bluuebunny/crossref_metadata_2025 huggingface dataset:
P.116 Anatomical fiducials used to quantify localization and registration accuracy in deep brain stimulation
Authors: Abbass M , Gilmore G , Santyr BG , Chalil A , Taha A , Jog M , Parrent A , MacDougall K , Lau JC
Published: June 2023

Background: Studies of deep brain stimulation (DBS) require accurate electrode localization and image registration. We used anatomical fiducials to investigate localization and registration errors in patients who underwent subthalamic nucleus (STN) DBS for Parkinson’s disease (PD). Methods: We conducted a retrospective analysis of patients who underwent bilateral STN DBS for PD. Pre and post operative MRI scans were non-linearly normalized to a standard template (MNI152NLin2009bAsym). Four raters localized DBS electrodes (Lead-DBS), the anterior commissure (AC) and posterior commissure (PC). Errors between rater localizations were calculated (fiducial localization error; FLE). We transformed AC and PC coordinates from template to patient space to calculate the fiducial registration error (FRE)Results: Ninety-nine patients were analyzed, with a median FLE of 0.76mm, 0.74mm, 0.71mm and 0.66mm for the right electrode, left electrode, AC and PC respectively (no significant difference, Wilcoxon sign rank). The median FRE was 1.59mm for AC and 1.21mm for PC, significantly higher than FLE at those coordinates (Wilcoxon sign rank, p<0.001). Conclusions: Raters can accurately localize DBS electrodes, AC and PC from clinical images with sub-millimetric accuracy. Higher FREs at AC and PC suggested registration errors may contribute more than localization errors to electrode uncertainty in a common space.
P.120 Traumatic penetrating head injury by crossbow projectiles: a case report and literature review
Authors: Khayat M , Khayat H , Aljoghaiman M , Alhantoobi M , sommer D , Guha D , Algird A
Published: June 2023

Background: Penetrating head injury secondary to crossbows is a rare encounter in neurosurgical practice with only few cases reported in the literature. Methods: Chart review and literature review. Results: A 31-year-old man with a previous psychiatric history sustained a self-inflicted injury using a crossbow he bought from a department store. The patient arrived neurologically intact. He was not able to verbalize due to jaw fixation with the arrow. The trajectory of the object showed an entry point at the floor of the oral cavity and an exit through the calvarium just off the midline. The oral and nasal cavities, along with the palate and the skull base, and the left frontal lobe were all breached (figure). No vascular injury was identified on imaging (figure). The arrow was surgically removed in the operating room after establishing an elective surgical airway. A planned delayed CSF leak repair was performed. The patient made a substantial recovery and was discharged home in good status. Conclusions: - Multidisciplinary team is key.

Vascular imaging should be done pre and post-intervention.

Surgical approach is determined by the trajectory.

Psychiatric illness and access to weapons are major risk factors.

Elective surgical airway might be indicated.
P.127 Hemodynamic factors of internal carotid artery blister aneurysms: role of the Wall Shear Stress Distribution
Authors: Martin T , El Hage G , Shedid D , Bojanowski MW
Published: June 2023

Background: The pathophysiology of internal carotid artery (ICA) blister aneurysms is poorly understood. Our goal is to investigate the hemodynamic factors contributing to their formation and progression using computational fluid dynamics. Methods: We developed software allowing 3D reconstruction of type I and II blister aneurysms (Bojanowski et al., 2015) from ICA angiography. Kinematic blood flow data was obtained using a finite volume solver. We compared the wall shear stress distribution (WSS) of the healthy arterial wall under various blood pressure conditions. Results: WSS was maximal on the dorsal wall of the supraclinoid segment of the ICA at the distal part of the future site of the aneurysm sac, suggesting that the aneurysm sac initially develops in a retrograde fashion. The WSS gradient (WSSG) was maximal at both the proximal and distal boundaries of the bulging aneurysm. Hypertension exponentially exacerbates the WSS distribution. Very low WSS associated with a high WSSG at the proximal part of the aneurysm sac could explain the extension of the hemorrhage proximal to the forming blister. Conclusions: WSS and its gradient participate in the formation and progression of blister aneurysms of the supraclinoid segment of the ICA. Increasing blood pressure contributes exponentially to the formation of blister aneurysms.
P.133 Women in Canadian neurosurgery: an update
Authors: Veilleux C , Figueroa EL , Samuel N , Yan H , Rosseau G , Hodaie M , Zadeh G , Milot G
Published: June 2023

Background: Women continue to represent a minority of the neurosurgery workforce in Canada. We herein aim to provide an update of the current Canadian landscape to gain a better understanding of the factors contributing to this disparity. Methods: Chain-referral sampling, interviews, personal communications, and online resources were used as data sources. Online survey results obtained from women attending neurosurgeons across Canada were also utilized. Quantitative analyses were performed, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding. Results: We observe a positive trend in the incoming and graduating of female residents across the country, although this trend is lagging compared to other surgical specialties. The proportion of women in active practice remains low. Positive enabling factors for success include supportive colleagues and work environment (52.6%), academic accomplishments (36.8%), and advanced fellowship training (47.4%). Perceived barriers reported included inequalities regarding career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Conclusions: Women continue to represent a small proportion of practicing neurosurgeons across Canada. Our work highlights several key factors contributing to the low representation of women in neurosurgery and identifies actionable items that can be addressed by training programs and institutions.
P.134 Neurosurgery research output in The Association of Southeast Asian Nations (ASEAN) region: a scientometric analysis
Authors: Rosales P , Escuadra C
Published: June 2023

Background: Various challenges and innovations have led to the evolution of neurosurgery in the ASEAN region. This has increased interest among neurosurgeons to publish research papers for the past years. The study aims to compare the publication trend, and topic trend on research in the region using scientometric techniques. Methods: Publications from Web of Science (WoS) using the keywords “neurosurgery” OR “neurological surgery.” were obtained. Results only included English articles published from ASEAN countries. Publication, citation, collaboration, and text-co-occurrence analysis were done using WoS and VOSViewer. Results: 1951 articles published between 1996 to 2022 were analyzed. The ASEAN countries’ productivity are: Singapore (34.07%), Thailand (21.66%), Indonesia (15.25%), Malaysia (14.72%), Philippines (5.99%), Vietnam (5.15%), Cambodia (1.78%), Myanmar (1.16%), Brunei (0.21%). Singapore, Thailand, Malaysia, and Indonesia were the top research collaborators. Publications have clusters of co-occurring keywords: (1) seizure, aneurysm, pain; (2) traumatic brain injury, mortality, functional outcome; (3) technology, application; (4) survey, training; (5) glioblastoma, brain metastases, chemotherapy. Conclusions: Trend in publications support the growing importance of neurosurgery. Variations in publications are attributed to differences in research interest, training, technology and culture between countries. These are relevant to aid in future capacity-building projects, research agendas, policy guidelines, and collaboration between countries, to improve research production.
P.137 Implementation of Canadian driving guidelines following cranial procedures: a systematic review and survey of Canadian neurosurgeons
Authors: Ndongo Sonfack D , MacLean M , Christie S , Bergeron D , Walling S
Published: June 2023

Background: Following craniotomy, there is widespread agreement that post-operative neurological impairments require specialized evaluation to evaluate fitness to drive. However, for patients who had a craniotomy and do not have neurological deficits or known seizures, there is less consensus as to when return to driving is safe. In this study, we aim to review existing guidelines regarding driving post-craniotomy and assess the current practices for post-craniotomy recommendations in Canada. Methods: Our study has three components: 1) systematic review of existing guidelines for return to driving after cranial procedure; 2) review of primary evidence (cohort studies) regarding seizure risk following a craniotomy, depending of the underlying pathology; 3) online questionnaire distributed to Canadian neurosurgeons by the Canadian Neurosurgery Collaborative (CNRC) network. Results: Our systematic review unveiled various sets of guidelines for driving after a craniotomy. For instance, UK Driving and Vehicle Licensing Agency writes into law specific guidelines for return to driving varying based on underlying pathology. Their results were drawn from large cohort studies measuring the occurrence of post-operative seizures after craniotomy for a variety of conditions. The questionnaire is currently being distributed to Canadian neurosurgeons. Conclusions: Our study lays the first steps towards the development of Canadian guidelines for return to driving post-craniotomy.
P.139 Cerebral toxoplasmosis in an HIV-negative patient
Authors: Liu E , Kakodkar P , Toyota P , Pendleton N , Persad A , Zherebitskiy V , Hamula C , Auer RN , Vats K , Hnenny L , Radic J
Published: June 2023

Background: Toxoplasma gondii is a protozoan parasite with the ability to infect any nucleated cell in humans. Most immunocompetent infected individuals are asymptomatic. Latent toxoplasma can become reactivated in immunocompromised individuals though this is exceptionally rare in HIV-negative individuals. Methods: We present the case of a 47-year-old male with chronic immunosuppression secondary to marginal zone lymphoma and steroid therapy. Results: The patient presented to hospital with a 1-week history of word-finding difficulties, intermittent right facial numbness and leg weakness, and tonic-clonic seizures. CT head showed a left temporal heterogenous mass measuring 2.8 × 2.8 × 3.5 cm. Biopsy of the lesion showed Multiple tachyzoites and rare bradyzoites with strong positivity for the toxoplasma specific immunostain. The patient was treated with trimethoprim/sulfamethoxazole which resulted in complete neurologic recovery. Conclusions: Our literature review included 32 cases of cerebral toxoplasmosis in HIV-negative patients with an overall mortality rate of 48%. Cerebral toxoplasmosis has a predilection for immunosuppressed patients with an underlying hematologic malignancy (74%, n= 23). Successful treatment requires early recognition of the disease and prompt treatment with sulfamethoxazole and trimethoprim, pyrimethamine, or sulfadiazine. Patients who recover from acute toxoplasmosis should remain on lifelong suppressive antibiotic therapy to prevent relapse.
P.143 Exploring end-of-life decision making and perspectives on Medical Assistance in Dying through the eyes of individuals living with cervical spinal cord injuries in Nova Scotia
Authors: Leck E , Christie S , Marshall E
Published: June 2023

Background: Individuals with spinal cord injuries (SCI) are invariably faced with decisions around management of their injury; from life prolonging to palliating interventions. End-of-life (EOL) decision-making has recently come to include conversations around Medical Assistance in Dying (MAID), as legislation changes have expanded access. The intersection between SCI and MAID, and other EOL decision-making has yet to be explored. We sought to discuss awareness and perspectives on MAID and EOL decision-making. Methods: We conducted hour-long semi-structured interviews with 15 individuals living with cervical SCI. Interviews took place over the telephone or virtually, and transcripts were analyzed using an iterative coding process and thematic analysis. Results: There was a global lack of awareness of options, that changed with time as participants assumed more independent roles in decision making. Participants possessed general awareness of MAID, but variable understanding of who legislation applies to. The way individuals with SCI could interact with MAID legislation brought forth interesting discussions around bodily autonomy and self-determination. Some voiced their own desire initially for MAID, while others vacillated or were more strongly opposed. Conclusions: This study emphasizes the importance of engaging with difficult conversations, and striking the balance of respecting autonomy and self-determination, within the constraints of each individual’s situation.
P.144 Awake craniotomy in pregnancy: a systematic review
Authors: Kazerouni A , Mofatteh M , Mashayekhi MS , Arfaie S , Bernstein M
Published: June 2023

Background: Awake Craniotomy during pregnancy is a rare but urgent procedure. Since pregnancy can both accelerate the progression of a tumor and mask other diagnoses, cases may lead to premature termination of pregnancy. From a neurosurgical, anesthetic, and obstetrical perspective, these operations may be challenging. Methods: In accordance with the PRISMA guidelines, MEDLINE, Scopus, and Web of Science databases were searched from inception to January 3rd, 2023. Studies were included if they included pregnant patients who underwent awake craniotomy. Results: Nine papers fit the criteria for the final analysis. All investigations were case studies. A total of nine patients were included. Mean age at surgery was 26.9 years, and mean gestational age at craniotomy was 20.9 weeks. Eight (88.9%) patients underwent craniotomy for tumor resection and the other had a pseudoaneurysm repair. Glioma was the most common tumor pathology (n=5), followed by meningioma (n=1), and glioblastoma (n=1). None of the patients experienced significant intraoperative or immediate postoperative complications. There were no obstetrical complications or significant changes in fetal status during or after surgery, and all reported deliveries were successful with healthy infants. Conclusions: Awake craniotomy during pregnancy can be a safe procedure with appropriate pre-operative patient selection and extensive multidisciplinary planning.
P.148 Perceptions of frailty in spinal metastatic disease: international survey of the AO spine community
Authors: MacLean MA , Georgiopoulos M , Charest-Morin R , Germscheid N , Goodwin CR , Weber M
Published: June 2023

Background: Frailty is increasingly recognized for an association with adverse events, mortality, and hospital discharge disposition among surgical patients. The purpose of this study was to describe how spinal surgeons conceptualize, define, and assess frailty in the context of spinal metastatic disease (SMD). Methods: We conducted an international, cross-sectional, 33-question survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to elucidate preoperative surrogate markers of frailty in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. Results: Results were analyzed for 312 respondents (86% completion rate). Study participants represented 71 countries. Most respondents informally assess frailty in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained regarding the association between 14 clinical variables and frailty. Severe comorbidities, systemic disease burden, and poor performance status were most associated with frailty; severe comorbidities included high-risk cardio-pulmonary disease, renal failure, liver failure, and malnutrition. Conclusions: Surgeons recognized frailty is important but commonly evaluate it based on general clinical impression rather than using existing frailty tools. We identified preoperative surrogate markers of frailty perceived as most relevant in this population.
A.2 Corticosteroid management in neuromuscular disease: a Canadian Survey
Authors: Stepanian L , Bacher C , Laughlin RS , Breiner A , Izenberg A , Hodgkinson V , Dyck A , Kassardjian CD
Published: June 2023

Background: Systemic corticosteroids (CS) are first-line therapy for many neuromuscular diseases. Although long-term use is associated with many adverse effects, guidelines regarding prevention and management of CS-induced (CSI) complications in neurology are lacking, introducing potential practice variation. We aimed to evaluate Canadian neuromuscular neurologist practices for screening and management of CSI complications. Methods: A web-based anonymous questionnaire was disseminated to 99 Canadian neuromuscular neurologists addressing the screening, prevention, monitoring and treatment of CSI adverse effects, such as infection and osteoporosis. Results: 71% completed the survey. Of those, 52% perform screening blood work prior to initiating CS, 56.3% screen for infections, and 18.3% for osteoporosis. The majority monitor glycemic control and blood pressure. 28.6% never use pneumocystis jiroveci pneumonia prophylaxis, and 28.6% routinely recommend vaccinations prior to CS initiation (most commonly influenza and pneumococcal). 80.0% recommended calcium supplementation to prevent osteoporosis. 36% were unaware of any existing guidelines for preventing CSI complications, and 91% endorsed a need for neurology-specific guidelines. Additional data and details of responses will be presented. Conclusions: There is substantial variability in the management of CSI adverse effects among neuromuscular neurologists. This suggests a need for neurology-specific guidelines to help standardize practice.
A.4 Apomorphine effects on Parkinson’s disease fluctuation related pain
Authors: Alizadeh P , Achen B , Abusrair A , Amorelli G , Naser K , Cantu Flores K , Bruno V
Published: June 2023

Background: Fluctuation-related pain (worse in OFF periods) is a frequent and disabling symptom in Parkinson’s disease (PD). As evidence-based treatments to treat pain in PD are limited, exploring alternatives to treat it are imperative. Apomorphine is the only antiparkinsonian agent compatible with levodopa in improving PD motor symptoms and is usually well tolerated. We explored the effects of apomorphine in PD fluctuation-related pain. Methods: Small pilot double-blind, placebo controlled, randomized crossover study evaluating the safety and efficacy of subcutaneous apomorphine vs. placebo on fluctuation-related PD pain including participants experiencing pain during OFF periods. Primary outcomes: changes in a Visual Analogue Scale for pain and MDS-UPRDS III from baseline to 30 and 60 minutes after injections (two doses, separated by 60 min) and adverse events. Domperidone was used as premedication to avoid nausea/vomiting. Results: 16 patients were screened and 11 completed the study. All participants tolerated both treatments without significant side effects. Efficacy results remain blinded until the end of February 2023 and will be shown at the conference. Conclusions: Apomorphine, recently approved by Health Canada as an adjunctive therapy in PD patients and experiencing “off” periods, has shown to be safe when used to treat fluctuation-related PD pain. Efficacy outcomes will be soon available.
B.2 Short-term outcome in simultaneous acute code stroke activations in the emergency department
Authors: Sarmiento R , Jeerakathil T , Sheriff A , Wagner A , Taralson C , Moniz N , Opsahl J , Buck B , Shuaib A , Kate M
Published: June 2023

Background: We aim to assess the effect of simultaneous acute code stroke activation(ACSA) in patients undergoing reperfusion therapies in the emergency department on home time at 90 days. Methods: We assessed ACSA over 20 months from the QuICR(Quality Improvement and Clinical Research Alberta Stroke Program) Registry. We defined Simultaneous reperfusion therapy as, ACSA within 60 min of the arrival of any patient receiving intravenous thrombolysis or ACSA within 150 min of the arrival of any patient receiving endovascular thrombectomy (based on the Canadian Triage and Acuity Scale, average local
door-to-needle and door-to-puncture times)Results: A total of 2607 ACSA occurred at a mean±SD of 130.8±17.1 per month during the study period. 545 (20.9%) underwent acute reperfusion therapy with a mean age of 70.6±14.2 years, 45.9%(n=254) were female and a median (IQR) NIHSS of 13(8-18). Simultaneous reperfusion therapies occurred in 189(34.6%). There was no difference in the median door-to-CT time between the simultaneous (16, 11-23 min) and non-simultaneous (15, 11–21 min, p=0.3) activations. There was no difference in the median home time at 90 days between the two groups. Conclusions: Simultaneous ACSA occurs in one-third of patients receiving acute reperfusion therapies. An optimal workflow may help mitigate the clinical and system burden associated with simultaneity.
C.2 SUNFISH parts 1 and 2: 4-year efficacy and safety data of risdiplam in types 2 and 3 spinal muscular atrophy (SMA)
Authors: Mah JK , Oskoui M , Day JW , Deconinck N , Mazzone E , Nascimento A , Saito K , Vuillerot C , Baranello G , Boespflug-Tanguy O , Goemans N , Kirschner J , Kostera-Pruszczyk A , Servais L , Braid J , Gerber M , Gorni K , Martin C , Yeung W , Scalco RS , Mercuri E
Published: June 2023

Background: SMA affects individuals with a broad age range and spectrum of disease severity. Risdiplam (EVRYSDI®) is a centrally and peripherally distributed, oral SMN2 pre-mRNA splicing modifier. Methods: SUNFISH is a multicenter, two-part, randomized, placebo-controlled, double-blind study in patients with Types 2/3 SMA. Part 1 assessed the safety, tolerability and pharmacokinetics/pharmacodynamics of different risdiplam dose levels in patients with Types 2/3 SMA. Part 2 assessed the efficacy and safety of the selected dose of risdiplam versus placebo in Type 2 and non-ambulant Type 3 SMA. In Part 2, participants were treated with risdiplam or placebo for 12 months, then received risdiplam in a blinded manner until month 24. At month 24, patients were offered the opportunity to enter the open-label extension phase. Results: Change from baseline in MFM32 total score (Part 2- primary endpoint) in patients treated with risdiplam versus placebo was met at month 12. These increases in motor function were sustained in the second and third year after risdiplam treatment. Here we present 4-year efficacy and safety data from SUNFISH. Conclusions: SUNFISH is ongoing and will provide further long-term efficacy and safety data of risdiplam in a broad population of individuals with SMA.
C.4 Understanding the role of deep brain stimulation for Refractory Status Dystonicus in children: case series and systematic review
Authors: Vogt LM , Yan H , Santyr B , Ibrahim GM , Gorodetsky C
Published: June 2023

Background: Status dystonicus (SD) is a life-threatening form of dystonia with limited treatments available. We sought to better understand the processes, outcomes, and complications of deep brain stimulation (DBS) for pediatric SD through a systematic review alongside an institutional case series. Methods: Data regarding treatment, stimulation parameters, dystonia severity and outcomes was collected for the case series (n=7) and systematic review (n=70, conducted in accordance with PRISMA guidelines). This was analysed descriptively (rates, outcome measures). For the case series we created probabilistic voxel-wise maps for improvement in dystonia based on brain region stimulated. Results: All patients in our case series and > 95% of patients in the systematic review had resolution of SD with DBS, typically within 2-4 weeks. Most patients in the review (84%) and all patients in the case series had DBS implanted to the globus pallidus internus. In terms of dystonia severity scores, there was a mean improvement of 25% (case series) or 49% (systematic review). Reported mortality was 4% in the systematic review. Conclusions: DBS for pediatric SD is feasible and safe. It allows for increased survival as well as quality of life - however risks still exist. More work is needed to determine timing, eligibility, and stimulation parameters.
D.1 Feasibility and impact of palliative care at any stage of amyotrophic lateral sclerosis
Authors: Zwicker J , Smith I , Rice J , McNeely S , Buenger U , Breiner A , Murphy R , Watt C
Published: June 2023

Background: Although palliative care (PC) is recommended for patients with amyotrophic lateral sclerosis (ALS), many patients receive PC very late or not at all. Our study goals included 1) determing the feasibility of early PC 2) describing patient/caregiver satisfaction with early PC and 3) measuring the impact of early PC on quality of life (QOL) and mood. Methods: Patients followed at the multidisciplinary ALS clinic in Ottawa, Canada and their caregivers were eligible for the study irrespective of duration or severity of disease. All participants completed questionnaires tracking QOL and mood and all were offered a palliative care consultation. Participants completed a satisfaction survey post-PC consultation. Results: 32 patients and 20 caregivers received a PC consultation, conducted virtually. All of them found the consult beneficial and none of the patients reported preferring the consultation later in their illness. The PC consultations were most highly rated by patients with high levels of anxiety and worse bulbar function, and by caregivers of patients with low function. There was no statistically significant change in mood or QOL compared to the 7 participants who declined PC consultation. Conclusions: PC consultations are feasible and beneficial at all stages of illness. Patients with anxiety and bulbar dysfunction may benefit most.
E.4 Hippocampal subfield thickness measurements evaluated using HippUnfold in patients with mild cognitive impairment and Alzheimer’s disease
Authors: Siddique M , Yousif M , Camicioli R , Khan A , Steve T ,   Alzheimer's Disease Neuroimaging Initiative (ADNI)
Published: June 2023

Background: Alzheimer’s disease (AD) is an emerging public health crisis and biomarkers are playing a large role in AD research. Magnetic Resonance Imaging (MRI) holds advantages over existing biomarkers for AD. This project aims to measure subfield thickness throughout the hippocampal long axis using HippUnfold, a novel open-source automated hippocampal segmentation software. Methods: High resolution (0.39×0.39×2mm) Hippocampal MR Images [control, n= 16, mild cognitive impairment (MCI, n =16), and AD, (n = 16)] acquired by the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were analyzed with an automated segmentation software (HippUnfold) to compute thickness measurements. ADNI data such as Positron Emission Tomography (PET) biomarkers, Cerebrospinal Fluid biomarkers, and cognitive scores such as Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer’s Disease Assessment Scale (ADAS13), and Rey Auditory Verbal Learning Test (RAVLT), were correlated to thickness along the hippocampal long axis using linear regression models. Results: We found significant cluster correlations (p < 0.05) throughout the long axis between hippocampal subfield thickness to MoCA scores, ADAS13 scores, PET phosphorylated tau levels, and PET beta-amyloid levels. Conclusions: Subfield atrophy throughout the hippocampal long axis is associated with disease severity (as measured with existing biomarkers and cognitive testing) in patients with MCI and AD.
Estimating Parties’ Policy Positions in Uruguay: Comparing Scaling Methods Based on Legislative Speeches and Roll-Call Votes
Authors: Luján Diego , Schmidt Nicolás , Moraes Juan A.
Published: June 2023

This research note takes advantage of a novel dataset to analyze legislators’ behavior in Uruguay’s Parliament. Comparing the positions of legislators based on floor speeches and roll-call voting, it discusses the relationship between discourse and voting among individual legislators and parties. The dataset contains more than 57,000 speeches from more than 1,000 Uruguayan legislators between 1985 and 2015 and its related R package. The study estimates the parties’ policy positions on the basis of two data sources, roll-call votes and floor speeches, and then compares both results. Contrary to expectations, no clear association appears between the two scaling methods, demonstrating that vote and legislative speech may reflect the behavior of individual legislators with potentially conflicting goals. Strategic calculations or party discipline may be plausible explanations for the divergent results obtained from text and roll-call scaling methods.
Who Is Responsible for the Emergency Aid? Cash Transfer and Presidential Approval During the COVID-19 Pandemic in Brazil
Authors: Batista Pereira Frederico , Russo Guilherme , Nunes Felipe
Published: June 2023

Studies show that cash transfer programs increase incumbent approval through their financial impact and clear association with the executive. But does this effect hold when it is the legislature rather than the incumbent proposing the program? Amid the 2020 COVID-19 pandemic, more than 60 million Brazilians received an emergency assistance payment that was proposed by Congress against resistance from the executive. This study leverages this unique case to examine if cash transfer programs affect presidential approval under circumstances of unclear responsibility. Survey results showed that while approval ratings increased, the public was divided about who was responsible for the program. Moreover, a survey-experiment that informed respondents about the negotiations between the president and Congress found that information improves views about Congress but does not affect presidential approval. The results suggest that even cash transfer programs may promote limited vertical accountability in contexts of unclear policy responsibility.
Bolsonaro and the Black Vote: Racial Voting in Brazil’s 2018 Election
Authors: De Micheli David
Published: June 2023

Two competing narratives characterize the role of race in Brazil’s 2018 election. Journalists observe that Jair Bolsonaro “entranced” nonwhite voters while “insulting them.” Scholars argue that Bolsonaro politicized race, costing him nonwhite support. In contrast, this article argues that racialized patterns of voter behavior were not distinct from those in recent general elections, and that voters’ electoral choices varied within as well as between racial categories. This study incorporates recent findings on racial subjectivity in Brazil, which emphasize the interaction of racial identification and educational status in shaping racial consciousness. Survey data show that racial differences are driven by highly educated black voters, who are least likely to support Bolsonaro compared to educated white voters and more likely to support leftist candidates. By incorporating findings on racial subjectivity into theoretical predictions and leveraging the 2018 election, this study identifies conditions in which racial identification operates to shape electoral behavior.
Lockdowns for Public Health Can Also Reduce Violence
Authors: IJAZ SYEDA SHAHBANO
Published: June 2023

As lockdowns were imposed across the world in the wake of COVID-19, people in conflict-affected states worried that armed groups might try to capitalize on the pandemic and increase attacks. However, a recent APSR article by Brancati, Birnir, and Idlbi suggests that these restrictions on population mobility to address a public health concern had the unintended beneficial effect of reducing violent attacks. They investigate the impact of COVID-19 lockdowns on attacks by armed groups by focusing on the case of the Islamic State of Iraq and Syria (ISIS), an insurgent group, and find that ISIS attacks decreased because of lockdowns, particularly in areas that were heavily populated and areas where ISIS did not have established bases. The authors propose that lockdowns can reduce attacks by groups like ISIS since they reduce the availability of resources and high-value targets while also making it logistically more difficult to carry out attacks.
Want Your New Government to Stick Around? Violent Resistance May Be the Answer
Authors: SABETI ANNTIANA MARAL
Published: June 2023

While some revolutions last, others quickly fall victim to counterrevolution. What leads to these divergent outcomes? The use of violence by rebels during revolutionary upheaval might have a role in preventing future political clapback from the deposed regime as Killian Clarke finds in his recent APSR article on counterrevolutions and their causes.
Exiled Activists Mobilize Online
Authors: TORRES-BELTRAN ANGIE
Published: June 2023

Exile—the banishment of individuals from their home country—is a commonly used form of repression against activists, dissidents, and other political opponents. The aftermath of exile usually limits opposition influence and weakens home-country networks. However, while banishment may keep exiles physically away from home, it does not keep political opponents from promoting their agendas from abroad. In a new article published in the American Political Science Review, authors Jane Esberg and Alexandra A. Siegel demonstrate how exile affects political opponents’ online activism. Their research highlights the importance of digital technologies and social media as an accessible and powerful political tool.
NEW RADIOCARBON DATES FOR THE MIDDLE CHALCOLITHIC PERIOD OF THE CENTRAL ZAGROS, IRAN
Authors: Bahranipoor Hanan
Published: June 2023

As one of the most extensive prehistoric entities of western Iran, Dalma culture belonging to the Zagros Chalcolithic, flourished in vast areas of the Central Zagros and Northwest Region of the country. This culture is defined essentially by its characteristic ceramic assemblages that show a marked uniformity in terms of technology, vessel forms, and painted designs throughout its territory. One of the main issues regarding this culture is its chronology, which was largely based on comparative studies, a few radiocarbon (14C) dates analyzed in the 1960s–1970s, or a few confusing thermoluminescence dates. In this paper, a series of 15 charcoal samples from a recent salvage excavation at Nad Ali Beig, a single-period site dated to Dalma period, is presented that provide the first reliable absolute dates for a part of the Middle Chalcolithic period of the Central Zagros region. Based on these new dates we may suggest that Dalma culture flourished between ca. 5200/5100–4600 BCE. Furthermore, based on these dates it is now possible to determine the order of appearance of different types of the Dalma culture ceramic assemblage, including the Ubaid-related painted buff ceramics.
Human–wildlife conflicts in Patagonia: ranchers’ perceptions of guanacoLama guanicoeabundance
Authors: Flores Celina , Lichtenstein Gabriela , Schiavini Adrián
Published: June 2023

Conflicts between people and wildlife have become widespread as people move to areas previously home to wildlife and as wild populations recover. In Patagonia, one of the main threats to guanacoLama guanicoeconservation is the animosity of sheep ranchers towards the species. As key stakeholders in guanaco conservation we assessed ranchers’ perceptions regarding guanaco abundance in Isla Grande de Tierra del Fuego, Argentina. We contrasted these perceptions with estimated guanaco abundance and explored the socio-ecological factors influencing perceptions and how perceptions of overabundance are rooted in contextual factors rather than actual abundance. We performed semi-structured interviews with ranchers from Isla Grande and estimated guanaco abundance independently using density surface modelling. Ranchers were divided into three categories depending on their perception of guanaco abundance: ‘too many’, ‘many’ and ‘normal’. Those in the ‘many’ and ‘normal’ categories perceived guanaco abundance as being similar to actual abundance, whereas those in the category ‘too many' overestimated guanaco abundance. The perceived issues affecting livestock production varied between categories, although feral dogs emerged as the main problem. Negative perceptions of the guanaco stemmed from ranchers' beliefs that the species reduces forage availability for livestock, and from their disappointment about the government's handling of concerns regarding livestock production. Greater understanding and integration of the human dimension in conservation are needed to design more inclusive and resilient management plans.
Ectoparasites associated with the Bushveld gerbil (Gerbilliscus leucogaster) and the role of the host and habitat in shaping ectoparasite diversity and infestations
Authors: Smith Amber T. , Krasnov Boris R. , Horak Ivan G. , Ueckermann Eddie A. , Matthee Sonja
Published: June 2023

Rodents are known hosts for various ectoparasite taxa such as fleas, lice, ticks and mites. South Africa is recognized for its animal diversity, yet little is published about the parasite diversity associated with wild rodent species. By focusing on a wildlife-human/domestic animal interface, the study aims to record ectoparasite diversity and levels of infestations of the Bushveld gerbil, Gerbilliscus leucogaster, and to establish the relationship between ectoparasite infestation parameters and host- and habitat factors. Rodents (n = 127) were trapped in 2 habitat types (natural and agricultural) during 2014–2020. More than 6500 individuals of 32 epifaunistic species represented by 21 genera and belonging to 5 taxonomic groups (fleas, sucking lice, ticks, mesostigmatan mites and trombiculid mites) were collected. Mesostigmatan mites and lice were the most abundant and fleas and mesostigmatan mites the most prevalent groups. Flea and mesostigmatan mite numbers and mesostigmatan mite species richness was significantly higher on reproductively active male than female rodents. Only ticks were significantly associated with habitat type, with significantly higher tick numbers and more tick species on rodents in the natural compared to the agricultural habitat. We conclude that the level of infestation by ectoparasites closely associated with the host (fleas and mites) was affected by host-associated factors, while infestation by ectoparasite that spend most of their life in the external environment (ticks) was affected by habitat type.
Clinical significance of psychotic-like experiences across U.S. ethnoracial groups
Authors: Lewis-Fernández Roberto , Chen Chih-nan , Olfson Mark , Interian Alejandro , Alegría Margarita
Published: June 2023

Background

Prevalence of psychotic-like experiences (PLEs) – reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder – varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups?

Methods

We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest.

Results

Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0–11.9%) and mean number (0.09 v. 0.11–0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers.

Conclusions

While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.
Best practice considerations on the assessment of robotic assisted surgical systems: results from an international consensus expert panel
Authors: Erskine Jamie , Abrishami Payam , Charter Richard , Cicchetti Americo , Culbertson Richard , Faria Eliney , Hiatt Jo Carol , Khan Jim , Maddern Guy , Patel Anita , Rha Koon Ho , Shah Paresh , Sooriakumaran Prasanna , Tackett Scott , Turchetti Giuseppe , Chalkidou Anastasia
Published: June 2023

Background

Health technology assessments (HTAs) of robotic assisted surgery (RAS) face several challenges in assessing the value of robotic surgical platforms. As a result of using different assessment methods, previous HTAs have reached different conclusions when evaluating RAS. While the number of available systems and surgical procedures is rapidly growing, existing frameworks for assessing MedTech provide a starting point, but specific considerations are needed for HTAs of RAS to ensure consistent results. This work aimed to discuss different approaches and produce guidance on evaluating RAS.

Methods

A consensus conference research methodology was adopted. A panel of 14 experts was assembled with international experience and representing relevant stakeholders: clinicians, health economists, HTA practitioners, policy makers, and industry. A review of previous HTAs was performed and seven key themes were extracted from the literature for consideration. Over five meetings, the panel discussed the key themes and formulated consensus statements.

Results

A total of ninety-eight previous HTAs were identified from twenty-five total countries. The seven key themes were evidence inclusion and exclusion, patient- and clinician-reported outcomes, the learning curve, allocation of costs, appropriate time horizons, economic analysis methods, and robotic ecosystem/wider benefits.

Conclusions

Robotic surgical platforms are tools, not therapies. Their value varies according to context and should be considered across therapeutic areas and stakeholders. The principles set out in this paper should help HTA bodies at all levels to evaluate RAS. This work may serve as a case study for rapidly developing areas in MedTech that require particular consideration for HTAs.
Capturing the whole-school food environment in primary schools
Authors: Moore Sarah E , Brennan Sarah F , Lavelle Fiona , Dean Moira , McKinley Michelle C , Olgacher Dilara , McCole Patrick , Hunter Ruth F , Dunne Laura , O’Connell Niamh E , Elliott Chris T , McCarthy Danielle , Woodside Jayne V
Published: June 2023

Objective:

The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations.

Design:

SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion.

Setting:

Primary schools.

Participants:

An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16).

Results:

The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %).

Conclusions:

The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.
The Effectiveness of Remote Psychological Support During the Italian COVID-19 Lockdown
Authors: Scimeca Giuseppe
Published: June 2023

Abstract. The aim of the present study was to address the psychopathological impact of the interruption of traditional mental care during the COVID-19 lockdown on a group of public psychology service (PPS) users. For this purpose, a sample of 17 individuals requesting psychotherapeutic treatment within an Italian PPS was selected. Symptoms of psychopathologies were measured before and after the lockdown period. The investigation explored the effects of remote support, and the possible influence of adverse childhood experiences, dissociation, somatoform symptoms, and maladaptive personality traits. The results of this study showed that patients who continued with their psychological treatment by means of remote technological supports, resumed their in-person sessions showing a significant reduction of global psychopathological symptoms, anxiety, and phobic anxiety. The results also suggest that dissociative tendencies and maladaptive personality traits prevented symptomatic improvement. Finally, it was found that symptomatic improvement was favored by an absence of subjective distress during the lockdown. Implications for public services are discussed.