bluuebunny/crossref_metadata_2025 huggingface dataset:
Lotus spp.: a Mediterranean genus with high environment and economic impact in the Salado River Basin (Argentina)
Authors: Ruiz Oscar Adolfo , Gortari Maximiliano , Maguire Vanina Giselle , Arese Romina Paola , Campestre María Paula , Antonelli Cristian Javier , Calzadilla Pablo Ignacio , Menéndez Ana Bernardina , Escaray Francisco José , Carrasco Sorli Pedro Miguel , Bailleres Matías Andrés , Ezquiaga Juan Pedro , Paolocci Francesco , Garriz Andrés , Nieva Amira Susana del Valle
Published: May 2024

This review has the principal objective in to hypothesise that the introduction of Lotus species could have significant benefits in constrained soils due their worldwide distribution. This idea is major based on results obtained in the lowlands of the most important livestock breeding area in Argentina denominated Salado River Basin (also called “Flooding Pampas”). Mostly of their land surface is dominated by salt-affected soils with severe constraints for traditional crop cultivation (i.e., maize, soybean, etc.). In order to increase their economic importance, farmers have utilized species such as non-native L. tenuis (ex- Lotus glaber), originating from European Mediterranean area, which shows a successfully and fast naturalization (in less than 60 years) in constrained areas improving forage performance. The increase in soil quality associated to this legume is achieved by an increment of the organic matter content and improvement of fertility and physicochemical parameters. Moreover, other studies have evidenced some genetic determinants associated with interesting agronomic traits such as plant tolerance to environmental stresses and the importance of leaves condensed tannins concentrations. This revision has many topics including a brief analysis of economic and environmental changes that occur under Lotus species implantation. In addition, we incorporate references recently published concerning the evaluation of the biochemical and physiological mechanisms involved in their adaptation to strong abiotic stresses characteristic of the region, the soil and plant microbiota diversity and soil physical and chemical characteristics associated to the presence of Lotus genotypes.
Potentialities of Technosol-isolated PGPB consortium in promoting plant growth in lettuce seedlings
Authors: Castaldi Stefany , Lorenz Christian , Vitale Ermenegilda , Santorufo Lucia , Isticato Rachele , Arena Carmen
Published: May 2024

Background and aims

Reducing land degradation and safeguarding agricultural productions ensures the provision of ecosystem services and economic welfare, as highlighted by the 2030 Sustainable Development Goals. Among the promising solutions to tackle these issues, the study investigates the use of Technosol-isolated PGPB, as a novel approach for enhancing plant growth and the capability to cope with soil salinization.

Methods

Several bacteria have been isolated from a Technosol in Naples (Italy), selected to produce a consortium, based on their PGP features and tested on lettuce. The promotion of lettuce growth was evaluated both in soil (sterilized and not-sterilized Technosols) and in water agar media differing in NaCl concentrations, focusing on total polyphenols, 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity, soluble proteins, and sugars, which were evaluated on seedlings.

Results

Germination kinetics differed among treatments in both soil and artificial media setups. In the Technosol trial, the PGPB treated seeds were the quickest to emerge, showing a higher radical scavenging activity and lower soluble carbohydrate content. In the salinity trial, total soluble proteins were significantly higher in primed seeds at null saline cocentration.

Conclusion

Our results indicate that the PGPB application has a beneficial outcome on the Technosol but under saline stress produces an inhibitory or a costly effect on the biochemistry and germination kinetics. However, Technosol PGPBs employement may open new research scenarios on their potential application considering Nature-Based Solutions and/or plant growth in degraded environments.
Decoding value exchange in entrepreneurial ecosystems through a service-dominant lens
Authors: Donaldson Colin , Newbery Robert , Mirabent Jasmina Berbegal , Kallmuenzer Andreas
Published: May 2024

Research on entrepreneurial ecosystems has consolidated over the past decades. This study ventures beyond traditional analyses that primarily focus on quantitative outcomes to investigate the foundational processes that can facilitate a range of socio-economic advantages. Recognizing a gap in the existing literature, which often correlates input factors with anticipated benefits yet struggles to unearth underlying mechanisms, our research offers a novel perspective through applying a network-centric service ecosystem lens grounded in a service-dominant logic. Utilizing a qualitative approach based on pragmatic abduction, 16 narrative interviews explored the experiences and perspectives of multiple entrepreneurial actors within a privately governed Spanish ecosystem. Findings present a conceptual model that bridges emphasis between structure and outcomes with those of agency and strategy.
The effect of 11th rib excision on perioperative outcomes in patients undergoing partial nephrectomy for upper pole renal tumors
Authors: Baylan Burhan , Gurel Abdullah
Published: May 2024

Introduction

We aimed to evaluate the effect of eleven11th rib resection.on the perioperative period TRIFECTA criteria in patients who underwent retroperitoneal partial nephrectomy (PN) with the diagnosis of upper pole kidney tumors.

Materials and methods

We conducted a retrospective analysis of the data of the patients who underwent Open PN for upper pole renal masses between 2018 and 2023. The patients were divided into two groups: PN with rib resection and PN without rib resection. The demographic characteristics, tumor sizes, PADUA scores, warm–cold renal ischemia times, mass excision and tumor bed suturing times, histopathological tumor type and surgical margin positivity of the patients were examined. Both groups were evaluated comparatively based on this data.

Results

The renal nephrometry scores of the two groups were similar. The total renal ischemia time was significantly shorter in the patients who underwent a rib resection than in those who did not (p < 0.001). Both the tumor excision and tumor bed suturing times were significantly shorter in the group that underwent a rib resection than in the group that did not (p < 0.001). The Clavien–Dindo complication grades were statistically similar between the two groups.

Conclusion

Complex in nature and high–risk renal masses located in the upper pole of the kidney, partial nephrectomy performed with an 11th rib resection can be considered a reliable surgical option with a shorter ischemia time, supporting the preservation of long-term renal function.
Role of the salt glands of Armeria maritima (halophyte) in removal of lead from tissues
Authors: Wierzbicka Małgorzata , Begiedza Martyna , Bodzon Karolina , Bemowska-Kałabun Olga , Brzost Krzysztof , Wróbel Monika , Trzybiński Damian , Woźniak Krzysztof
Published: May 2024

Armeria maritima is a halophyte exhibiting a strong tolerance to heavy metals. It grows on zinc–lead waste heaps. This study aimed to determine the role of salt glands in the removal of lead (Pb) from plants and to trace the path of lead from the shoots to the salt glands on the surface of leaves. Mechanisms allowing high tolerance to lead in A. maritima were also evaluated. These examinations were conducted on a lead-tolerant population and a lead-sensitive plant population. The plants were treated with Pb(NO3)2 and the path of lead was traced from the roots to the leaves. The lead-tolerant population transported twice as much lead as the sensitive population. The action of the salt glands resulted in 40% of the leaf lead content in the lead-tolerant population being expelled onto the surface of the leaves. These features indicate the high phytoremediation capabilities of these halophyte plants. The excretion of multi-ionic solutes by the salt glands results in the appearance of tiny crystals on the surface of the leaves. In this publication, for the first time, an attempt was made to determine what chemical compounds build up these crystals and to determine their crystal structure. Solving this problem was possible through the usage of single-crystal X-ray structural analysis.
Sex differences in health-related quality of life and psychological distress among colorectal cancer patients: a 2-year longitudinal study
Authors: Bonhof Cynthia S. , de Rooij Belle H. , Schoormans Dounya , Wasowicz Dareczka K. , Vreugdenhil Gerard , Mols Floortje
Published: May 2024

Purpose

While sex differences in the incidence and mortality of colorectal cancer (CRC) are well documented, less is known about sex differences in patients’ health-related quality of life (HRQoL) and psychological distress. To enhance patient-tailored care, we aimed to longitudinally examine sex differences in HRQoL and psychological distress among CRC patients from diagnosis up until 2-year follow-up.

Methods

Newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 334) completed questions on HRQoL (EORTC QLQ-C30) and psychological distress (HADS) before initial treatment (baseline), 4 weeks after surgery, and at 1 and 2 years after diagnosis. Also, HRQoL and psychological distress were assessed in a sex- and age-matched reference population.

Results

When directly comparing female (N = 126, 38%) and male (N = 208, 62%) CRC patients, female patients reported significantly worse HRQoL, such as more insomnia at baseline, worse physical and role functioning 4 weeks after surgery, more diarrhea at 1 year, and more pain and constipation at 2-year follow-up. However, a comparison with the reference population revealed larger differences between patients and reference in males than in females. For example, at 1- and 2-year follow-up, male patients reported significantly worse cognitive and social functioning, more insomnia, and more anxiety compared with a reference population.

Conclusions

Especially male CRC patients reported worse HRQoL and more psychological distress when compared with a reference population.

Implications for cancer survivors

Knowledge of sex-specific differences in HRQoL and psychological distress among CRC patients may help healthcare providers anticipate and appropriately address patients’ unique healthcare needs.
Quality of life, diabetes-related stress and treatment satisfaction are correlated with glycemia risk index (GRI), time in range and hypoglycemia/hyperglycemia components in type 1 diabetes
Authors: Díaz-Soto Gonzalo , Pérez-López Paloma , Férnandez-Velasco Pablo , Bahillo-Curieses Pilar , de la O Nieto de la Marca María , Jimenez Rebeca , de Luis Daniel
Published: May 2024

Introduction

To evaluate the relationship between the GRI -component of hypoglycemia (CHypo) and hyperglycemia (CHyper)- with diabetes quality of life (DQoL), diabetes-related stress (DDS), perception of hypoglycemia (Clarke Test), visual analogic scale (VAS) and diabetes-knowledge (DKQ2) in T1D.

Methods

Cross-sectional study in 92 patients with T1D under intensive insulin treatment (21.7% CSII) and flash glucose monitoring (isCGM). Clinical, metabolic and glycometric parameters and quality of life/satisfaction questionnaires were analyzed.

Results

92 patients (54.3% male, BMI 25.4 ± 4.5 kg/m2, HbA1c 7.5 ± 1.0%, TIR 53.9 ± 15.9%) with mean age 36.1 ± 12.6years and 17.8 ± 11.3 T1D duration. The mean GRI was 60.6 ± 22.2 with a CHypo and CHyper of 5.9 ± 4.8 and 27.3 ± 14.4, respectively. 19.1% presented a pathological Clarke’s test. Patients with TIR > 70% and GRI < 40 showed better VAS (8.8 ± 1.3 vs 9.3 ± 0.9, p < 0.05) and DDS (46.4 ± 22.1 vs 36.7 ± 16.6, p < 0.05) scores, showing no differences between groups. CHyper > 15 and Chypo > 3.4 were related to worse levels of DQoL (91.1 ± 23.9 vs 76.6 ± 18.6 and 94.6 ± 24.8 vs 79.8 ± 20.1, p < 0.01), DDS(49.8 ± 22.4 vs 35.7 ± 16.5 and 49.8 ± 22.4 vs 35.7 ± 16.5, p < 0.01),and DKQ2 (24.4 ± 4.3 vs 26.8 ± 5.2 and 24.1 ± 4.8 vs 26.0 ± 4.6, p < 0.05), respectively. Worse metabolic control defined by GRI correlated with worse scores in VAS (r = −0.209, p < 0.05), DQoL (r = 0.205, p < 0.05), and DDS (r = 0.205, p < 0.05). No difference was observed in knowledge´s scale. CHyper correlated with worse scores in VAS (r = −0.231, p < 0.05), DQoL (r = 0.422, p < 0.01), and DDS (r = 0.341, p < 0.01) and lower degree of knowledge DKQ2 (r = −0.231, p < 0.05). When analyzing DQoL as a dependent variable in a multiple lineal regression, only age (β = 0.747; p < 0.001) and CHyper (β = 0.717; p < 0.001) maintained statistical significance.

Conclusions

Higher GRI was related to worse quality of life, diabetes-related stress and satisfaction with treatment, analogous to the TIR results.CHyper an Chypo were related to a greater decline in quality of life, diabetes-related stress, and lower satisfaction with treatment.However, in a multiple linear regression, only CHyper maintained statistical significance.
Profit and loss attribution: an empirical study
Authors: Flaig Solveig , Junike Gero
Published: May 2024

The profit and loss (P &L) attribution for each business year into different risk factors (e.g., interest rates, credit spreads, foreign exchange rate etc.) is a regulatory requirement, e.g., under Solvency 2. Three different decomposition principles are prevalent: one-at-a-time (OAT), sequential updating (SU) and average sequential updating (ASU) decompositions. In this research, using financial market data from 2003 to 2022, we demonstrate that the OAT decomposition can generate significant unexplained P &L and that the SU decompositions depends significantly on the order or labeling of the risk factors. On the basis of an investment in a foreign stock, we further explain that the SU decomposition is not able to identify all relevant risk factors. This potentially effects the hedging strategy of the portfolio manager. In conclusion, we suggest to use the ASU decomposition in practice.
PBF-LB of large-area magnesium WE43 structures surface-enhanced by plasma electrolytic oxidation
Authors: Abel Arvid , Sharma Anutsek , Holländer Hannes , Zheng Dawn , Emminghaus Nicole , Buling Anna , Hermsdorf Jörg , Zerrer Jörg , Kaierle Stefan
Published: May 2024

Due to the improved understanding of the industry, additive manufacturing processes are becoming increasingly accepted for fabricating complex lightweight components. The focus of the magnesium research is primarily on small implant structures. Due to challenges in the manufacturing process and oxidation behavior, large structures for lightweight components are mainly fabricated with titanium. This paper expands the scope of the laser-based powder bed fusion (PBF-LB) of larger-area magnesium parts with surface enhancement using the Ultraceramic® by the plasma electrolytic oxidation (PEO). For this purpose, the PBF-LB process development for cylindric structures with a diameter of 31 mm is carried out. The processing strategies are adapted for a crack and porosity free process. To mitigate the inherent oxidation of the biodegradable WE43 and reduce the surface wear in tribologically challenging applications, the additively manufactured magnesium is modified by the Ultraceramic®. The thickness of the ceramic surface could be tailored between 10 and 40 µm, while enclosing adhering powder particles of the PBF. Electrochemical impedance spectroscopy showed an increased resistance to corrosion by an increased modulus |Z0.01| by a factor of 658. The tribological behavior was characterized in pin-on-disc experiments and showed a decrease of surface wear down to 7.9 × 10–6 mm3/N·m up to a Hertzian pressure of 720 MPa tested by a tungsten carbide ball. Therefore, the synthesis of the PBF-LB of large-area magnesium parts and the PEO of the Ultraceramic® enables lightweight components for challenging oxidative and tribological conditions in real world applications.
Nature’s values in marine resource governance: an ethnographic case study of rockweed in Norway
Authors: Kvanneid Aase J. , Sundnes Frode
Published: May 2024

This article addresses the shortcomings in the governance of the Norwegian macroscopic brown algae Ascophyllum nodosum (rockweed) that appeared when approaching rockweed as a socio-ecologic object in the Vega archipelago on the Norwegian Helgeland coast. A common seaweed along the Norwegian coast, rockweed constitutes an important species in Norway’s ‘blue forests’. Historically, rockweed harvesting was an important source of income for the local coastal population in Norway. Although not comparable to the newer and expanding kelp industry, rockweed harvesting is still profitable along the coast. Despite revived attention from the seaweed industry, state management of rockweed in 2024 is conspicuously absent. Combined with the lack of scientific knowledge of the consequences of rockweed harvesting on the local coastal ecosystems, the responsibility for ensuring sustainable harvesting of rockweed lies with the industry itself. On Vega, however, where rockweed is a highly valued and contested coastal species with a high economic, ecologic, and cultural significance, rockweed harvesting was a conflicted issue. In approaching rockweed as a socio-ecologic object from ‘below’, the article identifies hegemonic structures and discourses in Norwegian marine governance, suggesting how a narrow definition of ‘value’ comes to matter—not only for rockweed—but for sustainable governance of all marine and coastal ecosystems. This article is also an important contribution to the burgeoning interdisciplinary research on nature’s values, power, and knowledge in environmental management.
Heterostructure catalyst coupled wood-derived carbon and cobalt-iron alloy/oxide for reversible oxygen conversion
Authors: Zhou Limin , Li Junxiao , Yin Jiao , Zhang Gaoyue , Zhang Pengxiang , Zhou Jingjing , Zhang Anqi , Wang Ao , Li Baojun , Liu Yanyan , Sun Kang
Published: May 2024

As promising energy-storage devices, zinc–air batteries (ZABs) exhibit slow reaction kinetics for oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) occurring at their electrodes. High-performance bifunctional catalysts must thus be synthesized to accelerate the reversible conversion of oxygen and improve the rate and overall performance of ZABs. Herein, we reported the promising prospects of self-supported composite electrodes composed of wood-derived carbon (WDC) and bimetallic cobalt-iron alloys/oxides (CoFe-CoFe2O4@WDC) as efficient electrocatalysts for alkaline ORR/OER. WDC provided a favorable three-phase interface for heterogeneous reactions owing to its layered porous structure and genetic stability, thereby enabling mass diffusion and improving reaction kinetics. The CoFe2O4 spinel surface was reduced to bimetallic CoFe alloy to form abundant heterostructure interfaces that promote electron transfer. Under alkaline conditions, the optimized composite electrode exhibited a remarkable high half-wave potential of 0.85 V and an exceptionally low overpotential of 1.49 V. It also exhibited stable performance over an impressive 2340 cycles in a ZAB. Theoretical calculations also confirmed that the heterointerface addresses the issue of proton scarcity throughout the reaction and actively facilitates the creation of O–O bonds during the reversible transformation of oxygen. This study introduces a new concept for developing bifunctional and efficient electrocatalysts based on charcoal and encourages the sustainable and high-value use of forest biomass resources.

Graphical Abstract
A Semi-implicit Finite Volume Scheme for Incompressible Two-Phase Flows
Authors: Ferrari Davide , Dumbser Michael
Published: May 2024

This paper presents a mass and momentum conservative semi-implicit finite volume (FV) scheme for complex non-hydrostatic free surface flows, interacting with moving solid obstacles. A simplified incompressible Baer-Nunziato type model is considered for two-phase flows containing a liquid phase, a solid phase, and the surrounding void. According to the so-called diffuse interface approach, the different phases and consequently the void are described by means of a scalar volume fraction function for each phase. In our numerical scheme, the dynamics of the liquid phase and the motion of the solid are decoupled. The solid is assumed to be a moving rigid body, whose motion is prescribed. Only after the advection of the solid volume fraction, the dynamics of the liquid phase is considered. As usual in semi-implicit schemes, we employ staggered Cartesian control volumes and treat the nonlinear convective terms explicitly, while the pressure terms are treated implicitly. The non-conservative products arising in the transport equation for the solid volume fraction are treated by a path-conservative approach. The resulting semi-implicit FV discretization of the mass and momentum equations leads to a mildly nonlinear system for the pressure which can be efficiently solved with a nested Newton-type technique. The time step size is only limited by the velocities of the two phases contained in the domain, and not by the gravity wave speed nor by the stiff algebraic relaxation source term, which requires an implicit discretization. The resulting semi-implicit algorithm is first validated on a set of classical incompressible Navier-Stokes test problems and later also adds a fixed and moving solid phase.
Isochorismate synthase is required for phylloquinone, but not salicylic acid biosynthesis in rice
Authors: Wang Zengqian , Yang Guiqing , Zhang Dandan , Li Guangxin , Qiu Jin-Long , Wu Jie
Published: May 2024

Salicylic acid (SA) is a phytohormone required for plant growth and defense signaling. There are two major SA biosynthesis pathways in plants: the isochorismate synthase (ICS) pathway and the phenylalanine ammonia-lyase (PAL) pathway. It has been demonstrated in several plant species, including the model plant Arabidopsis, that SA is derived predominantly from the ICS pathway. Here, we employed the CRISPR/Cas9 system to generate ICS knockout mutants in rice (Oryza sativa L.). The Osics mutants display severe growth defects, and are completely devoid of phylloquinone, an isochorismate-derived product. The growth defects of Osics can be rescued through exogenous application of 1,4-dihydroxy-2-naphthoic acid (NA), a precursor of phylloquinone. Remarkably, the basal SA levels are not altered in the Osics mutants. Our findings support a role of OsICS in the biosynthesis of phylloquinone, and imply that SA biosynthesis in rice may occur through an alternative route other than the ICS pathway.
On Grüss, Ostrowski and trapezoid-type inequalities via nabla integral on time scales
Authors: Nosheen Ammara , Khan Khuram Ali , Shahzadi Iram
Published: May 2024

Ostrowski inequality gives the absolute deviation of the function from its integral mean. Delta and nabla calculi are first two approaches to study time scales calculus. This article presents the Ostrowski inequality for univariate first order nabla differentiable function by using Montgomery identity established for nabla integrals. Some extensions of dynamic Ostrowski-type inequality are investigated with the help of integration by parts for nabla integrals, properties of the modulus and polynomials on time scales. Furthermore, dynamic Grüss and trapezoid-type inequalities are established in their generalized form for twice nabla differentiable functions by utilizing the Montgomery identity. In addition, the obtained inequalities are discussed for continuous and discrete time scales.
F.3 Multicentre prospective validation of integrated molecular classification of meningiomas and prediction of recurrence risk using DNA methylation
Authors: Wang JZ , Patil V , Landry AP , Gui C , Ajisebutu A , Wilson C , Cohen Gadol A , Rebchuk A , Makarenko S , Yip S , Aldape K , Nassiri F , Zadeh G
Published: May 2024

Background: Meningiomas have significant heterogeneity between patients, making prognostication challenging. For this study, we prospectively validate the prognostic capabilities of a DNA methylation-based predictor and multiomic molecular groups (MG) of meningiomas. Methods: DNA methylation profiles were generated using the Illumina EPICarray. MG were assigned as previously published. Performance of our methylation-based predictor and MG were compared with WHO grade using generalized boosted regression modeling by generating time-dependent receiver operating characteristic (ROC) curves and computing area under the ROC curves (AUCs) along with their 95% confidence interval using bootstrap resampling. Results: 295 meningiomas treated from 2018-2021 were included. Methylation-defined high-risk meningiomas had significantly poorer PFS and OS compared to low-risk cases (p<0.0001). Methylation risk increased with higher WHO grade and MG. Higher methylome risk (HR 4.89, 95%CI 2.02-11.82) and proliferative MG (HR 4.11, 95%CI 1.29-13.06) were associated with significantly worse PFS independent of WHO grade, extent of resection, and adjuvant RT. Both methylome-risk and MG classification predicted 3- and 5-year PFS and OS more accurately than WHO grade alone (ΔAUC=0.10-0.23). 42 cases were prescribed adjuvant RT prospectively although RT did not significantly improve PFS in high-risk cases (p=0.41). Conclusions: Molecular profiling outperforms conventional WHO grading for prognostication in an independent, prospectively collected cohort of meningiomas.
P.002 Distinct neuropsychiatric symptom trajectories in frontotemporal dementia across genetic mutations
Authors: Lee H , Scott IM , Chatterjee A , Mackenzie IR , Lapid MI , Huey ED , Tartaglia C , Kantarci K , Rankin KP , Rosen HJ , Boeve BF , Boxer AL , Hsiung G
Published: May 2024

Background: Frontotemporal dementia (FTD) often presents with varying neuropsychiatric symptoms (NPS), which may differ based on genetic mutations. We hypothesized distinct NPS trajectories in FTD progression among carriers of chromosome 9 open reading frame 72 (C9orf72), progranulin (GRN), and microtubule-associated protein tau (MAPT) mutations. Methods: We analyzed 1662 participants from ALLFTD, including 342 C9orf72, 148 GRN, 168 MAPT mutation carriers, and 1004 noncarriers. We categorized participants into four stages based on CDR plus NACC FTLD global scores: 1) Presymptomatic (consistent CDR=0), 2) Early conversion (CDR increasing from 0 to 0.5), 3) Advanced conversion (CDR increasing from 0.5 to ≥1.0), and 4) Symptomatic (CDR>1.0). The Neuropsychiatric Inventory-Questionnaire (NPI-Q) assessed NPS changes, analyzed using a mixed-effects model, accounting for age and baseline scores. Results: Our results indicated similar NPS trajectories in the presymptomatic stage for all groups. Notably, during early conversion, C9orf72 and GRN carriers exhibited significantly higher NPI-Q score increases than MAPT carriers, primarily in psychosis and hyperactivity domains. In later stages, increases in NPS were similar across groups. Conclusions: This study suggests familial FTD progression, particularly in TDP-43 pathology, may involve more severe NPS like psychosis or hyperactivity, differing from tau pathology or sporadic FTD. Further research is needed to explore these distinct trajectories.
P.013 Accuracy of clinical assessments with virtual care in outpatient neurological setting
Authors: Pellegrino J , Lee L
Published: May 2024

Background: Virtual neurological assessments were increasingly used and an important viable option during the COVID-19 pandemic. However, the accuracy of such assessments is unknown. Methods: Clinical records were reviewed in a predominant multiple sclerosis outpatient clinic at an academic teaching hospital from March 23rd 2020 to March 23rd 2021 during the COVID-19 pandemic. Patients assessed during this period were analyzed with an initial virtual assessment compared to subsequent in person evaluations. Results: 1036 patients were included. 27.8% (n=288) of consultations were video and 72.2% (n=748) telephone. A total of 13.8% (n=143) of virtual consultations revealed clinical disparities, specifically 13.5% (n=39) video and 13.9% (n=104) telephone consultations. Of all the 1036 cases, 2.32% (n=24) patients stated they were stable but significant changes were seen on the exam, changing the clinical impression. 11.5% (n=119) stated they were deteriorating virtually but not confirmed when examined in person, with an alternative explanation found. Conclusions: Virtual assessments were accurate in over 85% of the outpatient neurological cases during the pandemic. However, it should be noted that the in person neurological exam led to a change in clinical opinion in 13.8% of assessments. 2.32% patients described clinical stability, but different clinical management plans resulted when significant exam findings were identified.
P.016 Re-norming medical education: centering patient experience and diverse bodies in Lumbar Puncture (LP) instruction
Authors: Lin E , Koopman W , Dilkes D , Casserly C
Published: May 2024

Background: Medical curricula are often created with limited patient and student input and underrepresent certain body types. Traditional medical education often prepares learners to perform procedures, such as lumbar punctures (LPs), on a young white able-bodied 70kg male. When approaching diverse patients, this educational gap can lead to medical learners’ lack of confidence, skill, and knowledge, resulting in poor patient experiences. Methods: This co-design project involves patient and student input. We interviewed five patients who underwent LPs and explored their experience through a trauma-informed approach. To visualize landmarking across body types, we recruited nine volunteers of diverse body sizes, ages, tattoos, and skin colour (Fitzpatrick Scale). Incorporating patient narratives, as well as videos and photographs showing landmarking on diverse bodies, we crafted an online LP instructional module. Focus groups of 6-10 students will be held to collect student perception of the effectiveness of the module. Results: Our learning module and related media will be built into Western University’s Undergraduate Medical Education curriculum, available under a Creative Commons license through the Western Health Education Media Library. Conclusions: Integrating patient experience and student feedback, we are developing a comprehensive educational tool to better equip medical learners to deliver patient-centered LPs across diverse body types.
P.021 Nonclinical studies of abuse potential with dual orexin-receptor antagonists: concordance with real-world use
Authors: Moline M , Cheng JY , Henningfield JE , Sembower MA , Pype S , Buchhalter AR
Published: May 2024

Background: Traditional insomnia drugs enhance gamma-aminobutyric acid and are associated with abuse/dependence. Dual orexin-receptor antagonists (DORAs) represent an alternate mechanism promoting wakefulness, rather than inhibition. Nonclinical studies indicate DORAs do not demonstrate abuse potential. Nonetheless, based on human abuse potential (HAP) studies and lack of postmarketing data at approval, DORAs are Schedule 4 controlled substances. However, HAP studies may not predict real-world abuse-potential risk. Methods: Adverse events with preferred terms (PTs) of drug-withdrawal-syndrome, drug-abuse, and drug-dependence were evaluated from Eisai’s ongoing global postmarketing safety surveillance system in the US, Canada, and Japan (20/Dec/2019–30/Sep/2023) and the FDA Adverse Event Reporting System (FAERS; 01/Jan/2015–30/Jun/2023). In FAERS, reports of those PTs from DORAs (lemborexant/suvorexant/daridorexant) were compared with zolpidem and with benzodiazepines approved for patients with insomnia (estazolam/temazepam/triazolam). Results: Since lemborexant’s approval, few of the 3 PTs were reported in Eisai’s surveillance system (~0.15 cases per million patient-days of global exposure). Reports in FAERS for PTs of drug-withdrawal-syndrome, drug-abuse, and drug-dependence for DORAs (10,202 reports) were <0.1%/<0.1%/0.1%, respectively. Reports for benzodiazepines (5534 reports) were 0.8%/12.9%/3.7%, respectively, and 1.0%/9.1%/5.3% for zolpidem (18,330 reports), respectively. Conclusions: Abuse potential may be better represented by nonclinical studies and national surveillance systems, suggesting DORAs may not pose meaningful abuse potential and related risks.
P.022 Gender disparity in canadian institutes of health research funding within neurology
Authors: Tsai C , Tao B , Wang C , Vosoughi AR , Bui E , Chapman KM , Fox SH , Khosa F
Published: May 2024

Background: Despite efforts to advance equity, women face gender-based barriers in research, including fewer senior authorship and grant opportunities. We examined gender disparities in Canadian Institutes of Health Research (CIHR) funding for Canadian neurology divisions and departments. Methods: Data on CIHR grant recipients and metrics (duration, quantity, and contribution) within Canadian neurology divisions and departments (2008-2022) were acquired from the CIHR Funding Decisions Database. Gender-based differences in grant prevalence, duration, and contribution amount within neurology were calculated with subgroup analysis for Canadian neurologists and Project Grant awards. Results: 1604 grants were awarded to Canadian neurology divisions and departments between 2008-2022. Women received fewer grants (41.46%), less funding (p<0.0001), and shorter grant durations (p<0.0001) than men annually. Women comprised the minority of recipients (45.47%) and were less likely to be awarded grants (p<0.001) annually relative to men. Differences were consistent in subgroup analyses, except grant durations were equal across genders in Project Grant awards. Conclusions: Gender disparities persist in CIHR grant funding to Canadian neurology divisions and departments. Women receive fewer grants, lower contribution amounts, and are less likely to be recipients compared to men. Future work includes addressing gender differences and continuing to evaluate CIHR funding to provide equitable opportunities for women.
P.023 Review of imaging changes, cognitive decline, and dementia risk in cancer survivors after chemotherapy
Authors: Lee H , Au-Yeung P , Hennawy M , Harrison RA , Bates A , Hsiung G
Published: May 2024

Background: Cancer survival rates in Canada have been improving, leading to a steady increase in the number of survivors entering the typical ages of dementia onset. Yet, some cancer treatments (e.g. chemotherapy) are neurotoxic and adversely affect normal brain functioning. We conducted a review to examine changes observed in brain imaging and cognitive measures in survivorship, and long-term risk of dementia among cancer survivors. Methods: 91 Primary studies were selected from PubMed. Inclusion criteria were studies investigating the changes in brain imaging, cognition, and future dementia risk among adult survivors who received chemotherapy. Study quality was assessed based on 1) prospective, controlled design, 2) sample size, and 3) validated imaging and cognitive metrics. Results: Imaging studies identified MRI-based structural grey and white matter changes and functional network changes among survivors. Cognitive studies reported heterogeneous impairments in attention, memory, and executive function. In studies that examined dementia risk among cancer survivors, 67% reported lower risk of dementia, while 33% reported no association or a higher risk. Conclusions: While short-term cognitive impairment with associated changes on brain imaging is widely reported, findings concerning future or long-term cognitive impairment are mixed. Studies are warranted to identify potential connections between short-term and long-term cognitive function after cancer treatment.
P.033 Electrophysiological signatures of sedation in pediatric patients
Authors: Grinberg M , Han M , Jones K , Blain-Moraes S
Published: May 2024

Background: Sedation in PICU masks physical exam findings, leading to diagnostic challenges. In adult models, electroencephalography can evaluate the brain’s response to sedation using feedforward connectivity and anteriorization of alpha hubs, proving useful for prognostication. Feasibility of model translation into pediatric population was assessed, with the hypothesis that the same markers of adaptive reconfiguration would correlate with a higher potential for recovering consciousness. Methods: Electroencephalograms from children undergoing sedation were analyzed for strength and direction of functional connectivity using the weighted and directed phase lag index. Target population was refined with an iterative inclusion criteria. We examined relationships between hub location reconfiguration, directed phase lag index, baseline Glasgow Coma Scale, and 3-month post-treatment Glasgow Outcome Scale-Extended. Results: Evaluation of 14 subjects showed promise in children aged 5-18 undergoing sedation with midazolam, dexmedetomidine, and propofol. Further analysis of five subjects revealed a correlation between adaptive reconfiguration during anesthesia and both higher baseline Glasgow Coma Scale and Glasgow Outcome Scale-Extended scores post-treatment. Conclusions: The findings indicate that the functional brain network connectivity model may have diagnostic and prognostic potential regarding children’s consciousness levels. While the initial data is promising, further analysis of six additional cases is pending and deemed essential to thoroughly evaluate the model’s efficacy.
P.036 Vagal nerve stimulation in three cases of continuous spike and wave in slow-wave sleep
Authors: Bourcier D , Stewart W
Published: May 2024

Background: Continuous spike and waves during slow-wave sleep (CSWS) is a childhood-onset epileptic encephalopathy that is characterized by clinical seizures, electrical status epilepticus during sleep (ESES), and neurocognitive regression. Early intervention can preserve neurocognitive development, and vagus nerve stimulator (VNS) therapy had positive outcomes in the few previously reported case reports. We present three patients with intractable CSWS unresponsive to medications, who had a positive response to VNS therapy. Methods: Review of clinical records of three pediatric patients diagnosed with CSWS were compared for selected clinical outcomes and electrographic data both prior to and in the years following the initiation of VNS therapy. Results: Three patients now aged 13, 16 and 20 years, were treated with VNS following intolerance and a lack of response to multiple medications (5-9) for CSWS. The ketogenic diet was not an option. The CSWS resolved in all three patients, resulting in improved cognitive function. Patient 3 had resurgence of CSWS on EEG when the VNS settings inadvertently reset to the factory settings and improved with adjustment in the cycling. Conclusions: In patients who are unresponsive to medication, VNS provides an alternative option for resolving CSWS to preserve and, in some cases, potentially restore neurocognitive function.
P.039 Informing treatment advancement and innovation in a tertiary care neurocritical care (NCC)) program
Authors: Foster L , Martin D , Esser MJ , Woodward K
Published: May 2024

Background: Children with neurological injuries/insults carry the highest risk of death and disability in Pediatric and Neonatal ICUs. These patients comprise 25-30% of admissions and have a myriad of diagnoses. Longitudinal outcome data is required to inform treatment effects and innovation strategies. NCC at the Alberta Children’s Hospital (ACH) participates in acute, subacute, and long-term/outpatient management with an aim to use comprehensive clinical data to improve outcomes. Methods: A prospective, longitudinal, population-based observational cohort study of NCC patients from local NICUs, PICU, and a NCC follow-up program, with comprehensive data from clinical records, development scores and QoL assessments. Results: Since 2019, 929 patients have been enrolled including: 407 neonates, 167 infants, 106 preschool-age and 100 school-age children, and 152 adolescents. The most common reasons for NCC consult were paroxysmal events (36%), encephalopathy (27%) and neonatal HIE (20%). Conclusions: Our database encapsulates the diverse nature of NCC patients and has enabled cohort-specific studies (e.g., neonatal HIE and ECLS outcomes). Program evolution will further facilitate higher powered research studies through large enrollment, comprehensive data capture (with a provincial EHR), and longitudinal outcomes. Engagement with staff and families will also inform treatment and afford evidence-based counseling to families.
P.045 Trofinetide for the treatment of Rett syndrome: long-term safety and efficacy results from the open-label LILAC and LILAC-2 studies
Authors: Percy AK , Neul JL , Benke TA , Berry-Kravis EM , Glaze DG , Marsh ED , Lamontagne A , An D , Bishop KM , Youakim JM
Published: May 2024

Background: Trofinetide significantly improved core symptoms of Rett syndrome (RTT) with an acceptable safety profile in LAVENDER. Here, we report the safety and efficacy results of LILAC and LILAC-2, open-label extension studies of LAVENDER. Methods: Females with RTT, aged 5–21 years, received twice-daily, oral trofinetide in LILAC for 40 weeks. Participants who completed LAVENDER and LILAC continued trofinetide in LILAC-2, a 32-month extension study. Safety assessments included the incidence of adverse events (AEs). Efficacy endpoints included the Rett Syndrome Behaviour Questionnaire (RSBQ) and the Clinical Global Impression–Improvement (CGI-I) scale. Results: Overall, 154 patients were enrolled in LILAC. The most common AEs were diarrhea (74.7%) and vomiting (28.6%). The mean (standard error [SE]) change from the LAVENDER baseline to Week 40 in the LILAC study in RSBQ was -7.3 (1.62) and -7.0 (1.61) for participants treated with trofinetide and placebo in LAVENDER, respectively. Mean (SE) CGI-I scores compared with the LILAC baseline at Week 40 were 3.1 (0.11) and 3.2 (0.14) for patients treated with trofinetide and placebo in LAVENDER, respectively. Similar safety and efficacy trends were observed in LILAC-2. Conclusions: Trofinetide continued to improve symptoms of RTT in LILAC and LILAC-2 with a safety profile consistent with LAVENDER.
P.050 Spike source localizations between the three non-REM sleep stages: resemblances to wakefulness and distinctions from REM sleep
Authors: Hatamzadeh A , Hasen M , Ng M
Published: May 2024

Background: Sleep-wake states (SWS) affect the expression of interictal epileptiform discharges (“spikes”), which affects resultant source localization calculations used in epilepsy evaluation. We hypothesize that spike localizations from non-REM sleep 1-3 are most concordant with one another. Methods: We used Standardized low-resolution brain electromagnetic tomography (sLORETA) in Curry 8 software to calculate source localization voxels of spikes in N1-3, REM, or wakefulness (W). We assessed voxel concordance between N1-N2-N3/N1-N2-W/N1-N3-W/N2-N3-W/REM-N1-N2/REM-N1-N3/REM-N2-N3/REM-N1-W/REM-N2-W/REM-N3-W. We classified concordances into those containing and not containing a SWS (e.g. N1 vs. not-N1 = N1-N2-N3/N1-N2-W/N1-N3-W/REM-N1-N2/REM-N1-N3/REM-N1-W vs. REM-N2-W/REM-N3-W/REM-N2-N3/N2-N3-W) for comparison. Results: Concordances did not differ for N1-3 or W. However, concordances with REM were lower than those without REM as a fraction of source localization space (median 32.1% vs. 56.1%, p<0.001) and cortical grey matter (median 20.4% vs. 27.3%, p=0.003). Conclusions: As expected, source localizations from spikes in N1, N2, and N3 did not significantly differ from one another because these three states are constituent members of non-REM sleep. Surprisingly, however, source localizations derived from awake spikes – not a constituent of non-REM sleep – also did not differ. In contrast, REM was most different by reproducibly exhibiting the least three-way concordance. These findings reinforce the unique localizing ability of REM sleep.
P.059 Weill-Marchesani Syndrome – a rare etiology for bilateral carpal tunnel syndrome in children
Authors: Chiu H
Published: May 2024

Background: Carpal tunnel syndrome (CTS) is less common in children but can be associated with significant disability. Pediatric CTS can be associated with an underlying disorder most commonly storage disorders including mucopolysaccharidoses (MPS). We report a patient with bilateral severe CTS secondary to Weill-Marchesani Syndrome (WMS). Methods: A retrospective chart review was completed. Results: A five-year-old female presented with a three-year history of bilateral thumb weakness and insensate digits two and three. Nerve conduction studies (NCS) revealed severe bilateral CTS. She underwent bilateral carpal tunnel release (CTR). Unfortunately, post-operative NCS was unchanged. Ultrasound showed significant median nerve compression with flexor tendon thickening. Metabolic investigations showed no evidence of a storage disorder. Trio whole exome sequencing showed two de novo likely pathogenic variants in ADAMTS10: c.1174delC, p.H392TfsX9 and a deletion of exons 3-8. Her exam was also noted to show bilateral camptodactyly and brachydactyly, and bilateral cataracts characteristic of WMS. Conclusions: Identifying the etiology of CTS is important for management and prognosis. WMS is a genetic connective tissue disorder that can cause brachydactyly and abnormal tendon thickening, which can have implications on surgical outcomes. Awareness of this diagnosis prior to surgery would allow for better patient counseling and management decisions.
P.060 Provider and patient perspectives on outcome measure use in clinical care for chronic inflammatory neuropathy
Authors: Smith CB , Beadon K , Ogalo E , Ashe M , Mezei MM , Chapman KM
Published: May 2024

Background: The use of patient reported and functional outcome measures in routine practice enhances shared decision making and supports patient-centred care. This study compared the perspectives of Chronic Inflammatory Neuropathy (CIN) patients and providers regarding their experience using an outcome measure panel. Methods: A one year study was conducted to evaluate a nine measure outcome set in routine clinical practice for CIN. The panel included patient-reported outcome measures (e.g., I-RODS and EQ-5D-5L) and functional measures (e.g., grip strength). At the conclusion of the study, participants and providers completed an online questionnaire on their experience. Results: 25 patients and five providers completed the questionnaire. Both patients and providers reported benefit in tracking disease progression, supporting treatment-related decisions, and broadening views of health. Both groups agreed patient involvement in care was enhanced. Preference for specific measures, frequency, and data presentation differed. Providers emphasized integration into electronic medical records and streamlining processes. 100% of providers and 80% of patients wanted to continue completing outcome measures. Conclusions: CIN patients and providers recognize the value of integrating outcome measures into routine care. To effectively implement these measures in clinical settings, it is important to understand the patient and provider perspective and prevent unnecessary burdens to ensure sustainability of use.