bluuebunny/crossref_metadata_2025 huggingface dataset:
A promising unisource thermal evaporation for in situ fabrication of organolead halide perovskite CH3NH3PbI3 thin film
Authors: Liang Guang‐Xing , Fan Ping , Luo Jing‐Ting , Gu Di , Zheng Zhuang‐Hao
Published: June 2015

In this work, a new method of fabricating organolead halide perovskite CH3NH3PbI3 thin film by unisource thermal evaporation was proposed, which ensured high‐quality film with composition, crystal‐structure homogeneity, full surface coverage, well‐defined grain structure, high crystalline, and reproducibility, suggesting its promising applicability for significant optimization in efficient. Copyright © 2015 John Wiley & Sons, Ltd.
Psychosocial determinants of Chinese parental HPV vaccination intention for adolescent girls: preventing cervical cancer
Authors: Wang Linda Dong‐Ling , Lam Wendy Wing Tak , Wu Joseph , Fielding Richard
Published: June 2015

Background

Intention is an important precursor of decisions to undergo vaccination. Using an extensively modified theory of planned behaviour, we explored psychosocial determinants of vaccination intention against human papillomavirus (HPV) among Hong Kong Chinese parents.

Methods

A random sample of 368 (response rate 54.6%) Chinese parents who had at least one daughter aged 12–17 years, had heard of HPV vaccine before but had not vaccinated daughters against HPV and had completed telephone interviews between February and April 2014. Hierarchical multiple regression analysis examined the additive effect of theoretical constructs. Stepwise multiple regression analysis determined which variables contributed the most to the prediction of vaccination intention.

Results

Principal determinants of parental HPV vaccination intention were anticipated worry if not vaccinated (β = 0.23,p = 0.001), anticipated anxiety reduction after HPV vaccination (β = 0.19,p = 0.005), proneness to peer influence (β = 0.17,p = 0.002), private health insurance for children (β = 0.14,p = 0.009), perceiving daughter's susceptibility to cervical cancer (β = 0.17,p = 0.003), number of daughters (β = −0.13,p = 0.011), descriptive norms of HPV vaccination (β = 0.13,p = 0.021), perceiving cervical cancer as behaviour‐preventable disease (β = −0.11,p = 0.031) and anticipated regret if not vaccinated (β = 0.14,p = 0.046). Cervical cancer‐related worry/anxiety explained 32.8% of the variance in parental HPV vaccination intention.

Conclusions

Results suggest that cervical cancer‐related worry/anxiety is the most important predictor of parental HPV vaccination intention in Hong Kong Chinese and possibly other populations. Social influences also play an important role affecting parental vaccination intention, particularly peer influence and descriptive norm beliefs. Implications of these results are discussed in terms of future HPV vaccination promotion and cervical cancer prevention programme. Copyright © 2015 John Wiley & Sons, Ltd.
Development of antiviral drugs for the treatment of hepatitis C at an accelerating pace
Authors: De Clercq Erik
Published: June 2015

Anno2015, the race for developing the ideal therapy, or what is now called “cure,” for hepatitis C virus infection has continued unabatedly. The targets (NS3/4A protease, NS5A protein, and NS5B polymerase) have remained the same, and the number of compounds [direct‐acting antivirals (DAAs)] interacting with these targets has continued to increase. Whereas pan‐genotypic activity has remained a mandatory requirement, the problem of virus drug resistance has become less crucial. The need for combining DAAs acting at different sites has remained compelling, with the drugs used for combinations emanating from the same pharmaceutical company, that is, Gilead (sofosbuvir and ledipasvir) (Gilead Sciences, Foster City, CA, USA) (AbbVie, North Chicago, IL, USA), AbbVie (ABT/r, ombitasvir, and dasabuvir), and BMS (Bristol‐Myers Squibb), (New York City, NY, USA) (asunaprevir and daclatasvir) among the leading contenders. At stake is the definitive cure of HCV infection [as reflected by a sustained viral response (SVR) after 12 weeks of treatment]. This SVR is expected to reduce cirrhosis and hepatocellular carcinoma, two complications inherently linked to HCV infection. Unlike hepatitis B virus and human immunodeficiency virus, HCV infection can be definitely and permanently cured by antiviral therapy because HCV has no long‐term reservoir in the body. Peginterferon combined with ribavirin and even the first‐wave protease inhibitors telaprevir and boceprevir now belong to the milestones that had an important, although historical, role in the final conquest of hepatitis C. Copyright © 2015 John Wiley & Sons, Ltd.
Multirobot Cooperative Learning for Semiautonomous Control in Urban Search and Rescue Applications
Authors: Liu Yugang , Nejat Goldie
Published: June 2015

The use of cooperative multirobot teams in urban search and rescue (USAR) environments is a challenging yet promising research area. For multirobot teams working in USAR missions, the objective is to have the rescue robots work effectively together to coordinate task allocation and task execution between different team members in order to minimize the overall exploration time needed to search disaster scenes and to find as many victims as possible. This paper presents the development of a multirobot cooperative learning approach for a hierarchical reinforcement learning (HRL) based semiautonomous control architecture in order to enable a robot team to learn cooperatively to explore and identify victims in cluttered USAR scenes. The proposed cooperative learning approach allows effective task allocation among the multirobot team and efficient execution of the allocated tasks in order to improve the overall team performance. Human intervention is requested by the robots when it is determined that they cannot effectively execute an allocated task autonomously. Thus, the robot team is able to make cooperative decisions regarding task allocation between different team members (robots and human operators) and to share experiences on execution of the allocated tasks. Extensive results verify the effectiveness of the proposed HRL‐based methodology for multi‐robot cooperative exploration and victim identification in USAR‐like scenes.
Reclaiming Race as a Topic of the U.S. Biology Textbook Curriculum
Authors: DONOVAN BRIAN M.
Published: June 2015

Even though human racial difference has been a longstanding topic of the school biology curriculum, there is little evidence that contemporary biology textbooks challenge stereotypical racial beliefs that are based in biological thinking. Rather, the modern biology curriculum may be a place where such beliefs about race are perpetuated unwittingly. Drawing upon a theoretical framework of racial conceptualization based in psychological essentialism, this paper argues that biology textbook curricula ought to directly challenge problematic and unscientific racial beliefs to increase understanding of human genetic variation and decrease racial beliefs associated with prejudice.
Preparation and characterization of protein resistant zwitterionic starches: The effect of substitution degrees
Authors: Wang Jinmei , Li Junjie , Yang Huaming , Zhu Chuanshun , Yang Jun , Yao Fanglian
Published: June 2015

Zwitterionic polymers are known to possess excellent protein resistance due to high hydration capacity of their zwitterionic moieties. In this study, polysaccharide‐based zwitterionic polymers 3‐dimethyl(propyl) ammonium propanesulfonate starches (Z‐starches) with different degrees of substitution of the zwitterionic moieties (DSZM) were synthesized successfully. The value of DSZM can be controlled exactly in the range of 0–0.46. The cytotoxicity of Z‐starches with different DSZM was evaluated by an MTT assay, and the Z‐starch with DSZM of 0.26 promoted cell proliferation when the concentration of this polymer solution was 1–25 mg/mL. The protein resistance and cell adhesion of Z‐starch hydrogels were evaluated, and the amount of protein adsorption or cell adhesion on Z‐starch hydrogels was decreased as the DSZM increased. The preliminary protein resistance and cell adhesion tests suggest that the Z‐starches have potential applications in drug delivery carriers and coatings of implanted sensors where protein resistance is needed.
Placental magnetic resonance imaging T2* measurements in normal pregnancies and in those complicated by fetal growth restriction
Authors: Sinding M. , Peters D. A. , Frøkjær J. B. , Christiansen O. B. , Petersen A. , Uldbjerg N. , Sørensen A.
Published: June 2015

Objectives

The magnetic resonance imaging (MRI) variable transverse relaxation time (T2*) depends on multiple factors, one important one being the presence of deoxyhemoglobin. We aimed to describe placental T2* measurements in normal pregnancies and in those with fetal growth restriction (FGR).

Methods

We included 24 normal pregnancies at 24–40 weeks' gestation and four FGR cases with an estimated fetal weight below the 1st centile. Prior to MRI, an ultrasound examination, including Doppler flow measurements, was performed. The T2* value was calculated using a gradient echo MRI sequence with readout at 16 different echo times. In normal pregnancies, repeat T2* measurements were performed and interobserver reproducibility was assessed in order to estimate the reproducibility of the method. Placental histological examination was performed in the FGR cases.

Results

The method was robust regarding the technical and interobserver reproducibility. However, some slice‐to‐slice variation existed owing to the heterogeneous nature of the normal placenta. We therefore based T2* estimations on the average of two slices from each placenta. In normal pregnancies, the placental T2* value decreased significantly with increasing gestational age, with mean ± SD values of 120 ± 17 ms at 24 weeks' gestation, 84 ± 16 ms at 32 weeks and 47 ± 17 ms at 40 weeks. Three FGR cases had abnormal Doppler flow, histological signs of maternal hypoperfusion and a reduced T2* value (Z‐score < –3.5). In the fourth FGR case, Doppler flow, placental histology and T2* value (Z‐score, −0.34) were normal.

Conclusions

The established reference values for placental T2* may be clinically useful, as T2* values were significantly lower in FGR cases with histological signs of maternal hypoperfusion. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Placental volume and uterine artery Doppler evaluation at 11 + 0 to 13 + 6 weeks' gestation in pregnancies conceived with in‐vitro fertilization: comparison between autologous and donor oocyte recipients
Authors: Rizzo G. , Aiello E. , Pietrolucci M. E. , Arduini D.
Published: June 2015

Objective

To compare first‐trimester uterine artery pulsatility index (UtA‐PI) and three‐dimensional (3D) placental volume in pregnancies conceived through in‐vitro fertilization (IVF) using autologous or donor oocytes and pregnancies conceived naturally, and to relate these measurements to the development of pre‐eclampsia (PE).

Methods

UtA‐PI and placental volume were measured at 11 + 0 to 13 + 6 weeks of gestation in 416 IVF pregnancies (307 with autologous and 109 with donor oocytes) and in 498 spontaneously conceived pregnancies. We recruited nulliparous women with singleton pregnancy. The measured mean UtA‐PI and placental volume values were converted to multiples of the expected normal median (MoM), adjusted for gestational age. MoM values of IVF pregnancies were compared with MoM values of the naturally conceived pregnancies and related to PE development.

Results

Placental volume was significantly reduced in IVF pregnancies (K = 169.3; P < 0.0001) compared with natural pregnancies. No difference was found in UtA‐PI MoM between the two groups. Among IVF pregnancies, significantly lower placental volumes were seen in those that received donor oocytes when compared with those with autologous oocytes (z = 3.89; P < 0.001). In IVF pregnancies that developed PE, lower values of placental volume were demonstrated with respect to normotensive pregnancies (donor: U = 6.8; P = 0.009; autologous: U = 5.1; P = 0.023), whereas no difference was found in UtA‐PI. Multivariate logistic regression analysis demonstrated that placental volume (odds ratio (OR), 1.97 (95% CI, 1.33–2.27)) and donor oocytes in IVF pregnancy (OR, 2.24 (95% CI, 1.5–2.83)) were independent predictors of PE, whereas autologous oocytes in IVF pregnancy were not found to be significant in the model.

Conclusions

First‐trimester placental volume, as assessed by 3D ultrasound, is reduced in IVF pregnancies and this reduction is more marked in those involving donor oocyte recipients. The relative decrease in placental volume in IVF pregnancies that developed PE suggests an etiological mechanism different from uterine perfusion in such patients. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
2‐Amino‐5‐(2‐pyridyl)‐thiadiazole as Bidentate Ligand
Authors: Huxel Timo , Demeshko Serhiy , Klingele Julia
Published: June 2015

The amino substituted bidentate chelating ligand 2‐amino‐5‐(2‐pyridyl)‐1,3,4‐thiadiazole (H2L) was used to prepare 3:1‐type coordination compounds of iron(II), cobalt(II) and nickel(II). In the iron(II) perchlorate complex [FeII(H2L)3](ClO4)2·0.6MeOH·0.9H2O a 1:1 mixture of mer and fac isomers is present whereas [FeII(H2L)3](BF4)2·MeOH·H2O, [CoII(H2L)3](ClO4)2·2H2O and [NiII(H2L)3](ClO4)2·MeOH·H2O feature merely mer derivatives. Moessbauer spectroscopy and variable temperature magnetic measurements revealed the [FeII(H2L)3]2+ complex core to exist in the low‐spin state, whereas the [CoII(H2L)3]2+ complex core resides in its high‐spin state, even at very low temperatures.
A 3D Polyoxometalate‐Based Framework Constructed from Ag/trz Metal‐Organic Ribbons and P2W18 Polyoxoanions: Synthesis, Structure and Electrochemical Properties
Authors: Wang Xiang , Zhang Rui , Tian Aixiang , Wang Xiuli
Published: June 2015

A Wells‐Dawson Polyoxometalate‐based hybrid, Ag9(trz)3(Htrz)4 (H2O)(P2W18O62)·3H2O (1) (Htrz = 1,2,4‐1H‐triazole) was hydrothermally synthesized through using trz ligand and silver nitrate in the presence of [P2W18O62]6– polyoxoanion. In the 3D framework structure of compound 1, two kinds of wave‐like Ag/trz chains originated from trz ligands and silver cations are aggregated in a “2+1” mode by {Ag2/trz} linkages to result in a 1D Ag/trz metal‐organic ribbon, which is further extended into a 3D framework structure by [P2W18O62]6– polyoxoanions through Ag‐O covalent bonds. Additionally, the electrochemical properties of compound 1 have also been investigated.
Efficacy of Intravenous Lidocaine for Postoperative Analgesia Following Laparoscopic Surgery: A Meta‐Analysis
Authors: Ventham Nicholas T. , Kennedy Ewan D. , Brady Richard R. , Paterson Hugh M. , Speake Doug , Foo Irwin , Fearon Kenneth C. H.
Published: June 2015

Background

Intravenous (IV) lidocaine has analgesic and anti‐inflammatory properties. This study aims to evaluate the efficacy of IV lidocaine in controlling postoperative pain following laparoscopic surgery.

Methods

A meta‐analysis of randomised controlled trials (RCTs) comparing IV lidocaine versus placebo/routine treatment for postoperative analgesia following laparoscopic surgery. The primary outcome was opiate requirement at 24 h. Secondary outcomes included cumulative opiate requirement, numerical pain scores (2, 12, 24, 48 h at rest and on movement), recovery indices (nausea and vomiting, length of stay, time until diet resumption, first flatus and bowel movement) and side effects (cardiac/neurological toxicity). Subgroup analyses were performed according to operation type and to compare IV lidocaine with intraperitoneal lidocaine.

Results

Fourteen RCTs with 742 patients were included. IV lidocaine was associated with a small but significant reduction in opiate requirement at 24 h compared with placebo/routine care. IV lidocaine was associated with reduced cumulative opiate requirement, reduced pain scores at rest at 2, 12 and 24 h, reduced nausea and vomiting and a shorter time until resumption of diet. The length of stay did not differ between groups. There was a low incidence of IV lidocaine‐associated toxicity. In subgroup analyses, there was no difference between IV and intraperitoneal lidocaine in the measured outcomes.

Conclusions

IV lidocaine has a multidimensional effect on the quality of recovery. IV lidocaine was associated with lower opiate requirements, reduced nausea and vomiting and a shorter time until resumption of diet. Whilst IV lidocaine appears safe, the optimal treatment regimen remains unknown. Statistical heterogeneity was high.
Sickle Cell Trait Screening of Collegiate Athletes: Ethical Reasons for Program Reform
Authors: Ferrari Rosalie , Parker Lisa S. , Grubs Robin E. , Krishnamurti Lakshmanan
Published: June 2015

The National Collegiate Athletic Association (NCAA) requires all student‐athletes have their sickle cell trait (SCT) status confirmed prior to athletic participation. The NCAA approved the screening program in 2010 for institutions participating in Division I athletics and extended it in subsequent years to institutions at Division II and III levels. Ethical concerns about the controversial policy focus on its mandatory nature and potential impact on student‐athletes, particularly through stigmatization of and discrimination against those with SCT. Organizations, such as the American Society of Hematology (ASH), oppose the imposition of SCT testing and instead recommend universal precautions that would protect the entire student‐athlete population without revealing student‐athletes’ SCT statuses. This paper discusses these issues and offers recommendations, including genetic counseling, which would improve the current SCT screening program. It argues that implementation of universal precautions would ensure that the most ethically sound practices are afforded to every student‐athlete.
“Positive Attitude”: A multilevel model analysis of the effectiveness of a Social and Emotional Learning Program for Portuguese middle school students
Authors: Coelho Vítor Alexandre , Marchante Marta , Sousa Vanda
Published: June 2015

This study investigated the impact, reported by students and their teachers, of a universal, school‐based, social‐emotional learning program, implemented in three school years on the social‐emotional competencies of middle school students (7th to 9th grade). It also analyzes, at post‐test and follow‐up, the differential results by gender and among students with lower levels of competence. There were 1091 participants, 855 students received the treatment condition (i.e., Project Attitude) and 236 students the control condition. Self‐reports identified positive intervention results in social awareness, self‐control, self‐esteem, social isolation and social anxiety, teachers reported gains in all dimensions. These positive effects were stably effective along the three cohorts. Self‐reports also identified bigger gains for girls in social awareness and for boys in social anxiety, self‐esteem and leadership. Students with initial lower levels of competence benefited more from the intervention, especially at follow‐up. These results support the effectiveness of social‐emotional learning programs.
Schauder estimates for nonlocal fully nonlinear equations
Authors: Jin Tianling , Xiong Jingang
Published: June 2015

In this paper, we establish pointwise Schauder estimates for solutions of nonlocal fully nonlinear elliptic equations by perturbative arguments. A key ingredient is a recursive Evans–Krylov theorem for nonlocal fully nonlinear translation invariant equations.
There Is No Rawlsian Theory of Corporate Governance
Authors: Singer Abraham
Published: June 2015

The major aim of this article is to show that John Rawls’s theory of justice cannot be applied effectively to questions of business ethics and corporate governance. I begin with a reading of Rawls that emphasizes both the critical and pragmatic nature of his theory. In the second section I look more closely at the notion of society’s “basic structure” and its place within Rawls’s theory. In the third section, I argue that “the corporation” cannot be understood as part of this basic structure and is not, therefore, a subject of justice for Rawls or his interpreters. Finally, I show that Rawls’s inability to speak to the corporation is a weakness, regardless of one’s particular view on the corporation. I conclude by considering what Rawls’s theory helps us to understand about the problems involved in integrating corporate governance, business ethics, and political philosophy.
HERBRAND’S THEOREM AND NON-EUCLIDEAN GEOMETRY
Authors: BEESON MICHAEL , BOUTRY PIERRE , NARBOUX JULIEN
Published: June 2015

We use Herbrand’s theorem to give a new proof that Euclid’s parallel axiom is not derivable from the other axioms of first-order Euclidean geometry. Previous proofs involve constructing models of non-Euclidean geometry. This proof uses a very old and basic theorem of logic together with some simple properties of ruler-and-compass constructions to give a short, simple, and intuitively appealing proof.
Cost-minimization analysis comparing intravenous immunoglobulin (IVIg) with plasma exchange (PLEX) in the management of patients with myasthenia gravis: different perspectives for different payers
Authors: Furlan JC , Barth D , Barnett C , Bril V
Published: June 2015

Introduction: A cost-minimization analysis (CMA) was performed comparing IVIg and PLEX in the management of patients with exacerbation of myasthenia gravis (MG). Methods: This study combines Ontario-based health costing data with clinical data from a randomized clinical trial where patients with moderate/severe MG received either IVIg or PLEX. The CMA was undertaken under the perspective of a public health care insurer and under the perspective of a tertiary hospital payer. Results: The IVIg group (n=32) was comparable with the PLEX group (n=38) regarding demographics, disease characteristics and severity. PLEX was less costly than IVIg among patients with body mass index (BMI) ≤15.7 Kg/m2, under the perspective of a public health care insurer (CAN$6,271.18 versus CAN$8,309.72, p<0.0001). However, PLEX was more costly than IVIg under the perspective of the hospital payer when the costs of blood products were excluded (CAN$4,815.36 versus CAN$1,486.12, p<0.0001). Conclusions: PLEX may be a short-term cost-minimizing therapy when compared with IVIg for treatment of MG exacerbation among patients with BMI ≤15.7 Kg/m2, under the perspective of a public health care insurer. However, when the costs of blood products are absorbed by a third party, the hospital administration may see IVIg as a more attractive therapeutic alternative.
Parachute Canada/ThinkFirst Hockey Spinal Injuries Registry update
Authors: Tator CH , Provvidenza C
Published: June 2015

Background: The Registry has collected data on spinal injuries in hockey for 30 years. This paper identifies the nature and incidence of spinal injuries in Canadian ice hockey and the impact of prevention programs. Methods: Data about spinal injuries with and without spinal cord injury in ice hockey have been collected by Parachute Canada/ThinkFirst’s Canadian Ice Hockey Spinal Injury Registry since 1981 through retrospective questionnaires from practitioners, ice hockey organizations and media reports. Injury risk factors assessed include age, gender, location, and injury mechanism. Results: From 1943-2011, 355 cases have been documented. Injuries were primarily sustained by males (97.7%), and were cervical (78.9%)in location, resulting mainly from impact with the boards (64.2%). Checking/pushing from behind (36.0%) was the most common cause of injury, although slightly lower during 2006-2011. Major differences between provinces continue; Ontario and Quebec, continue to show markedly different injury rates, with Ontario’s more than twice that of Quebec. Conclusions: Spinal injuries in hockey continue to occur, although at lower rates than in the peak years from 1981-2000. Injury prevention education and rules reinforcement (e.g. no checking/pushing from behind). Data indicate that multifaceted prevention programs have reduced the risk of injury.
Child Neurology (General Pediatric Neurology)
Authors: Bernier A , Landry JS , Kristof AS , Carmant L , Major P
Published: June 2015

Background: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome that can present with many disabling neurological symptoms, the most common being seizures. Although it is a chronic systemic syndrome, healthcare utilization and long-term outcome of subjects with TSC are not well defined. The goal of this study was to evaluate the direct cost and long-term outcome of TSC compared to other forms of epilepsy and healthy controls. Methods: Our provincial health care database was interrogated to determine use of medical services by patients with TSC, epilepsy and healthy controls from 1996-2011. Data on demographics, outcomes and health care utilization were analyzed. Results: 1004 TSC, 41,934 with epilepsy and 41,934 controls were identified. The prevalence of TSC was 1/7,872 compared to 1/189 for epilepsy. TSC experienced more hospitalizations, medical visits and prescription drug use, resulting in higher total health care costs. Their most common admission diagnosis was seizures and age at death was significantly lower: 61,3 years old for TSC vs 69,6 and 76,6 years old for epilepsy and controls, (p<0,001). Conclusions: TSC subjects have a significantly higher burden of disease than other subjects with epilepsy. These results stress the need for specialized services in this population through the lifespan.
The term “epilepsy in the elderly” is conceptually irrelevant and needs to be replaced by an etiology-driven classification system in the aging brain
Authors: Pohlmann-Eden B , Crocker CE , Legg KT , Schmidt MH
Published: June 2015

Objective: “Epilepsy in the elderly (EE)” is considered a homogeneous, benign syndrome in patients aged > 60 years, with cerebrovascular disease as the most frequent etiology. We challenge this concept by comparing EE and middle-aged adults with epilepsy (MAE). Methods: We compared: 1) seizure dynamics, 2) MRI lesions, 3) EEG findings and 4) treatment course in EE and MAE at the Halifax First Seizure Clinic. Results: 48 EE patients aged > 60.2 years (median 66.9 years). 31 MAE patients aged 50.2 – 59.6 years (median 55.1 years). Seizure dynamics in EE/MAE included first seizure in 50/54.8%, new onset epilepsy (new seizures within 12 months) in 43.8/35.5%, newly diagnosed epilepsy (seizures for >> 12 months) in 9.6/6.3%. First seizure evolved into new onset epilepsy in 12.5/3.2%. MRI in EE/MAE was normal in 22.5/27.6% or showed microangiopathy (25/38.5%), atrophy (10/15.4%), tumors (7.5/11.5%), vascular malformations (7.5/3.8%), hippocampal pathologies (0/3.8%), infarcts (12.5/0%). EEG in EE/MAE was normal in 64.4/65.5% or showed diffuse (6.6/3.5%) or focal slowing (8.8/7%), generalized (4.3/13.7%) or focal (15.4/10.4%) epileptiform activity. At 12 months, 87% of EE and 93.8% of MAE were seizure-free. Conclusions: EE and MAE show similar heterogeneity. We propose an etiology-driven classification of epilepsy syndromes in the aging brain.
fMRI for language: how can it replace the Wada test?
Authors: Mousavi S , Massot Tarrus A , Bihari F , Hayman Abello S , Hayman Abello B , Mirsattari S
Published: June 2015

Background: The goal of our project is to assess the feasibility of replacing the invasive Wada test considered as the gold standard with non-invasive fMRI test for assessment of language dominance preoperatively. Methods: fMRI test with three language paradigm tasks (verb generation, sentence completion and naming) were conducted on our cohort of patients. fMRI laterality indices (LI) were then defined as a ratio (L-R)/(L+R) between the number of activated voxels in the left and right ROIs for Anterior Language Area (ALA) and Posterior Language Area (PLA). fMRI results were divided into the right (LI < -0.2), left (LI > 0.2) or bilateral (-0.2 < LI <0.2) hemispheric language dominance and compared to the results of the Wada test. Results: 28 patients were studied. The concordance rate between Wada and fMRI tests for the ALA and PLA was 68.2% and 52.2% for sentence completion; 56% and 52% for verb generation and 25% and 35% for naming paradigm, respectively. Conclusions: Sentence completion and verb generation fMRI paradigms showed higher concordance with Wada test than naming paradigm. The higher discordance between the Wada test and fMRI was related to bilateral results suggestive of less stringent thresholds used for either test.
Redefining true leukocytosis in the traumatic lumbar puncture
Authors: Rizvi SA , Moein-Afshari F
Published: June 2015

Objective: To compare and contrast the observed versus predicted number of white blood cells (WBCs) in a traumatic cerebrospinal fluid (CSF) sample in children and adults. Background: Clinicians rely on a correction formula (Predicted_CSF_WBC=CSF_RBC×Blood_WBC/Blood_RBC) to determine if a true CSF leukocytosis exists. This formula may overestimate true CSF leukocytosis and lead to delayed treatment of meningitis. Methods: A retrospective review of CSF data of 105 patients who met the following criteria: 1) CSF from lumbar puncture (LP) contained≥1000 RBC/mm^3 and 2) CBC performed≤24 hours of LP; 3) negative CSF cultures. Regression analysis was performed to determine the relationship between actual and predicted CSF WBC values. Results: Regression modeling indicated a discrepancy in the predicted versus actual WBC values. Mean adult age was 48.9 years; CSF profile (mean WBC 146.3×10^6/L; RBC 17374×10^6/L; glucose 4.1 mmol/L; protein 1.4 g/L); mean peripheral WBC was 8.2×10^9/L; RBC 3.9×10^9/L. Mean pediatric age was 1.4 years; CSF profile (mean WBC 171.8x10^6/L; RBC 41763x10^6/L; glucose 2.7 mmol/L; protein 1.7 g/L); mean peripheral WBC was 12×10^9/L; RBC 7.2×10^9/L. Observed LP CSF WBC value was 47% of predicted (r^2=0.54 pediatric cohort; r^2=0.91 adults). Conclusion: True CSF leukocytosis could be missed in a traumatic CSF sample based on a currently applied correction formula. We propose the following modifcation: Observed_CSF_WBC=0.5x[CSF_RBC×Blood_WBC/Blood_RBC].
The use of standardized order sets to optimize treatment for Guillain-Barre Syndrome: a literature review
Authors: Karnik V , Roberts T , Johnston W
Published: June 2015

Background: Standardized order sets are thought to improve patient outcomes in multiple ways. They reduce costs without reducing quality of care, and improve efficiency. In both surgical and medical conditions patients benefit from order sets in various disease states. In Guillain-Barre syndrome (GBS), the use of standardized order sets may be beneficial as there are a defined set of disease-specific diagnostic tests and treatments to be implemented. Here, the primary aim was to search for, and evaluate standardized order sets for GBS, and to provide a basis for development of future pathways. Methods: We used the Cochrane, TRIP, and MEDLINE/PUBMED databases, searching between January 1966 and April 2014. Search terms included: “Guillain-Barre Syndrome” and its synonyms, “(standardized) order set”, “clinical pathway”, “neurology” and “admission bundle.” Results: Despite anecdotal evidence of order sets, no formal data has been published showing benefit after implementation of these sets in GBS or any neurological condition. Conclusions: Although evidence exists for use of standardized order sets in surgical and medical settings, no published data exist in neurology. Given GBS has a defined set of disease-specific and state-specific treatment options, a standardized order set used on admission for GBS patients may prove to be beneficial.
Seropositive PERM associated with leucocytoclastic vasculitis
Authors: Steven BK
Published: June 2015

Background: Progressive encephalomyelitis, rigidity, and myoclonus (PERM) is a variant stiff-person plus syndrome consisting of brainstem and pyrimidal dysfunction, muscular rigidity, stimulus-evoked spasms, and dysautonomia. Continuous motor-unit activity from ectopic anterior horn cell discharges underlies the myotomal hyperactivity. Case Report: A 51-year-old man with an 8-year history of “spasmodic” mid and low back pain presented with increasing stiffness, hyperekplexia-induced opisthotonus-like posturing, urinary retention, long-tract motor signs, and diplopia. He had a recent history of biopsy-confirmed leucocytoclastic vasculitis-associated diffuse maculopapular rash. He responded well to IVIg treatment manifested by improved 1) gait fluidity, 2) bowel and bladder function 3) tolerance to startle, and 4) vision. Results: Serological testing revealed positive anti-glycine receptor antibodies. Anti-glutamic acid decarboxylase and voltage-gated K+-channel antibodies were absent. A chest CT was unremarkable. Conclusions: This is the second case of seropositive PERM in Canada and the first associated with leucocytoclastic vasculitis. Pathologic findings in PERM reveal perivascular lymphocytic cuffing in the rhombencephalon and spinal cord. Glycine receptor localization correlates with neurologic dysfunction. Mid-brain involvement may underlie the autonomic dysfunction but evidence of direct glycinergic inhibition of the external urethral sphincter in Onuf’s nucleus may be responsible for urinary retention.
Bilateral thalamic infarction due to artery of percheron occlusion with corresponding CT perfusion abnormalities
Authors: MacLellan A , Boyle K
Published: June 2015

Background: The Artery of Percheron (AOP) is a rare anatomic variant that supplies the bilateral medial thalami from a common origin; occlusion results in a characteristic pattern of bilateral thalamic infarction seen on neuroimaging. To date, we have not identified any cases in the literature describing corresponding ischemic changes seen on hyperacute CT Perfusion imaging. We aimed to characterize perfusion abnormalities seen in AOP occlusion by describing a case presentation, highlighting the importance of recognizing this syndrome clinically, and radiologically, in an acute stroke presentation. Methods: Description of a case, and literature search on PubMed. Results: A 74-year-old man was seen in the ER as a Code Stroke protocol with acute alteration of level of consciousness (LOC). ER assessment showed no focal abnormalities and was significant only for disorientation. CT/CTA/CTP initially appeared unremarkable for acute abnormalities. His LOC deteriorated requiring intubation, and subsequent MRI showed bilateral thalamic infarction. Further CT Perfusion review demonstrated increased Mean Transit Time and decreased Blood Flow without Volume abnormalities in the bilateral paramedian thalami. Conclusion: AOP infarction is an uncommon cause of bilateral thalamic infarction. We have demonstrated a case highlighting perfusion abnormalities not previously reported in AOP occlusion, illustrating the importance and utility of advanced CT perfusion imaging whilst considering less common stroke syndromes.
The effectiveness of a concussion-u educational presentation on knowledge and attitudes of concussion amongst elite bantam and midget hockey players
Authors: Eagles M , Powell M , Bradbury-Squires D , Murphy J , Campbell G , Maroun FB
Published: June 2015

Background: The diagnosis of a concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving athlete’s knowledge and attitudes towards concussions may increase self-reporting behavior; however, research in this area is inconclusive. The objective of this study is to determine if a Concussion-U educational presentation improves knowledge and attitudes of youth hockey players towards concussions. This is part of a larger study designed to determine the impact of an informational presentation on the knowledge and attitudes over a full hockey season. Methods: 56 elite male Bantam and Midget hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey (RoCKAS) questionnaire immediately before and after a Concussion-U educational presentation on the subject. Results: Concussion knowledge and attitude scores significantly (p<.001) increased from pre-presentation to post-presentation by 13.1% and 8.7%, respectively. Discussion: A Concussion-U educational presentation designed to improve concussion knowledge and attitudes in youth hockey players resulted in increased knowledge and improved attitudes towards concussion in elite male Bantam and Midget hockey players. Future research should examine the long-term effects of such presentations.
Compliance with brain trauma foundation (BTF) guidelines for management of traumatic brain injury (TBI) patients: systematic review and meta-analysis
Authors: Khormi YH , O’Kelly C
Published: June 2015

Background: TBI is a leading cause of death and disability. Management based on the BTF guidelines is widely accepted and thought to improve outcome. The objectives of this study were: 1) to review the rate of adherence to BTF guidelines; 2) to identify factors influencing adherence; and 3) to determine the effect of guideline-based management on outcome. Methods: We searched all electronic bibliographic databases. In duplicate and independently, two investigators screened titles, abstracts and articles to select appropriate studies reporting compliance rate, factors influencing compliance, and adjusted mortality or morbidity. Data extraction and assessment of bias risk were performed independently by both investigators. We excluded pediatric and military-related TBI studies. Results: A total of 30 articles met inclusion/exclusion criteria out of 1153 papers screened. Most are retrospective and cross-sectional observational studies; there were no randomized control trials. Preliminary analysis showed considerable variation in compliance rate with BTF guidelines ranging from 5.6-96%. Conclusions: Variation in the care of TBI patients persists across the world. Compliance with BTF guidelines was strongly influenced by implementing a guidelines-based protocol. Heterogeneity of the article prevents outcome assessment. Well-conducted study to support the existing literature of the beneficial effect of current guidelines is needed.
Management of inadvertent injury to superior sagittal sinus in parasagittal meningioma: technical note
Authors: Ahmed AA , Yarascavitch B , Murty N
Published: June 2015

Background: Parasagittal meningioma is a common type of intracranial meningiomas. Surgical resection of such lesions can result in injury to superior sagittal sinus. In rare occasions, extended craniotomy might be required for uncontrollable hemorrhage from a lacerated venous wall. Objective: In order to avoid extended craniotomy, we attempted a surgical technique that would provide more sustained control over the lacerated venous sinus. Method: A 56 year old lady underwent surgical resection for parasagittal meningioma. The lateral wall of the superior sagittal sinus was preached while scraping the tumor capsule from the sinus wall. Owing to difficulty in controlling the bleeding site, a tack up falx-assisted tension suture was attempted with a mass of Gelfoam and Surgicel over the laceration. Results: Adequate control for the venous sinus laceration. Conclusion: The falx-assisted suturing technique is quick, easy to perform and efficient in maintaining a constant tamponade effect over the lacerated site. We highly recommend such technique prior to extending the craniotomy over an injured venous sinus.
Intramedullary spinal cord metastasis from primary esophageal carcinoma
Authors: Dalkilic T , Tymchak Z , Kindrachuk M , Fourney D
Published: June 2015

Background: Intramedullary spinal cord metastasis (ISCM) are rare with primary lung, breast and melanoma accounting for up to 80% of cases. Diagnosis is often delayed or incorrect and these lesions can often be mistaken for primary astrocytoma or ependymoma given similar radiologic features. Methods: We present the case of an 80 year-old male with rapidly progressive quadriparesis and an enhancing intramedullary lesion at C4-7 with diffuse peri-lesional edema. The patient had previously undergone resection of non-metastatic esophageal carcinoma. Results: Bone scan revealed no evidence of skeletal or organ metastases. The patient underwent C5-7 laminectomy and resection of tumor with intra-operative monitoring. Final pathology revealed metastatic adenocarcinoma consistent with esophageal primary. PETCT revealed recurrent esophageal disease and pleural-based metastatic deposits. The patient went on to receive palliative radiotherapy to the cervicothoracic spine. Neurologic status improved marginally. Conclusions: ISCM from primary esophageal carcinoma is extremely rare. We present to our knowledge one of three reports of such in the literature. Hematogenous dissemination via Batson’s plexus and peri-veretebral plexuses is thought to be the likely route of spread. Treatment is primarily palliative, however surgical resection should be considered in the absence of metastatic disease.
Primary supratentorial intracerebral malignant paraganglioma
Authors: Ahmed AA , Lach B , Kachur E , Cenic A
Published: June 2015

Paragangliomas are extra-adrenal neuroendocrine tumours that derive from neural crest. They are benign tumours in general but few cases had shown their tendency to metastasize. Malignant forms have been reported previously with intracranial metastasis from duodenal origin but primary intracranial origin represent a rare and unusual location for such tumours. We report a rare case for a 48 year old lady who presented with symptomatic right sided insular mass with negative metastatic work up. A complete surgical resection had been done with an unexpected diagnosis of primary gangliocytic paraganglioma with malignant features.
Evaluation of fusion in a PEEK cage after anterior cervical discectomy and fusion
Authors: Voisin M , Saunders F , Yen D , Fenton P
Published: June 2015

Anterior Cervical Discectomy and Fusion (ACDF) is the gold standard treatment for cervical spondylosis but there is a lack of consensus in the literature regarding which type of bone graft is superior: autograft or allograft. The purpose of this study is to evaluate fusion after ACDF using a stand-alone intervertebral cage packed with autologous cervical bone shavings acquired during the procedure. Twenty patients that underwent single-level ACDF from 2011 to 2014 using a stand-alone polyetheretherketone (PEEK) cage were recruited. Patients were evaluated for evidence of bone fusion by plain films and CT scan. Fusion was primarily assessed by grading the level of trabecular bridging bone across the bone-graft interface. Odom’s criteria were used to assess clinical outcome. All interbody disc spaces achieved successful fusion at follow-up. A total of 80% (16/20) of patients had radiographic evidence of trabecular bone present both within and around the cage. The other 20% exhibited bridging bone within the cage but had evidence of minor radiolucent gaps and lack of bridging bone completely surrounding the cage. Eighty percent of patients reported excellent/good clinical outcomes. ACDF using a PEEK stand-alone cage with autograft bone shavings has a high rate of fusion and avoids potential complications of classic autograft harvesting and decreased allograft fusion rates.
Free calcium induces degenerative changes in the intervertebral disc through the calcium sensing receptor
Authors: Rakan B , AlGarni N , Salem O , Epure L , Habis AA , Antoniou J , Mwale F , Grant M
Published: June 2015

Introduction: Degenerative disc disease (DDD) is a common cause of lower back pain. Calcification of the intervertebral disc (IVD) has been correlated with DDD. The role of IVD calcification in the development DDD is unknown. We noticed an increase in ionic calcium content and expression of the extracellular calcium-sensing receptor (CaSR) in the degenerate discs, however, its role in DDD remains unclear. Material and Methods: IVD Cells: Bovine and human NP and AF cells were incubated in culture media supplemented with various concentrations of calcium, and a CaSR agonist IVD Cultures: IVDs from bovine tails were isolated and the vertebral bone was removed. IVDs were cultured for 6 weeks in culture medium supplemented with calcium (1.0, 2.5, or 5.0 mM), or a CaSR agonist. Western blotting was performed on extracts to assess for aggrecan and Col II. Results: The expression of aggrecan and Col II decreased dose-dependently in both NP and AF cells, as well as in the organ culture model following supplementation with calcium or the CaSR agonist. Conclusion: Our results suggest that changes in the local concentrations of calcium are not benign, and that activation of the CaSR may be a contributing factor in IVD degeneration.
Neonatal hemorrhagic stroke: population-based epidemology
Authors: Cole L , Hodge J , Kirton A
Published: June 2015

Background: Stroke is a leading cause of perinatal brain injury and cerebral palsy. Term neonatal hemorrhagic stroke (NHS) is a common syndrome with poorly defined epidemiology. We aimed to determine incidence and mechanisms within a large population-based NHS sample. Methods: The Alberta Perinatal Stroke Project (APSP), a provincial registry ascertained NHS cases using exhaustive ICD-9/10 code searching (1992-2012, >2400 chart reviews). Prospective cases were captured through the Calgary Pediatric Stroke Program from 2007-2014 (n=387). All NHS cases underwent structured chart review using a data capture form and blinded review of neuroimaging. Provincial live births were obtained from statistics Canada. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure (PSOM). Results: We identified 74 cases: 49 NHS (26 retrospective, 27 prospective), 4 presumed perinatal HS (PPHS), and 21 hemorrhagic transformation (HT) of ischemic injury. Incidence of NHS was 1:8800 live births (1:5820 for all forms). HT was common (28.4%) including global, arterial venous ischemic lesions. Presumed perinatal hemorrhagic stroke presented with epilepsy. No risk factor was identified in 68% of cases. Outcomes were abnormal (PSOM 1 or more) in 30% and better in the HT group. Conclusion: NHS occurs in 1:8800 live births. Imaging classification is essential to define mechanisms.
Laboratory and clinical adverse events following initiation of dimethyl fumerate
Authors: Al Malik YM , Greenfield J , Wall W , Metz LM
Published: June 2015

Background: Dimethyl fumerate (DF) is a first line therapy for relapsing remitting multiple sclerosis (RRMS). This retrospective cohort study aims to determine adverse events (AEs) after initiation of DF in a real world clinical setting. Methods: Data from patients at the Calgary MS Clinic with RRMS who initiated DF between July 1, 2013 and December 31, 2014 were analyzed. Demographic, clinical and lab information were collected from patient electronic medical records and the clinic database. Results: This analysis included 170 patients. At treatment initiation mean age was 42.1 years, 75% were women, mean disease duration was 12.5 years, median EDSS was 2.0, and 24% were treatment naïve. Median follow-up was 6.4 months (range: 1.5-17.7). AEs occurred in 101 (59%); the most common were flushing (31%), gastrointestinal (GI) side effects (24%), and elevated liver enzymes (18%). Other less frequent AEs included lymphopenia (lymphocyte count < 0.5) (4%) and proteinuria (4%). DF was discontinued by 17 (10%); median time to discontinuation was 3.1 months. Fifteen (9%) discontinued due to AE. Conclusions: AE associated with DF in a real world clinical setting is comparable to the Canadian monograph for flushing, GI side effects, and lymphopenia but lower for elevated liver enzymes and proteinuria.