bluuebunny/crossref_metadata_2025 huggingface dataset:
Counterfactuals and Causal Inference
Authors: Morgan Stephen L. , Winship Christopher
Published: December 2014

In this second edition of Counterfactuals and Causal Inference, completely revised and expanded, the essential features of the counterfactual approach to observational data analysis are presented with examples from the social, demographic, and health sciences. Alternative estimation techniques are first introduced using both the potential outcome model and causal graphs; after which, conditioning techniques, such as matching and regression, are presented from a potential outcomes perspective. For research scenarios in which important determinants of causal exposure are unobserved, alternative techniques, such as instrumental variable estimators, longitudinal methods, and estimation via causal mechanisms, are then presented. The importance of causal effect heterogeneity is stressed throughout the book, and the need for deep causal explanation via mechanisms is discussed.
Bourgeois Radicals
Authors: Anderson Carol
Published: December 2014

Bourgeois Radicals explores the NAACP's key role in the liberation of Africans and Asians across the globe even as it fought Jim Crow on the home front during the long civil rights movement. For NAACP's leaders, the way to create a stable international system, stave off communism in Africa and Asia, and prevent capitalist exploitation was to embed human rights, with its economic and cultural protections, in the transformation of colonies into nations. Indeed, the NAACP aided in the liberation struggles of multiple African and Asian countries within the limited ideological space of the Second Red Scare. However, its vision of a 'third way' to democracy for the hundreds of millions in Asia and Africa was only partially realized due to a toxic combination of the Cold War, Jim Crow, and imperialism. Bourgeois Radicals examines the toll that internationalism took on the organization and illuminates the linkages between the struggle for human rights and the fight for colonial independence.
The Pleasures of Reason in Plato, Aristotle, and the Hellenistic Hedonists
Authors: Warren James
Published: December 2014

Human lives are full of pleasures and pains. And humans are creatures that are able to think: to learn, understand, remember and recall, plan and anticipate. Ancient philosophers were interested in both of these facts and, what is more, were interested in how these two facts are related to one another. There appear to be, after all, pleasures and pains associated with learning and inquiring, recollecting and anticipating. We enjoy finding something out. We are pained to discover that a belief we hold is false. We can think back and enjoy or be upset by recalling past events. And we can plan for and enjoy imagining pleasures yet to come. This book is about what Plato, Aristotle, the Epicureans and the Cyrenaics had to say about these relationships between pleasure and reason.
From Slavery to the Cooperative Commonwealth
Authors: Gourevitch Alex
Published: December 2014

This book reconstructs how a group of nineteenth-century labor reformers appropriated and radicalized the republican tradition. These 'labor republicans' derived their definition of freedom from a long tradition of political theory dating back to the classical republics. In this tradition, to be free is to be independent of anyone else's will - to be dependent is to be a slave. Borrowing these ideas, labor republicans argued that wage laborers were unfree because of their abject dependence on their employers. Workers in a cooperative, on the other hand, were considered free because they equally and collectively controlled their work. Although these labor republicans are relatively unknown, this book details their unique, contemporary, and valuable perspective on both American history and the organization of the economy.
Rethinking the Law School
Authors: Stolker Carel
Published: December 2014

Law, by its very nature, tends to think locally, not globally. This book has a broader scope in terms of the range of nations and offers a succinct journey through law schools on different continents and subject matters. It covers education, research, impact and societal outreach, and governance. It illustrates that law schools throughout the world have much in common in terms of values, duties, challenges, ambitions and hopes. It provides insights into these aspirations, whilst presenting a thought-provoking discussion for a more global agenda on the future of law schools. Written from the perspective of a former dean, the book offers a unique understanding of the challenges facing legal education and research.
Categorial Features
Authors: Panagiotidis Phoevos
Published: December 2014

Proposing a novel theory of parts of speech, this book discusses categorization from a methodological and theoretical point a view. It draws on discoveries and insights from a number of approaches - typology, cognitive grammar, notional approaches, and generative grammar - and presents a generative, feature-based theory. Building on up-to-date research and the latest findings and ideas in categorization and word-building, Panagiotidis combines the primacy of categorical features with a syntactic categorization approach, addressing the fundamental, but often overlooked, questions in grammatical theory. Designed for graduate students and researchers studying grammar and syntax, this book is richly illustrated with examples from a variety of languages and explains elements and phenomena central to the nature of human language.
Analysis of Panel Data
Authors: Hsiao Cheng
Published: December 2014

This book provides a comprehensive, coherent, and intuitive review of panel data methodologies that are useful for empirical analysis. Substantially revised from the second edition, it includes two new chapters on modeling cross-sectionally dependent data and dynamic systems of equations. Some of the more complicated concepts have been further streamlined. Other new material includes correlated random coefficient models, pseudo-panels, duration and count data models, quantile analysis, and alternative approaches for controlling the impact of unobserved heterogeneity in nonlinear panel data models.
Free Trade and Faithful Globalization
Authors: Reynolds Amy
Published: December 2014

Through an analysis of Christian communities in the United States, Canada, and Costa Rica, this book analyzes how religious groups talk about the politics surrounding economic life. Amy Reynolds examines how these Christian organizations speak about trade and the economy as moral and value-laden spaces, deserving ethical reflection and requiring political action. She reveals the ways in which religious communities have asked people to engage in new approaches to thinking about the market and how they have worked to create alternative networks and policies governing economic and social life.
Descendancy
Authors: Fitzpatrick David
Published: December 2014

This book examines Protestant loss of power and self-confidence in Ireland since 1795. David Fitzpatrick charts the declining power and influence of the Protestant community in Ireland and the strategies adopted in the face of this decline, presenting rich personal testimony that illustrates how individuals experienced and perceived 'descendancy'. Focusing on the attitudes and strategies adopted by the eventual losers rather than victors, he addresses contentious issues in Irish history through an analysis of the appeal of the Orange Order, the Ulster Covenant of 1912, and 'ethnic cleansing' in the Irish Revolution. Avoiding both apologetics and sentimentality when probing the psychology of those undergoing 'descendancy', the book examines the social and political ramifications of religious affiliation and belief as practised in fraternities, church congregations and isolated sub-communities.
IDEAL PROJECTIONS AND FORCING PROJECTIONS
Authors: COX SEAN , ZEMAN MARTIN
Published: December 2014

It is well known that saturation of ideals is closely related to the “antichain-catching” phenomenon from Foreman–Magidor–Shelah [10]. We consider several antichain-catching properties that are weaker than saturation, and prove:

(1)

If${\cal I}$is a normal ideal on$\omega _2 $which satisfiesstationary antichain catching, then there is an inner model with a Woodin cardinal;

(2)

For any$n \in \omega $, it is consistent relative to large cardinals that there is a normal ideal${\cal I}$on$\omega _n $which satisfiesprojective antichain catching, yet${\cal I}$is not saturated (or even strong). This provides a negative answer to Open Question number 13 from Foreman’s chapter in the Handbook of Set Theory ([7]).
ON FORKING AND DEFINABILITY OF TYPES IN SOME DP-MINIMAL THEORIES
Authors: SIMON PIERRE , STARCHENKO SERGEI
Published: December 2014

We prove in particular that, in a large class of dp-minimal theories including the p-adics, definable types are dense amongst nonforking types.
DIFFERENTIATION IN P-MINIMAL STRUCTURES AND A
p-ADIC LOCAL MONOTONICITY THEOREM
Authors: KUIJPERS TRISTAN , LEENKNEGT EVA
Published: December 2014

We prove a p-adic, local version of the Monotonicity Theorem for
P-minimal structures. The existence of such a theorem was
originally conjectured by Haskell and Macpherson. We approach the problem by
considering the first order strict derivative. In particular, we show that, for
a wide class of P-minimal structures, the definable functions
f : K → K are
almost everywhere strictly differentiable and satisfy the Local Jacobian
Property.
Holomorphic Line Bundles Over Domains in Cousin Groups and the Algebraic Dimension of Oeljeklaus-Toma Manifolds
Authors: Battisti Laurent , Oeljeklaus Karl
Published: December 2014

In this paper we extend results due to Vogt on line bundles over Cousin groups to the case of domains stable by the maximal compact subgroup. This is used to show that the algebraic dimension of Oeljeklaus—Toma manifolds (OT-manifolds) is 0. In the last part we establish that certain Cousin groups, in particular those arising from the construction of OT-manifolds, have finite-dimensional irregularity.
Hostels for Jobless Workers in Interwar Yugoslavia (1921–1941)
Authors: Petrungaro Stefano
Published: December 2014

This article analyses the establishment of a network of hostels for unemployed workers in Yugoslavia between the two world wars. The analysis investigates the legal, political, and institutional background to these hostels, and how they were conceived and financed. By looking at the development of a new public social policy from the perspective of the jobless, the article aims to examine the nature, goals, and especially the boundaries of a modern provision for Yugoslav workers, namely its strategies and practices of social inclusion and exclusion. The article reveals how a modern concept of unemployment gradually emerged. These hostels were not part of a traditional policy on poverty; they were the expression of a new and more modern form of social policy. The article further shows how new social differences and distances between “non-working” people were created, and what specific impact those differences and distances had on the functioning of these institutions.
Personalising nutritional guidance for more effective behaviour change
Authors: Celis-Morales Carlos , Lara Jose , Mathers John C
Published: December 2014

Improving diet and other lifestyle behaviours has considerable potential for reducing the global burden of non-communicable diseases, promoting better health across the life-course and increasing wellbeing. However, realising this potential will require the development, testing and implementation of much more effective behaviour change interventions than are used conventionally. Evidence-based, personalised (or stratified) interventions which incorporate effective behaviour change techniques (BCT) and which are delivered digitally are likely to be an important route to scalable and sustainable interventions. Progress in developing such interventions will depend on the outcomes of research on: (i) the best bases for personalisation of dietary advice; (ii) identification of BCT which are proven to enhance intervention efficacy; (iii) suitable platforms (digital-based tools) for collection of relevant participant characteristics (e.g. socioeconomic information, current diet and lifestyle and dietary preferences) linked with intelligent systems which use those characteristics to offer tailored feedback and advice in a cost-effective and acceptable manner. Future research should focus on such interventions aiming to reduce health inequalities and to improve overall public health.
Control of appetite and energy intake by SCFA: what are the potential underlying mechanisms?
Authors: Chambers Edward S. , Morrison Douglas J. , Frost Gary
Published: December 2014

In recent years, there has been a renewed interest in the role of dietary fibre in obesity management. Much of this interest stems from animal and human studies which suggest that an increased intake of fermentable fibre can suppress appetite and improve weight management. A growing number of reports have demonstrated that the principal products of colonic fermentation of dietary fibre, SCFA, contribute to energy homeostasis via effects on multiple cellular metabolic pathways and receptor-mediated mechanisms. In particular, over the past decade it has been identified that a widespread receptor system exists for SCFA. These G-protein-coupled receptors, free fatty acid receptor (FFAR) 2 and FFAR3 are expressed in numerous tissue sites, including the gut epithelium and adipose tissue. Investigations using FFAR2- or FFAR3-deficient animal models suggest that SCFA-mediated stimulation of these receptors enhances the release of the anorectic hormones peptide tyrosine tyrosine and glucagon-like peptide-1 from colonic L cells and leptin from adipocytes. In addition, the SCFA acetate has recently been shown to have a direct role in central appetite regulation. Furthermore, the SCFA propionate is a known precursor for hepatic glucose production, which has been reported to suppress feeding behaviour in ruminant studies through the stimulation of hepatic vagal afferents. The present review therefore proposes that an elevated colonic production of SCFA could stimulate numerous hormonal and neural signals at different organ and tissue sites that would cumulatively suppress short-term appetite and energy intake.
Human-induced eutrophication maintains high parasite prevalence in breeding threespine stickleback populations
Authors: BUDRIA ALEXANDRE , CANDOLIN ULRIKA
Published: December 2014

Anthropogenic activities are having profound impacts on species interactions, with further consequences for populations and communities. We investigated the influence that anthropogenic eutrophication has on the prevalence of the parasitic tapeworm Schistocephalus solidus in threespine stickleback Gasterosteus aculeatus populations. We caught stickleback from four areas along the coast of Finland, and within each area from one undisturbed and one eutrophied habitat. We found the prevalence of the parasite to be lower in the eutrophied habitats at the start of the breeding season, probably because of fewer piscivorous birds that transmit the parasite. However, while the prevalence of the parasite declined across the season in the undisturbed habitat, it did less so in eutrophied habitats. We discuss different processes that could be behind the differences, such as lower predation rate on infected fish, higher food availability and less dispersal in eutrophied habitats. We found no effect of eutrophication on the proportion of infected stickleback that entered reproductive condition. Together with earlier findings, this suggests that eutrophication increases the proportion of infected stickleback that reproduce. This could promote the evolution of less parasite resistant populations, with potential consequences for the viability of the interacting parties of the host–parasite system.
Genetic and environmental influences on obsessive–compulsive behaviour across development: a longitudinal twin study
Authors: Krebs G. , Waszczuk M. A. , Zavos H. M. S. , Bolton D. , Eley T. C.
Published: December 2014

Background

Little is known about the factors influencing the stability of obsessive–compulsive behaviour (OCB) from childhood to adolescence. The current study aimed to investigate: (1) the stability of paediatric OCB over a 12-year period; (2) the extent to which genetic and environmental factors influence stability; and (3) the extent to which these influences are stable or dynamic across development.

Method

The sample included 14 743 twins from a population-based study. Parental ratings of severity of OCB were collected at ages 4, 7, 9 and 16 years.

Results

OCB was found to be moderately stable over time. The genetic influence on OCB at each age was moderate, with significant effects also of non-shared environment. Genetic factors exerted a substantial influence on OCB persistence, explaining 59–80% of the stability over time. The results indicated genetic continuity, whereby genetic influences at each age continue to affect the expression of OCB at subsequent ages. However, we also found evidence for genetic attenuation in that genetic influences at one age decline in their influence over time, and genetic innovation whereby new genes ‘come on line’ at each age. Non-shared environment influenced stability of OCB to a lesser extent and effects were largely unique to each age and displayed negligible influences on OCB at later time points.

Conclusions

OCB appears to be moderately stable across development, and stability is largely driven by genetic factors. However, the genetic effects are not entirely constant, but rather the genetic influence on OCB appears to be a developmentally dynamic process.
Rationale for Use of Dopamine Agonists in Parkinson's Disease: Review of Ergot Derivatives
Authors: Blanchet Pierre J.
Published: December 2014

While dopamine agonists are still traditionally used as adjunct medications to improve performance and smooth out motor response complications in advanced levodopa-treated Parkinson's disease, they are increasingly used in monotherapy or early in combination with levodopa particularly in patients under 65 years of age. Long-term studies using bromocriptine showed efficacy in lowering the cumulative levodopa dose and reducing the early incidence of levodopa-related motor response complications. New dopamine agonists have recently shown efficacy as adjunct medications in short-term trials. While we now have more options to fit our individual patients' needs and tolerance, it is important to view the new agonists in the light of the results obtained with ergot derivatives. In this article, the rationale for use and efficacy profile of the ergolines are briefly reviewed.
New Developments in the Surgery for Parkinson's Disease
Authors: Honey Christopher , Gross R.E. , Lozano A.M.
Published: December 2014

Despite optimization of medical therapy, a large number of patients with Parkinson's disease continue to be disabled. For this group, alternate treatment strategies such as neurosurgical intervention can be considered. Recent advances in neurosurgical techniques and in understanding the pathophysiology of motor disturbances in PD have made surgery safer and more effective. Functional neurosurgical procedures to lesion or electrically modulate dysfunctional basal ganglia circuits or to protect or restore dopaminergic transmission are being increasingly used. These procedures are having a profound impact on the motor disturbances of PD and are producing important improvements in quality of life of patients.
The Scientific Basis of Medication Choice in Symptomatic Migraine Treatment
Authors: Goadsby Peter J.
Published: December 2014

With the rapid advances in the treatment of acute attacks of migraine in the last few years and a number of new treatments, has come the practical clinical problem of comparing emerging acute attack therapies alone and with regard to current treatments. Acute migraine therapies can usefully be regarded as non-specific and specific, from the perspective of migraine, since some medicines, such as aspirin or paracetamol, are used to treat pain more broadly. In this review I will compare both non-specific and specific compounds. To some extent the introduction into trial then clinical use of sumatriptan, the first of the 5HT1B/1D agonists or triptans, brought new standards in both clinical trial design, and execution and clinical outcome. Thus sumatriptan has become the de facto gold standard and will be thus employed here. To be practical the discussion of the new triptans will be limited to those available widely, naratriptan, rizatriptan and zolmitriptan. There are two broad issues when comparing treatments: what end-point should be considered and then, how can different compounds be compared with respect to that end-point. In terms of end-points those used here relate to pain relief because they have been collected robustly in the clinical studies and, fortunately, rapid pain relief is what patients questioned in population-based studies rate highest in an acute attack medicine. Headache pain has been rated on a scale of nil, mild, moderate and severe and success rated as either a response, nil or mild pain, or headache free, nil pain, at two or four hours. The ideal comparison of the triptans would be a randomized controlled clinical trial directly comparing the medicines in each case. Given that these are not available for all the compounds and the well characterised placebo response in acute migraine studies, summary measures have been developed to express the differences between compounds to try and adjust for the varying placebo effect. The two most widely used are the therapeutic gain, response on active medication minus response on placebo, and the number-needed-to-treat (NNT). The NNT is the reciprocal of the therapeutic gain as a proportion. The strengths and weaknesses of this approach will be discussed, including the importance of the calculation of confidence intervals. It can be concluded that our current instruments are rather blunt and patient preference needs much greater study.
Evidence Based Migraine Prophylactic Drug Therapy
Authors: Becker W.J.
Published: December 2014

Prophylactic drug therapy is a major component of overall migraine management. However, because we do not know how currently used prophylactic drugs exert their beneficial effects in migraine, their use is based primarily on clinical trials. In general, prophylactic drugs are indicated when patients have three or more attacks a month and symptomatic medication use alone is not satisfactory. The choice of drug must be individualized, and is influenced by contraindications, potential side effects, the need to treat associated symptoms like tension-type headache and insomnia, and drug cost. Whether an individual patient will respond to a given drug cannot be predicted, but there are varying degrees of scientific evidence supporting the use of each prophylactic drug in migraine. This evidence is best for metoprolol, divalproex, amitriptyline, atenolol, flunarizine and naproxen. Based on placebo-controlled crossover studies, it would appear that at least some prophylactic drugs exert the greater part of their prophylactic effects very quickly, and that these also disappear very quickly once the drug is stopped. This may not apply to all prophylactic drugs and more research is needed. More well designed clinical trials are needed to guide our use of migraine prophylactic drugs. Although clinical experience is useful, placebo responses and variations in the migraine tendency over time can make interpretation of this experience difficult. Major advances will likely only occur once the pathogenesis of migraine and the mode of action of the prophylactic drugs is better understood.
Responsiveness of the Scripps Neurologic Rating Scale During a Multiple Sclerosis Clinical Trial
Authors: Koziol James A. , Lucero Adriana , Sipe Jack C. , Romine John S. , Beutler Ernest
Published: December 2014

Objective:

The Scripps neurologic rating scale (SNRS) is a summary measure of individual components comprising a neurological examination, designed for use in multiple sclerosis (MS). Our objective is to evaluate the responsiveness of the SNRS, within the context of a 2-year, randomized, double-blind crossover study of the efficacy of cladribine for treatment of secondary progressive MS.

Methods:

Effect sizes were determined for the SNRS and its components, separately for each treatment group (initial placebo, and initial cladribine) over both years of the clinical trial, using a standard random effects model.

Results:

Individual components tended to show positive effect sizes (improvement) during periods of active therapy in both treatment groups, and negative effect sizes (deterioration) during periods of no active therapy. Summation indices derived from the individual components of the SNRS seemed somewhat more stable than the individual components. The two components mentation and mood, and bladder, bowel, or sexual dysfunction, were rather unresponsive in our clinical trial.

Conclusion:

Changes in the components of the SNRS over the course of our clinical trial were consistent between the two treatment groups. Most components were moderately responsive; and, the summary SNRS score appropriately summarized the moderate magnitudes of change evinced in the individual components.
Temporal Dermoid Cyst with a Partial Dermal Sinus Tract
Authors: Shehadi Joseph A. , Johnston Karen M. , Alorainy Ibrahim A.
Published: December 2014

Background:

Cranial dermal sinuses are rare and occur most frequently in the posterior fossa and along the midline. Likewise, supratentorial dermoid cysts are very uncommon.

Method:

We report a unique case of an adult female patient with both a supratentorial dermoid cyst and an incomplete dermal sinus tract.

Results:

The patient is a 31-year-old female, who presented with a new onset complex partial seizure. Neuroimaging and surgery revealed a right superior temporal dermoid cyst with an associated dermal sinus tract. Furthermore, the dermal sinus tract was incomplete and had no cutaneous manifestations.

Conclusion:

We present a rare patient with an off midline supratentorial dermoid cyst associated with a uniquely incomplete cranial dermal sinus tract. The dermal sinus tract involved the bone, dura and intradural compartment, without involving the overlying skin. This represents a novel variant in the spectrum of cranial dermal sinus abnormalities.
The Molecular Basis and Clinical Management of Ataxia Telangiectasia
Authors: Spacey Sian D. , Gatti Richard A. , Bebb Gwyn
Published: December 2014

The unique combination of phenotypic manifestations seen in ataxia telangiectasia (AT) has intrigued neurologists, oncologists, radiation biologists and immunologists for several decades. Initially, the primary care givers of AT patients are often pediatricians but neurologists will inevitably become involved in their care. Over the last few years great strides have been made in understanding the genetic basis of this disease but useful therapeutic interventions are still not available. In this article, we review the clinical features and the current understanding of the pathophysiology of the syndrome. In addition, we address issues related to genetic counseling, prenatal diagnosis, screening and implications for AT heterozygotes.
Alien Hand Phenomena: A Review with the Addition of Six Personal Cases
Authors: Fisher C.M.
Published: December 2014

This is a comprehensive literature review of the motor abnormalities that have come to be included under the designation of Alien Hand Phenomena (AHP). Some of the disorders are dyspractic in nature - intermanual conflict, mirror movements, interference etc., while others - groping, grasping with inability to release, utilization etc. are frontal lobe reflexes. AHP are mainly associated with two pathological processes: 1) Infarction or hemorrhage in the territory of the anterior cerebral arteries; and 2) Corticobasal degeneration. Included in the review is a description of AHPin six personal cases of corticobasal degeneration. The summary includes a short discussion of the possible anatomy of 'free will'based on AHP.
Callosal Atrophy Correlates with Temporal Lobe Volume and Mental Status in Alzheimer's Disease
Authors: Black Sandra E. , Moffat Scott D. , Yu David C. , Parker Jayson , Stanchev Peter , Bronskill Michael
Published: December 2014

Background:

Recent studies have reported significant atrophy of the corpus callosum (CC) in Alzheimer's Disease (AD). However, it is currently unknown whether CC atrophy is associated with specific cortical volume changes in AD. Moreover, possible atrophy in extra-callosal commissures has not been examined to date. The purpose of the present study was to quantify atrophy in two cerebral commissures [the CC and the anterior commissure (AC)], to correlate this measure with cognitive status, and to relate commissural size to independent measures of temporal lobe volume in AD patients.

Methods:

A sample of AD patients and of age- and education-matched normal control subjects (NCs) underwent MRI and a cognitive test battery including the Dementia Rating Scale and Mini Mental State examination. Mid-sagittal regional areas within CC and AC were measured along with superior, middle and inferior temporal lobes volumes.

Results:

Alzheimer's Disease patients had significantly smaller callosa than did NCs. The callosal regions most affected in AD included the midbody, isthmus and genu. The isthmus and midbody areas of the CC were positively correlated with cognitive performance and with superior temporal lobe volume in AD patients. The mid-sagittal area of the AC and the superior temporal volumes did not differ between AD patients and NCs.

Conclusion:

The study demonstrated that the regional morphology of the CC correlates with current cognitive status and temporal lobe atrophy in AD. As well, the lack of difference for the AC suggests that commissural atrophy in AD is regionally specific.
The Role of Stereotactic Cyst Aspiration for Glial and Metastatic Brain Tumors
Authors: Niranjan Ajay , Witham Timothy , Kondziolka Douglas , Lunsford L. Dade
Published: December 2014

Objective:

To evaluate the role of stereotactic cyst aspiration in the context of multimodality management of cystic glial and metastatic tumors, we retrospectively reviewed our experience with 38 patients during a 10-year interval.

Methods:

All 38 patients had one or more computed tomography or magnetic resonance imaging guided stereotactic cyst aspirations. Twenty-seven patients had glial neoplasms and 11 had metastatic brain tumors. Twenty-two patients underwent cyst aspiration as the initial treatment modality while 15 patients had cyst aspiration following previous treatments.

Results:

In the immediate postoperative period, 19 of the 27 (70%) patients with gliomas and nine of the 11 (82%) patients with metastatic tumors experienced symptomatic improvement. No procedure-related morbidity was encountered. Twelve patients (31.5%) eventually required a catheter-reservoir system. Thirty-seven percent of patients with cystic glial neoplasms and 18% of patients with metastatic tumors had delayed cytoreductive surgery by craniotomy subsequent to stereotactic cyst aspiration. Reduction in tumor volume following aspiration facilitated Gamma knife radiosurgery in seven patients.

Conclusion:

Single stereotactic aspiration is a low risk procedure that provides immediate relief of symptoms in patients with cystic brain tumors. It appears to be valuable together with the use of other therapeutic strategies.
Endovascular Treatment of a “Blister-like” Aneurysm of the Internal Carotid Artery
Authors: McNeely P.D. , Clarke D.B. , Baxter B. , Vandorpe R.A. , Mendez I.
Published: December 2014

Backgound:

“Blister-like” aneurysms of the supraclinoid internal carotid artery have recently been recognized as having unique pathological and clinical features. Little is known regarding their optimal treatment modality.

Methods:

We report a case of a “blister-like” aneurysm of the internal carotid artery treated with Guglielmi detachable coil (GDC) embolization. Case Report: A 55-year-old man presented with a Hunt & Hess grade II subarachnoid hemorrhage. Computed tomography revealed diffuse subarachnoid blood. Cerebral angiography demonstrated a broad-based bulge on the medial wall of the right distal internal carotid artery. The patient was taken to the operating room and underwent a right pterional craniotomy and wrapping of this unclippable aneurysm. On postoperative day 11, he developed signs of vasospasm, and repeat angiography showed remarkable growth of the aneurysm. The aneurysm was believed to be amenable to endovascular therapy and was treated by GDC embolization. The patient recovered well and remained neurologically intact on follow-up examinations. Repeat cerebral angiography was performed three and nine months following his initial presentation and revealed a significant aneurysm neck remnant. This neck remnant was treated by repeat GDC embolization 13 months following his subarachnoid hemorrhage.

Conclusion:

“Blister-like” aneurysms of the internal carotid artery are important to recognize and are difficult to manage using traditional surgical approaches. Early repeated cerebral angiography is indicated and, where appropriate, endovascular therapy should be considered in the management of these patients.
Minimum Standards for Electromyography in Canada: A Statement of the Canadian Society of Clinical Neurophysiologists
Authors: Bolton C.F. , Benstead T.J. , Grand'Maison F. , Tardif G.S. , Weston L.E.
Published: December 2014

Background:

Electromyography (EMG) is a widely used diagnostic technique for disorders of the nervous system. The Canadian Society of Clinical Neurophysiologists (CSCN) promotes the education, evaluation and standards of EMG in Canada. A statement of practice standards was needed to clarify the position of the CSCN on several issues relevant to the practice of EMG.

Methods and Results:

A subcommittee of the CSCN reviewed current patterns of practice and established guidelines for review by the CSCN. The guidelines developed by the subcommittee were reviewed by the CSCN and adopted as recommendations for EMG practice. The subcommittee was charged with formulation of a document for publication.

Conclusion:

This document deals with minimum standards for electromyographer education, laboratory operation, equipment and a variety of special circumstances relevant to the practice of EMG. The standards can be adopted by EMG laboratories to guide quality assurance.
Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients
Authors: Saeed Abdullah Bin , Shuaib Ashfaq , Emery Derek , Al-Sulaiti Ghanem
Published: December 2014

Background and objectives:

Internal carotid artery dissection has been extensively studied and well-described. Although there has been a recent increase in the number of reported cases of vertebral artery (VA) dissection, the clinical variety of presentation and the early warning symptoms have not been well-described before. Our objectives in this study include: (1) To determine the early symptoms and warning signs which may help the clinician in the early identification and treatment of patients with VAdissection. (2) To explore the variety of clinical presentation of VA dissection and its relation to prognosis.

Design and setting:

Retrospective analysis of hospital records in a tertiary academic centre for the period 1989-1999.

Results:

Twenty-six patients were identified (13 men and 13 women). The mean age was 48. Possible precipitating factors were identified in 14 patients (53%). Sporting activity and chiropractic manipulations were the most common (15% and 11% respectively). Headache and/or neck pain was the prominent feature in 88% of patients and was a warning sign in 53%, preceding onset of stroke by up to 14 days. The most common clinical features included vertigo (57%), unilateral facial paresthesia (46%), cerebellar signs (33%), lateral medullary signs (26%) and visual field defects (15%). Bilateral VA dissection presented in six patients (24%). The most common region of dissection was the C1-C2 level (16 arteries, 51%). Intracranial VAdissection was found in eight arteries (25%). The majority of patients (83%) had favorable outcome. Poor prognosis was associated with (1) bilateral dissection; (2) intracranial VA dissection accompanied by subarachnoid hemorrhage. Only two patients reported stroke recurrence.

Conclusion:

Our findings show that VA dissection affects mainly middle age persons and involves both sexes equally. Headache and/or neck pain followed by vertigo or unilateral facial paresthesia is an important warning sign that may precede onset of stroke by several days. Although the majority of patients will have excellent prognosis, this was less likely in patients presenting with subarachnoid hemorrhage or bilateral VA dissection. Recurrence rate was low.
Familial Adenomatous Polyposis and Benign Intracranial Tumors: A New Variant of Gardner's Syndrome
Authors: Leblanc Richard
Published: December 2014

Introduction:

Familial adenomatous polyposis (FAP) is associated with malignant tumors of the central nervous system, predominantly medulloblastomas and glioblastoma multiforme (Turcot's syndrome) and with craniofacial osteomas (Gardner's syndrome). This report details the occurrence of benign, intracranial tumors in two related individuals with Gardner's syndrome, an asso ciation not previously described.

Patients and Methods:

A 57-year-old woman (the propositus), her sister, two of her nieces and one of her grandnephews were previously diagnosed with Gardner's syndrome. The propositus came to neurosurgical attention because of vertigo associated with what proved to be an epidermoid cyst of the cerebellopontine angle. Her unaffected children and her relatives with Gardner's syndrome were examined and underwent computed tomography or magnetic resonance imaging.

Results:

A 39-year-old woman with Gardner's syndrome, the niece of the propositus, was found to harbor an asymptomatic left frontal meningioma.

Discussion:

Familial adenomatous polyposis, Gardner's syndrome, and that variant of Turcot's syndrome in which medulloblastoma predominate, are associated with a mutation of the adenomatous polyposis coli gene. The demonstration that patients with Gardner's syndrome can also have benign, nonneuroglial, intracranial tumors adds to the previously known extracolonic lesions associated with FAP. The molecular characterization of our patients should reveal if benign intracranial tumors represent a pleiotropic manifestation of the adenomatous polyposis coli gene mutation or if other genes are implicated.
Genetic Counselling and Genetic Screening for Alzheimer’s Disease and Other Dementias
Authors: Sadovnick A. Dessa
Published: December 2014

Genetic and nongenetic factors have been identified to have roles in the etiology of dementia. Etiologic heterogeneity and genetic heterogeneity are recognized, especially for Alzheimer’s disease which is the most common form of dementia. Asymptomatic individuals are increasingly requesting genetic services such as genetic counselling, predictive testing and screening for genetic risk factors. This paper provides an overview of the current knowledge about genetic counselling and genetic screening for dementia as well as guidelines for the physician.
Preventing Dementia
Authors: Black S.E. , Patterson C. , Feightner J.
Published: December 2014

Primary prevention will become increasingly important as dementia prevalence increases and effective retardive therapies are developed. To date, only one randomized controlled trial (involving treatment of systolic hypertension) has demonstrated that the incidence of dementia can be reduced. Physicians should remain alert to possible secondary causes of dementia and correct these whenever possible. Primary and secondary prevention of stroke should reduce dementia related to cerebrovascular disease either directly or as a comorbid factor in Alzheimer’s disease (AD). Epidemiological studies have revealed a number of risk factors for AD including genetic mutation, susceptibility genes, positive family history, Down’s syndrome, age, sex, years of education, head trauma and neurotoxins. In case-control studies non-steroidal anti-inflammatory medication and estrogen replacement therapy appear to decrease the relative risk of developing AD. Further research to develop and test preventative therapies in AD and other dementias should be strongly encouraged.
PCV for Oligodendroglial Tumors: In Search of Prognostic Factors for Response and Survival
Authors: Fortin David , Macdonald David. R. , Cairncross J. Gregory , Stitt Larry
Published: December 2014

Background:

We report survival and pretreatment prognostic factors for survival and chemosensitivity in 53 oligodendrogliomas treated with PCV (procarbazine, lomustine and vincristine) chemotherapy.

Methods:

A total of 53 patients with histologically proven oligodendroglioma, anaplastic oligodendroglioma or oligo-astrocytoma and treated with PCVwere extracted from the London Regional Cancer Center database. A retrospective review was conducted to evaluate overall survival and pretreatment prognostic factors for survival and chemosensitivity.

Results:

The median survival time from diagnosis was 123.6 months. The overall five- and ten-year survival rates were 72.7% and 52.7% respectively. Age <40, seizure as an initial symptom, absence of cognitive deficit and presence of a homogeneous hypodense lesion without contrast enhancement on the initial pretreatment CT scan were all factors independently associated with favorable outcome. The presence of increased cellularity, pleomorphism, mitosis, vascular proliferation and grading as an anaplastic lesion using these surrogates on pathological assessment, were all associated with an unfavorable outcome in univariable analysis. In multivariable analysis, only the anaplastic grading and presence of increased cellularity were significant determinants of unfavorable survival. The only factor adversely associated with chemosensitivity was the presence of a focal symptom at presentation.

Conclusion:

Overall survival is significantly longer in oligodendroglial lesions than in fibrillary astrocytic tumors. A two tier grading system using standard morphological features seems accurate in predicting outcome in these patients. The presence of a neoplastic astrocytic component does not seem to impact the outcome. No clinical, radiological or pathological factor could be identified to reliably predict chemotherapy response.
The Epidemiology of Infantile Spasms
Authors: Brna P.M. , Gordon K.E. , Dooley J.M. , Wood E.P.
Published: December 2014

Objective:

The aim of this study was to estimate population based incidence rates for infantile spasms (IS) and to study our clinical impression that the incidence of IS has recently decreased in the Canadian Provinces of Nova Scotia and Prince Edward Island.

Methods:

Birth cohorts from 1978 to 1998, identified through the hospital health records, EEG records and physician computerized databases, were followed for two years for the development of IS. Disease incidence rates were calculated using denominators derived from Statistics Canada's reported annual live birth rates.

Results:

The inclusion criteria for IS were fulfilled by 75 patients. The overall incidence of IS was 30.7/100,000 live births (95% CI 24.3, 38.8). Etiologic classification was symptomatic for 51 cases (68%), cryptogenic for 18 (24%), and idiopathic in six children (8%). Although there were more males (N=44) than females (N=31), the incidence rates were similar. There was a marked variability in annual and five-year incidence rates.

Conclusion:

Although the clinical characteristics of our patients were similar to other reported IS populations, the instability in IS incidence rates indicates a need for caution in interpreting smaller IS epidemiologic studies.
Parent Perceptions of the Value of Pediatric Neurology Clinic Visits
Authors: Dooley J.M. , Gordon K.E. , Wood E.P.
Published: December 2014

Background:

There is little data available on the acceptability to parents, of alternate methods of delivering care to their children. This pilot study explored parents'perceptions of conventional clinic visits and their attitudes to potential alternative methods of delivering care.

Methods:

Questionnaires were completed by the families of 200 consecutive children before and after a visit to a tertiary-care Pediatric Neurology Clinic in Nova Scotia, Canada.

Results:

Responses were received from 172 (86%) for the first questionnaire and 138 (69%) for the second. There were 59 new referrals, 76 follow-up visits and 39 were seen because of new concerns. Visiting the clinic resulted in school absenteeism for 85% of the children and lost pay for 19% of the parents. Telephone, video conference or replacement of the physician by a nurse practitioner were acceptable alternate methods of assessment for only 10%. The only factor which was associated with willingness to accept telephone as an assessment modality was an initial opinion that the visit was unnecessary.

Conclusion:

Escalating health care costs and limited specialist availability demand consideration of alternate methods of care delivery. Although adults seem comfortable with care outside the usual clinic setting, there is little data for the pediatric setting. The responses from the parents attending our clinic, indicate that families were happy with services offered in the conventional clinic. In contrast, only 10% found potential alternate methods acceptable. These opinions must be considered in the design of new methods of caring for children.
The Role of MRI and Nerve Root Biopsy in the Diagnosis of Neurosarcoidosis
Authors: Moore Fraser G.A. , Andermann Frederick , Richardson John , Tampieri Donatella , Giaccone Robert
Published: December 2014

Objectives:

Neurological involvement occurs in 5-15% of patients with sarcoidosis and isolated “neurosarcoidosis” occurs in less than 1% of all cases. Classical clinical presentations have been described, such as bilateral facial palsy, but often the disease presents insidiously with varied signs and symptoms. We present a patient who required biopsy of a lumbar nerve root for diagnosis of chronic, progressive neurosarcoidosis and review the literature with an emphasis on diagnosis.

Methods:

We have reviewed a patient who presented with signs and symptoms related to infiltration of her meninges and nerve roots by sarcoidosis. All pertinent history and physical information was taken from interviews with the patient and review of her chart. Laboratory, radiographic, and pathological investigations are presented.

Results and conclusions:

A high index of suspicion is required for the diagnosis of neurosarcoidosis. Gadolinium-enhanced MRI is useful but the findings are often nonspecific, and there should be a low threshold for biopsy whenever the diagnosis is considered.