bluuebunny/crossref_metadata_2025 huggingface dataset:
Convict Settlers, Seamen’s Greens, and Imperial Designs at Port Jackson: A Maritime Perspective of British Settler Agriculture
Authors: McGillivery Angus R.
Published: March 2022

This article is a contribution to the debate over Australia’s convict beginnings and the nature of the British colonization of New South Wales. The early agriculture of the convict colony is set in the maritime context of imperial rivalries and visions of empire in the Pacific Ocean. When the Port Jackson settlement is viewed from this maritime perspective, it is apparent that agriculture was an imperial imperative of the Pitt administration. The design and early function of the settlement as a port of shelter and refreshment ensured that, despite initial despondency and drought, a bountiful and secure agricultural hinterland was in the making. Within five years after the planting of New South Wales, convict settlers, mixed agriculture, and imperial designs had transformed "a rude, wild country into a pleasant garden." As a planned, self-sufficient, maritime settlement, Port Jackson rapidly developed its capacity to produce a surplus of antiscorbutic seamen’s greens essential for a distant port and naval base to become an assured resource of refereshment, services, and supplies necessary for Britain to "effectively occupy" the oceanic territory of New South Wales and thereby integrate the development of a global empire.
An Exceedingly Dicey Business: Frontier Horse Ranching on the Northern Great Plains
Authors: Elofson Warren
Published: March 2022

Many of the men who headed west to establish the open range ranching system on the northern Great Plains in the late nineteenth century failed to grasp the enormous challenge that faced them. Attempting to produce quality live-stock for local and eastern markets, they found themselves struggling with an array of unforeseen obstacles. The worst of these were natural predators, harsh winter weather, drought, the ability of the domesticated animals to wander over great distances on the unfenced plains, and their tendency to breed indiscriminately. This article provides a detailed explanation of how all these conditions came together in the high-bred horse business on one very large ranch in southern Alberta. The author’s central argument is frontier ranching proved uneconomic in this case and thus in many others on both sides of the Canadian/American border.
“Every Farmer Should Be Awakened”: Liberty Hyde Bailey’s Vision of Agricultural Extension Work
Authors: Peters Scott J.
Published: March 2022

Historians have portrayed the formative period of agricultural extension work in the United States as a search for the best method of convincing farmers to change their farming practices in order to improve agricultural efficiency, productivity, and profitability. However, one of the key leaders in extension’s formative period, Cornell University’s Liberty Hyde Bailey, articulated a different vision of extension’s central purpose and promise. Drawing on his writings during the years in which he led the development of Cornell’s extension program (1894-1902), this article argues that Bailey’s vision of agricultural extension work was centered on the provision of education aimed at awakening farmers to a new point of view on life. The new point of view combined sympathy with nature, a love of country life, and a scientific attitude, expressed by a habit of careful observation and experimentation. The main purpose of awakening farmers to this point of view was not to develop a more efficient, productive, and profitable agriculture, but to advance the larger cultural ideals of a "self-sustaining" agriculture and personal happiness. The account of Bailey’s vision provided in this article suggests the need to reconsider the story of the origins and early development of American agricultural extension work.
The Peasants of the Forest: Masculinity, Nation, and Landscapes in Agrarian Historiography in Finland, 1900–1930
Authors: Östman Ann-Catrin
Published: March 2022

This article studies agricultural history from the perspective of masculinity. It aims to show how early twentieth-century Finnish historical studies articulated manly ideals, mainly by looking at "The History of Karelian" Tribe in Finland published in 1915 by Väinö Voionmaa. This well-known book, central to Finnish historiography and important for later studies on rural history, dealt with swidden agriculture in the Finnish interior. The article focuses on the intertwining of societal ideals, landscapes, and masculinity and shows the intersection of nationalist, class-based, and racial conceptions of the peasantry. Through this interpretation stressing manly ideals, Voionmaa ascribed the Finnish swidden society, traditionally regarded as primitive, a more recognized place in the nation’s history.
Information Exchange and the Making of the Colonial Farm: Agricultural Periodicals in Late Nineteenth–Century New Zealand
Authors: Wood Vaughan , Pawson Eric
Published: March 2022

In the mid to late nineteenth century, the agricultural periodical emerged as a major new medium for circulating information. In colonial settings it proved particularly important, as settlers often lived remotely from the markets for their produce, and they did not have existing farming traditions to rely upon. This paper traces the early history of agricultural periodicals in New Zealand and considers their position relative to other potential sources of farming instruction, such as agricultural colleges and the state. Through a case study of New Zealand’s first agricultural periodical, the "New Zealand Country Journal" (1877-1898), it then examines what kinds of information was being circulated, the sources of that information, and how this helped to shape farming practices in a "new" land.
Peasant Friendly Plant Breeding and the Early Years of the Green Revolution in Mexico
Authors: HARWOOD JONATHAN
Published: March 2022

Despite their success in boosting cereals production overall, the Green Revolution programs of the 1950s and 1960s were often criticized for failing to achieve their declared aim of alleviating world hunger. Most critics argued that the programs had produced a technology unsuited to the needs of small peasant farmers. This paper explores why such inappropriate technology might have been developed, focusing on the early years of the Rockefeller Foundation’s Mexican Agricultural Program (MAP). It shows that some foundation officers as well as agricultural advisors had prior experience of the problems faced by small farmers in the United States and elsewhere.Moreover, the foundation’s expressed concern for rural poverty does not appear to have been mere posturing by an organization anxious to be seen as an agent of philanthropy. Furthermore, the program’s early work in maize-breeding was well tailored to the conditions of Mexican agriculture.Once the MAP was up and running, however, it became apparent that the task of getting new varieties and cultivation practices to small farmers was going to be difficult. Needing to make some kind of impact quickly, MAP staff chose to concentrate upon projects that were likely to find a rapid uptake. This meant setting aside the needs of peasant farmers to develop high-yielding varieties suited to large commercial farms.
101 Improving Understanding and Confidence by Use of 360 Virtual Reality During Neurosurgical Consultation
Authors: Barbery Daniela , Steineke Thomas C.
Published: March 2022

INTRODUCTION:

Virtual Reality (VR) technology has been implemented in the field of neurosurgery for a variety of applications. Here, we employ this tool to enhance physician-patient communication and engage the patient during their neurosurgery consultation.

METHODS:

Thirty-one participants took a pre-consult survey to assess their baseline understanding, level of satisfaction, confidence, and anxiety. The patients experienced a standard (2D) consult followed by a VR consult and filled out a corresponding survey after each consultation type. During the 2D consult the surgeon used standard imaging to explain the patient’s medical condition and recommended treatment. A VR model was created from the scans shown in the 2D consult and used to fly-through and explain the patient’s anatomy and treatment options. The data for the pre-, post-2D and post-360VR consult was analyzed using an unpaired t-test and wilcoxon statistical test.

RESULTS:

The data showed significant improvement (p<0.005) compared to the pre-consult data on understanding, confidence in hospital and physician, and satisfaction. Upon comparing each patient’s answers between 2D and 360VR they reported a significantly higher level of understanding of their medical condition and treatment proposed, and more confidence in the physician and hospital after their 360VR consultation. More patients reported that based on their 360VR experience that they will proceed with the recommended treatment option (2D: 80%, 360VR: 96%). Additionally, there was a significant improvement in HCAHPS as compared to the national average.

CONCLUSION:

The initial, significant improvement in a patient’s understanding and confidence following a standard consultation is significantly enhanced by engaging the patient with a 360VR rendering of their imaging.
103 Participants in Clinical Trials for Traumatic Brain Injury Are Not Representative of the Injured Population
Authors: Venkatesh Shivani , Schaaf Tory , Bravo Marcela , Sundeen Kiera , Samadani Uzma
Published: March 2022

INTRODUCTION:

Traumatic brain injury (TBI) has higher mortality in minority populations, but these individuals are less likely to participate in TBI trials than non-minorities due to reasons ranging from historical abuse to socioeconomic status. Therefore, it is imperative barriers to minority inclusion in TBI trials are overcome.

METHODS:

350 out of 592 TBI studies with published results were compared to the general population statistics on race/ethnicity and sex from the U.S. census and TBI statistics from the CDC.

RESULTS:

Trials with a completed status compared to withdrawn status were 128 times more likely to publish their findings. While sex was frequently reported (males- 68% of the study participants), the majority of studies did not report race/ethnicity. 9.9% of enrolled subjects are Black even though they represent 12.3% and 19% of TBI cases and mortalities, respectively. This same trend is seen in all other populations, except White people, who were found to be overrepresented in trials as 65.3% of participants are White even though they account for 63.1% and 52.0% of TBI cases and mortalities, respectively. Black patients were 1.9 more times likely to die from head injuries compared to White patients. The average number of days/sessions involved in TBI trials was 12 and the average trial duration was 6.3 years. 14 (29%) trials required phone calls for follow up visits and 14 trials specifically excluded non English speakers.

CONCLUSION:

The majority of TBI clinical trials reported sex, but not report race/ethnicity. Factors that may influence participation include trial duration and effort commitment. Our results demonstrate the need for demographic reporting to ensure the population being studied accurately reflects the population suffering from the burden of disease.
110 Effects of Dietary Phytoestrogens on Aneurysm Wall Inflammation and Intracranial Aneurysm Formation
Authors: Baranoski Jacob F. , Rutledge Caleb , Yokosuka Kimihiko , Kamio Yoshinobu , Kuwabara Atsushi , Sato Hiroki , Rahmani Redi , Purcell James , Eguchi Satoru , Margaryan Tigran , Tovmasyan Artak , Ai Jinglu , Lawton Michael T. , Hashimoto Tomoki
Published: March 2022

INTRODUCTION:

The discovery of pharmacologic treatments that can reduce the incidence of aneurysm formation or rupture is of considerable interest. Prior studies demonstrated that supplemental estrogen can protect against the formation and rupture of aneurysms in ovariectomized female mice. This is of particular clinical significance, as post-menopausal women are at an increased risk for aneurysmal rupture. However, systemic estrogen hormone replacement is associated with adverse clinical outcomes primarily due to off-target effects thus limiting its clinical applicability. Isoflavones are plant-based, diet-derived compounds that structurally resemble estrogens but exhibit tissue and receptor specificity resulting in the potential for targeted, tissue-specific activation of estrogen receptors while limiting potentially deleterious off-target effects.

METHODS:

Using a systemic hypertension and elastase injection murine model, we induced intracranial aneurysms in ovariectomized adult female mice. We fed the mice with an isoflavone-free diet with/without daidzein supplementation or in a combination of intraperitoneal equol; a separate group were also given oral vancomycin. Experiments were repeated using estrogen-receptor-beta knockout mice.

RESULTS:

Both dietary daidzein and supplementation with its metabolite, equol, were protective against aneurysm formation in ovariectomized mice. The protective effects of daidzein and equol required estrogen-receptor-beta. Oral vancomycin induced disruption of the intestinal microbial conversion of daidzein to equol abolished the protective effects of daidzein against aneurysm formation. mRNA expression analyses demonstrated that mice treated with equol had lower inflammatory cytokines in the cerebral arteries, suggesting that phytoestrogens modulate inflammatory processes important to intracranial aneurysm pathogenesis.

CONCLUSION:

Our study establishes that both dietary daidzein and its metabolite - equol - are protective against aneurysm formation in ovariectomized female mice through the activation of estrogen-receptor-beta and subsequent suppression of inflammation. Dietary daidzein's protective effect required the intestinal conversion to equol. Our results indicate the potential therapeutic value of dietary daidzein and equol for the prevention of the formation of intracranial aneurysms and related subarachnoid hemorrhage.
112 Global Sagittal Flexibility Predicts Proximal Junctional Kyphosis After Spine Deformity Surgery
Authors: Munjal Vikas , Gibbs David C. , Moranville Robert , Keister Alex , Mallory Noah , Maggio Dominic , Farhadi Francis , Viljoen Stephanus , Grossbach Andrew J.
Published: March 2022

INTRODUCTION:

Adult spinal deformity (ASD) is a devastating disease with an estimated prevalence of 68%. Proximal junctional kyphosis (PJK) is a common complication of surgical intervention for ASD. With an incidence reported as high as 40%, PJK can lead to sagittal decompensation and necessitate reoperation. Few studies exist that examine the predictive utility of preoperative radiographic measurements in foreseeing postoperative PJK.

METHODS:

Demographic information, radiographs, complications, and patient-reported outcome measures (PROMs) were retrospectively analyzed from 109 patients who underwent long-segment thoraco-lumbar fusion at one midwest academic medical center. A Youden J-statistic was calculated based on ROC analysis of the difference between pre-operative standing and supine Sagittal Vertical Axis (ΔSVA), and the development of PJK at UIV + 2. Risk analysis was performed utilizing 2 × 2 contingency tables and Fisher’s exact test.

RESULTS:

ROC analysis revealed an optimal ΔSVA threshold value of 38.8 mm. Patients with a ΔSVA > 38.8 were considered globally flexible, and those with ΔSVA ≤ 38.8 mm rigid. Rigid patients were noted to have a significantly higher change in their post-operative proximal junctional cobb angle (ΔPJCA p = 0.03) at the one-year time point, with a relative risk of 1.82 (Fisher's p = 0.0072).

CONCLUSION:

Based on this retrospective data, pre-operative global spinal rigidity portends an independently elevated risk (RR 1.82) for the development of PJK after ASD surgery. No differences in other complication rates or PROMs data was seen between groups. Our data collection is limited to a two year post-operative window. Future studies could look at longer timepoints to see if an increase in reoperation rates (extension of fusion surgery) is similarly seen.
127 Accessibility and Ease of Use in Neuromodulation Devices
Authors: Petersen Erika A. , Francio Vinicius , Glenn Brett , Goree Johnathan , Strand Natalie , Sparks Dawn
Published: March 2022

INTRODUCTION:

Inclusive design is an engineering process that requires the product development team to balance the needs and limitations of many stakeholders, including those of the end user, regulatory organizations, and the designing institution. However, some patients confront challenges in using neuromodulation devices. These challenges include visual or hearing impairment and mobility and dexterity limitations that affect operation of the device components.

METHODS:

A primary set of points based on the seven principles of universal design, Twenty-First Century Communications and Video Accessibility Act (CVAA), Section 508, Web Content Accessibility Guidelines (WCAG), and the Americans with Disabilities Act (ADA) were created to obtain ratings of neuromodulation device characteristics for accessible operation. The author team developed a list of FDA-approved devices for brain, spinal, and peripheral pain neuromodulation available in the United States in 2021 and a standard survey was administered to evaluate each component. Data were gathered from representative patient-operated components of neuromodulation systems including device controllers and chargers to compare and rank the inclusivity of each.

RESULTS:

A representative number of neuromodulation devices in each category were assessed. Current data show multiple areas to improve the inclusivity of these devices. Multiple disabilities are not adequately considered during design. Inclusivity scores for the considered disabilities are summarized.

CONCLUSION:

Many currently FDA-approved neuromodulation devices are limited in their utility for disabled patients. Incorporating the recommendations of universal design into future devices will increase quality of care for our diverse and aging population.
133 Quantitative Imaging Measurements Marginally Improve Risk Prediction for Children with Mild Traumatic Brain Injuries and Intracranial Injuries
Authors: Greenberg Jacob K. , Olsen Margaret , Johnson Gabbie , Ahluwalia Ranbir , Hill Madelyn , Hale Andrew T. , Belal Ahmed M. A. , Baygani Shawyon , Foraker Randi , Carpenter Christopher , Ackerman Laurie , Noje Corina , Jackson Eric , Burns Erin , Sayama Christina M. , Selden Nathan R. , Vachhrajani Shobhan H. , Shannon Chevis , Kuppermann Nathan , Limbrick David D.
Published: March 2022

INTRODUCTION:

The KIIDS-TBI model was recently developed and externally validated in two large, multicenter populations to risk-stratify children with mild traumatic brain injuries (mTBI) and intracranial injuries. However, the KIIDS-TBI model only evaluates the presence/absence of imaging findings, rather than quantitative measures (e.g., hematoma size).

METHODS:

We included children <18 years who presented to one of five centers within 24 hours of TBI, had GCS scores of 13-15, and had intracranial injuries on neuroimaging. The dataset was split into training (75%) and test (25%) cohorts. We used generalized linear models (GLM) and recursive partitioning (RP) to predict the composite outcome of neurosurgery, intubation >24 hours due to TBI, or death due to TBI. Each model’s performance was compared to the KIIDS-TBI model across three decision-making risk cutoffs (<1%, <3%, and <5% predicted risk).

RESULTS:

There were 1,126 children included in the training and 374 in the test dataset. The RP model included epidural hematoma size, amount of skull fracture depression, amount of midline shift, and extra-axial hematoma size. The GLM model included these imaging variables and added clinical predictors, such as GCS Score. The GLM (76-90%) and RP (79-87%) models showed similar specificity across the three risk cutoffs in the test dataset, but the GLM model had higher sensitivity (89-96% for GLM; 89% for RP). By comparison, the KIIDS-TBI model had slightly higher sensitivity (93-100%) but lower specificity (27-82%) across the three risk cutoffs.

CONCLUSION:

Despite having obvious face value in many aspects of neurosurgical decision-making, quantitative imaging measures only marginally improved efforts to identify low risk patients in a large dataset of children with mTBI and intracranial injuries. Given the tradeoff between improved specificity but decreased sensitivity, these results do not support the addition of quantitative imaging measures to the KIIDS-TBI tool.
162 Recruiting Women Into Neurosurgery: A Quantitative Analysis of Feeder Medical School Characteristics
Authors: Feghali James , Antar Albert , Wicks Elizabeth , Sattari Shahab A. , Li Sean , Witham Timothy F. , Brem Henry , Huang Judy
Published: March 2022

INTRODUCTION:

Despite a recent increase in the number of women pursuing neurosurgery residency, medical school characteristics associated with the successful recruitment of female medical students into the field remain poorly studied.

METHODS:

A total of 1572 current residents in U.S. Accreditation-Council-for-Graduate-Medical-Education-accredited neurosurgery programs, representing match cohorts from 2014 to 2020, were evaluated. U.S. medical school characteristics such as class size and number of total and female clinical neurosurgery faculty were recorded. Medical schools were ranked based on the percentage of female graduates entering neurosurgery, and yearly trends of the percentage of females constituting incoming neurosurgery resident cohorts were studied. Associations between percent female recruitment and medical school characteristics were then evaluated using univariable and stepwise multivariable linear regression (including significant univariable factors).

RESULTS:

The cohort consisted of 1255 male and 317 (20%) female residents. Yearly trends indicated a significant drop in incoming female residents in 2016 followed by significant increases in 2017 and 2019. The following factors were associated with a higher average percentage of female graduates entering neurosurgery on multivariable analysis: total affiliated neurosurgery clinical faculty (β = 0.006, 95% CI [0.001-0.011], p = 0.013), allopathic vs. osteopathic schools (β = 0.231, 95% CI [0.053-0.409], p = 0.011), and top-10 U.S. News ranking (β = 0.380, 95% CI [0.129-0.589], p = 0.002). Upon adding the number of female clinical faculty to the model, the variable was not statistically significant. Multivariable bibliometric analyses indicated a higher mean pre-residency H-index for males with an even greater gender difference identified in current H-index.

CONCLUSION:

This study characterizes which medical schools have recruited the most female students who are currently in neurosurgery residency. The overall number of clinical neurosurgery faculty rather than faculty gender was independently associated with female recruitment. Gender differences in research productivity persisted while controlling for confounders and increased between pre-residency and current time-points.
166 Predictors of Incomplete Aneurysm Occlusion After Treatment with Pipeline Embolization Device: PREMIER Trial 1-year Analysis
Authors: Monteiro Andre , Kallmes David , Lopes Demetrius K. , Nelson Peter K. , Hanel Ricardo A.
Published: March 2022

INTRODUCTION:

Failure of treatment with Pipeline Embolization Device (PED) occurs in 16.1% to 24.6% of aneurysms. Studies investigating mechanisms behind PED failure are mostly retrospective series with conflicting findings. We performed an analysis of aneurysms that failed to achieve complete occlusion in the Prospective Study on Embolization of Intracranial Aneurysms with the Pipeline Device (PREMIER) trial.

METHODS:

PREMIER was a prospective, multicenter and single-arm interventional. Assessment images was done by independent core laboratory. We retrospectively analyzed patients who failed the primary efficacy endpoint. Aneurysms with incomplete occlusion (RR > 1) were further analyzed and compared to completely occluded aneurysms.

RESULTS:

Twenty-five (18.1%) aneurysms were incompletely occluded at 1-year. Twenty-two patients had RR-3 and 3 had RR-2. There was a median reduction of 0.9 mm (IQR 0.41-2.43) in maximum-diameter between pre-procedure and 1-year follow-up. Mean age of patients with incomplete occlusion was significantly higher than in those with complete occlusion (mean ±SD; 59.9 ± 10.4 vs 53.6 ± 11.2, P = 0.011). Smoking (P = 0.045) and C6 segment location (P = 0.005) were significantly associated with complete occlusion, while location at V4 (P = 0.01) and C7 (P = 0.007) segments and involvement of a side branch (<0.001) were significantly associated with incomplete occlusion. There was no difference in the rate of inadequate wall apposition between complete and incomplete occlusion groups (12% vs 12.4%, P = 1). In multivariable logistic regression, significant predictors of incomplete occlusion were non-smoker status (adjusted OR, 4.49; 95% CI, 1.11-18.09; p = 0.03), and side branch involvement (adjusted OR, 11.68; 95% CI, 3.84-35.50; P < 0.0001), while the C6 location had reduced odds of incomplete occlusion versus those at other segment locations (adjusted OR, 0.29; 95% CI, 0.10-0.84; p = 0.02).

CONCLUSION:

In the PREMIER cohort, non-smoking status and vessel branch involvement were the strongest predictors of incomplete occlusion at 1-year. Although the presence of side branches can lead to incomplete occlusion, we observed decrease in aneurysm size and stable remodeling. The efficacy of protecting against rupture remains to be confirmed in longer follow-up. The results from our prospective study is consistent with previous retrospective series and warrants considerations for technique adaptations to achieve higher occlusion rates.
178 Multicenter Prospective Trial of Anti-Epileptics for Early Seizure Prevention in Mild Traumatic Brain Injury with a Positive CT Scan
Authors: Zaher Mazen , Pease Matthew , Lopez Alejandro , Yu Siyuan , Egodage Tanya , Semroc Suzan , Arefan Dooman , Jankowitz Brian T.
Published: March 2022

INTRODUCTION:

Post-traumatic seizures (PTS) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild or moderate TBI.

METHODS:

We performed a prospective, multicenter study evaluating consecutive patients who presented to a level 1 trauma center from January 2017 through December 2020. Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a 7-day course of prophylactic AEDs on a week-by-week basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire.

RESULTS:

490 patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; p = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; p = 0.02). Seizure rate increased linearly by age groups: <60 years-old (0%); 60-70 years-old (1.7%); 70-80 years-old (2.3%); and >80 years-old (4.6%).

CONCLUSION:

Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan. Future studies should be appropriately powered for the small effect size of AEDs in mild TBI and evaluate the effects between age and prophylactic AED use.
194 Why Do Ventricles Not Dilate in Pseudotumor Cerebri? A Circuit Model of Cerebral Windkessel
Authors: Wang Zhe , Yang Liu , Djuric Petar M. , Egnor Michael R.
Published: March 2022

INTRODUCTION:

Pseudotumor cerebri is characterized by elevated intracranial pressure (ICP) without ventricular dilation. The pathophysiology of pseudotumor is traditionally viewed as chronic cerebrovenous hypertension which causes impaired cerebrospinal fluid (CSF) resorption. Increased resistance to CSF absorption results in ventriculomegaly in obstructive hydrocephalus. In pseudotumor, however, lack of ventriculomegaly cannot be explained by this mechanism. In this study, we model the cerebral windkessel as a CSF pulsation absorber. We hypothesize that inability to absorb CSF pulsation diverts pulsatile energy to ventricles, causing ventriculomegaly, whereas effective CSF pulsation absorption leaves ventricles normal in size.

METHODS:

Cerebral windkessel is a band-pass filter considering arterial blood pressure (ABP) as input and ICP as output. We used a tank circuit with parallel inductance and capacitance to model windkessel and compare with the transfer function between ABP and ICP in normal dogs. Normal CSF dynamics were simulated by setting circuit parameters to correlate physiological recordings from dogs: frequency for heart rate, input and output voltages for ABP and ICP, and CSF and capillary resistance for resistance to pulsatile and pulseless flow, respectively. CSF path resistance was increased to simulate CSF space narrowing in hydrocephalus. Capillary resistance was increased to simulate impaired venous flow in pseudotumor.

RESULTS:

The circuit output shows agreement with physiological recordings, in which ICP pulse precedes ABP pulse. Windkessel is most effective at a given pulse frequency. In hydrocephalus, increased resistance to CSF flow disrupts cerebral windkessel, leading to ineffective pulse dampening and increased ICP phase lead. In pseudotumor, increased capillary resistance does not change cerebral windkessel effectiveness or ICP phase lead.

CONCLUSION:

The cerebral windkessel is a CSF pulsation absorber. An ineffective windkessel in hydrocephalus inhibits CSF pulsation absorption and diverts pulsatile energy to dilate ventricles, whereas an effective one in pseudotumor leaves ventricles normal. Our model of CSF dynamics emphasizes that ventricular dilation is a result of ineffective windkessel and decreased CSF pulsation absorption. This model provides a novel perspective on the pathophysiology of abnormal CSF dynamics and offers new directions for future research.
199 Electronic Clinical Decision Support for Children with Mild Traumatic Brain Injuries and Intracranial Injuries: A Sociotechnical Analysis
Authors: Greenberg Jacob K. , Otun Ayodamola , Carpenter Christopher , Brownson Ross , Kuppermann Nathan , Limbrick David D. , Yen Po-Yin , Foraker Randi
Published: March 2022

INTRODUCTION:

The management of children with mild traumatic brain injuries (mTBI) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) may improve patient safety and decrease resource use.

METHODS:

We conducted semi-structured qualitative focus group interviews to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine hospitals in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were cross-referenced with previously defined sociotechnical dimensions.

RESULTS:

We included 28 physicians and four information technology specialists in seven focus groups. Ten participants had administrative leadership positions, and the largest group (34%) was from neurosurgery. Through inductive thematic analysis, we identified five primary themes: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children, and also noted potential secondary uses (e.g., informing family discussions). However, some also identified potential harm that could result from misuse (e.g., conflict across specialties). Feedback from the interviews helped refine the tool content, highlight potential implementation barriers, and identify appropriate measures to evaluate after implementation.

CONCLUSION:

We identified key factors impacting the implementation of electronic CDS for children with mTBI and intracranial injuries, providing a strong foundation for prospective implementation efforts.
348 Multi-Center MRI Radiomic Texture Analysis Pre-Operatively Discriminates Between Primary Central Nervous System Lymphoma, Glioblastoma, and Brain Metastasis
Authors: Pease Matthew , Ak Murat , Ayoub Mira , Mamindla Priyadarshini , Kamal Abdallah , Peddagangireddy Vishal , Zinn Pascal O. , Moron Fanny , Colen Rivka R.
Published: March 2022

INTRODUCTION:

Primary Central Nervous System Lymphoma (PCNSL), glioblastoma (GBM), and brain metastasis (BM) collectively account for almost 75% of malignant brain tumors. Due to their similar radiographic appearance, the current standard of care is to perform an invasive biopsy for histological diagnosis. Radiomic approaches may allow for non-invasive identification of tumor histology to guide patient care.

METHODS:

We retrospectively identified 632 patients from three institutions with untreated solitary, pathology confirmed cases of PCNSL (133), GBM (129), and breast or lung BM (370). For each tumor, we segmented edema, contrast enhancement, necrosis, and contralateral white matter (cWM) regions of interest (ROI) for T2 FLAIR and T1 post-contrast sequences. A total of 205 texture features were extracted from each sequence’s ROI including 10 first-order features and 195 second-order features using gray-level co-occurrence matrices. We divided the 195 second level features by the volumes of each ROI to generate another 195 volume-independent features and 2,400 features total. We removed all highly correlated feautres, performed feature selection with Least Absolute Shrinkage and Selection Operator (LASSO), and built a model using gradient boosting. We split the cohort into 80% training and 20% testing with 5-fold cross-validation. We report area under the curve (AUC) for classifying each tumor type against all others (i.e., BM versus PCNSL and GBM).

RESULTS:

LASSO identified 173 independent features, of which 35 most relevant were used for model building. Our three-classification model robustly differentiated (p < 0.001) between PCNSL (AUC 0.95), GBM (AUC 0.93), and BM (AUC 0.93). Our accuracy was 84% and we achieved favorable sensitivity (PCNS 0.74; GBM 0.73; BM 0.91) and specificity (PCNSL 0.97; GBM 0.92; BM 0.83). With a specificity of 1 (i.e., never incorrectly classifying a tumor subtype), the sensitivity for PCNSL and BM was over 40% and approached 80% for GBM.

CONCLUSION:

MRI radiomic analysis may achieve enough classification accuracy to allow for avoidance of intracranial biopsy in select patients and differentiate between PCNSL, GBM, and BM.
361 Prevalence and Trends of Surgical Intervention for Trigeminal Neuralgia in the Inpatient Setting in the United States: Analyses from a National Database from 2002-2015
Authors: Alexander Yohan , Alvi Mohammed , Doherty Ronan , Yolcu Yagiz , Kerezoudis Panagiotis , Brown Desmond A. , Agarwal Vijay , Van Gompel Jamie J. , Ghogawala Zoher , Link Michael J. , Meyer Fredric B.
Published: March 2022

INTRODUCTION:

Trigeminal neuralgia is a debilitating neurological condition characterized by sharp, stabbing pain in the distribution of the trigeminal nerve and its branches. For trigeminal neuralgia that is refractory to medical therapy, surgery is generally indicated. Herein, we sought to assess the prevalence of trigeminal neuralgia among inpatient admissions, utilization of surgical intervention, and trends of utilization of common surgical approaches for TN using a national database.

METHODS:

The National Inpatient Sample (NIS) was queried for all patients with trigeminal neuralgia using international classification of disease 9th revision clinical modification (ICD-9-CM) diagnosis code (350.1) between the 1st quarter of 2002 and the 3rd quarter of 2015. Cases were also classified into surgical groups using ICD-9 procedure codes which included MVD, percutaneous procedures and stereotactic radiosurgery. Using weighted discharge methodology, national estimates for prevalence, primary admissions, and utilization of each surgery type were computed.

RESULTS:

A total of 405,445 patients with trigeminal neuralgia were identified between the 1st quarter of 2002 and the 3rd quarter of 2015. The inpatient prevalence of trigeminal neuralgia in this 14 year cohort was found to be 63.8 per 100,000, and was found to increase from 54.9 per 100,000 in 2002 to 76 per 100,00 in 2015. A total of 67,768 patients had a primary diagnosis of trigeminal neuralgia. Of these, 41,473 (61.2%) underwent a surgical procedure; surgical utilization increased from 59.7% cases in 2002 to 69.1% in 2015. Of the cases undergoing a surgical intervention for trigeminal neuralgia, an MVD was performed for the majority of patients (87%, n=36,083) followed by percutaneous procedures (7.3%, n=3,036) and stereotactic radiosurgery (7.1%, n=2,940). Furthermore, the percent-utilization of MVD among patients undergoing surgical intervention increased form 67.3% in 2002 to 98% in 2015, the percent utilization of percutaneous procedures fell from 17.9% to 2%, and the percent utilization of stereotactic radiosurgery fell from 15.5% to 0.4%.

CONCLUSION:

The trends within surgical management of trigeminal neuralgia have been rapidly evolving over the past two decades with a steady trend towards MVD.
372 Pediatric Abusive Head Trauma During the First Year of Covid-19
Authors: Singer Timothy , Mehl Steven , Kralik Stephen , Desai Nilesh , Orman Gunes , Sarpong Kwabena , Donaruma Marcella , Cain Cary , Warner Claire , Huisman Thierry , Naik-Mathuria Bindi , Weiner Howard L. , Donoho Daniel , Risen Sarah
Published: March 2022

INTRODUCTION:

During the Covid-19 pandemic parental burnout was associated with increases in child abuse. However, the effects of the pandemic on Abusive Head Trauma (AHT) have not yet been described.

METHODS:

We included all patients <5 years old with expert-confirmed AHT at our freestanding children's hospital from 3/2018-2/2021. Demographic and clinical data were excerpted, and pediatric neuroradiologists reviewed neuroimaging. Descriptive and inferential analyses were conducted with RStudio. Early morbidity was assessed using gross-motor milestones and developmental quotients with the Capute Scales (CAT/CLAMS).

RESULTS:

103 patients suffered AHT (64 pre-Covid-19, 39 Covid-19). The Covid-19 cohort was younger (median age 115 v. 152 days, p=0.027) and lived in homes with higher maternal unemployment (51% v. 22%, p=0.003), smaller spaces (apartments 56% v. 31%, p=0.043) and more people (median 5 v. 4, p=0.047). Clinical findings including Glasgow Coma Scale, Injury Severity Score, and multi-organ injury were similar. Neurosurgical intervention was similar (31% v. 20%, p=0.23). Neuroimaging found that during Covid-19 children suffered more extensive sub-arachnoid hemorrhage (32% v 14%, p=0.040) and spinal hemorrhage (6/39 v. 3/64 cases, p=0.046). Notably, mortality was 19% in both groups (p=0.92). During Covid-19 children removed from parental care were more likely to be placed with relatives (61% v. 36%, p=0.039) versus foster care (8.3% v. 30%, p=0.039). At 2-month follow-up, no differences were observed in new motor (43% v. 54%, p=0.45), language (33% v. 18%, p=0.59), or cognitive (36% v. 48%, p=0.36) developmental delays nor in severity of new deficits.

CONCLUSION:

Pediatric AHT is a serious public health problem and occurs especially at times of high family stress.(3) During Covid-19 children suffering AHT were younger and more likely to live in homes experiencing greater socioeconomic stressors compared with pre-pandemic levels.
374 Multi-omic Analysis Identifies a SPAK Kinase-regulated Ensemble of Choroid Plexus Ion Transport Proteins Relevant for Post-infectious Hydrocephalus
Authors: Robert Stephanie , Reeves Benjamin , Karimy Jason K. , Marlier Arnaud , Kiziltug Emre , DeSpenza Tyrone , Singh Amrita , Allington Garrett , Phan Duy , Zhang Jinwei , Kahle Kristopher Thomas
Published: March 2022

INTRODUCTION:

Postinfectious hydrocephalus (PIH) is the most common cause of acquired hydrocephalus worldwide. Treatment is typically through CSF diversion via ventriculoperitoneal shunting, which has high rates of morbidity and is often unavailable in developing countries.

METHODS:

SPAK knockout (KO) rats were generated using Crispr/CAS9. Control and SPAK KO male rats were implanted with an infusion catheter to introduce E. coli (genetically engineered +/-LPS) or LPS into the lateral ventricles over 72 hours. CSF secretion was measured by catheter placement into the lateral ventricle, and ventricular size by MRI. ChP were harvested for immunohistochemistry (IHC), western blot (WB), genomic/proteomic analysis, and single-cell RNA sequencing (scRNAseq). To investigate SPAK-associated ChP targets, we purified the SPAK-protein complex, identified physical interactors using liquid chromatography/dual mass spectroscopy (LC-MS/MS), and validated top candidates by WB/IHC.

RESULTS:

Robust bumetanide-sensitive, SPAK-dependent, CSF hypersecretion and ventriculomegaly was observed and dependent on the presence of LPS. LPS triggered significant up-regulation of activating SPAK phosphorylation (Thr233/185), and the bumetanide-sensitive cation-chloride cotransporter NKCC1 (Thr203/207/212). LC-MS/MS pull-down assay additionally revealed three other important SPAK-bound ion transporters, alpha-1 subunit of Na/K ATPase, K+ channel KCNJ13/Kir7.1, and Cl- channel CLIC6. All SPAK-bound targets co-localized with pSPAK at the ChP apical membrane in LPS conditions. This interaction, as well as CSF hypersecretion and ventriculomegaly, were abrogated in LPS-treated SPAK KO animals.

CONCLUSION:

Multi-omic analysis identified a SPAK-regulated ensemble of ion transport proteins relevant for PIH at the ChP apical membrane. Given the recent development of SPAK kinase inhibitors, our findings uncover a targetable mechanism for the pharmacological treatment of PIH and potentially other forms of inflammation-associated acquired hydrocephalus.
377 Complications of Pediatric Tethered Cord Release: Seattle Children’s Hospital Experience
Authors: Pan James , Hauptman Jason S. , Susarla Srinivas , Ellenbogen Richard G. , Lee Amy , Browd Samuel R. , Ojemann Jeffrey G.
Published: March 2022

INTRODUCTION:

We describe six years of surgical experience at our pediatric neurosurgery center, with a wide variety of operative complexity and etiologies related to tethered cord syndrome. While complications are well-described, the risk of complications associated with complexity of the procedure needs further investigation. Based on our findings, we propose guidelines to minimize complications and give attention to certain high-risk groups of patients.

METHODS:

Medical records of children who underwent surgery for tethered cord release (CPT 63200) from July 2014 to December 2020 were retrospectively reviewed after approval by the Institutional Review Board at Seattle Children's Hospital. Data collected included demographics, surgical technique, follow-up, and complications. We defined surgeries as complex if they involved usage of any of the following: plastic surgeon assistance, drain placement, duraplasty, or operative laser. Univariate analysis and multivariate logistic regression were used to determine covariates that were protective or risk factors for development of complications.

RESULTS:

In 242 contiguous tethered cord operations (51.8% male, mean age 74.8 months), the overall complication rate of any type was 10.7% (3.45% simple, 17.46% complex). Median time until complication was 11 days. Complications were associated with usage of the operative laser, increasing hospital length of stay, and increasing operative time. Plastic surgery assistance (OR 0.357, 95% CI 0.197-0.647, p=0.0007) and placement of a drain (OR 0.314, 95% CI 0.134-0.739, p=0.008) for complex cases were protective against development of complications.

CONCLUSION:

Our complication rate is comparable to those of others (1-4). However, multivariate logistic regression analysis suggests that plastic surgery assistance and drain placement can be protective factors, and should be considered in complex tethered cord operations.
404 Anatomy of the Dorsal Meningeal Artery Including its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging
Authors: McCormack Isabella G. , Lu Xu , Nerva John D. , Berry John F. , Melgar Miguel A. , Wysiadecki Grzegorz , Walocha Jerzy A. , Iwanaga Joe , Dumont Aaron S. , Tubbs R. Shane
Published: March 2022

INTRODUCTION:

The skull base vasculature is critical to surgeons operating in this region. However, one vessel with a vast skull base distribution, the dorsal meningeal artery (DMA), has had few anatomical studies performed to investigate not only its normal anatomy but also its variations.

METHODS:

In ten adult latex-injected cadaveric heads (twenty sides), the DMA was dissected using a surgical microscope and its branches were measured.

RESULTS:

A DMA was identified on all sides. In most (85%), it branched from the meningohypophysial trunk or common stem with either the inferior hypophysial or tentorial arteries and on three sides (15%), arose as a separate branch from the internal carotid artery. Within Dorello’s canal, the DMA was the most medial structure with the abducens nerve and the inferior petrosal sinus found laterally in most specimens. On one side (5%), the artery had two branches that traveled on either side of the abducens nerve distal to the petroclival ligament. Toward the midline, many (70%) of the clival branches pierced the clivus. Most (80%) clival branches anastomosed with their counterparts contralaterally and all traveled deep to the abducens nerve. Dural branches were found traveling to the clival dura and to the dura forming Meckel’s cave. Neural branches were identified traveling to the abducens and hypoglossal nerves. In two sides (10%), the DMA provided an ascending branch to the posterior pituitary gland. On 15% of sides, vascular branches traveled to the adventitia of the cavernous internal carotid artery and most sides (80%) had a descending branch to the inferior petrosal sinus which then anastomosed with jugular branches of the ascending pharyngeal artery.

CONCLUSION:

The DMA is a constant, although variable, vascular structure of the skull base and contributes to multiple structures in addition to the dura.