bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of suicidality and associated factors of suicide risk in a representative community sample of families in three East African refugee camps
Authors: Scharpf Florian , Masath Faustine Bwire , Mkinga Getrude , Kyaruzi Edna , Nkuba Mabula , Machumu Maregesi , Hecker Tobias
Published: June 2023

Purpose

To assess the prevalence of suicidality and associated factors of suicide risk in a sample of Burundian refugee families living in three refugee camps in Tanzania.

Methods

Children (n = 230) and their parents (n = 460) were randomly selected and interviewed about suicidality (suicidal ideation, plans, and attempts) and a range of sociodemographic, psychological, and environmental factors. Multinomial logistic regression analyses were conducted to examine factors associated with children and parents’ lower and moderate or high current suicide risk.

Results

Past-month prevalence of suicidal ideation, plans, and attempts were 11.3%, 0.9% and 0.9%, respectively, among children; 37.4%, 7.4% and 5.2%, respectively, among mothers; and 29.6%, 4.8% and 1.7%, respectively, among fathers. Older age in years (aORlower = 2.20, 95% CI 1.38–3.51; aORmoderate/high = 3.03, 95% CI 1.15–7.99) and higher levels of posttraumatic stress disorder symptoms (aORlower = 1.64, 95% CI 1.05–2.57; aORmoderate/high = 2.30, 95% CI: 1.02–5.16), internalizing (aORmoderate/high = 2.88, 95% CI 1.33–6.26) and externalizing problems (aORlower = 1.56, 95% CI: 1.06–2.31; aORmoderate/high = 3.03, 95% CI 1.42–6.49) were significantly positively associated with children’s current suicide risk. For mothers, higher perceived instrumental social support (aORmoderate/high = 0.05, 95% CI < 0.01–0.58) was significantly negatively related to suicide risk, whereas exposure to community violence (aORlower = 1.97, 95% CI 1.30–2.99; aORmoderate/high = 1.59, 95% CI 1.00–2.52), living in larger households (aORlower = 1.74, 95% CI 1.17–2.57), and higher psychological distress (aORmoderate/high = 1.67, 95% CI 1.05–2.67) were significantly positively associated with suicide risk. For fathers, higher perceived instrumental social support (aORmoderate/high = 0.04, 95% CI < 0.01–0.44) and having more years of formal education (aORmoderate/high = 0.58, 95% CI 0.34–0.98) were significantly negatively and exposure to war-related trauma (aORmoderate/high = 1.81, 95% CI 1.03–3.19) was significantly positively associated with suicide risk.

Conclusion

Prevention programs should target psychopathology, community violence and social support to mitigate children and parents’ current suicide risk.
Behavior automatic analysis for wolf pack hunting: making fast behavior analysis of massive data possible
Authors: Tang Dengqing , Huang Cheng , Xiang Xiaojia , Zhou Han , Zhu Shaohao , Hu Tianjiang
Published: June 2023

Automatic wolf pack hunting behavior analysis contributes to the identification of behavioral mechanism and the development of bio-swarm intelligence engineering. However, wolf pack hunting commonly involves a complicated background and high-speed motion, where the frequent interactions with each other lead to frequent visual occlusion of the individual wolves. These difficulties make the automatic analysis of group hunting behavior significantly more challenging. Hence, we develop an automatic wolf pack hunting behavior detection scheme appropriate for videos, comprising a four-level individual feature map (frame, video, space, and semantic) and a group feature map. We propose a temporal–spatial feature fusion-based motion state recognition algorithm appropriate for scale-varied and occlusion-frequent individuals to obtain a robust semantic-level feature. Based on this individual feature map, we propose a video-based wolf pack hunting automatic behavior detection method. The developed scheme is validated on our Wolf2022 dataset, while the proposed motion state recognition and group behavior detection algorithms are further tested through ablation experiments. The results revealed that the motion state recognition accuracy reaches 88%, correctly detecting 15 out of 17 group behavior video clips.

Significance statement

It is difficult to fast extract quantitative analysis results of wolf pack hunting behavior from video data. Our research focused on the research of the automatic analysis method for wolf pack hunting. Using the proposed method, the statical individual and group behavior attributes can be automatically generated from video data, which contributes to the building of a conceptual bridge between the wolf pack hunting behavior and bio-swarm intelligence engineering.
Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care
Authors: Scott Michael J. , Aggarwal Geeta , Aitken Robert J. , Anderson Iain D. , Balfour Angie , Foss Nicolai Bang , Cooper Zara , Dhesi Jugdeep K. , French W. Brenton , Grant Michael C. , Hammarqvist Folke , Hare Sarah P. , Havens Joaquim M. , Holena Daniel N. , Hübner Martin , Johnston Carolyn , Kim Jeniffer S. , Lees Nicholas P. , Ljungqvist Olle , Lobo Dileep N. , Mohseni Shahin , Ordoñez Carlos A. , Quiney Nial , Sharoky Catherine , Urman Richard D. , Wick Elizabeth , Wu Christopher L. , Young‐Fadok Tonia , Peden Carol J.
Published: June 2023

Background

This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra‐ and postoperative aspects of care.

Methods

Experts in aspects of management of high‐risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

Results

Twenty‐three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

Conclusions

These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high‐risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.
Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient
Authors: Peden Carol J. , Aggarwal Geeta , Aitken Robert J. , Anderson Iain D. , Balfour Angie , Foss Nicolai Bang , Cooper Zara , Dhesi Jugdeep K. , French W. Brenton , Grant Michael C. , Hammarqvist Folke , Hare Sarah P. , Havens Joaquim M. , Holena Daniel N. , Hübner Martin , Johnston Carolyn , Kim Jeniffer S. , Lees Nicholas P. , Ljungqvist Olle , Lobo Dileep N. , Mohseni Shahin , Ordoñez Carlos A. , Quiney Nial , Sharoky Catherine , Urman Richard D. , Wick Elizabeth , Wu Christopher L. , Young‐Fadok Tonia , Scott Michael J.
Published: June 2023

Background

This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care.

Methods

Experts in management of the high‐risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations.

Results

Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process.

Conclusions

These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end‐of‐life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high‐risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.
Integrating one-to-one peer support into psycho-oncological care in Germany: multi-perspective, mixed-methods evaluation of the isPO onco-guide service
Authors: Salm Sandra , Houwaart Stefanie , Cecon-Stabel Natalia , Dresen Antje , Pfaff Holger , Scholten Nadine , Krieger Theresia
Published: June 2023

Purpose

One-to-one peer supporters called isPO onco-guides (isPO OGs) are an integral part of the new German psycho-oncological form of care ‘integrated, cross-sectoral Psycho-Oncology’ (isPO), additionally to professional care. The isPO OGs are cancer survivors with experiential knowledge, offering information on local support services and answering questions ‘all around cancer’ to newly diagnosed cancer patients. We aimed to evaluate the isPO OG service from three perspectives: patients, isPO OGs, and professional service providers.

Methods

A mixed-methods approach was pursued. We conducted interviews and focus groups with the three person groups, and applied qualitative content analysis on the reported resources, processes and outcomes regarding the isPO OG service. Relations with patients’ utilisation and isPO OGs’ work satisfaction were identified with regression and correlation analyses of questionnaire and isPO care data. We compared isPO care networks (CN) withX2-tests or ANOVA. Qualitative and quantitative results were integrated during interpretation phase.

Results

Qualitatively, the three person groups agreed on the benefits of the isPO OG service. The implementation’s maturity differed between the CN concerning established processes and resource availability. Attitudes of professional service providers appeared to be crucial for patients’ utilisation of the isPO OG service. Quantitative results emphasised the differences between the CN.

Conclusion

Beyond differences in the CN, the isPO OG service has two psychosocial benefits: providing relevant, reliable, and understandable information; and offering the encouraging example that surviving and living with cancer is possible.

Trial registration

The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.
What do we know about the epidemiology and the management of human echinococcosis in Albania?
Authors: Luga Poleta , Gjata Arben , Akshija Ilir , Mino Ledina , Gjoni Valbona , Pilaca Arben , Zobi Michael , Martinez Gabriela Equihua , Richter Joachim
Published: June 2023

Echinococcosis is a life-threatening neglected zoonotic disease. Cystic echinococcosis (CE) due to Echinococcus (E.) granulosus usually involves livestock and dogs; alveolar echinococcosis (AE) due to E. multilocularis involves rodents and canines such as foxes and dogs. Human hosts are infected accidentally via hand to mouth and/or foodborne/waterborne pathways. Albania is deemed to be endemic for cystic echinococcosis (CE), but there is a scarcity of data to confirm this. A systematic literature search was performed in PubMed, Google Scholar, and in other medical sources. Because of the scarcity of existing information, data confirming CE cases were reviewed from the medical hospital records of Albania’s largest Hospital, the Mother Teresa University Hospital (UHCMT) Tirana, and from a large private laboratory in Tirana (Pegasus laboratory). A total of eight eligible publications on 540 CE patients were found. Three hundred forty seven additional cases hospitalized in UHCMT from 2011 to 2020 were confirmed, as well as 36 laboratory cases and 10 Albanian cases notified in Germany. Taking all cases into account and considering 162 overlapping cases, 771 cases were documented from 2011 to 2020. The only case reported as AE was most likely a multi-organic CE. Surgery was the most frequent therapy approach used (84.7%). Autochthonous human CE seems to be widespread, and transmission is ongoing in Albania. CE patients in Albania undergo surgery more frequently compared with CE cases in other European countries. In order to establish a realistic estimate of prevalence and incidence of CE in Albania, mandatory notification should be reinforced. Stage-specific therapy can be used in CE to reduce therapy cost and diminish mortality by avoiding surgical overtreatment.
The Number of Tangencies Between Two Families of Curves
Authors: Keszegh Balázs , Pálvölgyi Dömötör
Published: June 2023

We prove that the number of tangencies between the members of two families, each of which consists of n pairwise disjoint curves, can be as large as $$\Omega (n^{4/3})$$

Ω
(

n

4
/
3

)

. We show that from a conjecture about forbidden 0–1 matrices it would follow that this bound is sharp for so-called doubly-grounded families. We also show that if the curves are required to be x-monotone, then the maximum number of tangencies is $$\Theta (n\log n)$$

Θ
(
n
log
n
)

, which improves a result by Pach, Suk, and Treml. Finally, we also improve the best known bound on the number of tangencies between the members of a family of at most t-intersecting curves.
Evaluation of one-piece zirconia dental implants: An 8-year follow-up study
Authors: Kiechle Stella , Liebermann Anja , Mast Gerson , Heitzer Marius , Möhlhenrich Stephan Christian , Hölzle Frank , Kniha Heinz , Kniha Kristian
Published: June 2023

Objectives

Long-term studies of modern zirconia implants are still insufficient. This prospective 8-year follow-up study investigated one-piece zirconia implants.

Materials and methods

Patients who had received a one-piece zirconia dental implant (PURE ceramic implant, Institut Straumann GmbH, Basel, Switzerland) were included in this study. Next to the implant survival and success rates, the radiographic and clinical implant parameters were assessed.

Results

The overall survival rate of 67 zirconia implants in 39 patients was 100%. The overall success rate was 89.6%. Around the immediate zirconia implants, the success rate was 94.7%, and around the delayed implants, 87.5%. The immediate implants showed a significantly higher bone crest compared to the delayed implants (p = 0.0120). According to the pink esthetic score, the immediate implants revealed more favorable esthetic results compared to the delayed implants after an 8-year follow-up (p = 0.0002).

Conclusions

After 8 years, the one-piece zirconia implants presented an 89.6% success rate. Regarding the timing of implantation, in individual cases, immediate implantation can have slight advantages over delayed implantation.

Clinical relevance

Immediate implants can also be considered for zirconia implants and should not be excluded on principle.
Mass tourism urban destinations and climate change in small islands: resilience to extreme rainfall in the Canary Islands
Authors: Ley Bosch Pablo , de Castro González Óscar , García Sánchez Francisco
Published: June 2023

The Canary Islands are one of the main destinations for mass tourism in the European context, characterized by the absence of seasonality in tourist activity. Moreover, the level of activity increases during the winters, coinciding with a greater probability of extreme rainfall events, whose danger seems to be increasing as a result of climate change. Owing to its pronounced orography, the southern coast of the island of Gran Canaria houses several tourist settlements built along ravines and steeply sloping terrain. This scenario presents considerable risk because of spatial probability of landslide occurrence. The case of San Agustín, especially, serves to test the model of tourist urbanization along the hillside, demonstrating its high fragility in the face of extreme rainfall events. Especially owing to its importance in providing assistance in emergency situations, its vulnerability has been analyzed with regard to accessibility, which is entirely dependent on road mobility. The growth model of San Agustín serves as an example of mass tourism in small islands, allowing urban planners and designers to assess corrective measures based on managing its existing road infrastructure and open spaces right from the planning stage.
Moral Disagreement and Moral Education: What’s the Problem?
Authors: Balg Dominik
Published: June 2023

Although initially plausible, the view that moral education should aim at the transmission of moral knowledge has been subject to severe criticism. In this context, one particularly prominent line of argumentation rests on the empirical observation that moral questions are subject to widespread and robust disagreement. In this paper, I would like to discuss the implications of moral disagreement for the goals of moral education in more detail. I will start by laying out the empirical and philosophical assumptions behind the idea that widespread and robust moral disagreement undermines the prospects of transmitting moral knowledge in educational settings. Having thus provided a specific interpretation of the epistemic dynamics behind this so-called ‘challenge of disagreement’, I will proceed by discussing its didactical implications. More specifically, I will defend two claims: first, I will argue that the challenge of disagreement is not an effective challenge, because it undermines the possibility of knowledge transfer only with respect to a limited set of moral propositions. Second, I will argue that the challenge of disagreement is not a specific challenge, because the epistemically destructive effects of moral disagreement also pose a challenge for other prominent accounts of moral education that were originally proposed as promising alternatives to knowledge transmission accounts. If convincing, my arguments show that knowledge transmission accounts of moral education are in a much better position than is usually expected to incorporate the fact that moral questions are notoriously controversial.
Forms and Functions of Aggression in Young Adults: The Polish Modified Version of the Peer Conflict Scale
Authors: Moroń Marcin , Mozgol Ludwika , Gajda Anna N. , Rode Magdalena , Biela Marta , Stalmach Kamila , Kuchta Weronika , Marsee Monica , Vagos Paula
Published: June 2023

The goal of the present study was an initial validation of the Peer Conflict Scale (PCS) for Polish young adults (ages 18–30 years). The PCS measures two forms (overt and relational) and two functions (proactive and reactive) of aggression enabling multidimensional assessment of aggressive behavior in early adulthood. Study 1 (N =482) showed that the initially proposed 4-factor model provided the best fit for data, but the PCS required modifications which resulted in shortening of the measure. The modified version of the PCS was partially invariant by gender. Construct validity was examined through the analysis of gender differences and the investigation of the associations between forms and functions of aggression and emotion regulation strategies of cognitive reappraisal and emotion suppression. Study 2 (N = 220) confirmed the internal structure, reliability, convergent (by the examination of the associations with other measures of relational and overt aggression, and with the Dark Triad) and known-groups validity of the modified PCS. These initial results suggest that the modified PCS is a promising tool to assess aggression in young adults. However, there is a need of additional psychometric studies to further establish the internal structure and validity of this instrument.
Researcher capacity estimation based on the Q model: a generalized linear mixed model perspective
Authors: Forthmann Boris
Published: June 2023

Chance models of scientific creative productivity allow estimation of researcher capacity. One prominent such model is the Q model in which the impact of a scholarly work is modeled as a multiplicative function of researcher capacity and a potential impact (i.e., luck) parameter. Previous work estimated researcher capacity based on an approximation of the Q parameter. In this work, however, I outline how the Q model can be estimated within the framework of generalized linear mixed models. This way estimates of researcher capacity (and all other parameters of the Q model) are readily available and obtained by standard statistical software packages. Usage of such software further allows comparing different distributional assumptions and calculation of reliability of the Q parameter (i.e., researcher capacity). This is illustrated for a large dataset of multidisciplinary scientists (N = 20,296). The Poisson Q model was found to have negligibly better predictive accuracy than the original normal Q model. Reliability estimates revealed excellent reliability of Q estimates with conditional reliability being mostly in acceptable ranges. Reliability of Q parameter estimates further depended heavily on the number of publications of a scientist with reliability increasing with the number of papers. The future and limitations of the Q model in the context of researcher capacity estimation are thoroughly discussed.
Predictive policing and algorithmic fairness
Authors: Hung Tzu-Wei , Yen Chun-Ping
Published: June 2023

This paper examines racial discrimination and algorithmic bias in predictive policing algorithms (PPAs), an emerging technology designed to predict threats and suggest solutions in law enforcement. We firstdescribewhat discrimination is in a case study of Chicago’s PPA. We thenexplaintheir causes with Broadbent’s contrastive model of causation and causal diagrams. Based on the cognitive science literature, we also explain why fairness is not an objective truth discoverable in laboratories but has context-sensitive social meanings that need to be negotiated through democratic processes. With the above analysis, we nextpredictwhy some recommendations given in the bias reduction literature are not as effective as expected. Unlike the cliché highlighting equal participation for all stakeholders in predictive policing, we emphasize power structures to avoid hermeneutical lacunae. Finally, we aim tocontrolPPA discrimination by proposing a governance solution—a framework of a social safety net.
Horizontal Integrity a Prerequisite for Vertical Stability: Comparison of Elevation Change and the Unvegetated-Vegetated Marsh Ratio Across Southeastern USA Coastal Wetlands
Authors: Ganju Neil K. , Defne Zafer , Schwab Caroline , Moorman Michelle
Published: June 2023

Surface elevation tables (SETs) estimate the vertical resilience of coastal wetlands to sea-level rise (SLR) and other stressors but are limited in their spatial coverage. Conversely, spatially integrative metrics based on remote sensing provide comprehensive spatial coverage of horizontal processes but cannot track elevation trajectory at high resolution. Here, we present a critical advance in reconciling vertical and horizontal dynamics by assessing the relationship between elevation change, relative tidal elevation (Z*), and the unvegetated-vegetated marsh ratio (UVVR) across coastal wetland complexes in the southeastern USA. We first used the UVVR to determine the representativeness of the SET site relative to varying spatial footprints across the complex and found that SET sites generally represent the tidal wetland areas in terms of vegetated cover. There is also overall coherence between positive vertical change and high vegetative cover, but we also identified sites with high vegetative cover and negative vertical change (relative to SLR). The only sites exceeding the pace of SLR have UVVR values below the previously established 0.15 threshold. Some sites are not keeping up with SLR despite having intact marsh plains; this may indicate a risk of submergence with undetectable marsh plain loss, or an imminent transition to future open-water conversion. Aggregation of Z* across the same footprint as the UVVR demonstrates consistent coherence between elevation and vegetative cover, with lower elevation sites having larger UVVR. These results indicate that the UVVR is a suitable initial screening tool: areas above the 0.15 threshold are both horizontally and vertically vulnerable. Furthermore, this comparison suggests that horizontal integrity is a prerequisite for vertical stability: a marsh can only maintain elevation if the plain is intact with minimal unvegetated area.
Microbial reduction of antimony under anaerobic conditions by inocula from different sources
Authors: Moreno-Andrade Ivan , Regidor-Alfageme Enrique , Carrillo-Reyes Julián , Field Jim A. , Sierra-Alvarez Reyes
Published: June 2023

Antimony (Sb) is a toxic and carcinogenic metalloid that can be present in contaminated water generated by mining operations and other industrial activities. Dissimilatory Sb(V) reduction to Sb(III) under anaerobic conditions by prokaryotic microbial communities has been reported; however, the fate of antimony in anaerobic wastewater treatment systems is poorly understood. This study investigated the potential of six different inoculum sources to reduce Sb(V) under anaerobic conditions and correlated the Sb(V) reduction rate with the microbial community composition. Microbial reduction of Sb(V) to Sb(III) by all the inoculum sources tested was observed in anaerobic incubations using hydrogen as an electron donor after a month. The highest reduction rate observed was 12.5 mg Sb per gram of volatile suspended solids per day. In some inocula, not only Sb reduction was observed, but also a decrease in the total Sb concentration, suggesting the precipitation of Sb(III). Metagenomic analysis revealed high variability in the community diversity associated with the origin of the inoculum. For the family taxonomic category, the three inocula that showed the highest Sb reduction potential were characterized by the presence of the Bacillaceae family.
Book review: managing the myths of health care by Henry Mintzberg
Authors: Tian Brian W. C. A. , Catena Fausto , Agnoletti Vanni , Lusenti Carlo , Bravi Francesca , Carradori Tiziano
Published: June 2023

Internationally acclaimed management guru Professor Henry Mintzberg’s latest book gives valuable insights into the world of healthcare management. A must read for all those in healthcare!
Quantifying the impact of heat in support seal configuration for aero engines
Authors: Sun P. , Liu C.
Published: June 2023

Leakage, deformations, power loss, heat generation in the support seal system and other issues are typical when support seals are developed. The design of the support seal system has progressively evolved over recent decades as part of an ongoing effort to provide effective cooling for the aero engine secondary air system. In particular, oil heat management in the oil chamber has strict requirements, which limit the heat generation of the support seal system. The potential of supporting seal research with an oil system is investigated in this work. The combination of the CFD/FEA method and quantifying the heat generation entering the oil chamber allows for improvements not just to the individual buffer air seal unit, but the oil seal together. The analysis relies on the combination of quantifying heat generation entering the oil chamber to provide a mutual influence of neighbouring labyrinth seals. The mutual influence requires further analysis, considering the thermal deformation of the rotor/stator to provide further accurate geometry parameters in preliminary seal designs. The experimental test was conducted to verify the preliminary CFD-FEA loosely coupled analysis result, which reveals that in a turbine support seal system, the radius of the buffer air seal has a significant influence on the leakage flow rate and power loss of the oil seal, which should take into account the integral influence of the pressure difference of the oil seal caused by the radius change of the buffer air seal and the running clearance of the oil seal.
Towards equity in land protection
Authors: Sims Katharine R.E.
Published: June 2023

Land protection not only supports vital ecosystem services but also poses important challenges for social equity. Three key concerns emerge from economic frameworks about land protection policies: potential lost local economic development, reinforcement of existing structural inequalities, and disparities in access to the benefits of protected land. This article reviews evidence for each concern and identifies research needs as well as potential improvements in policy that could better support equity goals. Pathways forward towards greater equity include specific mechanisms that can ensure local communities benefit from land protection, attention to issues of spatial impacts and timing, explicit prioritization of equity in land protection initiatives, and community-centred processes. Economists have and can continue to play a role in strengthening these dimensions of land protection policies.
P.002 Increased epileptiform activity during N2 and slow wave sleep in Alzheimer’s Disease
Authors: Umair I , Ng M
Published: June 2023

Background: Recent evidence shows that epileptiform activity (EA) in sleep can present early in Alzheimer’s Disease (AD) with faster cognitive decline. Existing literature examining sleep, AD and seizures is mostly qualitative. We conducted a systematic review to quantify the sleep stage most associated with EA in AD and amnestic mild cognitive impairment (aMCI)Methods: We searched MEDLINE and Embase using MeSH terms: “Alzheimer’s Disease” AND “Epilepsy” OR “Seizures’’ AND “Sleep” OR “REM” (rapid eye movement sleep). We extracted data to determine the EA distribution across sleep stages. We averaged percentages across studies. If a study had AD and aMCI subgroups, we averaged percentages to represent that study. Results: 4/14 articles had quantitative sleep stage EA data from a total of 111 AD or aMCI patients. Most EA occurred in the non-REM stage (N2; 36.1±17.8%). EA next most frequently occurred in slow-wave sleep (SWS; 34.1±9.9%), N1 (15.5±6.7%), and REM (14.4±11.6%). Conclusions: N2 and slow-wave sleep were most associated with sleep EA in AD or aMCI. This suggests the importance of therapeutic interventions that may decrease N2 and slow-wave sleep and increase REM. Future studies could explore whether it is the quantity or quality of the N2 and slow-wave sleep that is associated with EA.
P.003 Structural integrity of the nucleus basalis of meynert in Parkinson’s Disease related cognitive and gait decline
Authors: Yeung A , Ba F , Gee M , Camicioli R
Published: June 2023

Background: In Parkinson’s disease (PD), mounting evidence implicates degeneration of cholinergic systems in cognitive and gait decline. The Nucleus Basalis of Meynert (NBM) is a major cholinergic nucleus with widespread cortical projections. We hypothesized that atrophy of the NBM is correlated with cognitive phenotypes and gait measures in PD. Methods: Subjects from the COMPASS-ND study (20 controls and 79 PD patients) were studied. Clinical measures included cognitive diagnosis (MCI, dementia) and quantitative gait parameters with dual task gait. Manual region of interest measurement of the NBM was performed on T1 MRI scans. NBM volumes were analyzed against clinical measures. Results: PD-MCI and PD-dementia patients had greater dual task costs to gait speed when performing serial 7s (mean difference -12%, p=0.02; -11%, p=0.04) and animal fluency tasks (mean difference -9%, p=0.02; -15%, p<.001) compared to controls. Reduced normalized NBM volume was associated with PD-MCI (mean difference 0.34, p=0.04) and PD-dementia (mean difference 0.55, p<0.001) phenotypes. NBM volume was weakly correlated with gait velocity (r2 0.06, p=0.01) and dual task cost to gait velocity with animal fluency (r2 0.06, p=0.02). Conclusions: NBM atrophy is associated with cognitive decline in PD and may be responsible for cognitive aspects of gait performance.
P.005 A virtual interdisciplinary diagnostic memory clinic: rural patient and caregiver satisfaction
Authors: O’Connell ME , Camicioli R , Cammer A , Chertkow H , Desmarais P , Fisk JD , Freedman M , Friedman N , Geddes M , Ismail Z , Kirk A , Lee L , Morgan DG , Pettersen J
Published: June 2023

Background: Saskatchewan’s Rural and Remote Memory Clinic (RRMC) has provided post-diagnostic virtual dementia care for approximately 19 years. In response to the COVID-19 pandemic and a new need for remote dementia diagnosis, we developed a virtual, team-based, interdisciplinary (neurology, neuropsychology, nursing), diagnostic memory clinic (vRRMC). We evaluated patient and caregiver satisfaction with the new virtual clinic. Methods: Semi-structured telephone interviews were conducted with rural vRRMC patients (n=7), caregivers (n= 13), and one patient/caregiver dyad. Ages of respondents ranged from 40 to 70 years old (60% female). Level of diagnosed cognitive dysfunction ranged from subjective cognitive impairment to major neurocognitive disorder. Respondents saved an average of 460 km of travel compared to a trip to Saskatoon. Results: Thematic analysis of responses revealed universal satisfaction with the virtual model. The technology training sessions, offered prior to the first vRRMC visit, was described as important for satisfaction. Analysis of preference for future visits revealed more nuance; some preferred in-person visits and planned to travel for future appointments post-pandemic, while others preferred to maintain the virtual model due to perceived travel burden (cost, time, and inconvenience). Conclusions: When clinically appropriate, virtual diagnostic memory clinics should persist as an option post pandemic for families who experience high travel burden.
P.011 Is the effect of the vagus nerve stimulation different in lesional and nonlesional medically resistant epilepsies?
Authors: Moshref R , Burneo J , Jones M , Steven D , Macdougall K , SullerMarti A
Published: June 2023

Background: The incidence of drug resistant epilepsy (DRE) is around 30% patients with epilepsy. Vagus nerve stimulation (VNS) is offered to patients who are not candidates for epilepsy resective surgery, however the results of lesional cases has not been explored previously Methods: The study was a retrospective cohort study that involved patients with DRE implanted with VNS at the Epilepsy program at Western University, Ontario. We classified our VNS cohort based on brain imaging of lesional (L) and nonlesional (NL) epilepsy. Results: The median age was 31.8 years, 70.69% were females. The VNS-L group average age was 31.8 years and the NL 35.2 years. The most common abnormality was nodular heterotropias 31.34% (n=9). 16 patients underwent palliative procedures before the VNS implantation, 12 in VNS-L and 4 in VNS-NL. The median period of follow-up was 69.97 months. 62% of the VNS-L group had a seizure reduction of 50% or greater, compared to 41.38% in the VNS-NL group. Seizure freedom was 10.34% in VNS-L, compared to 6.99% in VNS-NL. Conclusions: This is the first study reporting the outcome of VNS in lesional cases. Our results suggest that VNS in lesional cases is effective. However, a large multicenteric study is needed.
P.014 Eptinezumab improved work productivity in adults with migraine and prior preventive treatment failures: results from the DELIVER study
Authors: Goadsby PJ , Barbanti P , Lambru G , Ettrup A , Laurberg Christoffersen C , Krog Josiassen M , Phul R , Sperling B , Gohil V
Published: June 2023

Background: This analysis reports the impact of eptinezumab on work productivity and daily activities in patients with migraine and prior preventive treatment failures. Methods: The DELIVER study (NCT04418765) randomized adults with migraine and documented evidence of 2-4 prior preventive treatment failures to receive eptinezumab 100mg, 300mg, or placebo (IV every 12 weeks). At baseline and every 4 weeks, patients completed the migraine-specific 6-question Work Productivity Activity Impairment (WPAI:M) questionnaire (7-day recall). Changes from baseline in WPAI subscores were predefined secondary endpoints and analyzed without control for multiplicity. Results: The full analysis set included 890 patients (100mg, n=299; 300mg, n=293; placebo, n=298). Mean baseline WPAI subscores indicated a negative impact of migraine on work productivity and normal daily activities. Beginning at first post-baseline assessment at Week 4 and through Week 24, eptinezumab demonstrated larger reductions than placebo in absenteeism (P<0.05), presenteeism (P<0.001), work productivity loss (P<0.001), and activity impairment (P<0.001) subscores. Conclusions: In adults with migraine and prior preventive treatment failures, eptinezumab treatment robustly improved migraine-related absenteeism, presenteeism, work productivity loss, and activity impairment as early as Week 4 and throughout the study.
P.030 Antibody testing for autoimmune encephalitis: a multisite study examining clinical practices in a large Canadian city
Authors: Roberts J , Guitierez S , Hahn C , Yaraskavitch M
Published: June 2023

Background: Antibody panels are one diagnostic tool within the comprehensive evaluation of suspected autoimmune encephalitis (AIE). Over-reliance on antibody panels contributes to misdiagnosis and inflated healthcare costs. Methods: Inpatients or outpatients who had AIE antibody testing ordered from one of four adult hospitals in Calgary between January 2018 – January 2020 were included. Medical records of 150 individuals were reviewed, including those with positive antibodies or testing sent to Mayo Clinic, plus a random sample. Results: AIE antibody panels were sent for 469 individuals during the 2-year period; 42 were positive (9.0%) of which 10 were pathogenic. Of 150 individuals included in chart review, 27 (18.0%) met criteria for possible AIE at presentation and 16 (10.8%) met criteria for definite AIE at final diagnosis. Overall, antibody testing was ordered in both serum and CSF in 36.3% (versus 69.2% meeting possible AIE criteria); MRI brain was performed in 92.7% (possible AIE 92.6%), EEG in 78.7% (possible AIE 100.0%), and lumbar puncture in 66.7% (possible AIE 96.3%). A sizable proportion did not receive malignancy screening (overall 48.7%; possible AIE 29.6%). Conclusions: Antibody panels are overemphasized in the assessment for AIE and often performed unnecessarily, while other recommended clinical tests are not consistently completed.
P.036 Are there sex differences in the treatment of myasthenia gravis? a single centre cohort study
Authors: Beland B , Lee A , Perera T , Greenfield J , Korngut L , Jewett G
Published: June 2023

Background: Females with generalized myasthenia gravis (gMG) report lower quality of life (QoL) compared to males. Our objective was to determine whether sex differences in treatment and time to treatment initiation may contribute to this difference. Methods: We performed a single centre retrospective study of people diagnosed with gMG. We used multivariable logistic and Cox regression models to assess the association between sex and study outcomes, adjusting for duration from onset to diagnosis, age at diagnosis, thymoma, and antibody status. Results: 179 people with gMG were included. Mean age at diagnosis was 58.4 years, mean follow-up was 4.8 years, and 58.1% were male. There was no association between sex and odds of starting prednisone (adjusted odds ratio [aOR]=0.58, 95% confidence interval [95%CI]=0.28-1.19, p=0.14) or steroid sparing agents (aOR=0.72, 95%CI=0.39-1.35, p=0.31). Similarly, sex was not associated with time to starting prednisone (adjusted hazard ratio [aHR]=0.74, 95% confidence interval [95%CI]=0.52-1.06, p=0.10) or steroid sparing agents (aHR=0.82, 95%CI=0.55-1.22, p=0.33). Females were more likely to start plasmapheresis (aOR=3.15, 95%CI=1.09-9.07, p=0.03). Conclusions: We found no sex differences in first and second line immunotherapy for gMG that might explain differences in QoL. Females were more likely to initiate plasmapheresis, which may reflect greater disease severity.
P.038 Idiopathic inflammatory myopathies and malignancy screening: a survey of the current practices amongst Canadian neurologists and rheumatologists
Authors: Jekielek M , Vinik O , Kassardjian CD
Published: June 2023

Background: There is a well-established association between idiopathic inflammatory myopathies (IIM) and malignancy. There are no evidence-based guidelines amongst neurologists and rheumatologists on the choice and timing of malignancy investigations. Our aim is to characterize the current gaps and uncertainties amongst neurologists and rheumatologists with malignancy screening in IIM patients. Methods: An online survey consisting of 18 multiple-choice questions related to IIM malignancy screening was distributed to adult neurologists and rheumatologists in Canada. Quantitative and descriptive analysis was performed. Results: The majority of respondents (96%, n=68) performed malignancy screening. There was variability in practice including delegation and choice of screening tests, influence of patient-specific factors, and time and length of repeat testing. Only 18% of respondents were confident in their malignancy screening practices. Between neurologists and rheumatologists, there were differences in the number of IIM patients seen, consideration of patient-specific factors and choice of screening investigations. Further details and data will be presented at the conference. Conclusions: There is a lack of consensus and confidence in the choice and timing of malignancy investigations in IIM, with neurologists and rheumatologists differing in their approaches. Further research is required to better understand the relationship between IIM and malignancy to create expert-led consensus guidelines.
P.043 Long-term safety, tolerability, and efficacy of efgartigimod in patients with Generalized Myasthenia Gravis: concluding analyses from ADAPT+
Authors: Genge A , Pasnoor M , Bril V , Karam C , Peric S , De Bleecker JL , Murai H , Meisel A , Beydoun S , Vu T , Ulrichts P , Van Hoorick B , T’joen C , Utsugisawa K , Verschuuren J , Mantegazza R , Howard JF
Published: June 2023

Background: Efgartigimod is a human IgG1 antibody Fc-fragment that reduces total and pathogenic IgG autoantibody levels through FcRn blockade. ADAPT was a phase 3 trial evaluating efgartigimod in patients with generalized myasthenia gravis (gMG). Patients who completed ADAPT could enroll in ADAPT+ (open-label extension). Methods: Efgartigimod (10 mg/kg intravenous) was administered in cycles of 4 weekly infusions, with subsequent cycles initiated based on clinical evaluation. ADAPT+ evaluated long-term safety and tolerability of efgartigimod in patients with gMG. Efficacy was assessed utilizing MG-ADL and QMG scores. Results: Of 167 patients from ADAPT, 151 (90%) entered ADAPT+, and 145 received ≥1 cycle as of January 2022. Over 217.55 patient-years of follow-up (mean duration per patient, 548 days), incidence of adverse events did not increase with subsequent cycles. AChR-Ab+ patients with ≥1 year of follow-up across ADAPT/ADAPT+ (n=95) received a median (range) 5.0 (0.4–7.6) cycles per year. All AChR-Ab+ patients (n=111) demonstrated consistent improvements (mean change [SE], week 3 of cycle 1) in MG-ADL (-5.0 [0.33]; up to 14 cycles) and QMG (-4.7 [0.41]; up to 7 cycles) scores during each cycle. Conclusions: These ADAPT+ analyses suggest long-term efgartigimod treatment is well tolerated and efficacious. Additional final data cut analyses will be presented at CNSF 2023.
P.046 Real-world survival effectiveness of edaravone in amyotrophic lateral sclerosis: a propensity score weighted, registry-based, Canada-wide cohort study
Authors: Abrahao A , Vyas MV , Parks A , Hodgkinson V , Dyck A , Benstead T , Briemberg H , Genge A , Grant I , Jewett G , Johnston W , Kalra S , Marrero A , Massie R , Melanson M , O’Connell C , Pfeffer G , Schellenberg KL , Taylor S , Shoesmith C , Matte G , Zinman L , Korngut L
Published: June 2023

Background: ALS is a progressive neurodegenerative disease without a cure and limited treatment options. Edaravone, a free radical scavenger, was shown to slow disease progression in a select group of patients with ALS over 6 months; however, the effect on survival was not investigated in randomized trials. The objective of this study is to describe real-world survival effectiveness over a longer timeframe. Methods: This retrospective cohort study included patients with ALS across Canada with symptom onset up to three years. Those with a minimum 6-month edaravone exposure between 2017 and 2022 were enrolled in the interventional arm, and those without formed the control arm. The primary outcome of tracheostomy-free survival was compared between the two groups, accounting for age, sex, ALS-disease progression rate, disease duration, pulmonary vital capacity, bulbar ALS-onset, and presence of frontotemporal dementia or C9ORF72 mutation using inverse propensity treatment weights. Results: 182 patients with mean ± SD age 60±11 years were enrolled in the edaravone arm and 860 in the control arm (mean ± SD age 63±12 years). Mean ± SD time from onset to edaravone initiation was 18±10 months. Tracheostomy-free survival will be calculated. Conclusions: This study will provide evidence for edaravone effectiveness on tracheostomy-free survival in patients with ALS.
P.047 Effect of lemborexant on sleep architecture in subjects with comorbid insomnia and mild obstructive sleep apnea from a phase 3 trial
Authors: Kushida CA , Zammit GK , Cheng JY , Kumar D , Moline M
Published: June 2023

Background: Lemborexant (LEM), a dual-orexin-receptor-antagonist approved to treat adults with insomnia, increases total sleep time (TST) and rapid eye movement (REM) sleep. Patients with obstructive sleep apnea (OSA) or co-morbid insomnia and OSA (COMISA) report sleeping difficulties and reduced REM, therefore sleep architecture was analyzed during LEM treatment. Methods: Study E2006-G000-304 (NCT02783729) was a 1-month, randomized, double-blind, placebo (PBO)- and active-comparator zolpidem-ER 6.25mg (ZOL)-controlled study in adults ≥55y with insomnia disorder. Subjects received PBO, LEM 5mg (LEM5), 10mg (LEM10), or ZOL. Least-square-mean duration of each sleep stage (minutes) was compared from pooled data on Nights (NT)1/2 and NT29/30 for mild OSA subjects (apnea hypopnea index ≥5 to <15 events/h). Treatment-emergent adverse events (TEAEs) were recorded. Results: Of 409 subjects with mild OSA (LEM5=114/LEM10=105/ZOL=112/PBO=78) change from baseline (CFB) in TST and REM sleep was significantly larger with both LEM doses versus ZOL/PBO on both nights. CFB for total nonREM sleep was significantly higher (P<0.0001) with both LEM doses versus PBO on both nights. LEM5 showed significantly higher (P<0.05) nonREM sleep versus ZOL at NT29/30. Most TEAEs were mild/moderate. Conclusions: LEM significantly increased TST, REM, and nonREM sleep versus PBO in subjects with insomnia and mild OSA. Data support LEM treatment in the COMISA population.