bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource‐Limited Setting
Authors: Yohann Avital , Kayange Linda , Purcell Laura N. , Gallaher Jared , Charles Anthony
Published: January 2022

Introduction

Trauma is a leading cause of morbidity and mortality worldwide, and patients in low‐ and middle‐income countries are disproportionately affected. Organized trauma systems, including appropriate transfer to a higher level of care, improve trauma outcomes. We sought to evaluate the relationship between transfer status and trauma mortality in Malawi.

Methods

We performed a retrospective analysis of trauma patients admitted to Kamuzu Central Hospital (KCH), a trauma center in Lilongwe, Malawi, between January 1, 2013, and May 30, 2018. Transfer status was categorized as direct if a patient arrives at KCH from the injury scene and indirect if a patient comes to KCH from another health care facility. We used logistic regression modeling to evaluate the relationship between transfer status and in‐hospital mortality.

Results

A total of 8369 patients were included in the study. The mean age was 34.6 years (SD 15.8), and 81% of patients were male. The most common mechanism of injury was motor vehicle collision. Injury severity did not significantly differ between the two groups. Crude mortality was 4.8% for indirect and 2.6% for direct transfers. After adjusting for relevant covariates, odds ratio of mortality was 2.12 (1.49–3.02, p < 0.001) for indirect versus direct transfers.

Conclusion

Trauma patients indirectly transferred to a trauma center have nearly double the risk of mortality compared to direct transfers. Trauma outcome improvement efforts must focus on strengthening prehospital care, improving district hospital capacity, and developing protocols for early assessment, treatment, and transfer of trauma patients to a trauma center.
Emergency to Elective Surgery Ratio as a Disparities Sensitive Surgical Access Metric, A Study of Low Socioeconomic Status in Australia
Authors: de Jager Elzerie , Gunnarsson Ronny , Ho Yik‐Hong
Published: January 2022

Background

The emergency to elective surgery ratio is a proposed indicator for global access to surgical care. There is a well‐established link between low socioeconomic status and increased morbidity and mortality. This study examined the emergency to elective surgery ratios for low socioeconomic patients utilising both self‐reported unemployment and the neighbourhood Index of Economic Resources (IER).

Methods

A retrospective study was conducted at a regional tertiary care centre in Australia, including data over a ten‐year period (2008–2018). Multivariable logistic regression adjusting for year, age, sex, Charlson Comorbidity Index, rurality, and if surgeries were due to trauma or injuries, was performed.

Results

84,014 patients underwent a surgical procedure in the period examined; 29.0% underwent emergency surgery, 5.31% were unemployed, and 26.6% lived in neighbourhoods with the lowest IER. Following multivariable testing, the rate of emergency surgery was higher for unemployed patients (OR 1.42 [1.32–1.52], p < 0.001), and for those from the lowest IER (OR 1.13 [1.08–1.19], p < 0.001). For unemployed patients, this disparity increased during the study period (OR 1.32 [2008–2012], OR 1.48 [2013–2018]). When stratified by specialty, most (7/11) had significant disparities for unemployed patients: Cardiac/Cardiothoracic, Otolaryngology, Maxillofacial/Dental, Obstetrics/Gynaecology, Orthopaedics, Plastics, and Vascular surgery.

Conclusions

Unemployed Australians and those residing in the most disadvantaged IER neighbourhoods had higher emergency to elective surgery rates. The disparity in emergency to elective surgery rates for unemployed patients was found in most surgical specialties and increased over the period examined. This suggests a widespread and potentially increasing disparity in access to surgical care for patients of socioeconomic disadvantage, specifically for those who are unemployed.
Geriatrische Dermatologie
Authors: Joura Marie Isolde , Koszorú Kamilla , Czintner Dóra , Sárdy Miklós
Published: January 2022

Hintergrund

Die Bevölkerung erreicht ein höheres Lebensalter. Begleitend steigt die Inzidenz der Hauterkrankungen.

Ziel der Arbeit

Dargestellt werden die wichtigsten Hauterkrankungen geriatrischer Patienten.

Material und Methoden

Es erfolgten sowohl eine Literaturrecherche in der Datenbank von PubMed als auch aus dermatologischen Standardlehrbüchern.

Ergebnisse

Die Haut geriatrischer Patienten reagiert empfindlicher auf Umwelteinflüsse und kann im Rahmen von internistischen Grunderkrankungen mitbetroffen sein. Aufgrund von verzögerter Diagnostik werden maligne Hauterkrankungen bei alten Patienten erst in höheren Stadien diagnostiziert.

Diskussion

Physiologische Hautveränderungen im Alter sind durch entsprechende Pflegemaßnahmen zu behandeln. Bei unklaren Hautveränderungen ist eine rasche dermatologische Abklärung anzustreben.
Implantation of a VDD implantable cardioverter-defibrillator lead via a persistent left superior vena cava
Authors: Vamos Mate , Saghy Laszlo , Bencsik Gabor
Published: January 2022

A persistent left superior vena cava (LSVC) represents a challenging congenital abnormality for transvenous cardiac device implantation. In the current case a secondary prophylactic VDD implantable cardioverter-defibrillator (ICD) implantation was planned in a 75-year-old woman presenting with ischemic cardiomyopathy and elevated stroke risk. Since no venous communication to the right side was identified intraoperatively, the lead was placed via the persistent LSVC. The far-field signal on the floating atrial dipole could be successfully blanked out, and appropriate device function with high and stable atrial sensing was demonstrated at follow-up.
Linear-Time Algorithms for Maximum-Weight Induced Matchings and Minimum Chain Covers in Convex Bipartite Graphs
Authors: Klemz Boris , Rote Günter
Published: January 2022

A bipartite graph $$G=(U,V,E)$$

G
=
(
U
,
V
,
E
)

is convex if the vertices in V can be linearly ordered such that for each vertex $$u\in U$$

u
∈
U

, the neighbors of u are consecutive in the ordering of V. An induced matchingH of G is a matching for which no edge of E connects endpoints of two different edges of H. We show that in a convex bipartite graph with n vertices and mweighted edges, an induced matching of maximum total weight can be computed in $$O(n+m)$$

O
(
n
+
m
)

time. An unweighted convex bipartite graph has a representation of size O(n) that records for each vertex $$u\in U$$

u
∈
U

the first and last neighbor in the ordering of V. Given such a compact representation, we compute an induced matching of maximum cardinality in O(n) time. In convex bipartite graphs, maximum-cardinality induced matchings are dual to minimum chain covers. A chain cover is a covering of the edge set by chain subgraphs, that is, subgraphs that do not contain induced matchings of more than one edge. Given a compact representation, we compute a representation of a minimum chain cover in O(n) time. If no compact representation is given, the cover can be computed in $$O(n+m)$$

O
(
n
+
m
)

time. All of our algorithms achieve optimal linear running time for the respective problem and model, and they improve and generalize the previous results in several ways: The best algorithms for the unweighted problem versions had a running time of $$O(n^2)$$

O
(

n
2

)

(Brandstädt et al. in Theor. Comput. Sci. 381(1–3):260–265, 2007. 10.1016/j.tcs.2007.04.006). The weighted case has not been considered before.
Linear-Time Recognition of Double-Threshold Graphs
Authors: Kobayashi Yusuke , Okamoto Yoshio , Otachi Yota , Uno Yushi
Published: January 2022

A graph $$G = (V,E)$$

G
=
(
V
,
E
)

is a double-threshold graph if there exist a vertex-weight function $$w :V \rightarrow \mathbb {R}$$

w
:
V
→
R

and two real numbers $$\mathtt {lb}, \mathtt {ub}\in \mathbb {R}$$

lb
,
ub
∈
R

such that $$uv \in E$$

u
v
∈
E

if and only if $$\mathtt {lb}\le \mathtt {w}(u) + \mathtt {w}(v) \le \mathtt {ub}$$

lb
≤
w
(
u
)
+
w
(
v
)
≤
ub

. In the literature, those graphs are studied also as the pairwise compatibility graphs that have stars as their underlying trees. We give a new characterization of double-threshold graphs that relates them to bipartite permutation graphs. Using the new characterization, we present a linear-time algorithm for recognizing double-threshold graphs. Prior to our work, the fastest known algorithm by Xiao and Nagamochi [Algorithmica 2020] ran in $$O(n^{3} m)$$

O
(

n
3

m
)

time, where n and m are the numbers of vertices and edges, respectively.
Weak population spatial genetic structure and low infraspecific specificity for fungal partners in the rare mycoheterotrophic orchid Epipogium aphyllum
Authors: Minasiewicz Julita , Krawczyk Emilia , Znaniecka Joanna , Vincenot Lucie , Zheleznaya Ekaterina , Korybut-Orlowska Joanna , Kull Tiiu , Selosse Marc-André
Published: January 2022

Some plants abandoned photosynthesis and developed full dependency on fungi for nutrition. Most of the so-called mycoheterotrophic plants exhibit high specificity towards their fungal partners. We tested whether natural rarity of mycoheterotrophic plants and usual small and fluctuating population size make their populations more prone to genetic differentiation caused by restricted gene flow and/or genetic drift. We also tested whether these genetic characteristics might in turn shape divergent fungal preferences. We studied the mycoheterotrophic orchid Epipogium aphyllum, addressing the joint issues of genetic structure of its populations over Europe and possible consequences for mycorrhizal specificity within the associated fungal taxa. Out of 27 sampled E. aphyllum populations, nine were included for genetic diversity assessment using nine nuclear microsatellites and plastid DNA. Population genetic structure was inferred based on the total number of populations. Individuals from 17 locations were included into analysis of genetic identity of mycorrhizal fungi of E. aphyllum based on barcoding by nuclear ribosomal DNA. Epipogium aphyllum populations revealed high genetic diversity (uHe = 0.562) and low genetic differentiation over vast distances (FST = 0.106 for nuclear microsatellites and FST = 0.156 for plastid DNA). Bayesian clustering analyses identified only two genetic clusters, with a high degree of admixture. Epipogium aphyllum genets arise from panmixia and display locally variable, but relatively high production of ramets, as shown by a low value of rarefied genotypic richness (Rr = 0.265). Epipogium aphyllum genotype control over partner selection was negligible as (1) we found ramets from a single genetic individual associated with up to 68% of the known Inocybe spp. associating with the plant species, (2) and partner identity did not show any geographic structure. The absence of mosaicism in the mycorrhizal specificity over Europe may be linked to preferential allogamous habit of E. aphyllum and significant gene flow, which tend to promote host generalism.
“Wearables on vogue”: a scoping review on wearables on physical activity and sedentary behavior during COVID-19 pandemic
Authors: Panicker Rohit Muralidhar , Chandrasekaran Baskaran
Published: January 2022

Background

Wearables are intriguing way to promote physical activity and reduce sedentary behavior in populations with and without chronic diseases. However, the contemporary evidence demonstrating the effectiveness of wearables on physical health during the COVID-19 pandemic has yet to be explored.

Aim

The present review aims to provide the readers with a broader knowledge of the impact of wearables on physical health during the pandemic.

Methods

Five electronic databases (Web of Science, Scopus, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature and Embase) were searched. The eligibility criteria of the studies to be included were based on PICOT criteria: population (adults, children and elderly), intervention (wearable, smartphones), comparison (any behavioral intervention), outcome (physical activity or sedentary behavior levels) and time frame (between December 1st, 2019 and November 19th, 2021). The present scoping review was framed as per the guidelines of the Arksey and O’Malley framework.

Results

Of 469 citations initially screened, 17 articles were deemed eligible for inclusion and potential scoping was done. Smartphone-based applications with inbuilt accelerometers were commonly used, while a few studies employed smart bands, smartwatches for physical health monitoring. Most of the studies observed the increased use of wearables in healthy adults followed by elderly, children and pregnant women. Considerable reduction (almost—50%) in physical activity during the pandemic: daily step count (− 2812 steps/min), standing (− 32.7%) and walking (− 52.2%) time was found.

Conclusion

Wearables appears to be impending means of improving physical activity and reducing sedentary behavior remotely during the COVID-19 pandemic.
Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)
Authors: Otto Ronny , Blaschke Sabine , Schirrmeister Wiebke , Drynda Susanne , Walcher Felix , Greiner Felix
Published: January 2022

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.
The accumulation model of organic matters for the Niutitang Formation shale and its control on the pore structure: a case study from Northern Guizhou
Authors: Li Teng , Gao Hui , Wang Chen , Cheng Zhilin , Yang Yanning , Zhan Jie
Published: January 2022

Shale gas reservoir is a fine-grained sedimentary rock with component of clastic particles and organic matters, and the accumulation of the organic matters would determine the effective development of shale gas. The paleoclimate, detrital influx, redox of the water and paleoproductivity are effective geochemical indicators that could help to find the favorable shale gas reservoir stratum. In this study, the shale samples collected from Niutitang Formation (Northern Guizhou, China) were launched the measurements of the content of major elements and trace elements, and the characteristics of geochemical indicators were analyzed, which can be used to discuss the accumulation model of organic matters. Besides, the pore structure of shale sample controlled by the enrichment of organic matters is also discussed. The paleoclimate is dominant cold and dry, and it changes to warm and humid at the later Niutitang period, and the detrital influx also increased at the later Niutitang period; the water environment of Niutitang Formation shale presents as reductive, and the paleoproductivity of the Niutitang Formation shale is commonly high. The enrichment of organic matters in the Niutitang Formation is dominantly controlled by the redox of the water, while the hydrothermal activity and the paleoproductivity lead to the difference enrichment of organic matters in the Niutitang Formation shale. The accumulation model of organic matters also influences the characteristics of pore structure from the Niutitang Formation shale, and the pore structure could be divided into two types. The shale with high content of organic matters also features high content of quartz and pyrite, and these minerals contribute to the preservation of pore space in the shale, while that of the clay minerals is contrary. The high content of organic matters and preferable pore characteristics indicate the Niutitang Formation favors the development of shale gas, especially that for the lower Niutitang Formation.
Path homologies of motifs and temporal network representations
Authors: Chowdhury Samir , Huntsman Steve , Yutin Matvey
Published: January 2022

Path homology is a powerful method for attaching algebraic invariants to digraphs. While there have been growing theoretical developments on the algebro-topological framework surrounding path homology, bona fide applications to the study of complex networks have remained stagnant. We address this gap by presenting an algorithm for path homology that combines efficient pruning and indexing techniques and using it to topologically analyze a variety of real-world complex temporal networks. A crucial step in our analysis is the complete characterization of path homologies of certain families of small digraphs that appear as subgraphs in these complex networks. These families include all digraphs, directed acyclic graphs, and undirected graphs up to certain numbers of vertices, as well as some specially constructed cases. Using information from this analysis, we identify small digraphs contributing to path homology in dimension two for three temporal networks in an aggregated representation and relate these digraphs to network behavior. We then investigate alternative temporal network representations and identify complementary subgraphs as well as behavior that is preserved across representations. We conclude that path homology provides insight into temporal network structure, and in turn, emergent structures in temporal networks provide us with new subgraphs having interesting path homology.
Fractal dimension analogous scale-invariant derivative of Hirsch’s index
Authors: Fujita Yuji , Usami Noritaka
Published: January 2022

We propose a scale-invariant derivative of the h-index as “h-dimension”, which is analogous to the fractal dimension of the h-index for institutional performance analysis. The design of h-dimension comes from the self-similar characteristics of the citation structure. We applied this h-dimension to data of 134 Japanese national universities and research institutes, and found well-performing medium-sized research institutes, where we identified multiple organizations related to natural disasters. This result is reasonable considering that Japan is frequently hit by earthquakes, typhoons, volcanoes and other natural disasters. However, these characteristic institutes are screened by larger universities if we depend on the existing h-index. The scale-invariant property of the proposed method helps to understand the nature of academic activities, which must promote fair and objective evaluation of research activities to maximize intellectual, and eventually economic opportunity.
Deep Learning Strategies for ProtoDUNE Raw Data Denoising
Authors: Rossi Marco , Vallecorsa Sofia
Published: January 2022

In this work, we investigate different machine learning-based strategies for denoising raw simulation data from the ProtoDUNE experiment. The ProtoDUNE detector is hosted by CERN and it aims to test and calibrate the technologies for DUNE, a forthcoming experiment in neutrino physics. The reconstruction workchain consists of converting digital detector signals into physical high-level quantities. We address the first step in reconstruction, namely raw data denoising, leveraging deep learning algorithms. We design two architectures based on graph neural networks, aiming to enhance the receptive field of basic convolutional neural networks. We benchmark this approach against traditional algorithms implemented by the DUNE collaboration. We test the capabilities of graph neural network hardware accelerator setups to speed up training and inference processes.
Field evaluation of WALS truck-mounted A1 super duty mist sprayer® with VectoBac® WDG against Aedes aegypti (Diptera:Culicidae) populations in Manatee County, Florida
Authors: Williams Katie F. , Ramirez Samantha , Lesser Christopher R.
Published: January 2022

Aedes aegypti, the Dengue and Zika vector, is a domestic mosquito that is difficult to control. The challenge lies in the mosquito’s preference to lay its eggs in cryptic habitats such as fence post openings, buckets and bird baths, cups. Additionally, current methods of control are labor-intensive. We employed the WALS strategy to evaluate the operational efficacy of applying VectoBac WDG using a truck-mounted mister to control local populations of Ae. aegypti in urban settings with difficult-to-reach larval mosquito habitats. Our study was conducted in Cortez (Manatee County), Florida, USA (27° 27’ N, 82° 40’ W). We selected two study sites, one untreated control (21.9 ha) and one treatment site (23.1 ha) where historical data have shown high populations of Ae. aegypti based on weekly ovitrap surveillance. Weekly BGs and ovitraps (10–15 traps/site) were deployed to monitor adult population dynamics. A total of 50 bioassay jars were placed in the field each afternoon of the Bti application (8 application events) at fixed locations to collect droplets and gauge efficacy. We found significant reduction in female adults (P = 0.0002) and landing rate counts (P = 0.0058) as a result of treatment. Larval bioassays during the eight applications confirmed Bti deposit in a variety of coverage types regardless of placement in the yards. WALS applications with a truck-mounted mister can be effective at reducing disease carrying mosquito populations in residential areas and can be implemented in an integrated vector management program.
Nitrogen in plants: from nutrition to the modulation of abiotic stress adaptation
Authors: Ye Jia Yuan , Tian Wen Hao , Jin Chong Wei
Published: January 2022

Nitrogen is one of the most important nutrient for plant growth and development; it is strongly associated with a variety of abiotic stress responses. As sessile organisms, plants have evolved to develop efficient strategies to manage N to support growth when exposed to a diverse range of stressors. This review summarizes the recent progress in the field of plant nitrate (NO3-) and ammonium (NH4+) uptake, which are the two major forms of N that are absorbed by plants. We explore the intricate relationship between NO3-/NH4+ and abiotic stress responses in plants, focusing on stresses from nutrient deficiencies, unfavorable pH, ions, and drought. Although many molecular details remain unclear, research has revealed a number of core signaling regulators that are associated with N-mediated abiotic stress responses. An in-depth understanding and exploration of the molecular processes that underpin the interactions between N and abiotic stresses is useful in the design of effective strategies to improve crop growth, development, and productivity.
America's Energy Gamble
Authors: Gamper-Rabindran Shanti
Published: January 2022

How can America get back to an energy transition that's good for the economy and the environment? That's the question at the heart of this eye-opening and richly informative dissection of the Trump administration's energy policy. The policy was ardently pro-fossil fuel and ferociously anti-regulation, implemented by manipulating science and economic analysis, putting oil and gas insiders at the helm of environmental agencies, and hacking away at democratic norms that once enjoyed bipartisan support. The impacts on the nation's health, economy, and environment were - as this book carefully demonstrates - dire. But the damage can be reversed. Ordinary Americans, civil society groups, environmental professionals, and politicians at every level all have parts to play in making sure the needed energy transition leaves no one behind. This compelling book will appeal to course instructors and students, government and industry officials, activists and journalists, and everyone concerned about the nation's future.
The Wealth and Poverty of African States
Authors: Jerven Morten
Published: January 2022

A wealth of new data have been unearthed in recent years on African economic growth, wages, living standards, and taxes. In The Wealth and Poverty of African States, Morten Jerven shows how these findings transform our understanding of African economic development. He focuses on the central themes and questions that these state records can answer, tracing how African states evolved over time and the historical footprint they have left behind. By connecting the history of the colonial and postcolonial periods, he reveals an aggregate pattern of long-run growth from the late nineteenth century into the 1970s, giving way to widespread failure and decline in the 1980s, and then followed by two decades of expansion since the late 1990s. The result is a new framework for understanding the causes of poverty and wealth and the trajectories of economic growth and state development in Africa across the twentieth century.
Liberation in the Face of Uncertainty
Authors: Hermans Hubert J. M.
Published: January 2022

In this volume, Dialogical Self Theory is innovatively presented as a guide to help elucidate some of the most pressing problems of our time as they emerge at the interface of self and society. As a bridging framework at the interface of the social sciences and philosophy, Dialogical Self Theory provides a broad view of problem areas that place us in a field of tension between liberation and social imprisonment. With climate change and the coronavirus pandemic serving as wake-up calls, the book focuses on the experience of uncertainty, the disenchantment of the world, the pursuit of happiness, and the cultural limitations of the Western self-ideal. Now more than ever we need to rethink the relationship between self, other, and the natural environment, and this book uses Dialogical Self Theory to explore actual and potential responses of the self to these urgent challenges.
Elliott Carter's Late Music
Authors: Link John
Published: January 2022

The first comprehensive study of the late music of one of the most influential composers of the last half century, this book places Elliott Carter's music from 1995 to 2012 in the broader context of post-war contemporary concert music, including his own earlier work. It addresses Carter's reception history, his aesthetics, and his harmonic and rhythmic practice, and includes detailed essays on all of Carter's major works after 1995. Special emphasis is placed on Carter's settings of contemporary modernist poetry from John Ashbery to Louis Zukofsky. In readable and engaging prose, Elliott Carter's Late Music illuminates a body of late work that stands at the forefront of the composer's achievements.
GP.1 Changes in ischemic stroke presentations and associated workflow
during the first wave of the COVID-19 pandemic: A population study
Authors: Ganesh A , Stang JM , McAlister FA , Shlakhter O , Holodinsky JK , Mann B , Hill MD , Smith EE
Published: January 2022

Background: Pandemics may promote hospital
avoidance among patients with emergencies, and added precautions may
exacerbate treatment delays. Methods: We used linked
administrative data and data from the Quality Improvement and Clinical
Research Alberta Stroke Program – a registry capturing stroke-related data
on the entire Albertan population(4.3 million) – to identify all patients
hospitalized with stroke in the pre-pandemic(01/01/2016-27/02/2020) and
COVID-19 pandemic(28/02/2020-30/08/2020) periods. We examined changes in
stroke presentation rates and use of thrombolysis and endovascular
therapy(EVT), adjusted for age, sex, comorbidities, and pre-admission care
needs; and in workflow, stroke severity(National Institutes of Health Stroke
Scale/NIHSS), and in-hospital outcomes. Results: We
analyzed 19,531 patients with ischemic stroke pre-pandemic versus 2,255
during the pandemic. Hospitalizations/presentations dropped(weekly
adjusted-incidence-rate-ratio[aIRR]:0.48,95%CI:0.46-0.50), as did
population-level incidence of thrombolysis(aIRR:0.49,0.44-0.56) or
EVT(aIRR:0.59,0.49-0.69). However, proportions of presenting patients
receiving thrombolysis/EVT did not decline (thrombolysis:11.7% pre-pandemic
vs 13.1% during-pandemic, aOR:1.02,0.75-1.38). For out-of-hospital strokes,
onset-to-door times were prolonged(adjusted-coefficient:37.0-minutes,
95%CI:16.5-57.5), and EVT recipients experienced greater door-to-reperfusion
delays(adjusted-coefficient:18.7-minutes,1.45-36.0). NIHSS scores and
in-hospital mortality did not differ. Conclusions:
The first COVID-19 wave was associated with a halving of presentations and
acute therapy utilization for ischemic stroke at a population level, and
greater pre-/in-hospital treatment delays. Our data can inform public health
messaging and stroke care in future pandemic waves.
A.3 Use of diffusion-weighted imaging to distinguish seizure-related
change from limbic encephalitis
Authors: Budhram A , Britton JW , Liebo GB , McKeon A , Pittock SJ , Zalewski NL
Published: January 2022

Background: Limbic encephalitis (LE) classically
causes medial temporal lobe T2-hyperintensity on magnetic resonance imaging
(MRI), but this can also occur with seizure activity. Identifying
neuroimaging patterns that can distinguish between LE and seizure activity
may help avoid diagnostic confusion in such challenging cases.
Methods: Through retrospective review of Mayo
Clinic patients who had medial temporal lobe T2-hyperintensity on MRI, we
identified non-LE patients with seizure-related medial temporal lobe
T2-hyperintensity. Their diffusion-weighted imaging (DWI) was reviewed to
look for diffusion restriction patterns potentially unique to seizure
activity. Next, a control cohort of LE patients with medial temporal lobe
T2-hyperintensity was identified, and their DWI was reviewed to see if these
diffusion restriction patterns could help distinguish seizure activity from
LE. Results: We identified 10 non-LE patients who had
medial temporal lobe T2-hyperintensity due to seizure activity; 9/10 had one
of two medial temporal lobe diffusion restriction patterns we uncovered as
being potentially unique to seizure activity. In contrast, only 5/57 LE
patients had one of these diffusion restriction patterns identified, all of
whom had seizures reported. Conclusions: We report
two diffusion restriction patterns that may help distinguish seizure
activity from LE. Recognition of these diffusion restriction patterns should
prompt evaluation for possible seizure activity.
A.4 A Novel Recessive TNNT1 Congenital Core-Rod Myopathy in French
Canadians
Authors: Pellerin D , Aykanat A , Ellezam B , Troiano EC , Karamchandani J , Dicaire M , Petitclerc M , Robertson R , Allard-Chamard X , Brunet D , Konersman CG , Mathieu J , Warman Chardon J , Gupta VA , Beggs AH , Brais B , Chrestian N
Published: January 2022

Background: Mutations in the slow skeletal muscle
troponin T (TNNT1) gene cause a congenital
nemaline myopathy resulting in death from respiratory insufficiency in early
infancy. We report on four French Canadians with a novel congenital
TNNT1 myopathy.
Methods: Patients underwent lower extremity and
paraspinal MRI, quadriceps biopsy and genetic testing.
TNNT1 expression in muscle was assessed by
quantitative PCR and immunoblotting. Wild type or mutated
TNNT1 mRNAs were co-injected with morpholinos
in a zebrafish knockdown model to assess for rescue of the morphant
phenotype. Results: Four patients shared a novel
missense homozygous mutation in TNNT1. They
developed from childhood slowly progressive limb-girdle weakness with spinal
rigidity and contractures. They suffered from restrictive lung disease and
recurrent episodes of rhabdomyolysis. Older patients remained ambulatory
into their sixties. Lower extremity MRI showed symmetrical myopathic
changes. Paraspinal MRI showed diffuse fibro-fatty involution. Biopsies
showed multi-minicores. Nemaline rods were seen in half the patients.
TNNT1 mRNA expression was similar in controls
and patients, while levels of TNNT1 protein were
reduced in patients. Wild type TNNT1 mRNA rescued
the zebrafish morphants but mutant transcripts failed to do so.
Conclusions: This study expands the spectrum of
TNNT1-related myopathy to include a milder
clinical phenotype caused by a functionally-confirmed novel
mutation.
C.4 Epigenetic drivers of malignant transformation in diffuse
gliomas
Authors: Voisin MR , Patil V , Nassiri F , Zadeh G
Published: January 2022

Background: Despite treatment, gliomas often
exhibit disease progression, leading to recurrent glioblastoma (GBM) or
malignant transformation of low-grade gliomas (LGG) associated with
treatment resistance and poor prognosis. To date, the molecular factors
driving glioma recurrence are poorly understood.
Methods: We analyzed a cohort of 324 glioma
samples from our institution including a unique cohort of 81 patients with
matched primary and recurrent tumour pairs. We performed a paired,
integrated multi-platform analysis consisting of DNA methylation profiling
on all 324 samples, gene expression on 87 samples, and matched plasma
cell-free DNA methylome analysis on 82 samples.
Results: LGG that undergo malignant
transformation are associated with DNA hypomethylation at recurrence,
including decreased tumour purity and increased copy number variation.
Integrated pathway analyses identified IL-6,
associated with multiple pro-oncogenic pathways, and
CCR2, associated with the recruitment of
tumour-associated macrophages, as top genes involved in malignant
transformation. Matched plasma methylation demonstrated a shift in the
methylation signature at recurrence that can prove valuable as a
non-invasive biomarker for early detection of malignant progression.
Conclusions: We provide the first detailed
description of the epigenetic evolution of gliomas and identify epigenetic
drivers of malignant transformation including non-invasive biomarkers for
early detection of malignant progression.
C.5 Musashi-1 is a master regulator of aberrant translation in
MYC-amplified Group 3 medulloblastoma
Authors: Kameda-Smith MM , Zhu H , Luo E , Venugopal C , Brown K , Yee BA , Xing S , Tan F , Bakhshinyan D , Adile AA , Subapanditha M , Picard D , Moffat J , Fleming A , Hope K , Provias J , Remke M , Lu Y , Reimand J , Wechsler-Reya R , Yeo G , Singh SK
Published: January 2022

Background: Medulloblastoma (MB) is the most
common solid malignant pediatric brain neoplasm. Group 3 (G3) MB,
particularly MYC amplified G3 MB, is the most aggressive subgroup with the
highest frequency of children presenting with metastatic disease, and is
associated with a poor prognosis. To further our understanding of the role
of MSI1 in MYC amplified G3 MB, we performed an unbiased integrative
analysis of eCLIP binding sites, with changes observed at the transcriptome,
the translatome, and the proteome after shMSI1
inhibition. Methods: Primary human pediatric MBs,
SU_MB002 and HD-MB03 were kind gifts from Dr. Yoon-Jae Cho (Harvard, MS) and
Dr. Till Milde (Heidelberg) and cultured for in vitro and in vivo
experiments. eCLIP, RNA-seq, Polysome-seq, and TMT-MS were completed as
previously described.
Results:MSI1 is
overexpressed in G3 MB. shRNA Msi1 interference resulted in a reduction in
tumour burden conferring a survival advantage to mice injected with
shMSI1 G3MB cells. Robust ranked multiomic
analysis (RRA) identified an unconventional gene set directly perturbed by
MSI1 in G3 MB. Conclusions: Our robust unbiased
integrative analysis revealed a distinct role for MSI1 in the maintenance of
the stem cell state in G3 MB through post-transcriptional modification of
multiple pathways including identification of unconventional targets such as
HIPK1.
C.6 Action-Related Fixation in Microsuturing, a New Gaze Behavior Metric
to Differentiate the Level of Expertise
Authors: Chainey J , Zheng B , Kim M , Elomaa A , Bednarik R , O’Kelly C
Published: January 2022

Background: Gaze behavior differences between
expert and novice surgeons have been established in previous studies mainly
from the general surgery field.Limited information is available about
surgeon’s visual attention during microsurgery procedures where surgical
microscope is used. Methods: 4 experts and 3 novices
performed 37 independent sutures under the surgical microscope.Eye movements
of surgeons and scene video of the surgical performance were recorded.Total
suturing time and subtask times were compared between level of expertise.We
defined three discrete surgical actions and examined eye gaze (fixation)
directly related to each of these actions.Fixation duration (measured by
total,pre-action,and post-action duration) were compared between expert and
novice, over 3 subtasks (piercing, exiting and cutting) and between pre- and
post-action phases. Results: Expert surgeons
completed the suture with shorter total time than novices.On average,expert
displayed longer fixation time than novice.Experts also maintained their
visual engagement constantly over the 3 level of subtask in comparison to
novices who required a longer fixation time for the challenging subtask
(piercing).Experts use longer pre- than post-action fixation, and this
pattern is distributed over all three subtasks.This gaze engagement strategy
was not shown in novices. Conclusions: The
action-related fixation can be used to evaluate microsurgeons’ level of
expertise and in surgical education for gaze training.
P.007 Autoimmune Encephalitis Timing and Incidence: the Manitoba
Experience
Authors: Nguyen DH , Xu C , Ng M
Published: January 2022

Background: Early treatment of autoimmune
encephalitis (AE) can improve outcomes. Despite expert recommendation, it
remains unclear if suspected AE patients consistently receive empiric
treatments prior to availability of antibody results.
Methods: Retrospective chart review of patients
referred for AE testing in Manitoba. Primary outcomes were the proportion of
patients treated empirically prior to the availability of antibody results.
Incidence, clinical presentation, investigations, complications, mortality
rates, and hospital course were secondary outcome measures.
Results: We identified 151 patients from
2012-2018. 43 patients met inclusion criteria. The annual incidence of AE in
Manitoba was 0.37/100,000. 28/43 (65%) patients were treated prior to
availability of antibody results (“Early group”). 15/43 (35%) patients did
not receive treatment (“Late group”). Significantly more Early group
patients had repeat immunotherapy (p=0.001), abnormal MRI (p=0.027), and
investigations for malignancy (p=0.015). Durations of hospital and intensive
care admission, complication rates, and mortality rates were not different
between the two groups. Conclusions: This is the
first-ever AE incidence, timing, and management study of a comprehensive
Canadian geopolitical and medical catchment area. Just over 1/3 of suspected
AE over seven years were not treated prior to antibody results becoming
available. Patients treated earlier did not experience greater complication
rates.
P.016 Hypertensive disorders in pregnancy are associated with future
development of vascular dementia: A systematic review and
meta-analysis
Authors: Switzer A , Smith EE , Ganesh A
Published: January 2022

Background: We aimed to evaluate the association
between hypertensive disorders in pregnancy (HDP) and future risk of
cognitive impairment and dementia. Methods:
Systematic searches were performed in MEDLINE and EMBASE up to April
27th, 2020. Exposure of interest included the
different types of HDP. Outcomes of interest included dementia incidence,
dementia subtype, and cognitive testing. Results: On
qualitative review, 4/9 studies showed impaired memory, visual motor
processing speed, executive function, and verbal testing in previously
preeclamptic women. 2/4 studies showed impaired visual motor processing and
subjective cognitive complaints in previously eclamptic women. Six cohort
studies involving >2.6 million women were included in the meta-analysis.
Pooled hazard ratios (aHR) with 95% confidence intervals were generally
adjusted for age at delivery ethnicity, and vascular risk factors. Women
with a history of gestational hypertension were more likely to develop
vascular dementia (aHR 2.02 [1.45-2.83],I2:0%), but not
Alzheimer disease (1.24 [0.93-1.66],single-study). Women with a history of
preeclampsia were also more likely to develop vascular dementia (2.17
[1.20-3.91],I2:61.1%), but not Alzheimer dementia
(1.19 [0.83-1.69],I2:69.9%).
Conclusions: Whereas studies of
neuropsychological testing in previously preeclamptic and eclamptic women
have been heterogeneous, a history of HDP is associated with developing
vascular dementia in later life.
P.037 Benefits of Treatment with OnabotulinumtoxinA in Naive and
Non-naive Patients with Cervical Dystonia are Sustained over Time in CD
PROBE
Authors: Agarwal P , Schwartz M , Zuzek A , Patel A
Published: January 2022

Background: The sustained effects of
onabotulinumtoxinA in patients with cervical dystonia (CD) who were naïve or
non-naïve to botulinum toxin at enrollment in CD PROBE (CD Patient Registry
for Observation of BOTOX® Efficacy) were evaluated.
Methods: Patients were included if they completed
all three treatment cycles and had accompanying data in this prospective,
observational study. Assessments included CD severity, Cervical Dystonia
Impact Profile (CDIP-58), Toronto Western Spasmodic Torticollis Rating Scale
(TWSTRS), treatment interval, total dose, and adverse events (AEs).
Results: Changes in severity following each
onabotulinumtoxinA treatment were generally similar between naïve (n=212)
and non-naïve (n=138) patients. Severity scores were maintained or improved
in most patients with mild/moderate symptoms, while 30.0-66.7% with the
highest severity scores shifted to a lower score across treatments.
Sustained improvements were seen in all CDIP-58 subscales and TWSTRS total
scores irrespective of baseline CD severity and toxin status. The median
time interval between injections was similar in naïve (93.0–98.0 days) and
non-naïve patients (96.0–97.0 days); doses tended to be lower in naïve
patients. The most common AEs (dysphagia, muscular weakness) were similar.
Conclusions: CD severity was attenuated by repeat
onabotulinumtoxinA treatments at consistent intervals regardless of prior
botulinum toxin exposure. Treatments were well tolerated.
P.043 Long term MS clinical outcomes predicted by baseline serum
neurofilament light levels
Authors: Abdoli M , Thebault S , Freedman MS , Tessier D , Tobbard-Cossa V , Fereshtehnejad SM
Published: January 2022

Background: Prognostic biomarkers are badly
needed to direct MS treatment intensity early in the condition Levels of
serum neurofilament light chains (sNfL) result from the destruction of
central nervous system axons in MS and correlate with the aggressiveness of
the disease. Methods: In this prospective cohort
study, we identified patients with serum collected within 5 years of first
MS symptom onset with more than 15 years of clinical follow-up. Levels of
sNfL were quantified in patients and matched controls using digital
immunoassay. Results: Sixty-seven patients had a
median follow-up period of 17.4 years (range:15.1-26.1). Median serum NfL
levels in baseline samples of MS patients was 10.1 pg/ml, 38.5% higher than
median levels in 37 controls (7.26pg/ml, p=0.004). Baseline NfL level was
most helpful as a predictive marker to rule out progression; patients with
levels less 7.62pg/ml were 4.3 times less likely to develop an EDSS score of
34 (p=0.001) and 7.1 times less likely to develop
progressive MS (p=0.054). Patients with the highest NfL levels (3rd-tertile,
>13.2 pg/ml) progressed most rapidly with an EDSS annual rate of 0.16
(p=0.004), remaining significant after adjustment for sex, age, and
disease-modifying treatment (p=0.022). Conclusions:
This study demonstrates that baseline sNfL is associated with long term
disease progression.
P.061 Stroke Care and Neurological Emergency Response Simulation
(SCaNERS): Creation and Implementation into a Resident Curriculum
Authors: Archibold K , Graham B
Published: January 2022

Background: Resident physicians often observe
stroke alerts before managing them alone. However, this practice exposes
patients to potential harm from trainees’ lack of experience. To address
this, we created a acute stroke simulation course. Simulation training
offers a low-risk environment for skill acquisition, complimenting the Royal
College’s recent transition away from a time-based to competency-based
learning curriculum. The purpose of this project was to develop and
implement a stroke simulation training program into resident neurology
rotations at the University of Saskatchewan. Methods:
Six high-fidelity acute stroke simulation cases were developed with the aid
of a Simulation Operation Specialist. We identified objectives corresponding
to Royal College Entrustable Professional Activities for Adult Neurology
encompassing several diagnostic and therapeutic goals of acute stroke care.
To increase fidelity, a standardized patient was recruited and trained on
how to respond to neurologic exams given a specific stroke syndrome. A
standardized debrief was given after each session in a safe, non-judgemental
environment. Results: Simulation sessions have been
running monthly since March 25, 2021. Conclusions:
The creation and implementation of high-fidelity simulation training into a
resident curriculum is feasible. Ongoing data is being collected to explore
residents’ experiences and knowledge improvement in stroke, and to asses
local reductions in treatment delays.