bluuebunny/crossref_metadata_2025 huggingface dataset:
A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer
Authors: Ahern Tracey , Gardner Anne , Courtney Mary
Published: June 2015

Aim

To explore the role of the Australian breast care nurse in the provision of information and support to women with breast cancer, with a focus on the differences experienced depending on geographic work context.

Design

A cross‐sectional study.

Methods

This study conducted in 2013, involved surveying BCNs currently working in Australia, using a newly developed self‐report online survey.

Results

Fifty breast care nurses completed the survey, 40% from major cities, 42% from inner regional Australia and 18% from outer regional, remote and very remote Australia. Patterns of service indicated higher caseloads in urban areas, with fewer kilometres served. Breast care nurses in outer regional, remote and very remote areas were less likely to work in multi‐disciplinary teams and more likely to spend longer consulting with patients. Breast care nurses reported they undertook roles matching the competency standards related to the provision of education, information and support; however, there were barriers to fulfilling competencies including knowledge based limitations, time constraints and servicing large geographical areas.

Conclusions

This was the first Australian study to describe the role of the breast care nurse nationally and the first study to investigate breast care nurses perceived ability to meet a selection of the Australian Specialist Breast Nurse Competency Standards. Important differences were found according to the geographical location of breast care nurses.
Film Stress of Amorphous Hydrogenated Carbon on Biaxially Oriented Polyethylene Terephthalate
Authors: Bahre Hendrik , Behm Henrik , Grochla Dario , Böke Marc , Dahlmann Rainer , Hopmann Christian , Ludwig Alfred , Winter Jörg
Published: June 2015

Amorphous hydrogenated carbon (a‐C:H) deposited on steel with plasma enhanced chemical vapor deposition can be used as elongation tolerant oxygen barrier. However, the elongation tolerance of the a‐C:H film is lost if deposited on a poly(ethylene terephthalate) (PET) for reasons unknown. To assess this phenomenon, a‐C:H was deposited on PET, silicon substrates, and silicon micro‐cantilevers, and the stress was determined by measuring the radius of curvature. a‐C:H deposited on PET showed lower compressive stress than on silicon. This difference is not due to the formation of a gradient layer or plastic deformation of PET. Instead, the most probable explanation is that energetic ions cause a partial release of biaxial orientation within the PET, thereby reducing the compressive stress.
An Overview on Time‐Resolved Optical Analysis of HiPIMS Discharge
Authors: Britun Nikolay , Konstantinidis Stephanos , Snyders Rony
Published: June 2015

The progress in the time‐resolved characterization of HiPIMS discharges performed during the last decade in our group is overviewed. Optical emission and absorption spectroscopy, as well as laser‐induced fluorescence‐based techniques have been mainly utilized. The results covering such important aspects of the HiPIMS discharge as the density evolution of the discharge species, their ionization and excitation, propagation of secondary electrons in the discharge volume, dynamics of velocity distribution of the discharge species, gas rarefaction, etc. are discussed.
Host selection in insects: reproductive interference shapes behavior of ovipositing females
Authors: Noriyuki Suzuki
Published: June 2015

In nature, closely related species often utilize different host species, but it is still unclear what factors contribute to the evolution and maintenance of such diversified host selection. In this review, I describe how negative interspecific mating interactions (reproductive interference) can shape host selection by animals, focusing mainly on phytophagous and predatory insects. First, I explain an important premise of this hypothesis, which is that the adult reproductive site is the same as the feeding site for the offspring. Next, I describe several mathematical models and well‐studied empirical systems to show that reproductive interference can sufficiently drive and maintain different host selection between phylogenetically related species. Then, I argue for the first time that reproductive interference can cause an oviposition preference in insects that is not optimal for the survival and development of the offspring, as a result of maternal adaptive behavior that maximizes the mother's own fitness. Furthermore, I argue that in insects, reproductive interference probably shapes oviposition behavior before the female alights on the host (e.g., habitat preference), without affecting post‐alighting decision making. I would like to emphasize that these two arguments represent the novel approach to clarify the unrevealed pattern of complex insect oviposition behavior.
The Rise of the Populist Radical Right in Western Europe
Authors: Rooduijn Matthijs
Published: June 2015

Populist radical right (PRR) parties are on the rise in Western Europe. Where do the electoral successes of these parties come from? First, it has been shown that the opening of borders has fuelled the divide between the ‘losers’ and ‘winners’ of globalisation. The ‘losers’ are individuals who feel threatened by international competition. They vote for PRR parties because they agree with their nativist, populist and Eurosceptic positions. Second, various social and political developments have facilitated the success of these parties. Some examples of these developments are increased electoral volatility, the ideological convergence of the mainstream parties, and increasing immigration and unemployment. Third, PRR parties themselves are, to a large extent, responsible for their own successes. Without their increasingly moderated messages and profiles, their often appealing external and internal leaders, and their well-institutionalised party organisations, their (long-term) successes would not have been possible. Most probably, the PRR party family will remain with us for a while.
Use of neuropathic pain questionnaires in predicting the development of failed back surgery syndrome following lumbar discectomy for radiculopathy
Authors: Shamji MF , Shcharinsky A
Published: June 2015

Objective: Failed back surgery syndrome (FBSS) describes neuropathic pain that occurs when extremity symptoms in lumbar disease persist despite structurally corrective spinal surgery. It is unclear whether specific preoperative pain characteristics predict patients prone to such postoperative disabling symptoms. Methods: This prospective study analyzed surgical patients with painful radiculopathy secondary to lumbar degenerative disease. Clinical parameters included general demographic information, preoperative and postoperative clinical examination, self-reported pain and disability scores, and neuropathic pain scoring. The neuropathic pain screening tests used in this study were the Douleur Neuropathique 4 (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), with correlation tested for ordinal score and screen positivity. Multiple logistic regression analysis defined predictors of postoperative symptomatology. Results: Among 250 surgical radiculopathy patients, 12% were classified with FBSS. The condition was highly associated with abnormal preoperative screens for neuropathic pain, but not gender, smoking status, or preoperative pain severity (multiple logistic regression, α=0.05). Good correlation was seen between the two screening tests used in this study for absolute ordinal score (Spearman’s ρ=0.84, p<0.001) and thresholding for neuropathic pain features (Spearman’s ρ=0.48, p<0.001). Conclusion: Higher neuropathic pain screening scores correlated with likelihood of postoperative leg pain. Further work will develop more accurate prognostication tools for radiculopathy patients undergoing structural spinal surgery.
Utilizing NeuroTouch, a virtual reality simulator, to assess and monitor bimanual performance during brain tumor resection
Authors: Alotaibi FE , Del Maestro R , AlZhrani G , Mullah MA , Sabbagh A , Azarnoush H , Winkler-Schwartz A
Published: June 2015

Background: NeuroTouch simulator provides the potential to determine performance metrics, but validation and easily utilized software are essential before implementation of this platform into neurosurgical training. Objectives: Evaluate and validate neurosurgical performance metrics for simulated brain tumors resection. Develop software and a global web based system to allow utilization of these metrics. Methods: The bimanual resection of 8 simulated brain tumors with differing complexity was evaluated. Software was developed to automatically generate all the metrics from NeuroTouch data output including: blood loss, tumor percentage resected, total brain volume removed, maximum and sum of forces utilized, efficiency index, ultrasonic aspirator path length index (UAPLI), coordination index and ultrasonic aspirator bimanual forces ratio (UABFR). Six neurosurgeons and 12 residents were evaluated. Results: Resident performance was significantly more impaired than neurosurgeon by increasing tumor complexity. Significant differences were found between neurosurgeons, senior, and junior residents on efficiency index and UAPLI. UABFR outlined significant differences between senior and junior residents. Coordination index demonstrated significant differences between junior residents and neurosurgeons. Conclusions: Utilizing metrics employed the NeuroTouch platform differentiated novice from expert performance. Software was developed for metrics and will be made available online for all NeuroTouch users allowing global comparison of neurosurgical performance.
Disparity of volumetric and linear measurements of meningioma response to gammaknife radiosurgery
Authors: Mansouri A , Larjani S , Klironomos G , Cusimano MD , Schwartz M , Zadeh G
Published: June 2015

Objective: To identify clinical, radiological, and dosimetric predictors of meningioma response to stereotactic radiosurgery (SRS), and post-SRS adverse radiation events (ARE). Methodology: A retrospective review was conducted. Seventy-five patients had at least 24 months of clinical and radiological follow-up. Tumor control was defined as any volumetric/diametric change less than +10%. Volumetric measurements were made using T1-Gadolinium enhanced 3T MRI scans with ITK-SNAP2.2 software. Univariate statistics were used to identify predictors of post SRS AREs. Results: Females comprised 69.3% of patients, mean treatment age was 58.6 years, and median follow up was 36.2 months. Twenty-one patients had undergone prior surgical resection. Volumetric tumor control (52%) was inferior to diametric control (92%). Twenty-six patients (34.6%) experienced some form of new-onset complication after SRS: Headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremor (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new onset T2 signal change signifying of edema; eight of these patients were symptomatic. Lower Conformity index (1.24 vs. 1.4), and higher treatment-volume ratio (TVR) (0.80 vs. 0.72) were significantly associated with development of edema after SRS (p<0.05, power > 0.8). Conclusion: Volume-based reporting of SRS outcomes for meningiomas is more accurate for reporting tumor control. Conformity index and TVR were identified as predictors of edema following radiosurgery.
Child Neurology (Epilepsy and EEG)
Authors: Desmeules M , Cieuta-Walti C , Sébire G , Farmer M , Nadeau A , Legault G , Riou EM
Published: June 2015

Background: Febrile infection-related epilepsy syndrome (FIRES) is a devastating entity characterized by acute onset of refractory epileptic status preceded by a febrile infection, for which no aetiology has been identified so far. Methods: We report the cases of two males presenting with typical FIRES, for whom extensive investigations revealed no specific aetiology. Failure of controlling seizures with multiple anticonvulsants as well as barbiturate coma lead to the decision to try immunotherapy. The first patient received plasma exchange after a negative trial of IVIGs, while the second received plasma exchange in the beginning. Results: Significant improvement in the seizure frequency and intensity was obtained following plasma exchange, and weaning of barbiturate coma was successful in the days following treatment. Both patients remain with significant temporal lobe epilepsy, requiring treatment with 3 anti epileptics. However, cognitive outcome is surprisingly good for both, both exhibiting normal IQs and normal everyday function, with the second patient showing even better recovery, possibly due to earlier treatment with plasma exchange. Conclusion: Our findings of favourable outcome with plasma exchange favours the auto-immune hypothesis often discussed in FIRES. While awaiting further insight onto the aetiology of this syndrome, we suggest a trial of plasma exchange in patients affected.
Multidisciplinary
Authors: Zeiler FA , Sader N , Gillman LM , Teitelbaum J , West M , Kazina CJ
Published: June 2015

Introduction: Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, carries potential benefit in patients with neurological illness. The cerebrovascular/cerebral blood flow (CBF) response to ketamine has been poorly outlined in the literature. Methods: We performed a systematic review of the literature on the cerebrovascular/CBF effects of ketamine in both animal and human subjects. Results: We identified 38 animal studies, and 20 human studies. Within the animal studies, a variety of different models were utilized with the majority focusing changes in global CBF or regional cerebral blood flow (rCBF). Overall, ketamine led to an increase in either global CBF or rCBF, with a vasodilatory effect in medium cerebral vessels. With the human studies a total of 379 patients, 107 of which were control subjects, were studied. Most studies focused on either 131Xe CT or PET imaging with ketamine administration. There was a trend to an increase in global CBF and rCBF with ketamine administration. Conclusions: Animal models indicate an increase in global CBF and rCBF with ketamine administration. Human studies display an Oxford 2b, GRADE C, level of evidence to support an increase in global CBF and rCBF with ketamine administration in both healthy volunteers and elective surgical patients without neurological illness.
Postconcussion syndrome: demography and predictors in 221 patients
Authors: Tator CH , Davis HS , Tartaglia MC , Davis K , Ebraheem A , Hiploylee C
Published: June 2015

Background: Most individuals recover from a concussion within 7-10 days. However recovery may be very prolonged. Individuals who do not recover within the usual time are said to have postconcussion syndrome (PCS). The objective of this study was to examine the demography and predictors of PCS. Methods: This was a retrospective cohort study of 284 consecutive concussed patients 221 of whom had PCS on the basis of at least three symptoms persisting at least 1 month. A uniform, internationally accepted definition of concussion was used. Results: The 221 cases showed considerable heterogeneity in clinical features of PCS. They averaged 3.3 concussions with a range of 0 to 12+ concussions, and 62.4% occurred during sports and recreation. The median duration of PCS was 7 months at the time of examination, with 11.8% lasting more than 2 years. Surprisingly, 23.1% with PCS had only 1 concussion. The average age was 27 years (range 10-74). The average number of persistent symptoms was 8.1. 26.2% had a previous psychiatric condition, ADD/ADHD, a learning disability, or previous migraine headaches. The prevalence of arachnoid cysts and Chiari malformation in PCS exceeded the general population. Conclusions: In most of our cases, PCS was disabling, and lasted for months or years.
Real-time tracking of functional performance using accelerometers on the acute-stroke unit: proof-of-concept study
Authors: Jacobson AC , Bakashi Nategh B , Fellows LK , Mayo N
Published: June 2015

Background: Acute stroke care pathways are increasingly implemented to improve integration of best-practices, but evidence for impact on functional outcomes is not strong. Elements missing from care-pathways are those directly targeting improvement in function: sit-to-stand and time spent walking. The Stroke Team uses care-pathways to track functional capacity, what the patient can and cannot do, but performance on these key outcomes is difficult to track as the patient is observed by multiple people throughout the day. The purpose of this study is to demonstrate the feasibility and added-value of real-time tracking of patients’ mobility. Methods: A chart review was carried out to identify the extent to which functional capacity and performance is tracked routinely by the Stroke Team. Ethical approval was gained for routine use of accelerometers to be affixed to the unaffected thigh. Results: Swallowing, bladder control, toileting, and feeding were consistently tracked for ~90% of patients. Bed-mobility and capacity to transfer rarely tracked (<12%). Capacity for walking and sit-to-stand was noted but never frequency (performance). Conclusion: Our proof-of concept study will test 30 patients over the next 2 months and link real time performance on transitions and walking to stroke severity and outcome.
Neurology (Multiple Sclerosis)
Authors: Jacques FH , Harel B , Schembri A , Paquette C , Bilodeau B , Kalinowski P
Published: June 2015

Objectives: The objectives of this study are to understand the impact of natalizumab on cognition beyond two years of therapy and to investigate whether baseline characteristics are predictive of clinical response. Methods: This is a single-center, 24-month, observational study. Sixty-three patients treated with natalizumab were assessed prior to monthly infusions using a Cogstate battery and the SDMT. A linear mixed model was conducted with duration of natalizumab therapy as a between-subjects factor (<=2 or >2 years), assessment as a within-subjects factor, and MSSS as a covariate. Results: There were no statistically significant differences between the key demographic variables aside for the MSSS (p=.0074). No patient showed evidence of sustained cognitive deterioration over the 24 month period. Irrespective of time on natalizumab, significant improvements were observed at the group level in executive function, verbal memory and working memory, whereas processing speed and attention remained unchanged. Impaired cognition or any other baseline parameter did not influence the trajectory of cognitive change over 24 months. Conclusion: Our results suggest that natalizumab preserves cognitive function, including the ability to learn, for 4 years and beyond of continuous therapy. This occurs irrespective of baseline characteristics.
NMDA-receptor encephalitis: An unsual case of refractory status epilepticus
Authors: Lapointe S , Legault C , Giacomini P , La Piana R , Teitelbaum J , Tampieri D , Romano A
Published: June 2015

Objective: Case report of NMDA receptor encephalitis in a young man with early refractory status epilepticus and atypical radiological findings. Background: Anti-NMDA receptor encephalitis is an autoimmune disorder due to antibodies to the NR1-NR2B heterodimer of NMDA receptor. On imaging, it typically presents with T2 hyperintensities in mesio-temporal lobes, cerebral cortex and basal ganglia. We present a case with a dramatic clinical evolution and novel imaging findings. Design/Methods: Case report and review of imaging. Results: 29-year-old male presented with mood disturbance followed by partial-complex seizures, facial dyskinesia and choreo-athetotic movements. Initial MRI showed subtle T2-hyperintensities in mesio-temporal lobes. Diagnosis of NMDA-receptor encephalitis was confirmed after CSF antibody detection. Prior to diagnostic confirmation, he developed refractory status epilepticus, and concomitant signs of herniation. A repeated MRI showed increased T2-hyperintensities of thalami and mesencephalon, with cerebellar involvement and transtentorial/foraminal herniation. Restricted diffusion was documented in the cerebellar cortex/thalami/putamina and caudate. IV corticosteroids and hypertonic fluid reversed herniation, and halted the seizures. Conclusions: To our knoweldge, we report the first case report of uncal and tonsillar herniation in NMDA-r encephalitis secondary to atypical, predominant cerebellar involvement. This case highlights life-threatening manifestation that physicians might encounter, and a possible role for high dose IV corticosteroids as an adjunct treatment for brain edema and seizures.
Acute combined central and peripheral demyelination: a case report
Authors: Voll AR , Cooley R , Hunter G , Voll CL
Published: June 2015

Aim/Background: We report a case of Acute Combined Central and Peripheral Demyelination (ACCPD). This rare disease presents with features of both peripheral and central demyelination. Methods: Case Report Results: A 24 year-old Iraqi female presented with acute onset of ascending paralysis, numbness and areflexia over the course of a few days. Systemic examination was negative. She responded to IVIG. She suffered two severe relapses over the next three months, which resolved rapidly with PLEX/corticosteroid. CSF was normal after first and second relapses. Brain and cord MRI revealed multiple T2/FLAIR hyperintensities consistent with multiple sclerosis. There were no longitudinally extensive cord lesions. Aquaporin 4 antibody assay is pending. ANA was strongly positive; anti-DSDNA and SS antibodies were negative; complement4 was low and serum cyroglobulins were positive. Hepatitis C was negative. Ganglioside antibody assay was negative. Anti-neurofascin is pending. Neurophysiology confirmed features of an acquired demyelinating neuropathy with profound secondary axonal denervation. Conclusions: The underlying etiology of ACCPD is presumed autoimmune likely secondary to auto-antibody targeting of central and peripheral myelin epitopes. Low complement component 4 and cryoglobulinemia in this patient supports an autoimmune pathogenesis. Neurofascin has been previously reported as one such auto-antibody in ACCPD.
Noninvasive assessment of ischemic penumbra by using MR-SWI during the acute phase of cerebral infarction: a comparison to PWI
Authors: Luo S , Wu X , Deng F , Zhang Y , Miao J , Chen Y , Wang L , Feng J , Zhang H
Published: June 2015

Background: Assessment of ischemic penumbra during the acute stage of cerebral infarction is crucial for a decision to initiate thrombolytic therapy and for predicting stroke evolution. Although controversial as a perfect equivalence to penumbra, perfusion weighted imaging (PWI)-diffusion weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance on contrast agents in PWI, noninvasive alternatives remain an unmet need. Methods: We herein investigate the potentials of SWI as an alternative to PWI in defining ischemic penumbra and in predicting stroke outcome. A multimodal magnetic resonance imaging work-up which includes conventional magnetic resonance imaging sequences (T1WI, T2WI and FLAIR), DWI, PWI and SWI was performed. The Alberta Stroke Programme Early CT Score (ASPECTS) was used to evaluate the changes in DWI, SWI and PWI. Results: The mismatch of SWI-DWI was comparable with that of PWI-DWI (p>0.05). Furthermore, the grade of prominent vein and the cerebral blood volume in the ipsilateral brain tissue were positively correlated. Conclusions: SWI can be used as a noninvasive alternative to identify occlusive arteries and to evaluate the ischemic penumbra. The susceptibility vein sign may represent thrombosis in arteries whereby being helpful to identify responsible blood vessels in ischemic stroke.
Factors associated with recurrence after endoscopic transphenoidal surgery for Cushing’s disease
Authors: Meng Y , Suppiah S , Gonen L , Klironomos G , Gentili F , Zadeh G
Published: June 2015

Introduction: Surgical removal is the standard treatment for Cushing’s disease. Although endoscopic transsphenoidal surgical (ETS) approach has grown in popularity, its efficacy has not yet been established. Furthermore, achieving long-term remission remains challenging. Methods: We conducted a retrospective chart review of 39 consecutive patients who underwent ETS for Cushing’s disease at our institution between 2005 and 2014. Univariate analysis using Pearson’s χ2 test was carried out on variables of patient demographics, radiology, pathology, biochemical markers versus recurrence. Results: The mean age was 40, with 82% females. Average length of follow-up was 44.8 months. Based on serum cortisol level, 28 patients (71%) achieved mid to long-term remission after ETS. Of them, 25 experienced an immediate remission, and 3 achieved a delayed remission as long as 4 months postoperatively. MRI findings of (1) microadenomas or no detectable abnormality, (2) adjacency to the cavernous sinus wall were associated with significantly higher recurrence rate (p<0.05). Histologically, MIB-1 >5% was not a significant variable (p=0.55). Conclusion: We found ETS resection to be an effective and safe procedure for majority of the ACTH-secreting adenomas, with remission rates >70%. Additionally, patients with microadenomas, negative preoperative MR, and cavernous sinus adjacency were less likely to achieve remission.
Tele-assistance during neurosurgical education: Remote Education, Augmented Communication, Training and Supervision (REACTS)
Authors: Weil AG , Obaid S , Magro E , Effendi K , Sunna T , Chaalala C , Shedid D , Bojanowski MW
Published: June 2015

Introduction: Tele-medicine has gained in popularity worldwide, particularly to help offer medical expertise, healthcare delivery and education to developing nations. There is little literature reporting the implementation or analysis of tele-assitance in the setting of surgical education. We have implemented a tele-assistance system, called Remote Education, Augmented Communication, Training and Supervision (REACTS), as a tool to augment mentor-student education in the operating room. This system allows the mentor to observe the student during surgery remotely through screen sharing technology with integrated visual and audio interaction. The goal of this study is to assess the safety and the benefit of REACTS as an educational tool. Methods: Prospective observational study to evaluate the safety and qualitative benefit of REACTS. Results: REACTS was used in 20 cases, including 5 placement of EVDs, 5 pterional craniotomies, 5 Sylvian fissures dissection, 5 lumbar discectomies, and 5 lumbar spine decompressions. No untoward or adverse events were observed. It was judged to be a positive influence on resident and fellow education by the mentors. The main pitfall in its use is to appropriately select the learner for a given procedure. Conclusion: REACTS surgical system is a safe, and a useful adjunct tool for neurosurgical operative education.
Carotid artery occlusion secondary to retropharyngeal abscess treated with endovascular carotid sacrifice
Authors: Ahmed S , Peeling L , Kelly ME
Published: June 2015

Introduction: Carotid occlusion is a rare but serious complication of retropharyngeal abscess (RPA). Management questions that must be addressed include the choice between reconstruction and occlusion in the setting of an active infectious process. Case Report: A 4 year old female presented with hoarseness, shortness of breath, and a right-sided Horner’s syndrome. A CT scan confirmed the diagnosis of RPA, and contrast studies showed no filling in the right internal carotid artery (ICA). Surgical exploration of the abscess disrupted the occluded artery, causing deep, uncontrolled bleeding. Emergent angiographic evaluation was completed, and the decision was made to sacrifice the ICA. The patient recovered on antibiotics, but the Horner’s syndrome persisted. Discussion: The presence of a carotid artery occlusion must be ruled out in the setting of a RPA. When suspected, it should be investigated further. Therapeutic decisions regarding sacrifice or reconstruction of the carotid artery are burdened by risks associated with the setting of an infection, notably infection and systemic dissemination. Conclusion: The presence of a carotid occlusion is a serious complication resulting from a RPA that can lead to permanent neurological deficit. Endovascular vessel sacrifice is a viable treatment option for carotid occlusion in the setting of a retropharyngeal abscess, but must be considered on a case-by-case basis.
Hemangiopericytoma from meningioma - is diffusion weighted imaging useful in their differentiation?
Authors: Shankar JJ , Hodgson L , Sinha N
Published: June 2015

Purpose: Hemangiopericytoma and Meningioma appear similar on routine diagnostic imaging. Diffusion weighted images (DWI) has been used to characterize different types of tumors. The purpose of this study was to assess whether DWI can be used to differentiate hemangiopericytoma from meningioma on diagnostic imaging. Materials and Methods: In a retrospective study, our tumor database was analyzed for diagnosis of hemangiopericytoma with DWI available at the time of diagnostic imaging. These patients were then matched based on location and size of the tumor in a ratio of 1 hemangiopericytoma vs. 2 matched meningioma. The minimum and mean Apparent Diffusion Coefficient (ADC) was measured in the tumor and the contralateral Normal Appearing White Matter (NAWM) to calculate a normalized ADC (nADC) as the ratio of the two. The two tumors were also subjectively assessed for their heterogeneity. Results: Seven patients with histopathological diagnosis of hemangiopericytoma were matched based on size and location with 14 patients of meningioma. Primary meningioma were significantly homogeneous (p<0.001) in appearance compared to hemangiopericytomas. Hemangiopericytomas had a higher mean ADC compared to that of meningioma (p<0.001). Conclusion: Hemangiopericytoma showed heterogeneity on DWI and significantly higher ADC compared to that of meningiomas in our small study. This needs to be confirmed in a study with a larger sample size.
Serum lactate as a potential biomarker of meningioma malignancy and preoperative treatment effect
Authors: Meng Y , Bharadwaj S , Ebinu J , Venkatraghavan L , Zadeh G
Published: June 2015

Introduction: Serum lactate levels are useful indicators of illness severity such as sepsis. Previous investigations have shown that lactate is a potential biomarker for glioma malignancy; mechanism of which may be related to Warburg effect - accelerated lactate production when tumors uniquely undergo aerobic glycolysis. Our study reveals a correlation between serum lactate and meningioma WHO grade. We also observed a relationship between radiation effect on metastatic brain tumors and lactate levels. Methods: Data was collected from the charts of 14 patients with grade I meningiomas, 6 grade II meningiomas, and 9 metastatic brain tumors who underwent resection at our institution from 2013-2014. T test and ANCOVA were carried using R software controlling for base deficit. Results: The mean age was 53 years, with 75% females. There was a statistically significant change in intra- and post-operative lactate during meningioma resections, which had a strong positive correlation with grade (p<0.005). Interestingly, the lactate rise was not significant for metastatic brain tumors (p=0.13), but had a positive correlation with tumors that received pre-operative radiation (p<0.05). Conclusion: Lactate is a potential non-invasive biomarker for brain tumor malignancy, as demonstrated in gliomas and meningiomas. Identifying metabolic biomarkers and their relationship to tumor pathology is important to understanding disease processes and improving patient care.
Health-related quality of life in children with Duchenne muscular dystrophy: a follow-up study
Authors: Wei Y , Speechley K , Campbell C
Published: June 2015

Background: Improvement of health-related quality of life (HRQOL) is a major goal in chronic disease management and HRQOL has become an important outcome in clinical trials. Longitudinal data on HRQOL are needed to elucidate change over time and to assess effectiveness of interventions; such research is lacking in the paediatric Duchenne Muscular Dystrophy (DMD) population. Methods: We followed up participants from our initial HRQOL study in 2013 a year and a half later. Multidimensional generic and disease-specific measures from the Pediatric Quality of Life Inventory were used to assess HRQOL from child and parent perspectives. Mean changes in HRQOL were calculated. Results: Data collection is ongoing and currently, data from 16 families (out of the initial 98) are available. Preliminary results indicated that by both child and parent reports, there were declines in all domains of HRQOL except for social function, in which there was a slight improvement. Mean decline in HRQOL scores ranged from 1.6 to 8.6 for child reports; and 3.3 to 7.7 for parent reports. Conclusion: HRQOL of boys with DMD deteriorates over time. Our results may be helpful in interpreting patient reported outcomes in forthcoming clinical trials and determining minimally clinically important changes in this population.
Brain stimulation and constraint for hemiparesis after perinatal stroke: The PLASTIC CHAMPS trial
Authors: Kirton A , Andersen J , Herrero M , Carsolio L , Nettel-Aguirre A , Mineyko A , Hill M
Published: June 2015

Background: Perinatal stroke causes hemiparetic cerebral palsy. Constraint therapy (CIMT) improves function in congenital hemiparesis and adult stroke. Repetitive transcranial magnetic stimulation (rTMS) may improve function in adult stroke. The two have not been tested in perinatal stroke. Methods: PLASTIC CHAMPS (www.clinicaltrials.gov/NCT01189058) was a controlled factorial trial of rTMS and CIMT in perinatal-stroke hemiparesis. Children 6-18 years participated in a 2 week peer-supported motor learning camp, randomized to daily inhibitory rTMS (1200 stimulations, contralesional M1), CIMT, both or neither. Primary outcomes were Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) at 1, 8, and 24 weeks. Quality-of-life, safety and tolerability were evaluated. Change was assessed across treatment groups over time (linear mixed effects model). Results: All forty-five subjects completed the trial (median 11.4yrs). COPM scores increased >100% with maximal gains at 6 months (p<0.002). Addition of rTMS and/or CIMT doubled the chances of clinically significant gains. Combined rTMS+CIMT resulted in larger AHA gains at all time points (6 months p=0.006). CIMT or rTMS alone had more modest effects. Neither treatment decreased function in either hand. Procedures were well tolerated. Conclusions: Children with hemiparesis participating in intensive, psychosocial rehabilitation programs perceive marked increases in function. Non-invasive brain stimulation may enhance motor learning therapy in perinatal stroke hemiparesis.
CNS Francis McNaughton Memorial Prize
Authors: Furlan JC , Fang J , Silver FL
Published: June 2015

Background: This study examines whether abnormal blood hemoglobin concentration (bHB) is associated with worse clinical outcomes and poorer prognosis after acute ischemic stroke. Methods: We included data from the Registry of the Canadian Stroke Network on consecutive patients with ischemic stroke who were admitted between July/2003 and March/2008. Patients were divided into groups as follows: low bHB, normal bHB, and high bHB. Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurological Scale: <8), greater degree of disability at discharge (modified Rankin score: 3-6), and 30-day and 90-day mortality. Results: Higher bHB than the superior normal limit is associated with greater degree of impairment (OR=1.45, 95%CI: 1.06-1.95, p=0.0195) and disability (OR=1.49, 95%CI: 1.03-2.15, p=0.0331), and higher 30-day mortality (HR=1.98, 95%CI: 1.44-2.74, p<0.0001) after adjustment for major potential confounders. The Kaplan-Meier curves indicate that abnormal bHB is associated with higher mortality after acute ischemic stroke (p<0.0001). Lower bHB than the inferior normal limit is associated with longer stay in the acute stroke care center (OR=1.11, 95%CI: 1.02-1.22, p=0.017). Conclusions: Polycythemia on the initial admission is associated with poorer prognosis regarding the degree of impairment and disability, and 30-day mortality after an acute ischemic stroke. Anemia on admission is associated with longer stay in the acute stroke center.
Equestrian-related brain injuries presenting to emergency departments, Canada, 1990-2014
Authors: Shirazi M , Cusimano MD , Berger I , Lee A , McFaull S
Published: June 2015

Background: Horse riding is a hazardous activity with the potential for serious injury. Equestrian-related injuries account for a higher rate of injury per number of riding hours than motorcyclists and automobile racers. There is a lack of literature pertaining to equestrian-related brain injuries. The objectives of this study were to describe the incidence, characteristics, and mechanisms of equestrian-related brain injuries sustained amongst Canadians between 1990 and 2014. Methods: Data were obtained from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The study population consisted of individuals who sustained equestrian-related brain injuries between the years 1990 and 2014 and presented to one of 15 participating emergency departments. Results: Brain injuries accounted for 13.3% (N=1060) of all equestrian-related injuries. The greatest proportion of injuries occurred amongst individuals aged 15-19 years, followed by individuals aged 0-4 years. The predominant mechanism of injury was falls. 17.9% of individuals were admitted to hospital. Normalized rates of injury increased from 1990 to 2010. Conclusions: Brain injuries sustained while participating in equestrian are often of a greater severity than injuries sustained while participating in other recreational activities. A clear understanding of the epidemiology and mechanisms of equestrian-related brain injuries must be achieved in order to effectively implement prevention efforts.
2015 update on triple therapy for pyridoxine-dependent epilepsy
Authors: Jaggumantri S , Coughlin C , Stockler S , Barb C , Mary C , van Hove J , van Karnebeek C
Published: June 2015

Background & Objectives: Of patients with pyridoxine-dependent epilepsy (PDE) due to ATQ deficiency, 75% suffer intellectual disability despite adequate seizure control with high dose pyridoxine. We aimed to assess the safety and efficacy of two novel therapeutic strategies to reduce accumulation of toxic intermediates in this cerebral lysine degradation defect. Methods: In two open-label observational studies, seven children with confirmed ATQ deficiency were started on dietary lysine restriction with regular nutritional monitoring, and outcome evaluation pipecolic acid, AASA levels in body fluids; development/cognition via age-appropriate tests and parental observations; epilepsy). Subsequently additional arginine supplementation was initiated to reduce cerebral lysine flux (cation transporter competitive inhibition).. Results: Lysine-restriction was well tolerated and diet is safe, resulted in reduction of lysine intermediates in all body fluids in all patients (up to 80% reduction AASA in cerebrospinal fluid), with beneficial effects on seizure control and psychomotor development. Additional arginine fortification resulted in normalization of biomarkers and dramatic improvement of psychomotor development. Discussion: Triple therapy is effective, especially if implemented early; studies for PDE newborn screening have been initiated. For dissemination and evidence generation, our PDE Consortium published Recommendations, developed a Digital Diet App and established a RedCap study database (www.pdeonline.org).
Diffusion imaging of cerebral diaschisis in neonatal arterial ischemic stroke
Authors: Srivastava R , Rajapakse T , Roe J , Wei X , Kirton A
Published: June 2015

Background: Neonatal arterial ischemic stroke (NAIS) is a leading cause of brain injury and cerebral palsy. Diffusion-weighted imaging (DWI) has revolutionized NAIS diagnosis and outcome prognostication. Diaschisis refers to changes in brain areas functionally connected but structurally remote from primary injury. We hypothesized that acute DWI can demonstrate cerebral diaschisis and evaluated associations with outcome. Methods: Subjects were identified from a prospective, population-based research cohort (Calgary Pediatric Stroke Program). Inclusion criteria were unilateral middle cerebral artery NAIS, DWI MRI within 10 days of birth, and >12-month follow-up (Pediatric Stroke Outcome Measure, PSOM). Diaschisis was quantified using a validated software method. Diaschisis-scores were corrected for infarct size and compared to outcomes (Mann-Whitney). Results: From 20 eligible NAIS, 2 were excluded for image quality. Of 18 remaining, 16 (89%) demonstrated diaschisis. Thalamus (88%) was most often involved. Age at imaging was not associated with diaschisis. Long-term outcomes available on 13 (81%) demonstrated no association between diaschisis score and PSOM categories. Conclusion: Cerebral diaschisis occurs in NAIS and can be quantified with DWI. Occurrence is common and should not be mistaken for additional infarction. Determining additional clinical significance will depend on larger samples with long-term outcomes.
What is the weight of medications changes along treatment with vagal nerve stimulation?
Authors: Tellez-Zenteno JF , Hernandez-Ronquillo L , Arcand J , Vitali A , Watherhouse K
Published: June 2015

Vagus Nerve Stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug resistant epilepsy (DRE), although modification of AEDs during VNS treatment could explain improvement in patients. We retrospectively assessed the efficacy of VNS in 30 adult epileptic patients treated with > 6 months follow-up. The criteria for implantation were the following: a) not candidate for resective epilepsy surgery, b) DRE, c) impairment of quality of life, d) no other option of treatment. We assessed socio-demographics, seizure etiology, seizure classification and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50 seizure improvement from baseline, Thirty patients (females-18, males-12; age 35.1+13.3) were included. After 6 months, 12 months, 24 months and 36 months, the response rate was as follows: 13/30(43%), 13/27 (48%), 9/22(41%) and 16/8 (50%), none of them were seizure free. Changes of AEDs were done in 57% of patients at 6 months, 43% at 12, 43% at 24, 43% at 24 months. Other outcomes will be discussed. Our study shows that VNS is an effective therapy although significant changes in medications were done along the therapy, therefore the real effect of VNS could be controversial
Brain death rates in severe blunt traumatic brain injury: comparison of decompressive craniectomy to a medically managed cohort
Authors: Zeiler FA , Teitelbaum J
Published: June 2015

Introduction: Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) is controversial. The impact DC on cause of death is unclear in the literature to date. Methods: We performed an institutional retrospective review, from June 2003 to June 2013, of patients with severe blunt TBI undergoing DC whom subsequently died. We compared this group to a retrospectively matched cohort based: age, pre-hospital mRS, Marshall diffuse and TBI grades, Injury Severity Scores, and admission laboratory values. The goal was to determine the cause of death between those receiving DC and those managed medically. Results: Nineteen patients received DC and were compared to 16 retrospectively matched patients. The mean age of the DC and matched cohort were 47.1 and 43.6 years, respectively. The mean admission GCS/Marshall diffuse CT grades were 5.8/3.4 for the DC group, and 4.1/3.1 for the matched medical cohort. Overall, in the DC group 94.7% of the deaths occurred secondary to cardiac arrest after withdrawal of life sustaining treatment (WLST), with only 5.3% progressing to brain death. Alternatively, in the matched cohort 62.5% died of cardiac arrest post WLST, with 37.5% progressing to brain death. Conclusions: Progression to brain death appears to be more common in those severe blunt TBI patients treated medically compared to those undergoing DC.
Counterproductive work behavior and job satisfaction: A surprisingly rocky relationship
Authors: Czarnota-Bojarska Joanna
Published: June 2015

Counterproductive work behavior is detrimental to the organization or to coworkers. It includes both breaking rules or laws, as well as social norms. Many authors show a negative relationship between this behavior and work satisfaction, surmising that the lack thereof – and the ensuing desire to ‘get back’ at the employer – are the seeds of workplace deviance. A study carried out in Polish organizations found this relationship to be less clear. The study concerned work satisfaction and counterproductive behavior, organizational justice, stress at work and propensity for aggressive behavior. A cluster analysis identified a group of individuals in whom relatively high levels of job satisfaction are nevertheless accompanied by proclivity for counterproductive behavior. The configuration of results suggests that this group resorts to counterproductive behavior because of an inability to balance difficulties at work with personal inclinations. The implications of these results for personal management is discussed in the conclusions.
Adapting to Retirement Community Life: Changes in Social Networks and Perceived Loneliness
Authors: Crisp Dimity A. , Windsor Tim D. , Butterworth Peter , Anstey Kaarin J.
Published: June 2015

Improved social relationships and connectedness is a frequently cited benefit of retirement community living. However, few studies have prospectively investigated changes in loneliness or social networks following relocation. This study involved 83 Australians (aged 57–90 years) relocating to independent living units within a retirement community. A prospective longitudinal design was employed whereby data was collected prior to relocation, and 1, 6 and 12 months post relocation. Comparisons were made with a sample of community-dwelling (N = 549) residents of the same age. Individual characteristics (e.g., personality characteristics) associated with change were also explored. Results indicated reduced loneliness and increased neighbour support networks following relocation. A reduction in contact with friends was also observed. This study provides an important contribution to our understanding of the initial impact of transitioning into a retirement community on personal relationships. Through exploring factors associated with successful transition, we can begin to understand the characteristics of those individuals most likely to thrive in this type of environment.