bluuebunny/crossref_metadata_2025 huggingface dataset:
Tungsten Nitride, Well‐Dispersed on Porous Carbon: Remarkable Catalyst, Produced without Addition of Ammonia, for the Oxidative Desulfurization of Liquid Fuel
Authors: Khan Nazmul Abedin , Bhadra Biswa Nath , Park Suk Woo , Han Yong‐Su , Jhung Sung Hwa
Published: June 2019

Polyanilines (pANIs), loaded with phosphotungstic acid (PTA), are pyrolyzed to get WO3 or W2N (≈6 and ≈7 nm, respectively), which is well‐dispersed on pANI‐derived porous carbons (pDCs). Depending on the pyrolysis temperature, WO3/pDC, W2N/pDC, or W2N‐W/pDCs could be obtained selectively. pANI acts as both the precursor of pDC and the nitrogen source for the nitridation of WO3 into W2N during the pyrolysis. Importantly, W2N could be obtained from the pyrolysis without ammonia feeding. The obtained W2N/pDC is applied as a heterogeneous catalyst for the oxidative desulfurization (ODS) of liquid fuel for the first time, and the results are compared with WO3/pDC and WO3/ZrO2. The W2N/pDC is very efficient in ODS with remarkable performance compared with WO3/pDC or WO3/ZrO2, which is applied as a representative ODS catalyst. For example, W2N/pDC shows around 3.4 and 2.7 times of kinetic constant and turnover frequency (based on 5 min of reaction), respectively, compared to that of WO3/ZrO2. Moreover, the catalysts could be regenerated in a facile way. Therefore, W2N/pDC could be produced facilely from pyrolysis (without ammonia feeding) of PTA/pANI, and W2N, well‐dispersed on pDC, can be suggested as a very efficient oxidation catalyst for the desulfurization of liquid fuel.
Translanguaging in English‐Only Schools: From Pedagogy to Stance in the Disruption of Monolingual Policies and Practices
Authors: Menken Kate , Sánchez María Teresa (Maite)
Published: June 2019

This article presents findings from qualitative research conducted in eight New York City public schools offering English as a new language (also known as English as a second language), in which language education policies were monolingual in English at the start of data collection. These schools participated in an intensive professional development and technical assistance project for which they were required to engage students’ bilingualism as a resource in instruction and implement translanguaging pedagogy, using the entire linguistic repertoire of bilingual children flexibly and strategically in instruction (García, Ibarra Johnson, & Seltzer, 2016). This study documents the efforts of participating schools to make their practices for emergent bilinguals more multilingual. Findings suggest that translanguaging pedagogy initiated broader ideological shifts as educators adopted a translanguaging stance that has proven transformative to the schools as a whole. Specifically, findings reveal changes in how educators thought about emergent bilinguals, their language practices and the place of those practices in instruction, and how this ideological shift engendered significant changes in several schools to their language policies. Moreover, findings show how the introduction of translanguaging pedagogy in participating schools disrupted dominant monolingual approaches in theoretical and practical ways and the impact of doing so on educators and students.
P.005 Long-term retention on adjunctive brivaracetam in adults with focal seizures and previous carbamazepine, lamotrigine, levetiracetam, or topiramate use: Post-hoc analysis
Authors: Foris K , Martin M , Dimova S , Elmoufti S , Laloyaux C , Chung SS
Published: June 2019

Background: Previous post-hoc analysis of three 12-week, double-blind, placebo-controlled trials of adjunctive brivaracetam (BRV) in patients with focal seizures demonstrated similar efficacy over placebo regardless of previous carbamazepine (CBZ), lamotrigine (LTG), levetiracetam (LEV), or topiramate (TPM) failure. This analysis explored long-term retention of adjunctive BRV in patients with previous CBZ/LTG/LEV/TPM. Methods: Post-hoc analysis of double-blind, placebo-controlled trial (N01358 [NCT01261325]) and open-label extension (N01379 [NCT01339559]; cut-off 15-March-2017) of adjunctive BRV in patients (≥16 years) with focal seizures. Outcomes were assessed in patients randomized to BRV (100 or 200 mg/day) who had previous CBZ/LTG/LEV/TPM (stopped ≥90 days before BRV initiation). Results: 503 patients were analyzed. Baseline characteristics were generally similar in subgroups with previous CBZ/LTG/LEV/TPM (n=209/162/256/182). Overall, Kaplan-Meier-estimated BRV retention at 1-, 3-, and 5-years was 71.0%, 50.9%, and 32.4%. Across previous antiepileptic drug (AED) subgroups, Kaplan-Meier-estimated BRV retention (1-year: 64.8%–73.2%; 3-year: 41.9%–49.9%; 5-year: 31.5%–35.7%), BRV discontinuations (58.4%–63.0%), and most common reasons for discontinuation (lack of efficacy: 23.0%–25.3%; adverse event: 16.7%–22.2%) were generally similar. Conclusions: Post-hoc analysis demonstrated similar long-term retention rates and discontinuation reasons with adjunctive BRV in adults previously treated with CBZ/LTG/LEV/TPM. Adjunctive BRV provides long-term effectiveness in patients who failed common AED treatments, including LEV.

UCB Pharma-sponsored
P.008 Triphasic waves in powassan encephalitis: a case report
Authors: Malla P
Published: June 2019

Background: Powassan virus is a tick borne virus which can lead to encephalitis. Methods: 63 year old woman with history of migraine presented with 2 days of fever, headache, language difficulty and right sided facial droop. Her examination revealed right upper motor neuron type facial weakness and expressive aphasia. She rapidly deteriorated within 24 hours becoming non verbal and ultimately comatose. Results: MRI brain revealed T2 hyperintensities in bilateral caudate and putamen. Subsequent MRI brain showed progression of the caudate and basal ganglia changes and new T2 hyperintensities in bilateral thalami and midbrain with no abnormal enhancement. CSF revealed lymphocytic pleocytosis with normal protein and glucose. Viral Encephalitis was suspected and she was continued on Acyclovir until Varicella zoster and Herpes simplex virus serology in CSF returned negative. Prolonged video EEG showed near continuous generalized triphasic pattern without any evolution or seizure pattern. There was no improvement in clinical status or EEG with antiepileptic treatment. Paraneoplastic panel , serum HIV, Lyme and 14-3-3 protein were negative. Extensive viral serologies were sent and ultimately Powassan serology came back positive. Conclusions: This case highlights powassan virus as a cause of encephalitis and occurrence of triphasic waves in non metabolic causes of encephalopathy such as infectious encephalitis.
P.013 Needs assessment of rural telemedicine care for Parkinson disease in British Columbia
Authors: Peacock DJ , Baumeister PA , Monaghan A , Siever JE , Wile D
Published: June 2019

Background: People with Parkinson disease (PD) face progressive mobility loss, but medical treatment is dependent on clinical assessment and examination. Regional patient and physician density patterns pose further problems to accessing care. Telehealth may improve access particularly among rural populations, but an approach to this problem should consider patient perspectives. Methods: We surveyed and conducted a focus group for people with PD and their caregivers. Questions assessed perceptions of barriers to neurological care and use of telehealth for PD management. Thematic analysis was performed to classify qualitative data. Results: 18 individuals completed the survey and 7 parties joined the focus group. 52% of participants travel >50km for neurologist appointments (range = 59 to 842km). Perceived barriers include cost and difficulty of travel, wait times, lack of interdisciplinary healthcare and deep brain stimulation outside large cities. 80% of participants (95% C.I. 64-96%) would likely or very likely use telehealth for follow-up neurologist appointments if proven as good as in-office visits. Participants associated telehealth with improved quality of care, improved access to care, and cost savings. Conclusions: This sample of people with PD and their caregivers report willingness to access care via telehealth to reduce perceived cost and travel for specialty care.
P.015 Long-term progression and prognosis in different subtypes of Parkinson’s disease: validation of a new multi-domain subtyping method
Authors: Fereshtehnejad S , Zeighami Y , Dagher A , Postuma RB
Published: June 2019

Background: Parkinson’s disease (PD) varies in clinical manifestations and course of progression from person to person. Identification of distinct PD subtypes is of great priority to develop personalized care approaches. We aimed to compare long-term progression and prognosis between different PD subtypes. Methods: Data on 421 individuals with de novo early-onset PD was retrieved from Parkinson’s Progression Markers Initiative (PPMI). Using a newly developed multi-domain subtyping method (based on motor phenotype, RBD, autonomic disturbance, early cognitive deficit), we divided PD population into three subtypes at baseline: “mild motor-predominant”, “Diffuse malignant” and “Intermediate”. Rate of global progression (mixed motor and non-motor features) and developing dementia were compared between the subtypes. Results: Patients with “diffuse malignant” PD experienced 0.5 z-score further worsening of global composite outcome (p=0.017) and 2.2 further decline in MOCA score (p=0.001) after 6-years of follow-up. Hazard for MCI/dementia was significantly higher in “diffuse malignant” (HR=3.2, p<0.001) and “intermediate” (HR=1.8, p<0.001) subtypes. Individuals with “diffuse malignant” PD had the lowest level of CSF amyloid-beta (p=0.006) and SPECT striatal binding ratio (p=0.001). Conclusions: This multi-domain subtyping is a valid method to predict subgroups of PD with distinct patterns of long-term progression at drug-naïve early-stage with potential application in real-life clinical practice.
P.016 Clinical course of relapsing remitting multiple sclerosis post-natalizumab
Authors: Fiander MD , Bhan V , Stewart SA , Parks NE
Published: June 2019

Background: Natalizumab is an efficacious disease modifying therapy (DMT) for relapsing remitting multiple sclerosis (RRMS), however, duration of therapy is often limited by risk of progressive multifocal leukoencephalopathy (PML). We describe the clinical course of RRMS patients switched from natalizumab to another DMT in a Canadian MS clinic. Methods: We conducted a retrospective study of prospectively collected data from the Dalhousie Multiple Sclerosis Research Unit (DMSRU). We identified all RRMS patients treated with natalizumab for >3 months who discontinued therapy with serum JC virus antibody positive status and switched to another DMT. Results: There were 84 individuals who switched to another DMT following natalizumab with 57 (68%) switching to fingolimod. Survival without a relapse on fingolimod was 92% (95% confidence interval 80-97%) at 6 months, 90% (77-96%) at 12 months, 85% (71-93%) at 24 months, 74% (56-86%) at 36 months. Survival without disease progression on fingolimod was 90% (95% CI 78-96%) at 6 months, 86% (72-93%) at 12 months, 78% (63-88%) at 24 months, 78% (63-88%) at 36 months. Conclusions: Although alternative DMTs may be used post-natalizumab, fingolimod remains an effective therapy with a high proportion of patients remaining free of relapses or progression at 3 years.
P.033 Awareness and knowledge of stroke and heart disease:a follow-up study of the Chinese-Canadian cardiovascular health project
Authors: Chu JY , Chow C , Moe GW , Yan A , Tu JV , Lee C
Published: June 2019

Background: This is an updated on-line survey of the awareness and knowledge of stroke and heart disease amongst Chinese-Canadians carried out in 2017. Methods: 1001 randomnly selected Chinese-Canadians from Toronto and Vancouver area. Results: 46% were > 45 years old and male to female ratio was: 49.3 : 50.8, with native language being Cantonese in 40%, Mandarin 24% and 31% English. 82% were Canadian citizens and 31% had been in Canada < 10 years. 44% were from Mainland China, 37% Hong Kong , 6% Taiwan and 12% were borned in Canada. 85% were able to name at least one symptom of heart attack (p=0.005) while 80% were able to name at least one symptom of stroke (p=0.0008). 85% would call 911 in response to symptoms of heart attack or stroke compared to only 20% in a previous 2004 telephone survey (p=0.00001) . Conclusions: There is a dramatic improvement in the awareness and knowledge of stroke and heart disease amongst Chinese-Canadians compared to a previous telephone survey in 2004. This significant change could be due to difference in survey technique, but these improvements could also be due to the ongoing health promotion efforts by the Chinese-Canadian Council in support of the Heart & Stroke Foundation.
P.035 Impact of a telestroke system on acute ischemic stroke patient outcomes and thrombolysis rates
Authors: Rasmussen SL , Canales D , Blacquiere D
Published: June 2019

Background: Telestroke can improve ischemic stroke patient outcomes by improving access to physicians specialized in stroke care and increasing the rate of thrombolysis. The aim of this study to assess the effect of the newly implemented Telestroke service on ischemic stroke patient outcomes in New Brunswick, Canada, a province with a high rural population. Methods: By means of a retrospective chart review, data for 366 adult acute ischemic stroke patients (Telestroke = 15.3%; non-Telestroke = 84.7%) were collected from emergency departmentsspanning five sites in the province. Outcomes included home discharge rates, complications (i.e., hemorrhage,angioedema), mortality, rate of thrombolysis and time to treatment. Results: No significant differences emerged for home discharge rates, complications, mortality or door-to-needle time. Telestroke patients had a significantly greater rate of thrombolysis treatment (51.8% vs 6.1%) and significantly less door-to-CT time (M= 27.63 min vs M= 100.78 min) compared to the non-Telestroke group. Conclusions: Overall, both groups had similar outcomes with some trends toward improvements for patients utilizing Telestroke.
P.038 Bilateral carotid thrombi and cerebral infarction as a manifestation of heparin-induced thrombocytopenia with normal platelet count: a case report
Authors: Malla P
Published: June 2019

Background: This is the first report of Heparin induced thrombocytopenia (HIT) presenting as bilateral carotid thrombi and multiple cerebral infarcts. Methods: 54 year old woman presented with sudden onset of right arm numbness and weakness two days after discharge from hospital. During her hospitalization 9 days prior, she underwent colovesicular fistula repair, received heparin subcutaneously for DVT prophylaxis and had normal platelet counts. Results: On this admission, MRI Brain showed scattered multiple acute infarcts within the cortex of bilateral cerebral hemispheres. CT angiography head /neck showed non-occlusive thrombi at the carotid bifurcations bilaterally. Platelet count on admission was 267 K/uL q which decreased to 125 K/uL the next day, after which heparin was started for the carotid thrombi. The platelet count rapidly decreased further to 79 K/uL leading to suspicion for HIT and switching to Argatroban. HIT and serotonin release assay were positive confirming the diagnosis of HIT. CT chest and tranthoracic echocardiogram was normal. Venous Duplex of bilateral upper and lower extremities were negative for DVTs.Hypercoaguable evaluation was negative. Conclusions: This case highlights the importance of identifying HIT as a cause of arterial thrombosis and stroke even with normal platelet counts in the clinical setting of recent heparin use.
P.040 Efficacy and safety of periodic albumin infusions in refractory postural orthostatic tachycardia syndrome: a comparative study
Authors: Siddiqi ZA , Blackmore D , Soloway A
Published: June 2019

Background: Postural Orthostatic Tachycardia Syndrome (POTS) causes excessive heart rate and orthostatic intolerance on standing. About 25% patients have refractory POTS. Saline infusions reduce improve quality of life in such patients. Intravenous albumin expands circulatory volume by increasing plasma oncotic pressure. Efficacy of albumin infusions in POTS has not been studied. Methods: To assess the efficacy of albumin infusions in refractory POTS we treated patients with weekly or biweekly intravenous infusions of either 5% albumin in normal saline (n=16) or normal saline alone (n=7) in this open label comparative study. Most patients had failed multiple treatments. Serial clinical evaluations with individual symptom scores were the primary outcome measure of efficacy. Results: Mean follow up was 2 years (range 4 weeks - 5 years). 14/16 patients on albumin and 4/7 patients on saline infusions improved. Significantly more patients (7 vs. 1) on albumin showed marked improvement from baseline with more prominent reduction in orthostatic heart rate (mean reduction 19 vs. 14 beats minute). Albumin was well tolerated. More patients on saline (3/7 vs. 2/16) discontinued infusions due to lack of efficacy. Some patients required a permanent venous catheter. Conclusions: Intravenous albumin infusions are well tolerated and more effective than normal saline in refractory POTS.
P.046 Increasing EEG monitoring in the pediatric ICU - benefits and barriers
Authors: Ghossein J , Alnaji F , Pohl D
Published: June 2019

Background: Non-convulsive seizures are common in critically ill patients and are best detected by continuous EEG (cEEG) monitoring. A recent consensus statement from the American Clinical Neurophysiology Society (ACNS) outlines the indications for EEG monitoring in critically ill patients. Our aim was to assess adherence to these indications, barriers to cEEG utilization as well as to optimize cEEG monitoring in critically ill children. Methods: We conducted a retrospective review of electronic medical records, analyzing patients admitted to the PICU from January 1st until June 23rd 2018, followed by an 8-week mentorship period, consisting of educational interventions as well as daily patient rounds to help identify patients meeting cEEG monitoring criteria. Results: Prevalence of patients meeting cEEG monitoring indications were similar in both the retrospective and mentorship period (18% vs. 23%). During the retrospective period, 23% of patients received cEEG monitoring, reaching 100% at the end of the mentorship period. The median delay for initiation of monitoring was 17 hours, largely due to restrictions in the availability of technologists. All cEEGs performed informed anti-convulsive management. Conclusions: An educational intervention was effective in increasing PICU cEEG monitoring. However, limited hours of technologist availability represented the largest barrier to timely cEEG monitoring.
P.048 Characterization of somatic mutations in mTOR pathway genes in focal cortical dysplasias
Authors: Krochmalnek E , Accogli A , St-Onge J , Addour N , Dudley R , Myers K , Dubeau F , Karamchandani J , Farmer J , Atkinson J , Hall J , Poulin C , Rosenblatt B , Lapalme J Lafond , Albrecht S , Rivière J , Srour M
Published: June 2019

Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.
P.070 Thrombolysis without large vessel occlusion in a child with acute arterial ischemic stroke
Authors: Hanes IE , Orr SL , Davila J , Kirton A , Sell E
Published: June 2019

Background: Stroke is a rare neurological disease in children, with an annual incidence of 2 - 13/100,000 children per year. Pediatric stroke is associated with significant morbidity and mortality lasting many decades. Diagnosis of pediatric stroke is challenging and often delayed, limiting options for acute intervention, and the pharmacological and mechanical recanalization strategies that have revolutionized adult stroke remain undefined in children. Clinicians are left to draw conclusions from other retrospective cohort studies or case reports and extrapolate adult guidelines to the pediatric population. The TIPS trial eligibility criteria are often used in clinical practice, despite not being validated for this purpose. We present here the case of a healthy 14 year old male who was treated with intravenous tissue plasminogen activator (IV tPA) for a presumed arterial ischemic stroke without large vessel occlusion on neuroimaging. Methods: Retrospective chart review Results: Not applicable Conclusions: Following the administration of IV tPA, the patient made a full recovery. While we do not recommend the routine use of IV tPA for treatment of presumed large vessel or small vessel in children, we suggest that the decision to proceed with IV tPA be considered on a case-by-case basis.
P.071 Clinical and demographic predictors of stress in parents of children with genetically determined leukoencephalopathies
Authors: Dermer EA , Spahr A , Tran L , Mirchi A , Pelletier F , Guerrero K ,   The Leukodystrophy Family Impact Research Group, Bernard G
Published: June 2019

Background: Genetically-determined leukoencephalopathies comprise a rare group of inherited white matter disorders. The vast majority are associated with a progressive disease course and early death. This study seeks to determine the clinical and demographic correlates of stress in parents of leukodystrophy patients, for future clinical guidance. Methods: A cross-sectional study including 36 families was performed. Children aged 1 month to 12 years with a diagnosed leukodystrophy or genetically-determined leukoencephalopathy were included. 31 mothers and 24 fathers completed the Parental Stress Index, 4th edition (PSI-4). One demographic questionnaire was completed per family. Clinical data was gathered within 6 months of the questionnaires. Statistical analysis was performed with total stress (TS) scores as the primary outcome. Results: Mothers and fathers had comparable TS scores. No clinical or demographic factors predicted the father’s TS score. Greater ambulatory impairment, using the GMFCS scale, correlated to lower TS scores in the mother. Conclusions: The progressive nature of these conditions makes it such that anticipating a child’s inability to walk may cause more stress for mothers than a child’s actual inability to ambulate. The inability of all other variables to predict total stress highlights a need for individualized approaches when addressing stress in these families.
P.075 Clinical spectrum of POLR3-related leukodystrophy caused by biallelic POLR1C pathogenic variants
Authors: Gauquelin L , Cayami FK , Sztriha L , Yoon G , Tran LT , Guerrero K , Hocke F , van Spaendonk RM , Fung EL , D’Arrigo S , Vasco G , Thiffault I , Niyazov DM , Person R , Lewis KS , Wassmer E , Prescott T , Fallon P , McEntagart M , Rankin J , Webster R , Philippi H , van de Warrenburg B , Timmann D , Dixit A , Searle C , Thakur N , Kruer MC , Sharma S , Vanderver A , Tonduti D , van der Knaap MS , Bertini E , Goizet C , Fribourg S , Wolf NI , Bernard G ,   DDD Study
Published: June 2019

Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.
P.105 The “Comprehensive 3D Skull Base Lab”-- enhancing resident education with virtual/augmented reality and 3D printing at Northwestern University
Authors: Walsh MT , Khan OH
Published: June 2019

Background: Due to increasingly limited access to cadavers and first-hand operative experience, there is an increasing need for innovative modalities in neurosurgical education. Recent developments in computer modelling, virtual/augmented reality, and video game technology have created new opportunities for novel teaching tools. We set out to develop a library of 3D models of normal anatomy and pathologic states for use in conjunction with an interactive simulated environment and 3D printing for teaching of neurosurgical residents. Methods: Anatomically accurate 3D models were developed using CT/MRI data from multiple patients using open source segmentation and 3D animation software. An interactive simulated environment was then created using a 3D game engine and used in conjunction with a virtual/augmented reality system. 3D models were also used to for 3D printing. Results: 3D models and an interactive simulated environment were used in conjunction with various viewing modalities, including 3D video, 360 video, and virtual reality headsets, as well as 3D printing. These teaching tools were successfully implemented in neurosurgery didactic teaching sessions and in the skull base lab. Additional benefits were seen with patient engagement and marketing. Conclusions: 3D modeling and animation show considerable promise for neurosurgical education, with additional benefits for patient engagement, marketing, and social media.
P.116 Predicting cerebral vasospasm following aneurysmal subarachnoid hemorrhage is still an imperfect science
Authors: Pickett GE , Schmidt MH , Shankar JS
Published: June 2019

Background: Cerebral vasospasm is a leading cause of neurological disability following aneurysmal subarachnoid hemorrhage (aSAH). Clinical features associated with vasospasm development include blood burden on CT, neurological status, age and aneurysm location. Early cerebral CT perfusion (CTP) scanning in aSAH may be an independent predictor of vasospasm and/or delayed cerebral ischemia (DCI). Methods: Forty-one patients with aSAH were prospectively enrolled. Baseline data collected included WFNS grade, loss of consciousness at ictus, and modified Fisher grade. CTP was obtained at baseline and on day 6 post SAH. Cerebral blood volume, cerebral blood flow and mean transit time were measured. DCI was confirmed by a combination of clinical assessments, non-contrast CT and CTP. Radiological vasospasm was assessed with CT angiography. Results: Despite 80% of patients having a modified Fisher grade 3 or 4 aSAH, one-third presenting with ictal LOC and half having anterior communicating artery aneurysms, only one patient developed clinical evidence of vasospasm/DCI. Two others had asymptomatic radiological vasospasm. CTP parameters did not differ between groups defined by clinical predictors. Conclusions: In an unexpected finding, clinical and radiological vasospasm were very uncommon in this cohort. Clinical predictive variables correlated poorly with development of vasospasm. CTP may help refine the model but further work is needed.
P.123 Normal pressure hydrocephalus with associated tremor
Authors: Persad A , Meguro K
Published: June 2019

Background: Normal pressure hydrocephalus is a frequent cause of cognitive and functional impairment. Many symptoms are shared between Parkinson’s disease and normal pressure hydrocephalus. Only few studies examine extrapyramidal signs in NPH, and only one case report exists describing tremor improvement with shunting. Methods: We performed a retrospective chart review of our NPH database. We selected patients who had both NPH and question of Parkinsonism due to tremor. Results: Six patients with both NPH diagnosis and tremor were identified. Three patients were treated for Parkinson’s disease and followed by neurology. After shunting, all three improved and attempt was made to wean medications, which led to functional decline. The other three patients improved with shunting and after titration of the shunt had resolution of tremor. Conclusions: We provide evidence that NPH can result in tremor, treatable by shunting. We also emphasize that those patients do exist who have both diseases. This likely exists along a continuum. Careful consideration of NPH should be undertaken in those patients with suspected Parkinson’s disease and imaging findings reminiscent of NPH.
GP.01 Childhood obesity and multiple sclerosis susceptibility: a Mendelian randomization study
Authors: Harroud A , Mitchell RE , Morris JA , Forgetta V , Sawcer SJ , Smith G Davey , Richards B
Published: June 2019

Background: Observational studies have reported an association between childhood obesity and a higher risk of multiple sclerosis (MS). However, the difficulties to fully account for confounding and long recall periods make causal inference from these studies challenging. The objective of this study was to assess the contribution of childhood obesity to the development of MS through Mendelian randomization, which uses genetic associations to minimize the risk of confounding. Methods: We selected 23 independent genetic variants strongly associated with childhood body mass index (BMI) in a genome-wide association study (GWAS) which included 47,541 children. The corresponding effects of these variants on risk of MS were obtained from a GWAS of 14,802 MS cases and 26,703 controls. Standard two-sample Mendelian randomization methods were performed, with additional sensitivity analyses to assess the likelihood of bias from genetic pleiotropy. Results: The inverse-variance weighted MR analysis revealed that one standard deviation increase in childhood BMI increased odds of MS by 26% (odds ratio=1.26, 95% confidence interval 1.10-1.45, p=0.001). There was no significant heterogeneity across the individual estimates. Sensitivity analyses were consistent with the main findings and provided no evidence of pleiotropy. Conclusions: This study provides genetic support of a role for increased childhood BMI in the development of MS.
A.03 Cholinergic Neurons in Nucleus Subputaminalis in Primary Progressive Aphasia
Authors: Hamodat H , Fisk J , Darvesh S
Published: June 2019

Background: Primary Progressive Aphasia (PPA) involves an isolated impairment of language function at disease onset. The cholinergic system is implicated in language and cholinergic deficits are seen in brains of individuals with PPA. One major source of cholinergic innervation is the nucleus basalis of Meynert (NBM) within which lies the nucleus subputaminalis (NSP). We quantified cholinergic neurons in the NBM and NSP of PPA and controls. Also explored was whether individuals with PPA who subsequently developed different clinical and neuropathological profiles, showed similar cholinergic deficits in the NSP. Methods: Cytoarchitecture of the basal forebrain was studied using Nissl staining in control (n=5) and PPA (n=5) brains. Choline acetyltransferase immunohistochemical staining labelled cholinergic neurons, quantified using Neurolucida software. Results: Compared to matched controls, PPA showed reduction of cholinergic neurons in the NBM, t(4) = 4.224, p = 0.013; Cohen’s d=1.89 and the NSP, t(4) = 4.013, p = 0.016; Cohen’s d= 1.79. The average percent of cholinergic neuronal loss was higher in the NSP (64.66%) compared to NBM (17.66%). Conclusions: Regardless of underlying pathology, all cases presenting with PPA showed marked loss of cholinergic neurons in the NSP providing further evidence for the importance of this nucleus in language function.
A.05 Five-year clinical and health economic outcomes in patients with late functional improvement post-stroke: A population-based cohort study
Authors: Ganesh A , Luengo-Fernandez R , Rothwell PM
Published: June 2019

Background: We recently demonstrated that late functional improvement between 3-12 months post-stroke occurs in about one-fourth of patients with ischaemic stroke. It is unknown whether this improvement is associated with better long-term clinical or health-economic outcomes. Methods: In a prospective, population-based cohort of 1-year ischaemic stroke survivors (Oxford Vascular Study;2002-2014), we determined changes in functional status (modified Rankin Scale[mRS], Rivermead Mobility Index[RMI], Barthel Index[BI]) from 3-12 months post-stroke. We examined the association of late improvement (by ≥1 mRS grades, ≥1 RMI points, and/or ≥2 BI points) with 5-year mortality, institutionalization (Cox regressions), and health/social-care costs (generalized linear models), adjusted for age/sex/3-month disability/stroke subtype. Results: Among 1,288 1-year survivors, 1,135 had 3-month mRS>0, with 319(28.1%) demonstrating late improvement. 1-year survivors with late mRS improvement had lower 5-year mortality (aHR:0.68,95%CI 0.51-0.91,p=0.009), institutionalization (aHR:0.48,0.33-0.72,p<0.001), and costs (margin -$17,369,-25,271 to -9,469,p<0.001). These associations remained on excluding patients with recurrent strokes during follow-up (e.g. 5-year death/institutionalization aHR:0.59,0.44-0.79,p<0.001) and on examining late improvement per RMI and/or BI (e.g. 5-year death/institutionalization aHR:0.67,0.53-0.84,p=0.001). Conclusions: Late functional improvement post-stroke is associated with lower 5-year mortality, institutionalization, and costs. These findings should motivate patients and clinicians to maximize late recovery and encourage payers to consider access to rehabilitative services for at least 1-year post-stroke.
A.06 Assessing inter-rater reliability in localizing sleep-related hypermotor seizures: a video-based survey
Authors: Lobbezoo PM , Nobili L , Gibbs S
Published: June 2019

Background: Sleep-related hypermotor epilepsy (SHE) is a focal epilepsy characterized by abrupt sleep-related hypermotor seizures (SRHS) with complex semiology. Although difficult to localize within the frontal lobe recent studies using intracerebral EEG recordings have suggested the existence of four distinct semiology patterns (SP) organized in a rostro-caudal manner. It remains unclear however if these SP are clinically useful. Methods: We aimed to estimate the inter-rater reliability (IR) of classifying SP in SHE amongst epilepsy and sleep medicine experts. Following a short training session, ten experts were asked to review and classify 40 videos of SRHS in patients with confirmed SHE. IR was calculated using Kappa statistics. Results: SP1 and SP4, who are at the opposite ends of the SHE semiology spectrum, had substantial IR (0.82 and 0.67, respectively). Meanwhile, SP2 and SP3 showed fair agreement (0.25 and 0.35, respectively) and represented the major source of variance, with a small difference favouring epilepsy experts. Conclusions: Amongst epilepsy and sleep medicine experts, IR of classifying SRHS into four SP was only mildly satisfactory. SP1 and SP4 were shown to be easily recognizable while SP2 and SP3 were frequently confounded. Improvements in SP recognition are needed before widespread clinical use.
B.02 Long-term neurodevelopmental outcomes in preterm twins
Authors: Christensen R , Chau V , Synnes A , Grunau R , Miller S
Published: June 2019

Background: Preterm infants are at risk for adverse neurodevelopmental outcomes, however studies examining preterm twins are limited. The aim of this study was to examine whether preterm monozygotic (MZ) and dizygotic (DZ) twins have similar morbidities and long-term neurodevelopmental outcomes. Methods: From a cohort of 225 preterm neonates studied with MRI, 24 MZ and 52 DZ twins were included. Outcomes at 1.5-years, 3-years and 4.5-years were assessed with the Bayley-III, Movement Assessment Battery for Children and Wechsler Preschool and Primary Scale of Intelligence. Results: Twin pairs had substantial concordance for retinopathy of prematurity but only moderate-fair concordance for bronchopulmonary dysplasia, infection and brain injury. Differences in cognitive and language scores were stable over time, while motor differences increased. Discordant twins had significantly lower gestational age [Mean1(SD)=26.7(1.38); Mean2(SD)=29.1(2.1); P<0.001] and birth weight [Mean1(SD)=892.2(291.2); Mean2(SD)=1208.0(289.4); P=0.001] and a higher incidence of bronchopulmonary dysplasia and retinopathy of prematurity. In discordant twins, cognitive and language score differences decreased over time while motor differences increased. Conclusions: Preterm twin pairs have similar neurodevelopmental outcomes through early childhood despite poor concordance for perinatal illness. Discordant twins were born earlier and had more morbidities. Increasing concordance in cognitive and language outcomes over time may reflect the positive impact of early intervention programs.
C.03 Deformation-based morphometry analysis of longitudinal low-grade glioma growth
Authors: Gui C , Lau JC , Kai J , Khan AR , Megyesi JF
Published: June 2019

Background: Diffuse low-grade gliomas (LGGs) are primary brain tumours with infiltrative, anisotropic growth related to surrounding white and grey matter structures. Deformation-based morphometry (DBM) is a simple and objective image analysis method that can identify areas of local volume change over time. In this study, we illustrate the use of DBM to study the local expansion patterns of LGGs monitored by serial magnetic resonance imaging (MRI). Methods: We developed an image processing pipeline optimized for the study of LGG growth involving the fusion of follow-up MRIs for a given patient into an average template space using nonlinear registration. The displacement maps derived from nonlinear registration were converted to Jacobian maps, which estimate local tissue expansion and contraction over time. Results: Our results demonstrate that neoplastic growth occurs primarily around the edges of the tumour while the lesion core and areas adjacent to obstacles, such as the skull, show no significant expansion. Regions of normal brain tissue surrounding the lesion show slight contraction over time, representing compression due to mass effect of the tumour. Conclusions: DBM is a useful tool to understand the long-term clinical course of individual tumours and identify areas of rapid growth, which may explain the current presentation and/or predict future symptoms.
Defending the English Pale: the viceroyalty of Richard Nugent, third baron of Delvin, 1527–8
Authors: Ellis Steven G.
Published: June 2019

The kidnapping by the local chief, O'Connor Faly, of Henry VIII's governor, Lord Delvin, in 1528 plunged the Dublin administration into crisis. Delvin was the most obvious – but not entirely surprising – casualty of an ingenious but flawed experiment by the king, aimed at bolstering as governor a reliable border baron by harnessing to his governorship the manraed of the traditional ruling magnate, so saving the cost to the king of a border garrison. Delvin's weak administration underlined the low priority accorded to Irish affairs at Henry VIII's court; but even after its predictable collapse, the king disclaimed responsibility. Against advice at court and in Ireland, the king then insisted on reappointing a previously unsuccessful governor, thus simply compounding the difficulties faced by the Dublin administration.
Michael Jones and the survival of the Church of Ireland, 1647–9
Authors: Little Patrick
Published: June 2019

The marquess of Ormond's surrender of Dublin to the forces of the English parliament in the summer of 1647 has been seen as marking the demise of the Church of Ireland, with ministers given the choice of adopting the PresbyterianDirectory for Public Worshipor fleeing the country. This article examines the survival of the church thanks to the benign influence of the governor of Dublin, Colonel Michael Jones, and his brother, Dr Henry Jones, bishop of Clogher. Under Michael Jones's rule the Book of Common Prayer continued to be used, ministers were appointed to vacancies, and clerical networks continued to operate. It was only after the Cromwellian invasion in August 1649, and the replacement of Jones by the Cromwellian hard-liner, Colonel John Hewson, that the church was forced out of business – a process completed with its formal abolition by the autumn of 1650.
Select document: ‘Petition of the inhabitants of Cavan to the lord deputy and council’, 8 July 1629
Authors: Scott Brendan
Published: June 2019

This article examines a letter from Cavan's political elite to the lord deputy and council in July 1629 in protest against the imposition of charges relating to the Graces. The letter, with its graphic description of a county gripped by famine, tells us much about conditions on the ground at this time. What is most interesting about this petition, however, are the more than one hundred signatures appended to it. The names include a mix of both Gaelic Irish and British settlers and indicate a plantation county whose two communities were prepared to work with each other, on this occasion at least, in order to achieve a common goal.
Pilot study of a mobile smoking cessation intervention for low-income smokers with serious mental illness
Authors: Brunette Mary F. , Ferron Joelle C. , Geiger Pamela , Guarino Susan , Pratt Sarah I. , Lord Sarah E. , Aschbrenner Kelly A. , Adachi-Mejia Anna
Published: June 2019

Introduction

People with serious mental illness (SMI) have high rates of smoking and need better access to cessation treatment. Mobile behavioral interventions for cessation have been effective for the general population, but are not usable by many with SMI due to cognitive impairments or severe symptoms. We developed a tailored mobile cessation treatment intervention with features to reduce cognitive load.

Method

We enrolled 20 smokers with SMI and showed them how to use the program on a device of their choice. They were assessed at 8 weeks for intervention use, usability, satisfaction, smoking characteristics, and biologically verified abstinence.

Results

Participants accessed an average of 23.6 intervention sessions (SD = 17.05; range 1–48; median = 17.5) for an average total of 231.64 minutes (SD = 227.13; range 4.89–955.21; median = 158.18). For 87% of the sessions, average satisfaction scores were 3 or greater on a scale of 1–4. Regarding smoking, 25% of participants had reduced their smoking and 10% had biologically verified abstinence from smoking at 8 weeks.

Conclusion

Home and community use of this mobile cessation intervention was feasible among smokers with SMI. Further research is needed to evaluate such scalable approaches to increase access to behavioral treatment for this group.
Nicholas of Modruš and HisDe Bellis Gothorum: Politics and National History in the Fifteenth-Century Adriatic
Authors: Špoljarić Luka
Published: June 2019

This article analyzes the “De Bellis Gothorum,” a long neglected and misunderstood history of the ancient Goths written in 1472–73 by Nicholas of Modruš, the leading Croatian-Illyrian bishop at the papal curia. By placing the work in its proper context, this article reconstructs a previously unknown episode in the political history of the fifteenth-century Adriatic. It is argued that the “De Bellis Gothorum” was in fact a national history that was meant to provide a trans-Adriatic network of Croatian and Bosnian nobles and churchmen with support from Naples and the papacy for their border wars against the Ottomans and reestablishment of their national kingdom.
The Application of Elementary Linear Programming to Approximate Valuation
Authors: Benjamin S. , Bennett C. W.
Published: June 2019

It is a common experience in many fields of investigation to find that the standard methods which have been developed and used in a given field prove inadequate in a particular application. In these circumstances it is often found that no further progress can be made along lines hitherto considered conventional, because some fundamental question has not been explicitly posed and answered by the standard methods. In life assurance a feature of existing methods of approximate valuation, which has not received prominence, is their inability to measure satisfactorily the size of the possible error involved. A wide variety of approximate methods have been in use, and some have been found to give consistently ‘good’ results, but the question of what is meant by ‘good’ has been left unanswered. The background of this paper is that the authors, faced with this situation when tackling an essentially practical problem, were virtually forced to break away from traditional methods and seek a new tool.
The Impact of Income Tax on Life Assurance and Annuity Business
Authors: Puckridge C. E.
Published: June 2019

The original intention of this paper was to discuss the impact of income tax on annuity business only. In practice it was found impossible to discuss the impact on annuity business without at the same time discussing the impact on Life assurance business. A company transacting Ordinary life assurance, Pension annuity and General annuity business is not assessable in respect of three separate businesses; for the purpose of income tax the company conducts only one business, i.e. ‘Life Assurance and Annuity business’. Attention is drawn to this point at the outset because it is considered most important. A student coming freshly to the subject should not be misled into thinking that separate taxable units are involved because in the Income Tax Act, 1952 and the Finance Act, 1956 such terms as ‘annuity fund’ and ‘profits arising to an assurance company from pension annuity business’ are used. It may be noted that in this paper the term ‘fund’ has been avoided wherever possible, because, without precise definition on each occasion that it is used, it is liable to be misleading. It would be impracticable to discuss in one paper all the problems of a composite company which writes all classes of insurance business both at home and overseas. It is, therefore, proposed to consider only the position of a proprietary company which writes Ordinary life assurance and annuity business in the United Kingdom, values its liabilities annually and is taxed on an interest less expenses basis.