Background: This study aims to review the clinical outcomes, extent of resection, complications, and prognostic factors in patients undergoing endonasal endoscopic resection (EEA) of anterior cranial base meningiomas. Methods: We conducted a retrospective review of 25 patients who underwent EEA resection of these lesions between 2001 and 2023. We assessed the extent of resection, complications, postoperative outcomes, and key technical aspects of the procedure. Results: 84% of patients were classified as ASA class III. Additionally, 64% of patients presented with visual disturbances. The mean blood loss was 472 ml. Intraoperative lumbar drains were used in 40% of cases, and dural sealants in 56%. A pedicled nasal flap was employed for reconstruction in 92% of cases. One vascular injury was documented, and 16% of patients developed a cerebrospinal fluid (CSF) leak in the postoperative period The degree of resection varied according to tumor location. Prognostic factors for achieving gross total resection, functional improvement, and key factors for reconstruction are discussed. The rate of CSF leaks decreased dramatically in the later years of the series Conclusions: Cranial base meningiomas can be successfully managed via a purely endoscopic endonasal approach, with acceptable morbidity and mortality rates.

Background: Access to neurosurgical care is vital for conditions such as traumatic brain injuries and brain tumours. However, significant disparities in healthcare access persist in Canada, disproportionately affecting rural, Indigenous, and socioeconomically disadvantaged populations. This qualitative scoping review examines barriers and facilitators to neurosurgical access, addressing gaps in the literature concerning equity-deserving groups. Methods: A systematic literature search (2000–2024) was conducted within MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Scopus, along with gray literature from governmental and non-governmental organizations. From 1400 identified records, eight qualitative or mixed-methods studies met the inclusion criteria. Thematic analysis was conducted to explore socioeconomic, geographic, racial, gender-based, and cultural barriers. Results: Four major themes emerged: delays in access, alternative healthcare options, policy barriers, and communication and coordination issues. Barriers such as transportation gaps, socioeconomic inequities, and systemic discrimination were particularly pronounced for rural and Indigenous populations. Facilitators like telehealth and improved inter-hospital coordination show potential but are limited by infrastructure constraints and cultural misalignments. Conclusions: Addressing barriers to neurosurgical care requires systemic reforms, including equitable resource allocation, expanded digital infrastructure, and culturally competent care. The lack of intersectional research on overlapping barriers underscores the need for future studies to prioritize tailored interventions to ensure timely, equitable neurosurgical care across Canada.

A new species of Loimos MacCallum, 1917 is described more than half a century after the last species was described in 1972. The new species was collected from the gills of Rhizoprionodon taylori (Ogilby, 1915) off the Central Queensland coast, Australia, and is the first Loimos species and the first representative of the Loimoinae Price, 1936 known from Oceania. A detailed morphological description and 28S rDNA molecular sequences are provided for the new species. In the molecular phylogeny based on available 28S rDNA sequences for relevant Monocotylidae, the new species grouped together with the only other Loimos sequence available in GenBank, that of the nonugen Loimos sp. from China (OM060238), sister to Loimosina wilsoni Manter, 1944. The estimated genetic divergence between the new species and the nonugen Loimos sp. sequence is low, between 0.0452 and 0.0737, suggesting that the nonugen sequence may represent the new species, or a very closely related congener. Host identity was confirmed by comparing COI sequences with those of known sharks in GenBank. We also provide the first 12S and 16S molecular sequences for this shark species.

Background: Association between age, frailty, and the receipt of thrombectomy for acute ischemic stroke is not well understood. Methods: We conducted a population-based retrospective cohort study of adults hospitalized with an ischemic stroke between 2018 and 2022 in Ontario, Canada. In sex-stratified models, we studied whether frailty (based on hospital-based frailty index: mild, moderate and severe) modified the association between age and thrombectomy by using interaction terms in multivariable modified Poisson regression models. Results: Among 59,346 patients (median age 75 years, 47.0% female) with ischemic stroke 4,454 (7.5%) received thrombectomy, with no sex differences in this treatment. In both sexes, increasing age was associated with decreased use of thrombectomy (adjusted risk ratio [aRR] for every 5-year increase, female = 0.91; 0.89-0.92; male = 0.92; 0.90-0.94). Frailty was not associated with thrombectomy in females (aRR high vs. low frailty = 0.86; 0.68-1.10) or males (aRR high vs. low frailty = 1.10; 0.87-1.39). Furthermore, the interaction between age and frailty was not significant for either sex. Conclusions: Frailty was not associated with thrombectomy in either sex, and it did not modify the association between age and thrombectomy, suggesting a greater role of chronological age compared to frailty in thrombectomy decisions in ischemic stroke patients.

Background: Pathogenic variants in SYNGAP1causedevelopmental and epileptic encephalopathy (DEE) and intellectual disability. Seizures are medically refractory and there is limited evidence on the use of corpus callosotomy (CC) and vagal nerve stimulation (VNS). Methods: A retrospective study was completed examining the effectiveness of VNS and CC in children with SYNGAP1-DEE using the SynGAP Research Database and an additional child followed at our centre. Results: Fifteen patients from the SynGAP Database were included. Of those who had VNS (n=11), 7 children had an >50% reduction in seizure frequency (n=7/11, 64%), 2 had worsening (n=2/11, 18%), 1 had no change (n=1/11, 9%), and 1 had an unknown response (n=1/11, 9%). Two children had CC only, 1 had complete seizure freedom, and 1 had a >50% reduction. Two children underwent VNS and CC, 1 had a >50% reduction in seizure frequency and the other had no change. One child followed at our centre experienced a sustained >80% reduction in seizure frequency following CC (i.e., after 1.5 years). Conclusions: We provide the first in-depth description of the response to VNS and CC in children with SYNGAP1-DEE, and provide insight into the use of of palliative surgical procedures in this population.

In this article, I argue for a “multifunctional account” of political feasibility and against recent attempts by several theorists to defend accounts of political feasibility that reduce feasibility judgments to a single function. According to the view I defend, political feasibility can (and should) serve multiple useful functions in our political deliberative practices. This pluralist and context-dependent approach allows us to retain the insights provided by various monofunctional accounts, while avoiding the limitations of each.

Trematodes of the genus Paralecithodendrium parasitize bats worldwide. Among them, the identification of Paralecithodendrium longiforme and Paralecithodendrium cryptolecithum is complicated by their high morphological similarity. We studied Paralecithodendrium trematodes from the small intestine of bats inhabiting the Middle Volga region (European Russia). The aim of our study was to analyze these two Paralecithodendrium species using both morphological and molecular phylogenetic approaches. Here, we present the first complete morphological description and molecular phylogenetic analysis of Paralecithodendrium cryptolecithum from bats in Russia and confirm the validity of this species.

Background: This study explored whether Myelin Water imaging could detect myelin injury in Anti-NMDA receptor autoimmune encephalitis (NMDAr-AIE), where traditional neuroimaging is often normal. Myelin Water Fraction (MWF) quantifies myelin content by distinguishing myelin sheath water from other brain water compartments. Methods: Adult participants with confirmed NMDAr-AIE diagnoses and healthy controls (HC) underwent 3T brain MRI including MWF mapping. Participants were recruited after discharge from the hospital. Mean MWF was calculated for 4 white matter regions of interest (ROI). Patient demographics, clinical assessments, treatment, and outcomes were collected. Results: Five participants with NMDAr-AIE (4F/1M, mean age 30, SD 7) and four HC (3F/1M, mean age 36, SD 6) were included. All NMDAr-AIE participants had normal or non-specific T2 hyperintensities on initial imaging and had received immunotherapy. The mean Modified Rankin Score (MRS) on discharge was 2. MWF (mean ± SD) for normal-appearing white matter, corpus callosum, corticospinal tract, and superior longitudinal fasciculus were 0.10±0.02, 0.12±0.02, 0.15±0.03, 0.12±0.02, which were very similar to HC at 0.09±0.02, 0.11±0.01, 0.15±0.02, and 0.11±0.02, respectively. Conclusions: Myelin Water imaging showed no myelin pathology in five NMDAr-AIE patients, with MWF values comparable to HC. This suggests that myelin pathways are relatively preserved post-recovery from AIE.

Background: Anti-CD20 monoclonal antibodies are highly effective for RMS treatment. Ocrelizumab (OCR) is standard, while Rituximab (RTX) is an alternative. The impact of anti-CD20 therapies on immune markers remains understudied, though deficiencies are frequently observed and have been associated with increased risk of infection. Our objective is to characterize and compare lymphocyte, neutrophil, and immunoglobulin levels in OCR- versus RTX-treated persons with RMS. Methods: This retrospective chart review included RMS patients on OCR or RTX (2017–2023). Pre- and post-treatment levels of lymphocytes, neutrophils, and immunoglobulins (IgG, IgA, IgM) were analyzed. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used for survival analysis. Results: 350 patients (OCR=175, RTX=175) were included. The mean treatment length was 60.9 (SD 19.1) months for OCR and 42.7 (SD 19.5) months for RTX. RTX was associated with a significantly shorter time to IgM deficiency (29.6 vs. 40.0 months, p=0.02). Cox analysis confirmed RTX increased IgM deficiency risk (HR=1.54, 95% CI: 1.06-2.23, p=0.02). No differences were seen for lymphocytes, neutrophils, IgG, or IgA. Conclusions: RTX was associated with a shorter time to and increased risk of IgM hypogammaglobulinemia compared to OCR, highlighting the importance of long-term monitoring. Further research is needed to guide treatment decisions.

Background: Artificial intelligence (AI) holds promise to predict outcomes for patients sustaining moderate to severe traumatic brain injury (msTBI). This systematic review sought to identify studies utilizing AI-based methods to predict mortality and functional outcomes after msTBI, where prognostic uncertainty is highest. Methods: The APPRAISE-AI quantitative evidence appraisal tool was used to evaluate methodological quality of included studies by determining overall scores and domain-specific scores. We constructed a multivariable linear regression model using study sample size, country of data collection, publication year and journal impact factor to quantify associations with overall APPRAISE-AI scores. Results: We identified 38 studies comprising 591,234 patients with msTBI. Median APPRAISE-AI score was 45.5 (/100 points), corresponding to moderate study quality. There were 13 low-quality studies (34%) and only 5 high-quality studies (13%). Weakest domains were methodological conduct, robustness of results and reproducibility. Multivariable linear regression highlighted that higher journal impact factor, larger sample size, more recent publication year and use of data that were collected in a high-income country were associated with higher APPRAISE-AI overall scores. Conclusions: We identified several study weaknesses of existing AI-based prediction models for msTBI; this work highlights methodological domains that require quality improvement to ultimately ensure safety and effiicacy of clinical AI models.

We investigate the evolution of active galactic nucleus jets on kiloparsec-scales due to their interaction with the clumpy interstellar medium (ISM) of the host galaxy and, subsequently, the surrounding circumgalactic environment. Hydrodynamic simulations of this jet–environment interaction are presented for a range of jet kinetic powers, peak densities of the multiphase ISM, and scale radii of the larger-scale environment – characteristic of either a galaxy cluster or poor group. Synthetic radio images are generated by considering the combination of synchrotron radiation from the jet plasma and free-free absorption from the multiphase ISM. We find that jet propagation is slowed by interactions with a few very dense clouds in the host galaxy ISM, producing asymmetries in lobe length and brightness which persist to scales of tens of kpc for poor group environments. The classification of kiloparsec-scale jets is highly dependent on surface brightness sensitivity and resolution. Our simulations of young active sources can appear as restarted sources, showing double-double lobe morphology, high core prominence (CP $\gt 0.1$), and the expected radio spectra for both the inner- and outer-lobe components. We qualitatively reproduce the observed inverse correlation between peak frequency and source size and find that the peak frequency of the integrated radio spectrum depends on ISM density but not the jet power. Spectral turnover in resolved young radio sources therefore provides a new probe of the ISM.

Cattle (Bos spp.) grazing on weed–mixed forage biomass may potentially spread weed seeds, leading to plant invasions across pasturelands. Understanding the possibility and intensity of this spread is crucial for developing effective weed control methods in grazed areas. This research undertook an in vitro experiment to evaluate the germination and survival of five dominant weed species in the southern United States [Palmer amaranth (Amaranthus palmeri S. Watson), yellow foxtail [Setaria pumila (Poir.) Roem. & Schult.], johnsongrass [Sorghum halepense (L.) Pers.], field bindweed (Convolvulus arvensis L.) and pitted morningglory (Ipomoea lacunosa L.)] upon incubation in rumen fluid for eight time periods (0, 4, 8, 12, 24, 24, 48, 72, and 96 h). For the 96-h treatment, a full Tilley and Terry procedure was applied after 48 h for stopping fermentation, followed by incubation for another 48 h simulating abomasum digestion. Seed germination, upon incubation, varied significantly among weed species, with I. lacunosa reaching zero germination after only 24 h of incubation, whereas A. palmeri and S. halepense retained up to 3% germination even after 96 h of incubation. The hard seed coats of A. palmeri and S. halepense likely made them highly resistant, whereas the I. lacunosa seed coat became easily permeable and ruptured under rumen fluid incubation. This suggests that cattle grazing can selectively affect seed distribution and invasiveness of weeds in grazed grasslands and rangelands, including the designated invasive and noxious weed species. As grazing is a significant component in animal husbandry, a major economic sector in the U.S. South, our research provides important insights into the potential role of grazing as a dispersal mechanism for some of the troublesome arable weeds in the United States. The results offer opportunities for devising customized feeding and grazing practices combined with timely removal of weeds in grazeable lands at the pre-flowering stage for effective containment of weeds.

We present the first radio–continuum detection of the circumstellar shell around the well-known WN8 type Wolf-Rayet star WR16 at 943.5 MHz using the Australian Square Kilometre Array Pathfinder (ASKAP) Evolutionary Map of the Universe (EMU) survey. At this frequency, the shell has a measured flux density of 72.2$\pm$7.2 mJy. Using previous Australia Telescope Compact Array (ATCA) measurements at 2.4, 4.8, and 8.64 GHz, as well as the Evolutionary Map of the Universe (EMU) observations of the star itself, we determine a spectral index of $\alpha\,=\,+0.74\pm0.02$, indicating thermal emission. We propose that the shell and star both exhibit thermal emission, supported by the its appearance in near-infrared and H$\alpha$ observations. The latest Gaia parallax is used to determine a distance of 2.28$\pm$0.09 kpc. This star is well known for its surrounding circular nebulosity, and using the distance and an angular diameter of $8.^{\prime}42$, we determine the shell size to be 5.57$\pm$0.22 pc. We use the Gaia proper motion (PM) of WR16 to determine peculiar velocities of the star as $V_{\alpha}(pec) =$ –45.3$\pm$5.4 km s$^{-1}$ and $V_{\delta}(pec) =$ 22.8$\pm$4.7 km s$^{-1}$, which indicates that the star is moving in a north-west direction, and translates to a peculiar tangential velocity to be 50.7$\pm$6.9 km s$^{-1}$. We also use these proper motion (PM) to determine the shell’s origin, estimate an age of $\sim 9500\pm 1300$ yr, and determine its average expansion velocity to be $280\pm40$ km s$^{-1}$. This average expansion velocity suggests that the previous transitional phase is a Luminous Blue Variable (LBV) phase, rather than a Red Super Giant (RSG) phase. We also use the measured flux at 943.5 MHz to determine a mass-loss rate of $1.753\times 10^{-5}\,{\rm M}_\odot\,$yr$^{-1}$, and use this to determine a lower-limit on ionising photons of $N_{UV} \gt 1.406\times 10^{47}\,\textit{s}^{-1}$.

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is the increase in heart rate (HR) by ≥30 bpm within 10 minutes of upright posture without orthostatic hypotension (OH). This study specifcally investigated patients who develop delayed symptomatic orthostatic tachycardia (i.e. after >10 minutes) without OH. Methods: Clinical histories and laboratory tests of patients assessed for orthostatic intolerance (OI) during last 10 years were reviewed. All patients underwent autonomic tests (sweat test, heart rate variability to deep breathing/Valsalva, 45-minute head up tilt table test (TTT) and quantitative sensory testing. Results: Among 974 patients with OI, 43% (419/974) were diagnosed with POTS whereas 12.4% (121/974) had delayed orthostatic symptoms on TTT alongwith delayed orthostatic tachycardia (DOT; x¯ = 30.3 minutes) without OH. In this cohort, mean HR increase was 51.7 bpm (range: 40-104 bpm). Other findings were significant narrowing of pulse pressure (PP) i.e. ≤25% of systolic pressure (x¯ = 16.2%, range: 6.4% -24.3%), excessive BP oscillations and syncope (9.9%). About 1/3 (37.2%) with DOT had definite small fiber/autonomic neuropathy. Conclusions: Patients with OI may manifest delayed symptoms/DOT and maybe missed on a 10-minute TTT. The marked reduction in PP observed in these pateints signifies reduced cardiac output, possibly from peripheral blood pooling due to small fiber/autonomic neuropathy.

Background: Canadian neurosurgery residency programs have an alarming 28.4% attrition rate—seven times higher than the average for most other specialties (1–4%) and double that of US neurosurgery programs. Canadian data for this issue is over 30 years old, highlighting the need for updated research. This study identifies factors contributing to Canadian neurosurgery attrition rates. Methods: Using critical constructivist theory, virtual interviews were conducted with current program directors (PDs) from Canada’s 14 neurosurgery programs and neurosurgery residents who left training between 2013–2023. Interviews were recorded, transcribed, anonymized, and iteratively coded through descriptive thematic analysis to construct an analytical framework. Results: We conducted interviews with 7 PDs and 7 former neurosurgery residents, representing 7 neurosurgery programs across Canada. The average attrition rate was 14.11% (0%–28.6%) from 2013–2023. Contributing factors include poor job prospects in Canada, resource constraints leading to high workloads, poor work-life balance, moral distress due to high levels of patient mortality, and a lack of teaching and support from staff and senior residents. Conclusions: Neurosurgery residents are the future of neurosurgery. Our study uncovers factors contributing to high attrition rates in neurosurgery training, indicating that change must come from provincial governments and within training programs to retain residents.

Background: The COVID-19 pandemic posed significant challenges for people with multiple sclerosis (PwMS) in Oman, including heightened stress, treatment disruptions, and risks associated with immunosuppressive therapies. This study aimed to evaluate the pandemic’s impact on MS management, COVID-19 incidence and outcomes, psychosocial and mental health effects, and demographic and clinical predictors influencing these outcomes among Omani PwMS. Methods: In this cross-sectional study conducted from January to April 2021, 104 PwMS aged 18–60 participated in structured interviews and completed the Expanded Disability Status Scale (EDSS) and the World Health Organization Well-being Index (WHO-5). Clinical data on relapse rates, disease-modifying therapies (DMTs), and treatment adherence were analyzed using descriptive and inferential statistics. Results: Of the participants, 76 (73.1%) were female, and 23 (22.1%) reported contracting COVID-19, with fatigue being the most common symptom (87%). Female sex (p = 0.042), younger age (18–34 vs. 35–45 years; p = 0.014), COVID-19 diagnosis (p = 0.037), and lower mental well-being scores (p = 0.021) were strongly associated with COVID-19-related effects. Conclusions: Key predictors of self-reported COVID-19 effects in Omani PwMS were a confirmed diagnosis, female sex, younger age, and lower mental well-being. These findings highlight the need for exploration of mental resilience in this group and interventions during crises.

In Iceland, sheltered rocky intertidal zones like Breiðafjörður bay are dominated by monospecific stands of Ascophyllum nodosum, providing key habitats for marine organisms. Increasing demand for A. nodosum has led to its commercial exploitation, yet impacts on fish assemblages remain poorly known. Using a novel multi-mesh netting approach, we characterised seasonal patterns in fish composition, abundance, size structure, age, and diet. Additionally, to assess the local effects of seaweed harvesting, commercial harvesting was conducted, with comparisons being made between treatment and control unharvested areas during different seasons. Nine fish species were identified, with Pollachius virens, Myoxocephalus scorpius, and Gadus morhua being the most common. Fish abundance peaked in summer, and declined the following spring, suggesting cohort turnover with juvenile gadoids relying on these habitats as nurseries. P. virens showed increased length through seasons, whereas no trends in length or abundance were observed for M. scorpius. Effects of seaweed harvesting were minimal, although fish diversity was slightly higher and G. morhua significantly larger in control plots. Stomach contents exhibited a greater diversity of prey types in harvested sites, suggesting potential impacts on trophic dynamics. These findings underscore the importance of A. nodosum-dominated habitats as nursery grounds for commercially valuable gadoids and highlight the need for a precautionary approach to seaweed harvesting to maintain ecosystem health.

Background: Congenital myopathies (CM) are inherited muscle disorders historically classified according to features seen on muscle biopsy and congenital-onset weakness and hypotonia. The aim of our study was to evaluate the benefit of genetic testing, muscle biopsy, NCS/EMG and muscle MRI in obtaining a definite diagnosis for these patients. Methods: A retrospective chart review of all patients diagnosed at a single tertiary-care pediatric hospital over 15 years (2008-2022). REB approval was obtained. Results: Over a period of 15 years, 42 patients with CM were included. All (100%) had genetic testing (i.e. gene panel, WES), 65.9% had muscle biopsy, 67.5% had NCS/EMG and 20% had a muscle MRI. Definite diagnosis was obtained in 38% by genetic testing only, while 42.8% had a diagnosis made by genetic testing supported by the findings of one or more of the other diagnostic tools. Conclusions: Early diagnosis of CM is still essential in congenital myopathies to provide optimal care. Genetic testing is the gold standard for diagnosis, but other diagnostic tools remain valuable in the case of variants of unclear significance.