Programm kann dazu dienen, die nichtmedikamentöse Sekundärprävention bei den Betroffenen im Akutkrankenhaus zu initiieren und nach der Entlassung fortzuführen. Als Rahmenbedingungen müssen eine Anlaufstelle und die Funktion einer Cardiac rehabilitation nurse geschaffen werden. Somit kann diese spezialisierte Pflegeperson die Betroffenen in der Übergangsphase begleiten, während sie die Patientenedukation unter dem personenzentrierten Ansatz durchführt.
Mitigate SIR epidemic spreading via contact blocking in temporal networks
Authors: Zhang Shilun , Zhao Xunyi , Wang Huijuan
Published: January 2022

Progress has been made in how to suppress epidemic spreading on temporal networks via blocking all contacts of targeted nodes or node pairs. In this work, we develop contact blocking strategies that remove a fraction of contacts from a temporal (time evolving) human contact network to mitigate the spread of a Susceptible-Infected-Recovered epidemic. We define the probability that a contact c(i, j, t) is removed as a function of a given centrality metric of the corresponding link l(i, j) in the aggregated network and the time t of the contact. The aggregated network captures the number of contacts between each node pair. A set of 12 link centrality metrics have been proposed and each centrality metric leads to a unique contact removal strategy. These strategies together with a baseline strategy (random removal) are evaluated in empirical contact networks via the average prevalence, the peak prevalence and the time to reach the peak prevalence. We find that the epidemic spreading can be mitigated the best when contacts between node pairs that have fewer contacts and early contacts are more likely to be removed. A strategy tends to perform better when the average number contacts removed from each node pair varies less. The aggregated pruned network resulted from the best contact removal strategy tends to have a large largest eigenvalue, a large modularity and probably a small largest connected component size.
Student Burnout in Higher Education: A Demand-Resource Model Approach
Authors: Jagodics Balázs , Szabó Éva
Published: January 2022

Student burnout is a serious problem in higher education. It is associated with harmful consequences, such as decreased engagement, performance, and motivation, which can lead to dropout. The job demand-resource model of burnout is a comprehensive framework to grasp the factors related to the emergence of burnout. Although numerous studies claim its suitability in explaining burnout in work environments, its applicability in the educational context is less explored. The study aimed to analyze the structure and reliability of the newly developed University Demand-Resource Questionnaire (UDRQ) and to explore the links between its subscales and symptoms of student burnout. Using the online survey method, 743 Hungarian undergraduate students participated in the data collection. The student version of the Maslach Burnout Inventory was used in addition to the UDRQ. In the data analysis procedure, confirmatory factor analysis, correlation analysis, and structural equation modeling were utilized. The confirmatory factor analysis identified a five-factor structure related to both demands and resources. Correlation analysis revealed burnout to be associated positively to the subscales of demands and negatively to resources. Structural equation modeling analysis indicated that all five demands and two resources subscales can be used to build a model that predicts a significant proportion of the variance of student burnout scores. The findings suggest the demand-resource theory is an appropriate framework to predict burnout in higher education. The newly developed UDRQ has stable structure and good reliability and can be a useful tool in subsequent research related to student burnout.
Establishing a Thermal Imaging Technology (IRT) Based System for Evaluating Rat Erectile Function
Authors: Liu Shuai , Zhao Zhendong , Wang Ziwen , Diao Tongxiang , Zhang Keqin , Zhang Hui , Sun Dingqi , Kong Feng , Fu Qiang
Published: January 2022

Introduction

Measurement of intra-cavernous pressure (ICP) is an internationally recognized method to evaluate erectile function of animals, however, this process is invasive, destructive, and cannot be repeated, leading to a daunting challenge for monitoring the changes in erectile function throughout the whole treatment duration.

Aim

To verify whether infrared ray thermography technology based system could be a good substitution of ICP for evaluating rat erectile function.

Methods

A novel thermal image-based method, infrared ray thermography technology (IRT) was employed to monitor erectile function in erectile dysfunction (ED) rats. To detect the sensitivity and specificity of this new technology, 4 ED rat models (Diabetic, nerve-injury, vascular-injury and aged ED models) were established and subjected to both ICP and IRT test.

Outcomes

Statistical comparisons were done to test the effectiveness of this new way for detecting and dynamically monitoring erectile function.

Results

Based on the data curves obtained from ICP and IRT, the IRT showed a similar trend (including peak value, climbing speed) as that of ICP. IRT is considered as a precise way to monitor the real-time changes of erectile function in all ED rat models. The AUC of peak temperature detected by IRT in DMED, aged ED, vascular-injury ED, the nerve-injury ED and total ED rat models were 0.9811,0.9836,0.9893,0.9989 and 0.9882, respectively. Meanwhile, the AUC of temperature climbing rate were 0.6486,0.8357,0.9184,0.8675and 0.8168.Also,it is a non-invasive process of dynamically monitoring erectile function of a same rat at different time points (before and after drug intervention). The data showed that the real-time recovery by tadalafil was obtained by IRT methods even after treatment for only 2 weeks in the diabetic ED (DMED) rat model.

Conclusion

A novel noninvasive method for monitoring erectile function in rat ED models was established, and can replace or supplement ICP test.
Good Science
Authors: Clegg Joshua W.
Published: January 2022

Good Science is an account of psychological research emphasizing the moral foundations of inquiry. This volume brings together existing disciplinary critiques of scientism, objectivism, and instrumentalism, and then discusses how these contribute to institutionalized privilege and to less morally responsive research practices. The author draws on historical, critical, feminist, and science studies traditions to provide an alternative account of psychological science and to highlight the irreducibly moral foundations of everyday scientific practice. This work outlines a theoretical framework for thinking about and practicing psychology in ways that center moral responsibility, collective commitment, and justice. The book then applies this framework, describing psychological research practices in terms of the their moral dilemmas. Also included are materials meant to aid in methods instruction and mentoring.
Geometry of String Theory Compactifications
Authors: Tomasiello Alessandro
Published: January 2022

String theory is a leading candidate for the unification of universal forces and matter, and one of its most striking predictions is the existence of small additional dimensions that have escaped detection so far. This book focuses on the geometry of these dimensions, beginning with the basics of the theory, the mathematical properties of spinors, and differential geometry. It further explores advanced techniques at the core of current research, such as G-structures and generalized complex geometry. Many significant classes of solutions to the theory's equations are studied in detail, from special holonomy and Sasaki–Einstein manifolds to their more recent generalizations involving fluxes for form fields. Various explicit examples are discussed, of interest to graduates and researchers.
Input-Output Analysis
Authors: Miller Ronald E. , Blair Peter D.
Published: January 2022

This essential reference for students and scholars in the input-output research and applications community has been fully revised and updated to reflect important developments in the field. Expanded coverage includes construction and application of multiregional and interregional models, including international models and their application to global economic issues such as climate change and international trade; structural decomposition and path analysis; linkages and key sector identification and hypothetical extraction analysis; the connection of national income and product accounts to input-output accounts; supply and use tables for commodity-by-industry accounting and models; social accounting matrices; non-survey estimation techniques; and energy and environmental applications. Input-Output Analysis is an ideal introduction to the subject for advanced undergraduate and graduate students in many scholarly fields, including economics, regional science, regional economics, city, regional and urban planning, environmental planning, public policy analysis and public management.
The Stylistics of ‘You'
Authors: Sorlin Sandrine
Published: January 2022

This book takes 'you', the reader, on board an interdisciplinary journey across genre, time and medium with the second-person pronoun. It offers a model of the various pragmatic functions and effects of 'you' according to different variables and linguistic parameters, cutting across a wide range of genres (ads, political slogans, tweets, news presentation, literary genres etc.), and bringing together print and digital texts under the same theoretical banner. Drawing on recent research into intersubjectivity in neuropsychology and socio-cognition, it delves into the relational and ethical processing at work in the reading of a second-person pronoun narrative. When 'you' takes on its more traditional deictic function of address, the author-reader channel can be opened in different ways, which is explored in examples taken from Fielding, Brontë, Orwell, Kincaid, Grimsley, Royle, Adichie, Bartlett, Auster, and even Spacey's 'creepy' 2018 YouTube video, ultimately foregrounding continuities and contrasts in the positioning of the audience.
The Rule of Law for All Sentient Animals
Authors: Adenitire John
Published: January 2022

This paper argues for a theory of the rule of law that is inclusive of sentient non-human animals. It critiques the rule of law theories of Fuller, Waldron, and Allan, by showing that their theories presuppose that the legal subject is a person who can be guided by legal norms. This unduly excludes non-human animals, as well as certain humans who do not have rational capacities. If we view the basic idea of the rule of law as restraining arbitrary power, then rule of law theories need to give an account of who can be a potential victim of such power. Non-human animals and humans, whether endowed with rational capacities or not, can all be victims of arbitrary power. So, we need a new rule of law theory which is inclusive of all sentient animals, humans and non-human alike. This paper sets out such an inclusive theory.
Moving Along the Continuum of Loyalty From a Standard Towards Rules
Authors: Naftali Ben Zion Yifat
Published: January 2022

This article focuses on the location of the duty of loyalty—a unique legal norm in Common Law jurisdictions—both actual and desirable, on the continuum between rules and standards. A rule is a relatively ‘closed’ technical norm, at a high level of specificity; it requires little judicial discretion. A standard is an ‘open’ norm, with a greater degree of flexibility, that requires the exercise of discretion. The insights from this jurisprudential perspective are used to reveal the preferred way for further developing the duty of loyalty. The article explains that ‘loyalty,’ intuitively classified as a ‘pure’ standard, has been reconstructed over time as more specific rules. Moreover, it suggests that, ideally, this movement should continue; namely, when applying loyalty to a specific case, courts should include informative content that would promote predictability. It then illustrates that, unfortunately, this road is not always taken by the courts. A decision to retain loyalty as an ad hoc standard, or an inverse attempt to delineate the boundaries of this norm, has implications on the certainty, consistency, and ethical content of the law. Considering that this duty spreads across different legal fields, personal and commercial, the significance of this discussion becomes all the more evident.
GP.4 Can Quantitative Susceptibility Mapping Help Diagnose and Predict
Recovery of Concussion in Children?
Authors: Sader N , Gobbi D , Goodyear B , Frayne R , Beauchamp M , Craig WR , Doan Q , Zemek R , Yeates KO , Riva-Cambrin J
Published: January 2022

Background: Quantitative susceptibility mapping
(QSM) is an MR sequence that has potential as a biomarker in concussion. We
compared QSM in pediatric concussion patients versus a comparison group of
children with orthopedic injuries (OI) and assessed QSM’s performance
relative to the current clinical benchmark (5P risk score) for predicting
persistent postconcussion symptoms (PPCS). Methods:
Children (N=967) aged 8-16.99 years with either
concussion or OI were prospectively recruited from 5 Canadian centers.
Participants completed QSM at a post-acute assessment 2-33 days post-injury.
QSM z-score metrics for 9 regions of interest (ROI) were derived from 371
children (concussion=255, OI=116). PPCS at 1-month post-injury was defined
using reliable change methods. Results: The
concussion and OI groups did not differ significantly in QSM across ROI.
Increased frontal white matter (WM) susceptibility predicted reliable
increases in parent-rated cognitive symptoms (p=0.001). Together, frontal WM
susceptibility and the 5P risk score were better at predicting persistent
cognitive symptoms than the 5P risk score alone (p=0.0021). AUC were
0.71(95%CI: 0.62-0.80) for frontal WM susceptibility, 0.67(95%CI: 0.56-0.78)
for the 5P risk score, and 0.73(95%CI: 0.64-0.82) for both.
Conclusions: This is the first study to
demonstrate a potential imaging biomarker that predicts persistent symptoms
in children with concussion compared to the current clinical
benchmark.
A.5 Identification of predictors of response to Erenumab in episodic and
chronic migraine in a cohort of patients: a preliminary analysis
Authors: Salem-Abdou H , Puymirat J
Published: January 2022

Background: Erenumab is an antibody
anti-calcitonin gene related peptide (CGRP) receptor approved for the
treatment of episodic (EM) and chronic migraine (CM). In this study, we
aimed to identify the predictors of response to the treatment.
Methods: This is an ongoing retrospective cohort
study of 120 patients (49 with cervicalgia) with EM or CM treated with
Erenumab. The first endpoint was to identify the success rate of this
treatment (at least 50% reduction in monthly migraine days during the third
month of the treatment). The second endpoint was to identify the predictors
of response to Erenumab treatment. Results: Seventy
one percent of patients achieved a favorable response (P-value<0.001) to
Erenumab. Patients with cervicalgia showed a lower treatment success rate
(21.1% with vs 40.8% without cervicalgia) while patients without cervicalgia
showed a higher treatment success rate (78. 9% without vs 59.2% with
cervicalgia) with a P-value of 0.025 and an odd ratio of 0.388 (95% CI
0.174-0.869, P-value=0.021). A similar trend was observed in patients with
occipital neuralgia and obesity (P-value<0.08).
Conclusions: The preliminary analysis of this
study demonstrates that cervicalgia (and to a lesser extend occipital
neuralgia and obesity) is a negative predictor of response to Erenumab in
patients with migraine.
A.6 Vagus Nerve Stimulation in patients with therapy resistant
generalized epilepsy
Authors: Suller Marti AS , Mirsattari SM , MacDougall KW , Steven D , Parrent A , Andrade A , de Ribaupierre S , Diosy DC , McLachlan R , Burneo JG
Published: January 2022

Background: For patients with generalized
epilepsy who do not respond to anti-seizure medications, the therapeutic
options are limited. Vagus nerve stimulation (VNS) is a treatment mainly
approved for therapy resistant focal epilepsy. There is limited information
on the use of VNS on generalized epilepsies, including Lennox Gastaut
Syndrome(LGS) and genetic generalized epilepsy(GGE).
Methods: We identified patients with a diagnosis
of Lennox-Gastaut Syndrome or Genetic Generalized Epilepsy, who underwent
VNS implantation, between1997 and July 2018. Results:
A total of 46 patients were included in this study with a history of therapy
resistant generalized epilepsy. The mean age at implantation was 24
years(IQR= 17.8-31 years) and 50%(n=23) were female. The most common
etiologies were GGE in 37%(n=17) and LGS in 63%(n=29). Median follow-up
since VNS implantation was 63 months(IQR:31-112.8months). 41.7%(n=12) of the
LGS group became responders, and 64.7%(n=11) in the GGE group. The best
response in seizure reduction was seen in generalized tonic-clonic seizures.
There was a reduction of seizure-related hospital admissions from
89.7%(N=26) pre-implantation, to 41.4%(N=12) post-implantation
(p<0.0001). The frequency of side effects due to the stimulation was
similar in both groups(62.1% in LGS and 61.1% in GGE).
Conclusions: VNS is an effective treatment in
patients with therapy resistant generalized epilepsy, especially
GGE.
P.008 Surgical Procedures are Common in Patients with Prion
Disease
Authors: Porter AL , Prusinski CC , Lazar ES , Yuh C , Bucelli RC , Day GS
Published: January 2022

Background: Surgical instruments used in patients
with prion disease must be decontaminated or decommissioned to prevent
iatrogenic transmission. This is only done when the diagnosis of prion
disease is known. To assess the potential for iatrogenic transmission, we
determined the prevalence of surgeries and use of precautions in patients
with prion disease at two academic medical centers.
Methods: Clinical details, results of
investigations, and surgical interventions (performed within one-year of
symptom onset) were extracted for patients with probable/definite prion
disease at Mayo Clinic (n=107; 1-2014 to 12-2020) and Washington University
School of Medicine (n=14; 2-2015 to 12-2019).
Results: Twenty-six patients (21.5%) underwent 32
procedures, including 2 high-risk procedures involving the brain. Most
procedures (17/32, 53%) occurred in the 1-year period preceding the onset of
symptoms attributed to CJD. History of arthritis (OR: 7.4, 95%CI:
1.05-51.8), lack of behavioral symptoms (OR: 3.0, 95%CI 0.97-9.1), and
greater time (months) from symptom onset to first MRI (OR: 1.1, 95%CI
1.03-1.2) were independently associated with odds of undergoing an invasive
procedure. Prion disease precautions were observed in one case (diagnostic
brain biopsy). Conclusions: Procedures were common in
patients with diagnosis of prion disease; precautions were not. Coordinated
approaches to screening and reporting are needed to prevent iatrogenic
transmission.
P.023 Neurostimulation in Drug-Resistant Epilepsy: Systematic Review and
Meta-Analysis from the ILAE Evidence-Based Epilepsy Surgery Task
Force
Authors: Touma L , Dansereau B , Englot D , Keezer MR
Published: January 2022

Background: Drug-resistant epilepsy (DRE) can
affect up to one third of individuals with epilepsy. We conducted a
systematic review and meta-analysis of vagus nerve stimulation (VNS),
responsive neurostimulation (RNS), and deep brain stimulation (DBS) in
patients with DRE to summarize the current evidence on efficacy and
tolerability for these neuromodulation modalities.
Methods: We searched three online databases with
a pre-specified search strategy. We included published randomized controlled
trials (RCT) and their open-label extension studies, as well as prospective
case series, with samples greater than 20 participants, reporting efficacy
and tolerability. Results: We identified 31 studies,
six of which are RCTs and 25 prospective observational studies. At long term
follow-up, five observational studies for VNS reported a pooled mean
decrease in seizure frequency at last follow-up of 35%. In the extension
studies for RNS, the median seizure reduction was 53%, 66% and 75.0% at two,
five and nine years respectively. For DBS, the median reduction was then
56%, 69% and 75% at two, five and seven years respectively.
Conclusions: Neurostimulation modalities are
effective for the treatment of DRE, with improving outcomes over time and
few major complications. Higher quality long-term data on DBS and RNS
suggest larger seizure reduction rates than VNS.
P.032 Long-term safety and tolerability of eptinezumab in patients with
chronic migraine: A 2-year, open-label, phase 3 trial
Authors: Kudrow D , Cady R , Allan B , Pederson S , Hirman J , Meessen-Pinard M , Schaeffler B
Published: January 2022

Background: Eptinezumab is approved in the US for
the preventive treatment of migraine and was well tolerated in double-blind,
placebo-controlled studies in patients with episodic and chronic migraine
(CM). The PREVAIL study evaluated the long-term safety, immunogenicity, and
impact on patient-reported outcomes of repeat doses of eptinezumab in
patients with CM. Methods: PREVAIL was an open-label,
phase 3 trial comprising two 48-week treatment phases. Adults with CM
received eptinezumab 300 mg by 30-minute IV every 12 weeks for ≤8 doses,
with patients followed up to week 104. Results: 128
adults (mean age, 41.5y) with CM were treated. Over 2 years, the most
frequently reported treatment-emergent adverse events were nasopharyngitis
(14.1%), upper respiratory tract infection (7.8%), sinusitis (7.8%),
influenza (6.3%), bronchitis (5.5%), and migraine (5.5%). Study-drug
discontinuation due to adverse events was 6.3%. Anti-eptinezumab antibody
incidence peaked at week 24 and declined despite continued dosing, to
nondetectable levels at week 104. Patient-reported outcomes were improved at
first assessment (week 4) and generally sustained through week 104.
Conclusions: In adults with CM, eptinezumab 300
mg demonstrated a favorable safety profile, limited long-term
immunogenicity, early and sustained reductions in migraine-related burden,
and improvements in health-related quality of life over 2 years.
P.035 Health System Utilization and Medication Use among Adults with
Migraine in Alberta: An observational cohort study using Alberta
administrative health data
Authors: Rajapakse T , Kassiri J , Mailo J , Nabipoor M , Bakal J , Richer L
Published: January 2022

Background: Migraine is costly to governments.
Despite significant burden, Canada lacks population data regarding migraine
prevalence, resource and medication utilization. We sought to characterize
the demographics, health resource utilization, and medication use in an
adult migraine cohort in Alberta. Methods: Migraine
cohort: previously validated case definition of migraine (ICD 10 +
dispensation of abortive and/or preventative migraine drug
(04/2010-03/2016). Patients over 18 years, followed three years from index
date [first dispensation of migraine medication]. Health resource
utilization (HRU) assessed by emergency department (ED) visits, hospital
admission and physician claims. Medication assessed province-wide
dispensation database linkage. Patient demographics and Charlson Comorbidity
Index (CCI) included. Results: Over 5 years: 53,333
migraine cases identified (mean age 40.5 years, 79% female). Common
comorbidities: hypertension, COPD, diabetes mellitus, cancer,
cerebrovascular disease. Mean CCI 0.55 (SD 1.06). Metropolitan patients:
48%, urban 34.6%, rural 17.4%. Initial migraine diagnosis: 46% by GP, 31% in
ED. Rural patients present more to ED/hospital for care in 3-year follow-up
(IRR 2.95 [2.83, 3.08]). Conclusions: Our migraine
case definition is more specific than sensitive and underestimates Alberta’s
migraine prevalence. Higher female prevalence as expected. Rurally, migraine
care largely occurs in ED/hospital. Study of prevalence, HRU and medications
may help inform health policy in Alberta and Canada.
P.036 Burden of illness in patients with migraine in Canada: A patient
survey and retrospective chart review
Authors: Sauriol S , Hasani I , Rochdi D , Bastien N , Amoozegar F
Published: January 2022

Background: There are limited Canadian data on
the impact of migraine on quality of life, economic, and societal burden.
Therefore, the aim of this study was to characterize the humanistic and
economic burden of illness of migraine in Canada.
Methods:Retrospective medical chart
review and prospective patient survey were used to evaluate the
clinical, social, and economic burden of migraine in patients who failed
at least two prior prophylactic
therapies.Results: 287 migraine
patients were included. High- frequency episodic migraine (8 to 14 MMDs) and
chronic migraine (15+ MMDs) made up the majority of the cohort (35.2% and
35.9%, respectively). 72.8% of the patients had underlying comorbidities 78%
indicated that they experienced severe disability on their daily life due to
their headaches. The total estimated annual cost of chronic migraine was
$25,669 per patient while high-frequency episodic and low-frequency episodic
migraine was associated with an annual cost of $24,885 and $15,651 per
patient respectively. Conclusions: This study
provides a recent and comprehensive assessment of the burden of illness
associated with migraine in Canada and showed that migraine is associated
with a substantial humanistic and economic burden for patients and
healthcare systems.
P.217 Patient reported outcomes following surgery for lumbar spinal
stenosis: Comparison of a universal and multitier health care system
Authors: Ayling O , FIsher C
Published: January 2022

Background: Canada has a universal health care
system while the United States utilizes a combined public and private payer
system. The purpose of this study is to investigate whether there are
differences in clinical outcomes between those surgically treated for spinal
stenosis in Canada as compared to the United States.
Methods: Surgical lumbar spinal stenosis patients
treated in Canada that were enrolled in the Canadian Spine Outcome Research
Network (CSORN) prospective multicenter registry were compared with the
surgical cohort enrolled in the Spine Patients Outcome Research Trial
(SPORT) study. Spine-related patient reported outcomes (PROs) were compared
at 3 months and 1 year post-operatively. Results: The
CSORN cohort consisted of 432 patients and the SPORT cohort was made up of
278 patients. The CSORN cohort had a higher proportion of patients with a
symptom duration greater than 6 months (92.3% vs. 58.3%, p<0.0001). The
CSORN cohort demonstrated significantly greater rates of satisfaction after
surgery at 3 months (p=0.003) and 1 year (p<0.001).
Conclusions: Patients undergoing surgical
treatment for lumbar spinal stenosis in Canada (CSORN cohort) reported
higher rates of satisfaction at 3 months and 1 year post-operatively
compared to the United States cohort (SPORT) despite having longer durations
of symptoms prior to surgery.
P.218 Patient reported outcomes following surgery for lumbar disk
herniation: comparison of a universal and multitier health care
system.
Authors: Ayling O , FIsher C
Published: January 2022

Background: Canada has a universal health care
system that is funded by the government while the United States utilizes a
combined public and private payer system. The purpose of this study is to
investigate whether there are differences in clinical outcomes between those
surgically treated for lumbar disk herniation in Canada as compared to the
United States. Methods: Surgical lumbar disk
herniation patients enrolled in the Canadian Spine Outcome Research Network
(CSORN) prospective registry. were compared with the surgical cohort
enrolled in the Spine Patients Outcome Research Trial (SPORT) study.
Spine-related patient reported outcomes (PROs) were compared at 3 months and
1 year. Results: The CSORN cohort consisted of 443
patients and the SPORT cohort was made up of 573 patients. Patients in the
CSORN cohort were older (p<0.001), and were more likely to be employed
(p=0.003). The CSORN cohort demonstrated significantly greater rates of
satisfaction after surgery at 3 months (87.2% vs. 65.5%, p=0.003) and 1 year
(85.6% vs. 69.0%, p<0.0001). The CSORN cohort was a significant
independent predictor of patient satisfaction at 1 year.
Conclusions: Patients undergoing surgical
treatment for lumbar disc herniation in Canada reported higher rates of
satisfaction at 3 months and 1 year post-operatively compared to the United
States.
P.220 Mechanism of injury is associated with neurological outcomes in
cervical sensorimotor complete traumatic spinal cord injury
Authors: Bak AB , Moghaddamjou A , Fehlings M
Published: January 2022

Background: There is significant heterogeneity in
neurological recovery after complete (ASIA A) traumatic spinal cord injury
(tSCI). Neurological recovery is often associated with a conversion to a
higher letter grade of the American Spinal Injury Association’s impairment
scale (ASIA). The mechanism of injury (MOI) may play a significant role in
the primary injury and should be considered for greater precision in care.
Methods: We isolated ASIA A cervical tSCI
patients from three multicenter prospective randomized controlled trials
(NACTN, STASCIS, Sygen). Chi-square test with pairwise comparisons with
Bonferroni corrections was performed to compare the proportion of ASIA A
patients that converted to a higher ASIA grade between different MOI.
Results: We identified 486 complete cervical tSCI
patients. For patients who developed tSCI as a result of a fall, a
significant proportion converted to a higher ASIA grade by 52 weeks (p =
0.009). For patients who developed tSCI as a result of a sports injury, a
significantly smaller proportion did not convert to a higher ASIA grade
compared to those that converted (p = 0.034).
Conclusions: Due to the difference in outcomes,
tSCI patients should be treated differently depending on their mechanism of
injury.
P.079 Factors influencing HINTS exam usage by Canadian Emergency Medicine
Physicians
Authors: Byworth M , Johns P , Pardhan A , Srivastava K , Sharma M
Published: January 2022

Background: The HINTS examination is a sensitive
and specific tool for determining whether a patient presenting with an acute
vestibular syndrome has had a stroke. Despite its efficacy, it is often not
used by Emergency Medicine (EM) physicians when assessing patients with
vertigo. Methods: To ascertain why, we surveyed, by
email, physicians registered with the Canadian Association of Emergency
Physicians, to gather information on their practices when assessing patients
with vertigo, and their utilization and perspectives concerning the HINTS
examination. Results: 185 participants responded to
our survey, demographically representative of Canadian EM physicians. The
majority regularly use the HINTS exam in the appropriate setting, but
significant minorities employ the exam inappropriately, such as in patients
without nystagmus, with other neurological findings, or alongside tests for
intermittent vertigo. Misapplication was associated with older age, years of
practice, non-academic practice settings, and less residency training
(p<0.05). The predominant reasons for not using this examination are lack
of confidence in recalling and performing component exam techniques,
particularly the head-impulse test, and doubts about the necessity, safety,
or validity of this examination. Conclusions: HINTS
examination use is limited by lack of provider skill, safety concerns, and
doubts on its validity in excluding stroke when employed by EM
physicians.
P.091 Consensus Guidelines for Utilization and Monitoring of Intravenous
Immunoglobulin for Central Nervous System Disorders in British
Columbia
Authors: Uy CE , Cross HM , Percy J , Schrader D , Carruthers R , Traboulsee A , Beauchamp A , Shih AW , Morrison D , Chapman KM , Beadon K
Published: January 2022

Background: Intravenous immunoglobulin (IVIG) may
benefit many inflammatory central nervous system (CNS) disorders based on
multiple immunomodulatory effects. IVIG is being used in inflammatory CNS
conditions however robust evidence and guidelines are lacking in many
disorders. Over the last 5 years, the percentage of IVIG used for CNS
indications within neurology almost doubled in British Columbia (BC),
Canada. Clear local guidelines may guide rational use.
Methods: Consensus guidelines for IVIG use for
CNS indications were developed by a panel of subspecialty neurologists and
the Provincial Blood Coordinating Office, informed by focused literature
review. Guidelines were structured similarly to existing BC peripheral
nervous system guidelines and Australian Consensus Guidelines. Utilization
and efficacy will be monitored provincewide on an ongoing basis.
Results: Categories of conditions for Possible
Indication (N=11) and Exceptional Circumstance Use (N=4) were created based
on level of evidence for efficacy. Dosing and monitoring recommendations
were made and outcomes measures defined. Rationale for Not Indicated
conditions (N=3) was included. Guidelines will be distributed to BC
neurologists for feedback and re-evaluated after 1 year. Conclusions: IVIG
use in CNS inflammatory conditions has an emerging role. Guidelines for use
and monitoring of outcomes will help improve resource utilization and
provide further evidence regarding effectiveness.
P.095 The many clinical facets of pediatric occipital spikes and the
predictive value of consistent EEG dipole
Authors: Datta AN , Wallbank L , Micallef J , Wong PK
Published: January 2022

Background: Pediatric occipital epileptiform
discharges (OEDS) occur in various clinical settings, including benign and
symptomatic epilepsies. The study objective is to determine electro-clinical
predictors for aetiology and prognosis in children with OEDs.
Methods: 205 patients with OEDs were classified
into seizure groups: symptomatic (n=98), idiopathic focal (IF) (n=57),
idiopathic generalized (IG) (n=18), no-seizures (n=27) and febrile seizures
(n=5). Results: The median age of seizure onset was 3
years (range: 0-19). There was more EEG background slowing (P<0.05) in
the symptomatic; photosensitivity (P<0.0001) and GSW (P<0.0001) in IG;
and presence of consistent EEG spike dipole in IF group. The symptomatic had
more DD (P< 0.0001), autism (P <0.019), and school difficulties
(P<0.001) than the IF and IG groups, but not different from the
no-seizure group. Conclusions: OEDs with consistent
dipole spike is predictive of IF epilepsy. In contrast to frontal and
temporal lobe epilepsy, only 30% with symptomatic epilepsy had
occipital-predominant neuro-imaging abnormalities. Notably,
neuro-psychiatric co-morbidities were similar between the symptomatic and
no-seizure group.
P.107 Response to the Ketogenic Diet in refractory epileptic spasms at BC
Children’s Hospital
Authors: Webb PM , Datta A
Published: January 2022

Background: Epileptic spasms (ES) are a
devastating seizure type with poor neurodevelopmental outcome; 1/3 are
resistant to treatment with first line therapies. Recently attention has
been drawn to the ketogenic diet (KD) as a potentially effective therapy,
though data regarding optimal time of initiation, and its sustained
effectiveness, are lacking. Methods: Retrospective
chart review of all patients with ES treated with KD at BC Children’s
Hospital between 2002 and 2020 (n=28) with comparison of spasm response
based on age of initiation of KD in two groups: < 12 months (n=11) and ≥
12 months (n=17). Results: Comparing the <12
months and ≥ 12 months groups showed: unknown etiology in 9% vs 25%; spasm
freedom for 3 months on KD in 18% vs 41%; median time to spasm freedom was 2
vs 6 weeks; relapse after a period of spasm freedom occurred in 66% vs 70%.
Conclusions: Although more effective in children
≥ 12 months of age in the first 3 months, spasm freedom in either group was
not sustained with KD. KD is recommended as early therapy for refractory ES,
but this study suggests clinicians be aware the KD has limited efficacy in
long-term control of ES and must be used with other therapies.
P.111 Use of rituximab for pediatric central nervous system inflammatory
disorders in Alberta
Authors: Slobodan J , Pecuh I , McCombe J , Morneau-Jacob F , Smyth P , Wilbur C
Published: January 2022

Background: Rituximab is a B-cell-depleting
monoclonal antibody whose off-label use is funded in Alberta by the
Short-Term Exceptional Drug Therapy (STEDT) program. This study describes
the use of rituximab for pediatric central nervous system (CNS) inflammatory
disorders in Alberta. Methods: Rituximab applications
for CNS inflammatory indications in patients < 18 years of age were
identified from the STEDT database between January 1, 2012 – December 31,
2019. Patient information was linked to other provincial datasets, including
the Discharge Abstract Database, Pharmaceutical Information Network, and
provincial laboratory data. Analysis was descriptive.
Results: 51 unique rituximab applications were
identified, of which 50 were approved. New applications increased from one
in 2012 to a high of 12 in 2018. The most common indication was autoimmune
encephalitis (other than anti-NMDA receptor encephalitis; n=20, 39%). Most
children were approved for a two-dose (n=33, 66%) or four-dose (n=16, 32%)
induction regimen. Physician-reported outcomes were available for 24
patients, of whom 14 (58%) were felt to have fully met outcome targets.
Conclusions: The use of rituximab for pediatric
CNS inflammatory disorders has increased, particularly for the indication of
autoimmune encephalitis. This study identified significant heterogeneity in
dosing practices and laboratory monitoring, as well as regional disparities
in use.
P.117 Pediatric acute ischemic stroke protocols
Authors: Gladkikh M , McMillan H , Andrade A , Boelman C , Bhatal I , Mailo J , Mineyko A , Moharir M , Perreault S , Smith J , Pohl D
Published: January 2022

Background: Approximately 1,000 children present
with AIS annually in North America. Most suffer from long-term disability.
Childhood AIS is diagnosed after a median of 23 hours post-symptom onset,
limiting thrombolytic treatment options that may improve outcomes. Pediatric
stroke protocols decrease time to diagnosis. AIS treatment is not uniform
across Canada, nor are pediatric stroke protocols standardized.
Methods: We contacted neurologists at all 16
Canadian pediatric hospitals regarding their AIS management.
Results: Response rate was 100%. Seven centers
have an AIS protocol and two have a protocol under development. Seven
centers do not have a protocol – two redirect patients to adult neurology,
and five use a case-by-case approach for management. Analysis of the seven
AIS protocols reveals differences: 1) IV-tPA dosage: age-dependent 0.75-0.9
mg/kg (n=1) versus age-independent 0.9 mg/kg (n=6), with maximum doses 75 mg
(n=1) or 90 mg (n=6); 2) IV-tPA lower age cut-off: 2 years (n=4) versus 3, 4
or 10 years (n=1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (n=3),
<5 (n=1), or <6 (n=3); 4) Pre-treatment neuroimaging: CT (n=3) versus
MRI (n=4); 5) Intra-arterial tPA use (n=3).
Conclusions: The seven Canadian pediatric AIS
protocols show prominent differences. We plan a teleconference discussing a
Canadian pediatric AIS consensus approach.