bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of processing on selected pesticide residues in cottonseed (Gossypium spp.)
Authors: Subramani Thirukkumar , Ganapathyswamy Hemalatha , Sampathrajan Vellaikumar , Sundararajan Amutha , Marimuthu Murugan
Published: August 2022

Food processing techniques reduce pesticide residue accumulation in food components. The present study investigated the effectiveness of simple processing techniques, such as roasting, soaking, autoclaving, and storage conditions on 27 selected pesticides belongs to the class of organophosphates (OPs), organochlorines (OCPs), and pyrethroids (PPs) in pesticide fortified cottonseed. The residue concentration was analyzed by gas chromatography‐tandem mass spectrometry (GC–MS/MS) from the extract of differently treated samples as untreated and pesticide‐free, pesticide‐fortified and pesticide‐fortified cum processed cottonseed. Recovery values of the residues ranged from 78.20 to 114% by the application of 1, 5, and 10 μg/g of pesticide in pesticide‐free cottonseed. The pesticide residue concentration were presented in nondetected level to the pesticide‐free sample. Otherwise, pesticide‐treated samples contained all pesticide residues ranging from 856 to 1,138 ng/g of OPs, 782 to 1,058 ng/g of OCPs and 857 to 1,140 ng/g of PPs, which has higher than the maximum residue limits (MRLs) as set by the Japan Food Chemical Research Foundation (FFCR) for cottonseed. Among the different processing methods, autoclave sample had less number of residues (three compounds) followed by stored (five compounds), soaked (seven compounds) and roasted (eight compounds) samples. The stored cottonseeds contained residues for phorate, total lindane excluding δ‐lindane and deltamethrin at the end of storage. Nevertheless, the residue from phorate (88.93 ng/g), δ‐lindane (69.32 ng/g) and deltamethrin (128.64 ng/g) has exceeded the concentration of MRL's for 0.05, 0.01, and 0.04 mg/kg, respectively. The finding indicates that the most effective method for reducing the pesticide residues was autoclaved treatment from the respective pesticide‐fortified cottonseed sample.
Not a Prophet, A Mirror
Authors: Omer Atalia
Published: August 2022

Shaul Magid's Meir Kahane: The Public Life and Political Thought of an American Jewish Radical (2021) has the potential to urge American and Israeli Jews to “own” Meir Kahane and hold him up as a mirror reflecting the toxic and tragic dimensions of modern Jewish history. Such a look in the mirror can only happen once Jews see Palestinian suffering as central to the building of the state of Israel and also how they are complicit and implicated in such suffering.
Comparison of shear bond strength of orthodontic brackets bonded to human teeth with and without fluorotic enamel: A systematic review and meta‐analysis of experimental in vitro studies
Authors: Alvarez Daniela , Barmak Abdul Basir , Rossouw Paul Emile , Michelogiannakis Dimitrios
Published: August 2022

The aim of this systematic review was to compare the shear bond strength (SBS) of orthodontic brackets bonded to human teeth with and without enamel fluorosis (EF) using conventional bonding interventions/techniques. An unrestricted search of indexed databases was performed with the following eligibility criteria: (a) human fluorotic teeth (experimental‐group); (b) human teeth without fluorosis (control‐group); (c) studies using phosphoric acid (PA) etching without air abrasion (AA), PA etching combined with AA, and application of self‐etching primer (SEP) alone as bonding interventions/techniques and (d) measuring SBS in megapascals (MPa). Data screening, selection and extraction were performed by two reviewers. The risk of bias (rob) was assessed using the JBI Critical appraisal tool for Quasi‐Experimental Studies. Meta‐analyses were performed using a random effects model. The quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Ten in vitro studies were included. Subgroup analyses were performed for each intervention type. The SBS was significantly lower in fluorotic teeth when PA was used without AA (mean difference = 3.26 MPa, confidence interval: [1.00, 5.52]); and there were no significant differences for the PA combined with AA and SEP interventions. All studies had a low rob. The overall level of evidence was at best low. The SBS is lower in teeth with EF when traditional PA is used. No significant differences were found in SBS between teeth with and without EF when PA is used with AA or when SEP is used alone.
Regional variations and temporal trends of childhood myopia prevalence in Africa: A systematic review and meta‐analysis
Authors: Kobia‐Acquah Emmanuel , Flitcroft Daniel Ian , Akowuah Prince Kwaku , Lingham Gareth , Loughman James
Published: August 2022

Purpose

To provide contemporary and future estimates of childhood myopia prevalence in Africa.

Methods

A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ −0.50D; high myopia: SE ≤ −6.00D) in Africa. Population‐ or school‐based cross‐sectional studies published from 1 Jan 2000 to 30 May 2021 were included. Meta‐analysis using Freeman–Tukey double arcsine transformation was performed to estimate the prevalence of childhood myopia and high myopia. Myopia prevalence from subgroup analyses for age groups and settings were used as baseline for generating a prediction model using linear regression.

Results

Forty‐two studies from 19 (of 54) African countries were included in the meta‐analysis (N = 737,859). Overall prevalence of childhood myopia and high myopia were 4.7% (95% CI: 3.3%–6.5%) and 0.6% (95% CI: 0.2%–1.1%), respectively. Estimated prevalence across the African regions was highest in the North (6.8% [95% CI: 4.0%–10.2%]), followed by Southern (6.3% [95% CI: 3.9%–9.1%]), East (4.7% [95% CI: 3.1%–6.7%]) and West (3.5% [95% CI: 1.9%–6.3%]) Africa. Prevalence from 2011 to 2021 was approximately double that from 2000 to 2010 for all studies combined, and between 1.5 and 2.5 times higher for ages 5–11 and 12–18 years, for boys and girls and for urban and rural settings, separately. Childhood myopia prevalence is projected to increase in urban settings and older children to 11.1% and 10.8% by 2030, 14.4% and 14.1% by 2040 and 17.7% and 17.4% by 2050, respectively; marginally higher than projected in the overall population (16.4% by 2050).

Conclusions

Childhood myopia prevalence has approximately doubled since 2010, with a further threefold increase predicted by 2050. Given this trajectory and the specific public health challenges in Africa, it is imperative to implement basic myopia prevention programmes, enhance spectacle coverage and ophthalmic services and generate more data to understand the changing myopia epidemiology to mitigate the expanding risk of the African population.
Microcrystalline dolomite in a middle Permian volcanic lake: Insights on primary dolomite formation in a non‐evaporitic environment
Authors: Jiao Xin , Liu Yi‐Qun , Yang Wan , Li Hong , Meng Zi‐Yuan , Zhao Min‐Ru , Li Zhe‐Xuan
Published: August 2022

Lacustrine dolomite nucleation commonly occurs in modern and Neogene evaporitic alkaline lakes. As a result, ancient lacustrine microcrystalline dolomite has been conventionally interpreted to be formed in evaporitic environments. This study, however, suggests a non‐evaporitic origin of dolomite precipitated in a volcanic–hydrothermal lake, where hydrothermal and volcanic processes interacted. The dolomite occurs in lacustrine fine‐grained sedimentary rocks in the middle Permian Lucaogou Formation in the Santanghu intracontinental rift basin, north‐west China. Dolostones are composed mainly of nano‐sized to micron‐sized dolomite with a euhedral to subhedral shape and a low degree of cation ordering, and are interlaminated and intercalated with tuffaceous shale. Non‐dolomite minerals, including quartz, alkaline feldspars, smectite and magnesite mix with the dolomite in various proportions. The 87Sr/86Sr ratios (0.704528 to 0.705372, average = 0.705004) and δ26Mg values (−0.89 to −0.24‰, average = −0.55‰) of dolostones are similar to those of mantle rocks, indicating that the precipitates mainly originated from fluids that migrated upward from the mantle and were subject to water–rock reactions at a great depth. The δ18O values (−3.1 to −22.7‰, average = −14.0‰) of the dolostones indicate hydrothermal influence. The trace and rare earth element concentrations suggest a saline, anoxic and volcanic–hydrothermally‐influenced subaqueous environment. In this subaqueous environment of Lucaogou lake, locally high temperatures and a supply of abundant Mg2+ from a deep source induced by volcanic–hydrothermal activity formed favourable chemical conditions for direct precipitation of primary dolomite. This study's findings deepen the understanding of the origin and processes of lacustrine primary dolomite formation and provide an alternative possibility for environmental interpretations of ancient dolostones.
Follow‐up MRI appearance of the surgical site in dogs treated for thoracolumbar intervertebral disc herniation and showing ongoing or recurrent neurological symptoms
Authors: Peschard Anne‐Lorraine , Freeman Paul , Genain Marie‐Aude
Published: August 2022

Reherniation and reoperation rates of 4.5%–36% are reported in canine patients treated for intervertebral disc herniation (IVDH). Decision‐making for surgical reintervention can prove challenging, especially since common postoperative changes are poorly described on MRI. The purpose of this single‐center, retrospective, descriptive study was to describe the MRI characteristics of the surgical site in dogs treated for thoracolumbar IVDH and presenting for ongoing or recurrent neurological signs. Twenty‐one patients were included for a total of 42 MRI studies. Chondrodystrophic breeds, specifically Dachshunds, were overrepresented. Mean number of days between surgery and second MRI was 335 (range 2–1367). Metallic susceptibility artifacts were seen in seven of 21 cases (33%), but these were limited in extent, spanning on average 1.3 vertebral bodies. In 11 cases, spinal cord compression suspected to be clinically significant was found at the surgical site; the extradural compressive material consisted of intervertebral disc material only, or a combination of intervertebral disc material and hematoma or inflammatory changes in 10 cases, and a displaced articular process and fibrous tissue in one case. The latter is a newly described complication of mini‐hemilaminectomies. Paravertebral soft tissue changes and vertebral new bone formation varied according to the postoperative stage at which the patients were imaged. The results of this study supported the use of MRI as a diagnostic modality for spinal imaging following IVDH surgery, and showed that the presence of extradural disc material at a spinal surgical site is common along with various vertebral and paravertebral changes.
Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010–2019)
Authors: Adair Katherine V. , Lux Cassie N. , Sun Xiaocun
Published: August 2022

Objective

To compare short‐ and long‐term clinical variables between dogs undergoing a modified percutaneous cystolithotomy (PCCLm) and open cystotomy (OC) and evaluate for risk factors associated with complications and outcomes within the groups.

Study design

Retrospective study.

Animals

A total of 218 dogs.

Methods

Records were reviewed for dogs that underwent PCCLm or OC between January 2010 and December 2019. Signalment; history and diagnostic findings; procedural, anesthetic, and hospitalized care data; complications; urolith recurrence; and follow‐up were recorded. Logistic regression analysis was used to evaluate effects of clinical variables on outcomes within PCCLm and OC groups and to identify significant categorical variables between PCCLm and OC groups. Two sample t‐tests were used to identify significant numerical variables between PCCLm and OC groups.

Results

A total of 60.1% (131/218) of dogs underwent the PCCLm procedure and 39.9% (87/218) of dogs underwent the OC procedure. Anesthesia time (p < .001) was significantly longer in the OC group. No significant difference in incomplete urolith removal was noted between groups. Although surgical site infection and inflammation rates were not significantly different between OC and PCCLm groups, incisional infections were significantly associated with complications occurring during PCCLm (p = .027). Significantly reduced postoperative lower urinary tract signs (p = .022) were noted in the PCCLm group.

Conclusion

The PCCLm may result in reduced lower urinary tract signs postoperatively compared to OC, but other clear advantages of the PCCLm were not identified in this study.

Clinical significance

PCCLm procedures are an effective alternative to OC for urolith removal in dogs.
Capilla de la Natividad de Nuestra Señora del Ilustre Clero, templo mayor de Santiago de Tunja, siglo XVII
Authors: Leal del Castillo María del Rosario
Published: August 2022

La capilla de la Natividad de Nuestra Señora del Ilustre Clero, o capilla de la Niña María, fue la más grande construida por una cofradía en el Nuevo Reino de Granada. La fundación de la Hermandad del Clero surgió como respuesta a dos acontecimientos problémicos que amenazaban la unidad de la Iglesia católica: la Reforma, que puso en entredicho la autoridad de esta como único medio a través del cual los hombres podían salvarse, y el debate teológico entre católicos sobre la inmaculada concepción de María. De acuerdo con el renovado uso de la imagen desde los postulados del Concilio de Trento, el discurso visual de la capilla, plasmado en el tabernáculo mayor y en los tabernáculos laterales, obedeció a un programa contestatario frente a las dos amenazas que enfrentaba la Iglesia.
De la renta básica como contingencia a la renta básica como derecho
Authors: Bula Escobar Jorge Ivan
Published: August 2022

Frente a la iniciativa que se ha planteado para adoptar una Renta Básica de Emergencia habida cuenta del impacto que la pandemia del Covid-19 ha tenido en los sectores más vulnerables de la población, este trabajo pretende llevar la reflexión y la discusión sobre la Renta Básica más allá de sus propiedades de contingencia hacia una argumentación que trasciende este marco para situarlo en una perspectiva más comprehensiva como es el prisma de una teoría de la justicia y de los derechos humanos. A partir de la reclamación y postulado de la “dignidad humana” como condición sine qua non de la Declaración Universal de los Derechos Humanos, y de la comprensión de la ciudadanía como el sustrato propio de la Modernidad, la idea de la Renta Básica estaría en la base de brindar las condiciones materiales (Raventós) para el ejercicio de la ciudadanía y del goce efectivo de los derechos humanos y de la libertad de las personas. Haría parte de uno de los tres aspectos establecidos por T. H. Marshall, sobre el concepto de ciudadanía, el de la ciudadanía social que, sumada a la ciudadanía legal y a la ciudadanía política, habilitarían a las personas para el ejercicio pleno de sus derechos ciudadanos. En ese orden de ideas, la Renta Básica debería constituirse como una Renta Ciudadana, es decir un Ingreso Básico Universal (IBU) y, en consecuencia, debería más bien considerarse la opción de pensar en establecer una Renta Básica Universal y no simplemente de Emergencia.
Real Time Precursor Calculation for the Early Detection of Combustion Instabilities
Authors: Meloni R. , Giannini N.
Published: August 2022

The proper control of the pressure fluctuations inside the gas turbine combustors is becoming a key factor to contain the pollutant emissions and extend their operability limits, as a consequence of the leaner and leaner mixture the engines have to operate with. In this context, the mitigation of the combustion instabilities through active control strategies is nowadays taking more and more benefits from the most advanced data science techniques. The employment of such algorithms has not only the aim to detect an instability and bring the engine to operate in a stable window but, more and more often, to anticipate the rising of a dominant frequency in an early stage of growth, with advantages in terms of extension of the life of the mechanical components and, more importantly, the reduction of the number of startups. In this context, the present papers presents a reduced order model derived from the dynamic mode decomposition (DMD) algorithm that can be applied to analyze the time signals acquired by the pressure probes installed in a generic gas turbine combustor. The most useful information that are retrieved from the signal are the frequency content and the corresponding growth rate (GR). The latter parameter can be assumed to act like a precursor of the system instability, enabling the possibility to identify a potential issue well in advance with respect to the traditional approaches. This new method can pave the way to new control strategies, depending on the different kind of instabilities detected. Also these aspects will be addressed along this work, focusing the discussion on both thermo-acoustic instabilities and low-frequency tones associated with the flame extinction. Moreover, additional criteria that could be implemented along a control system based on this new methodology will be provided.
Navigating Management Dismissal and COVID-19 in a Professional Football Club: A Trainee Sport Psychologist Finds Her Way Through
Authors: Black Zoe A. , McCarthy Paul
Published: August 2022

In this case study, we report the experiences and reflections of a female trainee sport and exercise psychologist who navigated the dismissal of a management team and COVID-19 in a professional football club. The trainee delivered an educational intervention to a group of 10 players transitioning from a youth academy to the first team at a professional football club. This formed part of a larger organizational intervention to integrate sport psychology into the club. During the delivery, her mode of working changed from face to face to online support (because of the COVID-19 pandemic), and the management team, except the first author, were dismissed from their duties after lockdown. We discuss the challenges of integrating and working within an organization, experiencing the dismissal of the management team, the effect of the practitioner’s gender as a female working in a male-dominated sport, and the unrelenting football culture and how we, as practitioners, may choose to navigate it. We supplement personal reflections and notes from client work with learning logs and supervision as part of coursework components of a doctorate in sport and exercise psychology. This case study contributes to the literature by presenting and reflecting on challenges that novice practitioners might face working within a professional football organization.
Skiing Uphill: A Sport Ecology Case Study to Save the Snow
Authors: Solomon Beth D. , Stokowski Sarah
Published: August 2022

While outdoor sports, such as skiing, impact the environment, the environment also impacts the sport. North College is a small, private, liberal arts college in the mountains of New England that sponsors four National Collegiate Athletic Association Division I sports, men’s alpine skiing, women’s alpine skiing, men’s Nordic skiing, and women’s Nordic skiing. New England’s weather has been struggling to help the both the men’s and women’s teams access adequate early season training due to the changing environment and the lower snowfall totals. Climate change has posed a risk to the sport of skiing due to the decreased natural snow cover and shortened ski seasons. In addition, manmade snow may increase the risk of injury to student-athletes participating. Through advocacy, partnerships, and climate literacy, this case study seeks to explore North College’s sustainably efforts and attempts to prevent further change in the environment.
Effect of Exercise Cognitive Combined Training on Physical Function in Cognitively Healthy Older Adults: A Systematic Review and Meta-Analysis
Authors: Li Qiuhong , Gong Bingyan , Zhao Yiran , Wu Chao
Published: August 2022

This study aimed to evaluate the effects of exercise cognitive combined training (ECCT) compared with non-ECCT on physical function in cognitively healthy older adults. Databases were searched for randomized controlled trials from inception to December 2, 2021, and 22 studies (1,091 participants, Mage = 74.90) were included in the meta-review. The Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation tools were used for quality assessments. ECCT improved gait speed (mean difference: 0.06 m/s, 95% CI [confidence interval] [0.02, 0.11]; 446 participants, 11 studies) and balance (standardized mean difference: 0.38, 95% CI [0.14, 0.61]; 292 participants, seven studies). Simultaneous ECCT, but not nonsimultaneous ECCT, improved gait speed (mean difference: 0.11 m/s, 95% CI [0.07, 0.15]), balance (standardized mean difference: 0.40, 95% CI [0.16, 0.64]), and functional mobility (mean difference: −0.85 s, 95% CI [−1.63, −0.07]; 327 participants, nine studies). Future research should focus on the duration and form of ECCT intervention optimal for improving the functional activities of older individuals.
Leveling Up Sport Management Education: Gamification in the Classroom
Authors: Duguay Ashley M. , Shipherd Amber M. , LeCrom Carrie , Goebert Chad
Published: August 2022

In line with trends in sport management education that have encouraged a transition from traditional forms of passive and depersonalized learning to active and motivated learning, this essay draws on theoretical and applied insight to provide sport management educators with actionable information related to gamification. In educational contexts, gamification involves using game elements such as narratives, teams, and badges in the classroom as a way to support students’ intrinsic motivation and basic psychological needs (i.e., autonomy, competence, relatedness). This essay presents a case for gamification as a high-impact pedagogical approach that can help sport management educators replicate the global, complicated, and dynamic nature of the sport industry, thus creating more authentic, engaging, and influential experiences for students. Accordingly, this essay outlines gamification in education, discusses game elements and design, and provides a thorough description of a gamified sport psychology course. It concludes with future considerations and key takeaways for sport management educators.
Antarctic Peninsula warming triggers enhanced basal melt rates throughout West Antarctica
Authors: Flexas M. Mar , Thompson Andrew F. , Schodlok Michael P. , Zhang Hong , Speer Kevin
Published: August 2022

The observed acceleration of ice shelf basal melt rates throughout West Antarctica could destabilize continental ice sheets and markedly increase global sea level. Explanations for decadal-scale melt intensification have focused on processes local to shelf seas surrounding the ice shelves. A suite of process-based model experiments, guided by CMIP6 forcing scenarios, show that freshwater forcing from the Antarctic Peninsula, propagated between marginal seas by a coastal boundary current, causes enhanced melting throughout West Antarctica. The freshwater anomaly stratifies the ocean in front of the ice shelves and modifies vertical and lateral heat fluxes, enhancing heat transport into ice shelf cavities and increasing basal melt. Increased glacial runoff at the Antarctic Peninsula, one of the first signatures of a warming climate in Antarctica, emerges as a key trigger for increased ice shelf melt rates in the Amundsen and Bellingshausen Seas.
Surgical management of full-thickness macular hole following Nd:YAG laser hyaloidotomy for pre-macular haemorrhage in a patient with anaemic retinopathy
Authors: Kannan Naresh Babu , Kohli Piyush , Mishra Chitaranjan , Ramachandran N Obulu
Published: August 2022

Pre-macular haemorrhage (PMH) can cause profound visual loss. Some surgeons prefer neodymium-doped yttrium aluminium garnet (Nd:YAG) hyaloidotomy as the first line of treatment due to being an easy technique and having a high success rate. However, the use of high energy close to the fovea can lead to various macular complications. We present a case of a patient who presented with PMH secondary to anaemic retinopathy. He underwent Nd:YAG laser hyaloidotomy, but developed a full-thickness macular hole. He further underwent vitrectomy and a type 1 closure was achieved. However, the visual gain was poor due to the large hole size and the collateral thermal damage. The hole may not close spontaneously, thus requiring surgical intervention. The surgical outcome of these holes depends on the size of the hole and the collateral thermal damage caused during the laser procedure.
National quality improvement intervention to reduce high risk oral methotrexate prescribing
Authors: Innes James , Jamieson Tony , Dales Ruth , Lloyd Robert
Published: August 2022

Background

Harmful or fatal errors related to accidental overdose of methotrexate tablets are well documented. In England, the coprescription of 2.5 mg and 10 mg methotrexate tablets is not recommended, because both tablets look similar, and may be confused with each other, leading to a potential overdose of methotrexate. It is recommended that one tablet strength (usually 2.5 mg) is prescribed and dispensed. A recent retrospective cohort study identified that while 97% of patients in England were prescribed only 2.5 mg methotrexate tablets, the prescribing of 10 mg tablets or combinations of 2.5 mg and 10 mg tablets was still common practice in a small number of geographical areas across the country.

Aim and methodology

To reduce national variation in the prescription of oral methotrexate 10 mg tablets, for non-cancer treatment, by November 2021. A focused, five-stage quality improvement (QI) intervention was used, providing centralised support to a cohort of high prescribing integrated care systems (ICSs) in England.

Findings

23% (10) of ICSs in England were responsible for 76% of prescribing of methotrexate 10 mg tablets. Eight of these high prescribing ICSs participated in the QI intervention between March and November 2021. During the action period, the high prescribing cohort saw a 54% reduction in the prescribing of methotrexate 10 mg tablets, with seven ICSs seeing reductions of between 41% and 75%, resulting in reduced variation between the high prescribing ICSs and all other ICSs. The intervention was well received by ICSs with all making structural changes to their respective systems so that improvement would be sustained.

Conclusions

The success of this project raises several exciting opportunities for further work of this nature, particularly where this is significant variation in practice across the country.
Mildly elevated INR is associated with worse outcomes following mechanical thrombectomy for acute ischemic stroke
Authors: Chen Huanwen , Ahmad Ghasan , Colasurdo Marco , Yarbrough Karen , Schrier Chad , Phipps Michael S , Cronin Carolyn A , Mehndiratta Prachi , Cole John W , Wozniak Marcella , Miller Timothy R , Gandhi Dheeraj , Jindal Gaurav , Chaturvedi Seemant
Published: August 2022

Background

Elevated International Normalized Ratio (INR) is a marker of coagulopathy, but its impact on outcomes following mechanical thrombectomy (MT) in patients with stroke is unclear. This study investigates the impact of mild INR elevations on clinical outcomes following MT.

Methods

In this retrospective cohort study, consecutive patients with stroke treated with MT were identified from 2015 to 2020 at a Comprehensive Stroke Center. Demographic information, past medical history, INR, National Institutes of Health Stroke Scale score, use of tissue plasminogen activator, and last known normal to arteriotomy time were recorded. Outcome measures included modified Thrombolysis in Cerebral Infarction (mTICI) score, modified Rankin Scale (mRS) score at 90 days, and intracerebral hemorrhage (ICH). Patients were divided into two groups: normal INR (0.8–1.1) and mildly elevated INR (1.2–1.7).

Results

A total of 489 patients were included for analysis, of which 349 had normal INR and 140 had mildly elevated INR. After multivariable adjustments, mildly elevated INR was associated with lower odds of excellent outcomes (mRS 0–1, OR 0.24, p=0.009), lower odds of functional independence (mRS 0–2, OR 0.38, p=0.038), and higher odds of 90-day mortality (OR 3.45, p=0.018). Elevated INR was not associated with a higher likelihood of ICH, and there were no differences in rates of HI1, HI2, PH1, or PH2 hemorrhagic transformations; however, elevated INR was associated with significantly higher odds of 90-day mortality in patients with ICH (OR 6.22, p=0.024). This effect size was larger than in patients without ICH (OR 3.38, p<0.001).

Conclusion

In patients with stroke treated with MT, mildly elevated INR is associated with worse clinical outcomes after recanalization and may worsen the mortality risk of hemorrhagic transformations.
Procedural, workforce, and reimbursement trends in neuroendovascular procedures
Authors: Steiger Kyle , Singh Rohin , Fox W Christopher , Koester Stefan , Brown Nolan , Shahrestani Shane , Miller David A , Patel Naresh P , Catapano Joshua S , Srinivasan Visish M , Meschia James F , Erben Young
Published: August 2022

Background

This study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures.

Methods

The Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics’ Consumer Price Index Inflation calculator.

Results

The neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360%; p=0.02), neurosurgery (270%; p<0.01), and neurology (1070%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170%; p<0.01), neurosurgery (280%; p<0.01), neurology (240%; p<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, −13%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, −13%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, −12%; p<0.01), and intracranial stent placement (CPT61635, −12%; p=0.05).

Conclusions

The number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.
060 LFT monitoring for patients prescribed Cannabidiol -an audit of current practice at QEH -Birmingham
Authors: Elkider Mohammed , Samarasekera Shanika
Published: August 2022

Queen Elizabeth Hospital

Introduction

Cannabidiol (CBD) is approved for the treatment of refractory epilepsy associated with Dravet and Lennox-Gastaut syndromes. Affected individuals have co-morbid intellectual disability, making serum monitoring challenging. Those prescribed CBD at the Queen Elizabeth Hospital underwent at least one face to face appointment in the twelve months preceding treatment. Many were initiated on CBD remotely, in keeping with trust guidance to reduce the burden of face-to-face consultations during the Pandemic.

NICE recommends liver function test (LFT) monitoring in those prescribed CBD at baseline, 1, 3 and 6 months, then periodically thereafter 2. All patients initiating CBD were offered LFT on site, with a recom- mendation to GPs to continue LFT monitoring in the community.

Aim To assesses whether CBD patients undergo LFT monitoring in keeping with NICE guidance.

Results

Of thirty patients prescribed Cannabidiol for a minimum of six months, sixteen (53%) had LFTs undertaken at least once. Twelve (75%) were conducted by their GP. Three patients had abnormal LFT at some stage which normalised within six months of initiation of treatment.

Recommendations

Regular liaison with community healthcare providers about LFT protocols and access to finger prick testing (both on site and community) would potentially facilitate regular serum monitoring.
063 The role of Monoclonal antibodies in contrasting cases of NORSE
Authors: Samarasekera Shanika , Lightning Tom
Published: August 2022

1. A 42-year-old female developed status ten days following admission for alcohol-related liver disease. MRI brain showed symmetrical medial temporal high signal. No cause was identified.

Though the convulsive seizures settled, focal seizures persisted. A second MRI showed extensive multi- lobar signal change, presumed inflammatory in nature. Pulsed methylprednisolone and plasma exchange were ineffective.

Tocilizumab was administered ten weeks following onset of seizures.

Sequential MRIs showed resolution of inflammatory changes. The patient was discharged to rehabilitation- Modified Rankin Score 3.

2. A 79-year-old female presented with convulsive NORSE, 24hours after first dose of Pfizer COVID vaccine. She had a background of vascular dementia.

The patient never recovered her GCS. Convulsive seizures were replaced by epilepsy partialis continua. Sequential MRIs showed diffuse left parietal cortical high signal. An inflammatory aetiology was presumed, pulsed methylprednisolone and the ketogenic diet (3 months) were ineffective.

Anakinra was administered on week twelve. Subsequent MRIs showed progression of confluent white matter disease, now bi-hemispheric. She remains symptomatic, a year post presentation.

We hypothesise that both patients had NORSE arising from an unidentified inflammatory aetiology. Age and premorbid function are known to influence recovery. Early use of monoclonal antibodies may be beneficial, including in those with systemic disease.
065 Septal DNETs rarely cause seizures – consider other causes
Authors: Tanti Matthew , Mullatti Nandini , Sivakumar Gnanamurthy , Warren Daniel , Maguire Melissa
Published: August 2022

Dysembryoplastic neuroepithelial tumors (DNET) result in focal seizures. Septal DNET-like tumours however are only associated with seizures in 30% of cases. We report a patient with drug resistant epilepsy and another with functional seizures both with presumably incidental septal DNET-like tumours.

A patient with semiology of temporal lobe epilepsy had a right sided 7.5 mm cystic lesion in keeping with DNET. His epilepsy was refractory so he underwent surgery workup. Video telemetry captured eight right temporal lobe seizures. To rule out ictal spreading starting from the septal lesion he had stereotactic EEG. This revealed seizure onset from the right lateral temporal lobe, and the septal lesion was electrically silent. He is waiting for a temporal lobectomy.

A young patient presented with headaches and seizure like episodes. She was diagnosed with functional seizure. An initial MRI revealed high signal at the right temporal pole. Five years later she developed new sensory symptoms in the limbs and a repeat MRI revealed a new right DNET. Updated video telemetry captured numerous habitual events without evidence of electrical seizures.

These cases support the notion that seizures due to septal DNETs are rare and that alternative seizure foci or diagnoses should be entertained.
Risk factors and Parkinson’s disease presentations in primary care in a diverse UK population
Authors: Simonet Cristina , Bestwick Jonathan , Jitlal Mark , Waters Sheena , Ben-Joseph Aaron , Mar-Shall Charles R , Dobson Ruth , Jacobs Benjamin M , Schrag Anette , Noyce Alastair J
Published: August 2022

Background

Early features of Parkinson’s disease (PD) have been described through population-based studies, which over-represent white, affluent groups and may not be generalisable.

Methods

A nested case-control study was conducted in East London using primary care health records. A matched analysis with multivariable logistic regression was used to determine associations between risk factors and pre-diagnostic presentations with subsequent PD.

Results

1,055 patients with PD and 10,550 controls were included. The strongest associations were found for tremor (OR, 145.96; 95% CI, 90.55-235.28) and memory complaints (OR, 8.6; 95% CI, 5.91-12.49) <2 years before PD diagnosis which persisted up to 10 and 5 years prior to PD diagnosis respectively. Hyperten- sion (OR, 1.36; 95% CI, 1.19-1.55) and type 2 diabetes (OR, 1.39; 95% CI, 1.19-1.62) were associated with subsequent PD. Novel associations were found for epilepsy (OR, 2.5; 95% CI, 1.63-3.83) and hearing loss (OR, 1.66; 95% CI, 1.06-2.58) which were then replicated using data from UK Biobank. No association with future PD was found for ethnicity or deprivation index.

Conclusions

Here we present evidence for a range of comorbidities and symptoms encountered in primary care prior to PD diagnosis in a diverse population. Convincing novel associations were observed for epilepsy and hearing loss with subsequent PD. The prominence of memory symptoms hints at an excess of early cognitive dysfunction in this population or limited ascertainment in traditionally under- represented groups.
075 Anxiety and depression in women with idiopathic intracranial hypertension: a matched controlled retrospective cohort study
Authors: Sassani Matilde , Mollan Susan , Adderley Nicola , Subramanian Anuradhaa , Perrins Mary , Nirantharakumar Krishnara-jah , Sinclair Alexandra
Published: August 2022

Incidence rates for depression and anxiety has not been previously evaluated in a large matched cohort study in idiopathic intracranial hypertension (IIH).

We analysed data collected between January-1995 and September-2019 from IQVIA Medical Research Data, an anonymised and nationally representative UK database. Crude incident rates for depression and anxiety were calculated in IIH, migraine controls and population controls matched by age and body mass index (BMI). Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Anxiety incidence was 12.4, 12.6 and 8.2 per 1000 person-years in IIH, migraine and controls, respectively. For IIH, the adjusted HR for anxiety was 1.40 (CI=1.19-1.64) compared to controls, and 0.98 (CI=0.83-1.14) compared to migraine. Depression incidence was 20.1, 19.5 and 13.3 per 1000 person-years in IIH, migraine and controls, respectively. Compared to controls, depression adjusted HR in IIH was 1.38 (CI 1.20-1.58); compared to migraine, adjusted HR was 0.98 (CI 0.86-1.13).

Anxiety and depression are not more common in IIH compared to matched migraine population, but the hazard of anxiety and depression was approximately 40% higher compared to healthy age and BMI-matched controls. Physician recognition and management of this co-morbidity is an unmet clinical need in IIH.
076 Iatrogenic spinal haematoma post lumbar puncture: A case report and literature review
Authors: Sassani Matilde , Lyons Hannah , Ramalingam Satheesh , Mitchell James , Yiangou Andreas , Sinclair Alexandra , Mollan Susan
Published: August 2022

Lumbar puncture (LP) is a common diagnostic procedure in clinical neurology. Iatrogenic spinal haema- tomas can be a complication of LPs and range from mild and self-resolving to very severe or even fatal. We describe a case report and review current literature on post-LPs spinal haematomas.

A 28-year-old Lady with a background of post-meningitic hydrocephalous treated with a ventriculoperi- toneal shunt had recurrent headaches and blurred vision. For this reason, she had numerous attendances to the emergency department where she had a total of 15 LPs. At the time, there was no coagulopathy, but patient was taking sertraline regularly. She presented again, five days after a traumatic tap, with bilateral sciatica, saddle paraesthesia and urinary incontinence. She was diagnosed with iatrogenic epidural lumbosacral haematoma causing incomplete cauda equina. Following conservative treatment, the haematoma partially resorbed, but the patient was left with residual saddle paraesthesia and urinary incontinence.

Between 1974 to 2022, 41 case reports on LP-related spinal haematomas have been published. Coagu- lopathy is the only risk factor identified, although correlations with outcome are confounded by comorbidi- ties. Treating ICP disorder headaches with LP is not recommended due to poor evidence of prolonged efficacy and this case highlights a significant associated risk.
085 Medication overuse reversion following fremanezumab treatment in migraine patients with inadequate response to prior preventives
Authors: Ashina Sait , Campos Verena Ramirez , Cohen Joshua , Janka Lindsay , Krasenbaum Lynda , Blume Lydia
Published: August 2022

The Phase 3b FOCUS study demonstrated the efficacy and tolerability of fremanezumab, a humanised IgG2Δa monoclonal antibody that selectively targets the calcitonin gene-related peptide, for migraine prevention in patients with documented inadequate response to 2-4 prior preventive treatment classes. This subgroup analysis aimed to evaluate acute medication use in fremanezumab treated patients who had baseline medication overuse (MO; any acute medication ≥15 days/month or triptans, ergots, or combination medications ≥10 days/month).

In the double-blind (DB) period (DBP) of FOCUS, patients were randomised (1:1:1) to quarterly/monthly fremanezumab, or placebo. Patients completing the DBP entered the open-label extension (OLE) and received monthly fremanezumab; results from OLE are stratified by DB randomisation group. Changes from baseline in monthly average days of acute medication use and proportions of patients reverting to no MO were evaluated.

Patients with MO (427/838) had significant reductions in acute medication use with quarterly (least squares mean change, −3.8) or monthly (−4.7) fremanezumab during the DBP, versus placebo (−0.7; P<0.0001), which increased in OLE (quarterly, −6.1; monthly, −6.9; placebo, −5.0). A higher proportion of patients treated with quarterly or monthly fremanezumab reverted to no MO during the DBP, versus placebo (39% and 42% vs 13%), which further increased during the OLE (quarterly, 48%; monthly, 46%; placebo, 41%).

Fremanezumab patients with prior inadequate response to 2-4 prior classes of preventive medications and MO experienced a reduction in acute headache MO.
087 A rarity of a rare condition – do we have a HaNDL on it?
Authors: Kalra Seema , Ho Shing , Kioulachidis Konstantinos , Davies Brendan
Published: August 2022

A 31-year old male with a background of occasional Migraine without aura and mechanical lower back pain, presented with recurrent transient episodes of generalised headache, speech impairment, confusional state, and hemi-body sensory-motor symptoms. He had 9-10 episodes over a 2-week period. These were sudden, non-stereotypical, and lasted between 30-120 minutes. He was well in between and the very first episode happened just before his travel to the Canaries for holidays. He had 3 separate admissions with these episodes.

Routine blood tests were normal

Contrast CT head and MRI brain showed transient generalised leptome- ningeal enhancement, CSF showed sequential WCC of 420 and 200 before returning to normal. Repeat EEG showed no epileptiform abnormality. Extensive tests for infectious agents including viral serology were all either negative or suggestive of previous exposure. Only HSV-7 PCR was positive. Inflammatory and paraneoplastic tests were negative. He fully recovered from these in 2 months with no sequelae.

The clinical Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lympho- cytosis (HaNDL) is well described, rarely seen and poorly understood. Proposed mechanisms include migraine pathophysiology, post-infectious and immunological phenomenon. This is the first report of an active HSV-7 infection, causing HaNDL.
093 Screening of non-motor symptoms of Parkinson’s disease and dementia with Lewy bodies: clinical audit
Authors: Gurney Rowan , Weil Rimona
Published: August 2022

Non-motor manifestations of Parkinson’s disease (PD) are common and contribute a significant burden to patients and carers. They include constipation, depression, hallucinations, urinary symptoms, dysphagia, weight loss and drooling of saliva. Recognising and treating non-motor symptoms of PD reduces hospital admissions.

Aims

To assess screening of non-motor symptoms in a specialist Parkinson’s dementia outpatient clinic.

Methods

We conducted a closed-loop audit of a Parkinson’s dementia clinic, using the 2019 Parkinson’s UK Audit as gold standard. We collected data regarding enquiry about non-motor symptoms. Data were collated and analysed, and presented at a departmental meeting.

Results

A total of 38 patients with PD and Dementia with Lewy Bodies (DLB) were included. They attended the clinic over a 3-month period. Hallucinations (89%), urinary symptoms (68%) and mood (62%) were addressed the most frequently in the consultation. Malnutrition (24%) and problems with saliva (5%) were screened for rarely. Following this audit, a checklist tool was incorporated into the clinic proforma. A re-audit revealed increased rates of screening for non-motor symptoms after the new clinic checklist was introduced.

Conclusions

Non-motor symptoms are important features of PD and DLB but are often overlooked. Simple interventions can effectively improve screening of these symptoms.
094 Diffusion magnetic resonance imaging in dystonia: a review of methodological approaches and findings
Authors: MacIver Claire , Tax Chantal , Jones Derek , Peall Kathryn
Published: August 2022

Dystonia is a hyperkinetic movement disorder involving repetitive or sustained muscle contractions, resulting in abnormal postures. Proposed underlying pathophysiological mechanisms include neuronal network dysfunction, disruption to inhibitory processes and impaired synaptic plasticity. Here, we perform a systematic literature review of diffusion MRI brain studies of genetic and idiopathic forms of dystonia, aiming to identify brain regions and pathways consistently implicated in dystonia. Embase and PubMed databases were searched (to October 2021) for terms relating to diffusion MRI and idiopathic and inherited forms of dystonia. Of 40 identified studies, 10 assessed inherited, 24 idiopathic and 6 mixed types dystonia. The imaging methodology employed was variable, with key limitations including data acquisi- tion and processing steps. Study cohorts were also often small, particularly for Mendelian inherited forms. The most consistent abnormalities identified were lower FA (fractional anisotropy) and reduced number of tractography streamlines in white matter connecting the brainstem, cerebellum, basal ganglia and sensorimotor cortex. Findings were consistent across genetic and idiopathic forms of dystonia, although greater variability was seen in findings from idiopathic cohorts. Overall, microstructural white matter dif- ferences between dystonia cohorts and controls are evident, however the imaging measures used are often non-specific, with broad potential to its underlying biological meaning.