bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency Ablation for Benign Thyroid Nodules: 1‐Year Follow‐Up in 184 Patients
Authors: Vuong Nguyen Lam , Dinh Le Quang , Bang Ho Tat , Thuy Tran Thi Mai , Bac Nguyen Hoang , Vy Tran Thanh
Published: June 2019

Background

Benign thyroid nodules are common, and must be treated when symptomatic. Non‐surgical minimally invasive modalities, including radiofrequency ablation (RFA), have been widely used with good results. The factors related to the efficacy of RFA are still debated. This study was to evaluate the safety, efficacy and related factors of RFA in the treatment of benign thyroid nodules.

Methods

A retrospective single‐center study was conducted on 251 benign thyroid nodules in 184 patients treated with RFA. The procedure was performed under ultrasound (US) guidance using the trans‐isthmic approach and the moving‐shot technique. Clinical and US examinations were performed at 1, 3, 6, 12 months, and then at 6 month intervals. Study outcomes were volume reduction ratio (VRR) and complications.

Results

There were 153 women and 31 men included in the study. The mean age was 43.9 years. The median initial largest diameter and volume of nodules were 30 mm and 6.18 ml. The median length of follow‐up was 12 months. Two minor complications were found. The mean VRR was 66.8; 74.3; and 81% after 3, 6, and 12 months, respectively. Initial solidity was a factor related to the efficacy: cystic nodules had higher VRR compared to solid ones.

Conclusions

RFA is safe, effective and can be used as a routine treatment for benign thyroid nodules. More prospective multicenter studies with long‐term follow‐up are required to improve the safety and efficacy of RFA.
Training wheels needed: Lessons in professionalism from a liberal deferral policy
Authors: Daniel Michelle , Gay Tamara , Mangrulkar Rajesh , Ross Paula , Weir Sara , Hogikyan Emily , Thompson Owen , Santen Sally
Published: June 2019

Learning to self-regulate is an important aspect of professionalism. Thus, in 2015–16, the University of Michigan implemented a learner-centred ‘deferral’ policy called ‘trust and track’ in the preclinical phase. This gave students the autonomy to decide whether to attend required experiences, take quizzes and exams on schedule, or submit assignments on time. Surprisingly, quiz and exam deferrals remained relatively stable, but required experience deferrals more than doubled. While late assignments were not specifically tracked, there were multiple reports of assignments being months overdue. Some reasons for deferrals exhibited questionable judgement. Behavioural patterns carried forward, with an unusual spike in deferrals of licensure exams and requests for time off in the clinical phase. Wellness indices did not improve, despite learners having more autonomy and flexibility. It became clear to us that novice learners need clear professional expectations with limits to assist in developing professional behaviours. In 2016–17, we implemented a stricter policy that set clear expectations, established limits, and provided guidance on acceptable reasons to defer. We simultaneously implemented other measures to promote wellness. The moral of the story is that ‘training wheels’ are needed to help early learners develop the professional behaviours expected of practising physicians.
The role of acetylcholinesterase inhibitors such as neostigmine and rivastigmine on chronic pain and cognitive function in aging: A review of recent clinical applications
Authors: Eldufani Jabril , Blaise Gilbert
Published: June 2019

Chronic pain in patients with Alzheimer's disease or dementia is a complex issue in the medical field; these patients suffer from the common causes of chronic pain, especially in geriatric medicine. To ensure the correct type and level of given treatment, medical care should be taken to avoid the contribution of chronic pain and cognitive impairment in the elderly population. Acetylcholinesterase inhibitors (AChE‐Is) have been proven as an efficient therapeutic resource for significant improvement in dementia of Alzheimer's disease and chronic pain due to the fact that cholinergic deficit is considered as an early finding in cognitive impairment and persisting pain. Some AChE‐Is are investigated here in terms of treatment of dementia and chronic pain management. Neostigmine has been used as an adjunct analgesic in the postoperative period and in combination with other analgesic medications in an intrathecal approach. Rivastigmine has, over the past ten years, become the approved agent for the management of dementia of mild to moderate Alzheimer's disease and has gained approval for treating different types of non‐Alzheimer's dementia. In this review, we will focus on the two types of AChE‐Is (rivastigmine and neostigmine) in the development of their clinical use and their respective mechanisms of actions on improving cognitive function and managing chronic pain.
P.003 Differences between younger and older dementia patients at a rural and remote memory clinic
Authors: Wong J , Kirk A , Perlett L , Karunanayake C , Morgan D , O’Connell ME
Published: June 2019

Background: Young-onset dementia (YOD) patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients. Methods: A total of 333 consecutive patients (YOD=61, LOD=272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour, and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests. Results: YOD patients were more likely to be married, employed, current smokers, and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Conclusions: Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress, and barriers to services.
P.010 Efficacy, safety, and tolerability of ubrogepant for the acute treatment of migraine: a single-attack phase 3 study, ACHIEVE II
Authors: Lipton RB , Dodick DW , Ailani J , Lu K , Lakkis H , Finnegan M , Szegedi A , Trugman JM , Davidovic G
Published: June 2019

Background: To evaluate efficacy, safety, and tolerability of ubrogepant for acute treatment of migraine attacks. Methods: Multicenter, double-blind, phase 3 study (NCT02867709). Randomized patients (1:1:1, placebo or ubrogepant 25mg or 50mg) had 60 days to treat one migraine attack (moderate/severe pain intensity). Co-primary efficacy endpoints (2 hours post initial dose): headache pain freedom and absence of most bothersome migraine-associated symptom (MBS). Secondary endpoints: pain relief, sustained pain relief, sustained pain freedom, and absence of migraine-associated symptoms. Results: 1686 patients were randomized (safety population: n=1465; mITT population: n=1355). Mean age: 41 years; white: 81%; female: 89%. Significantly greater proportions of ubrogepant- than placebo-treated patients achieved 2-hour pain freedom (placebo: 14.3%; 25mg: 20.7%, adjusted P=0.0285; 50mg: 21.8%, adjusted P=0.0129) and absence of MBS for 50mg (placebo: 27.4%; 50mg: 38.9%, adjusted P=0.0129). Secondary endpoints (except absence of nausea at 2h) met statistical significance versus placebo for ubrogepant 50mg. Absence of MBS and secondary outcomes were not significant for 25mg after multiplicity adjustment. Ubrogepant’s and placebo’s AE profiles were similar. Conclusions: Co-primary endpoints were met for ubrogepant 50mg. Ubrogepant 25mg was significantly superior to placebo for 2h pain freedom. Ubrogepant was well tolerated. Results support the efficacy, tolerability, and safety of ubrogepant for acute treatment of migraine attacks.
P.020 Avelumab in newly diagnosed glioblastoma multiforme-the SEJ study
Authors: Jacques FH , Nicholas G , Lorimer I , Foko V Sikati , Prevost J
Published: June 2019

Background: Glioblastoma Multiforme (GBM) has well documented systemic and local immunosuppressive mechanisms to escape immune surveillance and grow. GBM tumor cells as well as the microglia within it have a high incidence of PD-L1 surface expression which makes it more susceptible to anti-PD-L1 antagonism and ADCC through avelumab therapy. Methods: This is a single center, phase 2, open label, add-on, single dose study of 156 weeks duration in patients receiving standard therapy for newly diagnosed GBM. In total 30 patients will be entered into the study within 3 weeks of finishing their last day of combined radiotherapy/temozolomide. The following are the results of the first interim analysis completed when the first eight patients completed 52 weeks or an end of study visit. Results: 24 patients have so far started therapy. There as been no unexpected treatment emergent adverse event (TEAE). Two patients transiently withheld therapy because of immune related TEAE’s and none permanently. The objective response rate at week 52 for the first eight patients was 50% with 2 (25%) having a complete response and 1 (12.5%) a partial response. Conclusions: These preliminary results suggest that the addition of avelumab to standard therapy in patients with GBM is safe. Efficacy trends look promising.
P.023 Eculizumab shows consistent improvements across muscle groups in patients with AChR antibody-positive refractory myasthenia gravis
Authors: Larue S , Mantegazza R , Fujita KP , O’Brien F , Howard JF
Published: June 2019

Background: The physician-reported Quantitative Myasthenia Gravis (QMG) test was a key efficacy measure in REGAIN, a 26-week, phase 3, placebo-controlled study of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalized MG. Ocular and generalized weakness have shown variable responses to therapies including prednisone and intravenous immunoglobulin/plasma exchange. Using the patient-reported MG Activities of Daily Living (MG-ADL) scale during REGAIN, eculizumab showed a consistent trend toward rapid and sustained improvement across bulbar, respiratory, limb and ocular domains. We analyzed the effect of eculizumab on bulbar, respiratory, gross motor and ocular domains during REGAIN, using the QMG test. Methods: QMG domain score changes to REGAIN week 26 were determined for patients with abnormal baseline scores. Repeated-measures analyses were performed for bulbar (swallowing/speech), respiratory (forced vital capacity), gross motor (limb/axial motor items) and ocular (ocular/facial muscles) domains. Results: Eculizumab-treated patients showed improvements in all four QMG domain scores to week 26. Rapid, sustained improvements were demonstrated across all domains, with a trend toward significant differences between eculizumab and placebo (bulbar, p=0.0628; respiratory, p=0.0682; gross motor, p=0.0114; ocular, p=0.0017). The eculizumab safety profile was consistent with previous reports. Conclusions: Eculizumab demonstrated a consistent response across all QMG muscle domains. This aligns with previously reported MG-ADL findings with eculizumab. (NCT01997229).
P.026 Response to eculizumab in patients with myasthenia gravis recently treated with chronic intravenous immunoglobulin
Authors: Genge A , Jacob S , Murai H , Utsugisawa K , Nowak RJ , Wiendl H , Fujita KP , O’Brien F , Howard JF
Published: June 2019

Background: Chronic intravenous immunoglobulin (IVIg) is used to treat refractory myasthenia gravis (MG). This subgroup analysis evaluated response to eculizumab in patients receiving chronic IVIg before entry to REGAIN, a phase 3, randomized, double-blind, placebo-controlled study of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalized MG. Methods: IVIg was only permitted during REGAIN as rescue therapy; previously treated patients underwent a 4-week washout before randomization. Patients included in this analysis had received chronic IVIg ≥4 times in 1 year, with ≥1 dose within 6 months before REGAIN entry. Exacerbations and MG status changes were assessed. Results: Eighteen patients were evaluated; four experienced exacerbations (eculizumab-treated, 1/9; placebo-treated, 3/9). Clinically relevant improvements were larger with eculizumab than placebo, respectively (mean change, standard deviation [SD]: MG Activities of Daily Living score [MG-ADL], -5.3 [4.0] vs -2.1 [2.8]; Quantitative MG score [QMG], -4.1 [6.1] vs -1.3 [3.5]). More patients receiving eculizumab (7/9) had clinically meaningful responses (MG-ADL ≥3 and/or QMG ≥5 points) than those receiving placebo (3/9). Eculizumab safety was consistent with previous reports. Interim data from the open-label extension of REGAIN will be presented. Conclusions: In patients previously receiving chronic IVIg, eculizumab showed a trend toward meaningful clinical improvements and fewer exacerbations compared with placebo. (NCT01997229, NCT02301624).
P.027 Incidence of amyotrophic lateral sclerosis in Newfoundland and Labrador
Authors: Aminian KS , Whelan G , Murphy D , Stefanelli M
Published: June 2019

Background: There is a paucity of research regarding ALS epidemiology in Canada. Previously published data from Newfoundland and Labrador (NL) demonstrate an average incidence of 2.4/100,000 from 2000-2004 (peak 3.3 in 2001, the highest reported in Canada). Local neurologists believe that the incidence has continued to increase. Methods: Clinicians affiliated with the electromyography (EMG) lab at the Health Sciences Centre in St. John’s compiled a list of patients diagnosed with ALS from 2012-2016, based on recall. Their medical records were reviewed and demographic information collected. This was cross-referenced with new referrals to the ALS Society NL per year. Results: Based on new referrals to ALS Society NL the average incidence between 2012-2016 was 2.81/100,000 (peak 3.6 in 2015). Average age-adjusted incidence from the EMG lab was 1.33 (peak 1.73 in 2016). The EMG lab documented a crude incidence of 3.97 in 2018. Conclusions: The incidence of ALS in NL is increased compared to the usual incidence of 1-2/100,000 per year. After the preliminary study, the EMG lab maintained more thorough records and an incidence of 3.97/100,000 was found in 2018. This makes a compelling argument for future research which could explore potential genetic or environmental causes for the increased incidence in this population.
P.036 Stroke in people with Down Syndrome: a retrospective study
Authors: Cieuta-Walti C , Mircher C , Marey I , Toulas J , Walti H , Conte M , Rebillat A , Ravel A
Published: June 2019

Background: There are only few studies approaching the prevalence and cause of stroke in children and adults with Down Syndrome (DS). Methods: We did a retrospective study of our cohort of 4962 patients of Jerome Lejeune Institute since 2007. We collected age of stroke, clinical presentation, cause (TOAST classification), treatment and clinical course. Results: We identified 20 patients from 6 to 56 years old .In all cases, it was a stroke of ischemic origin.: 8 children with a prevalence of 0.33%. 4 had a cardio-embolic origin, 3 secondary to Moya-Moya syndrome and one of undetermined origin. 12 adults (21 to 52 years old) with a prevalence of 0.46%.The majority of the causes of these ischemic strokes are indeterminate (9 of 12), Conclusions: We found a low prevalence and an ischemic cause in all cases of stroke, which differs from the general population. For pediatric stroke, the causes are expected thromboembolic in a context of heart disease most often or secondary to a Moya-Moya syndrome. For adult strokes, the average age is younger than that in the general population and the cause is indeterminate in most cases. We must better explore our patients to identify the risk factors in DS population.
P.045 Use of sodium bicarbonate to alkalinize the urine in pediatric patients treated with Topiramate (pilot study)
Authors: Sidhu M , Tharmaradinam S , Meaney B , Belostotsky V
Published: June 2019

Background: Topiramate is an antiepileptic frequently used in pediatrics with multiple mechanisms of action. This includes carbonic anhydrase inhibition, which has unclear relevance to its antiepileptic effect. Metabolic acidosis, hypocitraturia and nephrolithiasis are known side-effects of carbonic anhydrase inhibition and can limit therapeutic effect. Alkali therapy may normalize acidosis, increase urinary citrate, and reduce nephrolithiasis risk. We hypothesize that provision of sodium bicarbonate supplementation to patients with topiramate-induced acidosis will mitigate these side-effects without worsening seizure frequency or severity. Methods: Pediatric patients on antiepileptic therapy with topiramate are being recruited from outpatient pediatric neurology clinics at McMaster Children’s Hospital. We aim to recruit 20 patients with metabolic acidosis and 20 control patients. Measures include blood gas, electrolytes, urine electrolytes and citrate. Patients with metabolic acidosis will be given daily sodium bicarbonate for one month, followed by repeat bloodwork. Seizure frequency will be prospectively documented in all participants throughout the three-month period. Results: Recruitment is ongoing, and three patients (1 with acidosis) have been recruited thus far. Results will be analyzed with chi-squared and paired T tests. Conclusions: This pilot study is the first to evaluate the safety and efficacy of sodium bicarbonate supplementation in patients receiving topiramate for seizure control.
P.056 Combined conventional and amplitude-integrated EEG monitoring in neonates: a prospective study
Authors: Buttle SG , Lemyre B , Sell E , Redpath S , Bulusu S , Webster R , Pohl D
Published: June 2019

Background: Seizure monitoring via amplitude-integrated EEG (aEEG) is standard of care in many NICUs; however, conventional EEG (cEEG) is the gold standard for seizure detection. We compared the diagnostic yield of aEEG interpreted at the bedside, aEEG interpreted by an expert, and cEEG. Methods: Neonates received aEEG and cEEG in parallel. Clinical events and aEEG were interpreted at bedside and subsequently independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside aEEG as compared to expert aEEG interpretation and cEEG were evaluated. Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside aEEG analysis. None of the bedside aEEG events were confirmed as seizures on cEEG. Expert aEEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection (not adjusting for patient differences), and a sensitivity of 50% with 46% specificity for detecting patients with seizures. Conclusions: Real-world bedside aEEG monitoring failed to detect seizures evidenced via cEEG, while misclassifying other events as seizures. Even post-hoc expert aEEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside aEEG interpretation, combined monitoring may provide limited clinical benefit.
P.065 AVXS-101 gene-replacement therapy (GRT)) in presymptomatic spinal muscular atrophy (SMA): study update
Authors: Schultz M , Swoboda K , Farrar M , McMillan H , Parsons J , Farrow M , Ogrinc FG , Feltner DE , McGill BE , Spector SA , L’Italien J , Sproule DM , Strauss KA
Published: June 2019

Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of SMN1. Copies of a similar gene (SMN2) modify disease severity. In a phase 1 study, SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of symptomatic SMA patients with two SMN2 copies (2xSMN2) dosed ≤6 months. Because motor neuron loss can be insidious and disease progression is rapid, early intervention is critical. This study evaluates AVXS-101 in presymptomatic SMA newborns. Methods: SPR1NT is a multicenter, open-label, phase 3 study enrolling ≥27 SMA patients with 2–3xSMN2. Asymptomatic infants ≤6 weeks receive a one-time intravenous AVXS-101 infusion (1.1x1014 vg/kg). Safety and efficacy are assessed through study end (18 [2xSMN2] or 24 months [3xSMN2]). Primary outcomes: independent sitting for ≥30 seconds (18 months [2xSMN2]) or assisted standing (24 months [3xSMN2]). Results: From April–September 2018, 7 infants received AVXS-101 (4 female; 6 with 2xSMN2) at ages 8–37 days. Mean baseline CHOP-INTEND score was 41.7 (n=6), which increased by 6.8, 11.0, 18.0, and 22.5 points at day 14 (n=4), month 1 (n=3), 2 (n=3), and 3 (n=2). Updated data available at the time of the congress will be presented. Conclusions: Preliminary data from SPR1NT show rapid motor function improvements in presymptomatic SMA patients.
P.074 Infantile idiopathic intracranial hypertension - a case study and review of the literature
Authors: Boles S , Tibussek D , Pohl D
Published: June 2019

Background: Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is an increase in intracranial pressure due to unknown etiology. Presentation in infancy is extremely rare. Little is known about infantile IIH and age-specific treatment guidelines are lacking. Methods: Patient data was obtained from medical records at the Children’s Hospital of Eastern Ontario. A literature review of infantile IIH was performed. Results: A previously healthy 9-month-old boy presented with irritability, decreased appetite, and a bulging fontanelle. CT head imaging and cerebrospinal fluid studies revealed normal results. Symptoms transiently resolved after a lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cm H2O and led to a diagnosis of IIH in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/day was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide was increased to 38 mg/kg/day, with no further relapses to date. Conclusions: A diagnosis of IIH is challenging in infants, since the patients cannot yet verbalize typical IIH-related symptoms, and papilledema is difficult to assess. If undetected and untreated, IIH may result in permanent visual deficits.
P.090 A case of delayed uncal herniation secondary to external hydrocephalus post intraventricular surgery
Authors: Ellenbogen Y , Yang K , Lu J , Reddy K
Published: June 2019

Background: Central neurocytoma’s are typically located in the lateral ventricles and are optimally treated with surgical resection. Surgical entry into the ventricles are associated with a number of complications, including subdural hygroma and shunt-dependent hydrocephalus. Methods: We report a patient who developed acute bilateral uncal herniation from progessively enlarging subdural hygromas following intraventricular tumour resection. Results: A 60-year-old female underwent minimally invasive transcortical transventricular resection of an intraventricular CN. The patient’s postoperative course was complicated by repeated presentations to the emergency department due to persistent and intractable nausea and headaches, without focal neurological deficits. Imaging demonstrated small bilateral subdural hygromas. The patient eventually presented with acute deterioration in her level of consciousness with clinical and radiologic evidence of bilateral uncal herniation, requiring urgent insertion of a subdural drain to treat elevated intracranial pressure (ICP). After insertion of a ventriculoperitoneal shunt, the patient was discharged in stable condition and is currently followed by the multi-disciplinary neuro-oncology team. Conclusions: Bilateral subdural hygroma could mask underlying external hydrocephalus post transventricular surgeries. Patients who are symptomatic from bilateral subdural hygromas after transventricular resection of tumors should be carefully monitored for radiographic or clinical progression, in order to avoid acute deterioration caused by elevated ICP.
P.093 Visual outcomes after expanded endoscopic endonasal resection of suprasellar meningiomas and optic nerve decompression
Authors: Yang K , Ellenbogen Y , Kim J , Rodriguez A , Sommer D , Reddy K
Published: June 2019

Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p<0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p<0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p<0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.
P.096 Practice patterns in the management of residual/recurrent non-functioning pituitary adenomas: results from a Canada-wide survey
Authors: Samuel N , Kasper G , Khan OH
Published: June 2019

Background: Postoperative follow-up of non-functioning pituitary adenomas (NFAs) occasionally detects residual or recurrent disease. Subsequent treatment options range from continued follow-up, to re-resection or radiotherapy. To better understand current practice patterns on this topic, we surveyed neurosurgeons and radiation oncologists in Canada. Methods: Skull-base neurosurgeons and radiation oncologists across Canada were invited to complete a 25-item online questionnaire. Summary statistics were computed and 2-tailed t-tests were performed to assess significance. Results: 33 participants returned completed questionnaires: neurosurgeons (n=20, 61%) and radiation oncologists (ROs; n=13, 39%). When treating giant (>3cm) tumours, 92% of neurosurgeons in practice for less than 15 years use an endoscopic approach, as compared to only 57% of neurosurgeons in practice for 15 years or more. Additionally, younger neurosurgeons have a greater tendency to advocate for stereotactic radiosurgery (SRS) or re-resection (54% and 38%, respectively), as compared to older surgeons who show a higher propensity (29%) to advocate for observation. The presence of cavernous sinus extension appears to encourage neurosurgeons (40%) to offer radiotherapy sooner, as compared to 62% of ROs. Conclusions: Our results identify both variations and commonalities in practice amongst Canadian neurosurgeons. Approaches deviate in the setting of residual tumors based on years of practice.
P.131 Does a multidisciplinary triage pathway facilitate better outcomes after spine surgery?
Authors: Wu A , Fourney D , Liu L
Published: June 2019

Background: The Saskatchewan Spine Pathway (SSP) facilitates timelier imaging and more appropriate surgical referrals. In this prospective study, pre- and post-operative wait times, satisfaction, and outcomes were compared between SSP and conventionally referred surgical patients. Methods: A prospective matched cohort comparison of 150 patients (SSP group n=75; conventional group n=75) undergoing elective lumbar surgery for mechanical back and leg pain between 2011 and 2016 was performed with 1 year follow-up. Outcomes were measured with patient questionnaires, Oswestry disability index (ODI), visual analogue back and leg pain scores (VAS), and EuroQol Group 5 –Dimension self-report (EQ5D). Results: Baseline measures were the same in both groups. Wait times to see the surgeon and for surgery were the same, and wait time for MRI was significantly shorter for the SSP group (p<0.001). SSP patients utilized more non-operative treatment strategies such as physiotherapy (p<0.04), and had higher satisfaction with pre-surgical care (p=0.03). Good surgical outcomes were obtained in both groups with no significant differences. Conclusions: There are minimal differences in post-surgical outcomes for SSP patients versus conventionally referred patients; however, the SSP facilitates significantly shorter wait times for MRI and non-operative treatment strategies. Pre-surgical patient satisfaction is significantly higher among SSP patients.
A.02 Serum biomarkers of MS disease activity in patients treated with bone marrow transplant
Authors: Thebault S , Lee H , Tessier D , Bowman M , Bar-Or A , Arnold D , Atkins H , Freedman M
Published: June 2019

Background: There is an unmet need for blood-based biomarkers that can reliably detect MS disease activity. Serum Biomarkers of interest includ Neurofilament-light-chain (NfL), Glial-fibrillary-strocyte-protein(GFAP) and Tau. Bone Marrow Transplantation (BMT) is reserved for aggressive forms of MS and has been shown to halt detectable CNS inflammatory activity for prolonged periods. Significant pre-treatment tissue damage at followed by inflammatory disease abeyance should be reflected longitudinal sera collected from these patients. Methods: Sera were collected from 23 MS patients pre-treatment, and following BMT at 3, 6, 9 and 12-months in addition from 33 non-inflammatory neurological controls. Biomarker quantification was performed with SiMoA. Results: Pre-AHSCT levels of serum NfL and GFAP but not Tau were elevated compared to controls (p=0.0001), and NfL correlated with lesion-based disease activity (6-month-relapse, MRI-T2 and Gadolinium-enhancement). 3-months post-treatment, while NfL levels remained elevated, Tau/GFAP paradoxically increased (p=0.0023/0.0017). These increases at 3m correlated with MRI ‘pseudoatrophy’ at 6-months. NfL/Tau levels dropped to that of controls by 6-months (p=0.0036/0.0159). GFAP levels dropped progressively after 6-months although even at 12-months remained higher than controls (p=0.004). Conclusions: NfL was the closest correlate of MS disease activity and treatment response. Chemotherapy-related toxicity may account for transient increases in NfL, Tau and MRI brain atrophy post-BMT.
B.05 The importance of mental health in improving quality of life in transition-aged patients with epilepsy
Authors: Mabilangan KC , Healy S , Fantaneanu T , Whiting S
Published: June 2019

Background: Growing evidence has that a suggested that mental health strongly influences quality of life (QoL) in adolescents with epilepsy. In addition, research has suggested that these mental health issues are associated with increased seizure burden and worsened health outcomes. Despite this, and the elevated rate of mental health issues in this population, seizure control tends to be the dominant or sole concern for treating physicians. Methods: In order to look at potential predictors of QoL in adolescents we looked at seizure related data, demographic variables, and comorbid conditions in 70 adolescents with epilepsy aged 14 to 18 (M= 16.3l; 37 males, 33 females) enrolled into an epilepsy transition clinic. Results: Regression analysis found that mental health remained a significant and independent predictor of QoL even when other significant seizure related variables were accounted for (t(58)= -3.44, p= .001). Furthermore, when looking at the individual subscales of patient QoL (e.g., memory, social support, stigma), mental health was consistently found to be the strongest correlate. Conclusions: These results demonstrate that in order to ensure the best outcomes for transition-aged adolescents with epilepsy, it is important to not only manage and treat seizures, but also to assess and treat mental health issues.
Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program
Authors: Asundi Archana , Stanislawski Maggie , Mehta Payal , Baron Anna E. , Mull Hillary J. , Ho P. Michael , Zimetbaum Peter J. , Gupta Kalpana , Branch-Elliman Westyn
Published: June 2019

Objective:

To measure the association between receipt of specific infection prevention interventions and procedure-related cardiac implantable electronic device (CIED) infections.

Design:

Retrospective cohort with manually reviewed infection status.

Setting:

Setting: National, multicenter Veterans Health Administration (VA) cohort.

Participants:

Sampling of procedures entered into the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP) database from fiscal years 2008 through 2015.

Methods:

A sample of procedures entered into the CART-EP database underwent manual review for occurrence of CIED infection and other clinical/procedural variables. The primary outcome was 6-month incidence of CIED infection. Measures of association were calculated using multivariable generalized estimating equations logistic regression.

Results:

We identified 101 procedure-related CIED infections among 2,098 procedures (4.8% of reviewed sample). Factors associated with increased odds of infections included (1) wound complications (adjusted odds ratio [aOR], 8.74; 95% confidence interval [CI], 3.16–24.20), (2) revisions including generator changes (aOR, 2.4; 95% CI, 1.59–3.63), (3) an elevated international normalized ratio (INR) >1.5 (aOR, 1.56; 95% CI, 1.12–2.18), and (4) methicillin-resistant Staphylococcus colonization (aOR, 9.56; 95% CI, 1.55–27.77). Clinically effective prevention interventions included preprocedural skin cleaning with chlorhexidine versus other topical agents (aOR, 0.41; 95% CI, 0.22–0.76) and receipt of β-lactam antimicrobial prophylaxis versus vancomycin (aOR, 0.60; 95% CI, 0.37–0.96). The use of mesh pockets and continuation of antimicrobial prophylaxis after skin closure were not associated with reduced infection risk.

Conclusions:

These findings regarding the real-world clinical effectiveness of different prevention strategies can be applied to the development of evidence-based protocols and infection prevention guidelines specific to the electrophysiology laboratory.
A Grammatical Contrast and its Signals in Mandarin Chinese and in English
Authors: Shen Yao
Published: June 2019

Let us consider two lists of Chinese words in Mandarin Chinese, the spoken National language. (In this article the writer is also the informant). According to their syntactic functions, we shall call the words in one of these lists “nouns”, and those in the other list “verbs”.

Examples of nouns are: gou ‘dogs’; ji ‘chickens’; wudz ‘rooms’; tsai ‘vegetables, dishes (of food)’ Examples of verbs are: jiau ‘bark, call’; chr ‘eat’; hei ‘dark, are dark’; tian ‘sweet, are sweet’. In Chinese, there are sentences consisting of a noun followed by a verb. We shall call the formula for such sentences S = N V. Examples are: gou jiau ‘Dogs bark.’; ji chr ‘Chickens eat.’; wudz hei ‘Rooms are dark.’; tsai tian ‘Vegetable are sweet; dishes (of food) are sweet.’. There are also parts of sentences in Chinese consisting of a verb followed by a noun. We shall call the formula for such “verb noun” sentence parts V N. Examples are: jiau gou ‘call dogs’; chr ji ‘eat chickens; hei wudz ‘darkrooms’; tian tsai ‘desserts’.
The Second Round in Dialectology or North American English
Authors: McDavid Raven I.
Published: June 2019

May I begin by stating an advance disclaimer of any intent on my part to disparage the work of any preceding scholar, North American or otherwise, or to assert that the problems I am examining are in any way peculiar to this continent. If most of my examples are chosen from the English of the Western hemisphere, and particularly from the United States, the choice simply reflects my own inexperience. Reared in another culture, one might have cited analogous examples from Northern Chinese, Russian, Hindi, Indonesian, Burmese, or Arabic. In fact, Kloeke and Leopold respectively — to cite random examples — have commented on the social forces operating to produce present-day Afrikaans and mid-century West German; and the debates over the shape of standard Norwegian and standard Czech are matters of historical record, along with the milder discussions of the nature of standard Canadian English.
Le Mot “Sauvage” en franco-canadien
Authors: Dulong Gaston
Published: June 2019

Le mot sauvage est d’un emploi très fréquent dans la langue parlée ou écrite des francophones du Canada. Il s’agit là d’un phénomène déjà ancien et d’autant moins surprenant que, dès les débuts de la Nouvelle-France, aujourd’hui le Canada, les colons français furent en contact très étroit avec les populations indigènes abusivement appelées indiennes dans les manuels d’histoire.

Déjà, dans les Relations des Jésuites, nos aborigènes apparaissent sous le nom de Sauvages, vocable que la langue parlée leur a conservé. En effet, encore aujourd’hui ce mot s’applique à tous les Amérindiens nord-américains, à l’exception cependant des Esquimaux.
The “Linguistic” Theory of Usage
Authors: Baker R. J.
Published: June 2019

The battle between the new grammarians or linguists and the school grammarians has been won decisively by the linguists. In academic journals defenses of notional grammar are rare and new work based on notional categories almost non-existent. The struggles continues in pedagogical journal and in the schools, but there are signs that the new grammar is gaining ground. No such comments can be made about the battle over the various doctrines of usage. Since what is taken to be the “linguists’” view of usage frequently hinders the acceptance of their grammar, no harm will be done by re-examining a “linguistic” theory of usage.
Industrial Assurance and the Collecting Friendly Society Today
Authors: Fisher H. F.
Published: June 2019

Although two papers on industrial assurance by K. J. Britt (T.F.A.21, 265 and 26, 200) have been submitted to the Faculty of Actuaries in recent years there have been no similar discussions of this business at Institute sessional meetings. In addition, papers by G. W. E. Allaway (J.S.S.13, 1) and by K. F. Gardner (J.S.S.13, 22) have been published by the Students' Society, but in none of these papers have the particular problems of collecting friendly societies been fully considered. The industrial assurance funds of societies represent approximately one-fifth of all such funds in this country, and this paper is therefore intended to be complementary to those above-mentioned, to introduce current actuarial problems of collecting friendly societies, and to provide a vehicle for general discussion of industrial assurance.
Administration of Group Life and Pensions Business by Computer
Authors: Jecks R. G.
Published: June 2019

It is now some ten years since it was accepted, cautiously at first, that computers might be of some value in performing ordinary clerical procedures. Since that time, they have been gradually installed at an everincreasing rate in offices of all kinds, including insurance offices. Our own Institute was, I believe, the first body to publish tables—the a(55) tables—which had been prepared by means of a computer, In some respects it is a pity that the insurance world in this country has not been more to the fore in utilizing this new equipment although, from the number of insurance people who attend any meeting connected with computers, it is not due to any lack of interest in new methods but rather to a cautious attitude concerning making use of equipment until it has been fully proved by actual field service. This is in contrast to the position in U.S.A. where the insurance offices have been well to the front in development of office use of computers; indeed, an insurance office there was the first non-governmental business user and that office now has four very large machines in full-time use. As a result of this we were fortunate to have had the very instructive surveys published by our sister body, the Society of Actuaries.
Surplus: Two Hundred Years of Actuarial Advance
Authors: Cox P. R. , Storr-Best R. H.
Published: June 2019

On the occasion of the bicentenary of the foundation of scientific life assurance, it was thought fitting that a work should be prepared in which the development of some aspect of the subject might be discussed. The authors undertook some research on the origins and disposal of surplus and the results are set out in a book entitled Surplus in British Life Assurance—Actuarial Control over its Emergence and Distribution during 200 Years. The following pages convey some of the impressions formed in the course of its preparation. Much of the later part of the paper consists, in fact, of extracts from the text of the book. The introductory sections present a short outline of the book as a whole.
A Statistical Review of the Evidence for the Existence of Temporary Selection
Authors: Seal Hilary L.
Published: June 2019

The theory of ‘temporary selection’ is concerned with the variation, for fixed x, of q[x–t]+t the observed rate of mortality at age x during the t+1th year after the issue of an assurance or annuity contract. The classical view is that—apart from chance variations—q[x–t]+t increases gradually with increasing t until the effects of selection have disappeared after which time q[xx–t]+t is a constant depending on x only.

Various reasons have been suggested for the persistence of temporary selection in an observed series of values of q[xx–t]+t. The chief of these are:

(1) The continuing effects of an initial selection on the part of the assurance company or by the annuitant (Morgan, 1834);

(2) The gradual withdrawal from assurance of healthy lives (Higham, 1851); and

(3) Secular improvements in medicals election or in the self-selection of annuitants (Karup, 1903).
The Expenses of British Life Offices
Authors: Dyson E. J. W. , Elphinstone M. D. W.
Published: June 2019

Of the three major elements in the formulae for office premiums, mortality has been subjected to refined investigation; interest has been considered closely, particularly since the war; expenses alone have hardly been considered. We have found only four papers on the subject in the whole of J.I.A., three (19, 153; 44, 415; 49, 111) many years ago, and the fourth (69, 50) before the war. There have been a few papers since in T.S.A., notably Mr Pedoe's (4, 485).

Our object is to analyse the expenses of a group of British life offices, so as to provide a reliable basis for comparison of offices, to enable managements to test the efficiencies of their own offices against others, and to provide means for getting standard costs as a tool of administration.
The Assessment of Industrial Ordinary Shares
Authors: Weaver D. , Fowler B. G. N.
Published: June 2019

1. The assessment of industrial ordinary shares has not yet been discussed by the Institute. This is surprising, both in view of the fact that British insurance companies hold ordinary shares to a value approaching £1000 million and also because actuaries are playing an increasing part in the investment world. The Institute is indeed the only professional body which examines candidates for membership in investment knowledge. Hitherto the examinations have been concerned mainly with general principles, but the widening of the scope of the syllabus since the war makes it necessary that the methods by which industrial shares are assessed should be discussed. It is the purpose of this paper to provide an opportunity for such a discussion.
The feed intake and performance of dairy cows fed on cut grass
Authors: Halley R. J. , Dougall B. M.
Published: June 2019

In the years 1959, 1960 and 1961 sections of the College herd of pedigree Guernsey cows were fed indoors on cut grass. The grass, cut twice each day, was fed in excess of appetite.

The weight of grass dry matter consumed varied significantly in each year with the percentage of dry matter in the grass. In one year only did the dry-matter consumption vary significantly with the percentage of crude fibre in the grass.

The weight of drinking water consumed varied significantly with the percentage of dry matter in the grass. The total water intake, i.e. drinking water plus uncombined water in the grass, remained almost constant at approximately 14 gal per cow per day.

The use of a concentrate supplement in 1960 and 1961 produced small increases in yield which were not statistically significant. If, however, the differences recorded were real, then they would have been economic in one year and not in the other.

The intake of starch equivalent, calculated from the chemical analyses of the grass, could not be reconciled with the performance of the cows.
The estimation of carbon dioxide in Cheddar cheese
Authors: Robertson P. S.
Published: June 2019

A rapid method for the estimation of carbon dioxide in Cheddar cheese is described which gives good reproducibility and is free from major sources of error.
Observations on the luminescence ofPennatula phosphorea, with a note on the luminescence ofVirgularia mirabilis
Authors: Nicol J. A. C.
Published: June 2019

Pennatula phosphoreaLinn, is a well-known luminescent animal, which was studied by that pioneer investigator, Panceri (1871,1872a,b). He found that the animal luminesces when excited, and that the light emanates from the zooids. From the region stimulated luminous waves proceed, with measurable velocity, to the extremities of the animal. Since waves can be initiated in either direction, up or down the colony, it follows that the transmission system is non-polarized. Recent studies on other species of pennatulids have shown that luminescence is under control of a nerve net (Nicol, 1955a,b,c; Daven-port & Nicol, 1956). Harvey's book onBioluminescence(1952) gives a review of pertinent literature, plus a bibliography.
Vertical distribution of vitamin B12in the sea
Authors: Daisley K. W. , Fisher L. R.
Published: June 2019

A considerable seasonal variation in the vitamin B12concentration in oceanic surface water has been demonstrated by Cowey (1956).

The present investigation was undertaken to examine any variation with depth.
The uncanny accuracy of God's mathematical beliefs
Authors: KNOWLES ROBERT
Published: June 2019

I show how mathematical platonism combined with belief in the God of classical theism can respond to Field's epistemological objection. I defend an account of divine mathematical knowledge by showing that it falls out of an independently motivated general account of divine knowledge. I use this to explain the accuracy of God's mathematical beliefs, which in turn explains the accuracy of our own. My arguments provide good news for theistic platonists, while also shedding new light on Field's influential objection.
XII.—On the Structure of Samaropsis scotica Calder (emended) and Eurystoma angulare gen. et sp. nov., Petrified Seeds from the Calciferous Sandstone Series of Berwickshire
Authors: Long Albert G.
Published: June 2019

Synopsis

The Lower Carboniferous seed Samaropsis scotica Calder has been re-investigated from new material and assigned to a new genus Lyrasperma. It is shown to have a nucellar apex with a pollen chamber and a funnel-like structure interpreted as an expanded salpinx. The free parts of the two integumental lobes diverge as apical horns; there is therefore no micropyle. Eurystoma angulare gen. et sp. nov. possesses a similar nucellar apex but is usually quadrangular in section and has four apical lobes. The new genera are placed in the group Lagenostomales although the expanded salpinx is a character new to that group.