In recent years, the removal of orbital debris has become an increasingly urgent task due to advancements in human space exploration. Capturing space debris through caging manipulation offers notable advantages in terms of robustness and controllability. This paper proposes a configuration-based caging manipulation design method for a cable-driven flexible arm. First, the cable-driven flexible arm with multi self-lockable links is introduced. To quantify the caging configurations formed by different self-lockable link selections, a novel planar caging quality metric is then presented for arbitrary planar objects. Using this metric, a caging design method is developed for the flexible arm to conduct caging manipulations. Finally, the caging manipulation strategies are discussed with lock selection maps for different objects, and a robust caging strategy considering uncertainty is further explored. Simulation and experimental results validate the effectiveness of the proposed caging design method and demonstrate better performance compared to conventional caging methods.

Background: Normalized growth curves are an essential component in management of pediatric patients. Benign enlargement of subarachnoid spaces (BESS) is a common condition in infants that results in deviation from expected head growth but does not have long term implications. Differentiating BESS from pathological conditions is critical to minimize unnecessary imaging and specialist evaluations. Standardized growth charts specific to BESS do not exist, complicating monitoring and management. Methods: An analysis of head circumference (HC) data was performed for 315 children aged 0-6 years diagnosed with BESS at CHEO. Growth charts were created using Generalized Additive Models for Location, Scale, and Shape (GAMLSS). Z-scores derived from HC measurements were compared to World Health Organization (WHO) norms, stratified by sex. Results: Benign macrocephalic patients consistently tracked above the 97th percentile of WHO curves, with the 50th percentile in this cohort aligning with the 97th percentile of WHO data. HC growth accelerated in early infancy, stabilizing around ages 2-3. Growth charts demonstrated distinct patterns for BESS compared to normative data. Conclusions: This study provides novel charts for BESS, enabling improved monitoring and clinical management. These charts have the potential to reduce unnecessary imaging and specialist referrals, alleviating anxiety for caregivers and clinicians while optimizing resource use.

This project aims to identify and explain a phenomenon I call pain-related motivational deficit, which occurs when there is proper uptake of the epistemic contributions of a pain utterance, but defective uptake of the motivational contributions of a pain utterance. I argue that the normalization of fibroid pain in Black women, and of menstrual pain more broadly, causes a pain-related motivational deficit to be unfairly assigned to utterances about these pain experiences. I show that current ways of thinking about epistemic injustice cannot adequately explain these cases.

After dispensing major precedents affecting the public’s health in each of its prior three terms, the 2024-2025 term of the US Supreme Court was arguably less impactful amid several unanimous decisions preserving existing jurisprudence (at least in part). However, this is an understatement. While the Court issued key decisions arguably favorable to communal health this prior year it also denied minors access to medical procedures sought by their doctors, diminished diversity, equity, and inclusion (DEI) initiatives in employment, allowed states to deny health providers access to Medicaid because they also provided abortions, disallowed rural hospitals from collecting specific costs for treating low-income patients, and provided a “script” of sorts for executive control of federal health advisory committees.

Background: Aplasia Cutis Congenita is a rare congenital abnormality characterized by varying absence of skin and mesodermal tissues. Management remains controversial, with significant inconsistency across specialties and over time. This review evaluates trends in management based on journal specialty and publication epoch. Methods: A review of pediatric scalp Aplasia Cutis Congenita management was conducted. Articles were categorized by journal type (neurosurgery, plastic surgery, dermatology, other medical, and other surgical) and management approach (surgical, conservative, or combined). Descriptive statistics were used to summarize trends in recommendations, and assess associations between journal type and treatment. Trends over time were analyzed based on publication year. Results: A total of 171 studies were included. Among surgical journals, 33.7% recommended surgical management, while medical journals favored conservative (14.1%) or combined approaches (84.5%) (p < 0.001). Recommendations for surgical management decreased from 80% in the 1970s to 30% in the 2020s. Notably, among 119 studies advocating for a combined approach, only 27 provided criteria for surgical indications, with lesion thresholds ranging from >1cm to >15 cm. Conclusions: This study highlights the lack of guidelines for ACC management and reveals specialty and time epoch of publication-dependent biases in treatment. These findings emphasize the need for multidisciplinary guidelines for consistent, patient-centered care.

A local food-based approach, including school lunch with multiple-micronutrient fortified biscuits (MMB) as supplementary snacks, may enhance dietary adequacy, although current evidence remains limited. This study assessed nutrient inadequacies and developed food-based dietary recommendations (FBR) incorporating school lunch from the Ghana School Feeding Programme (GSFP) and MMB. Data from 292 girls aged 10–17 years, enrolled in the Ten2Twenty-Ghana study was analysed. Dietary intake was assessed via a quantitative 24-h dietary recall. Usual intakes were estimated using the National Cancer Institute method. Linear programming with Optifood was used to develop FBRs based on commonly consumed foods (≥5% of participants) and their median serving sizes, intake frequency, nutrient content, and cost per 100 g. Constraints included estimated energy needs and harmonised average nutrient requirements. The mean usual energy intake was 2351 (sd 66) kcal/d. Ca (99·8 %), vitamin B12 (99·8 %), riboflavin (96·2 %), vitamin A (91·5 %), vitamin C (87·6 %), Fe (73·7 %), folate (49·3 %) and Zn (8·5 %) inadequacies were prevalent. Optimised diets achieved adequacy for protein and most micronutrients, except Ca and vitamin B12, besides vitamin A for 15–17-year-old girls. School lunch from the GSFP did not enhance micronutrient levels when added to the daily diet. Adding MMB to the daily diet ensured adequacy for vitamin C, riboflavin and Fe, although marginal for Fe. Ca and vitamin A improved substantially with MMB for girls aged 15–17 but remained below the harmonised average requirements. Integrating regular school lunch with specialised fortified foods may be a cost-effective strategy to enhance dietary adequacy for adolescent girls in rural areas.

Background: Minimally invasive endoscopic techniques via the transorbital approach (ETOA) is emerging as an alternative approach for addressing skull base tumours. This study aims to showcase our institution’s 8 year experience in using ETOA, detailing the surgical technique employed and presenting comprehensive patient outcomes. Methods: A retrospective analysis was conducted on data from 32 patients who underwent ETOA within the past eight years. Demographic data was obtained as well as information on surgical approaches, intra-operative findings, recurrence and complications. Results: 33 ETOA procedures were performed on 29 patients, with an average age of 45, 14 of whom were women. The superior orbital corridor was utilized in 100% of cases, and in 79.17%, ETOA was complemented by a transnasal approach. Spheno-orbital meningioma accounted for the most common surgical indication (36.36%, n=12, followed by lateral frontal sinus mucocele (18.75%, n=6). The median length of stay was one day.Transient V1 numbness was the primary complication (33%, n=8), and 18.75% (n=6) necessitated another surgery. Notably, no mortality was associated with this procedure. Conclusions: Our institution’s experience underscores the notable safety and effectiveness of ETOA, The main complications being transient V1 numbness, proptosis, transient diplopia. Revision surgery was only required in 6 out of 33 cases.

Background: Nipocalimab (a fully human, effectorless anti-neonatal Fc receptor (FcRn) monoclonal antibody) may ameliorate gMG disease manifestations by selectively targeting FcRn IgG recycling and lowering IgG, including pathogenic autoantibodies in generalized myasthenia gravis (gMG). The objective was to evaluate the effectiveness and safety of intravenous nipocalimab added to background standard-of-care therapy in adolescents with gMG. Methods: Seropositive patients (12-<18 years) with gMG (MGFA Class II-IV) on stable therapy but inadequately controlled, were enrolled in a 24-week open label study. Nipocalimab was administered as a 30 mg/kg IV loading dose followed by 15 mg/kg IV every 2 Weeks. Results: Seven adolescents were enrolled; 5 completed 24-weeks of dosing. The mean(SD) age was 14.1(1.86) years; seven were anti-AChR+, six were female. Mean(SD) baseline MG-ADL/QMG scores were 4.29(2.430)/12.50(3.708). Nipocalimab showed a significant reduction in total serum IgG at week-24; the mean(SD) change from baseline to week-24 for total serum IgG was -68.98%(7.561). The mean(SD) change in MG-ADL/QMG scores at week-24 was -2.40(0.418)/-3.80(2.683); 4 of 5 patients achieved minimum symptom expression (MG-ADL score 0-1) by week-24. Nipocalimab was well-tolerated; there were no serious adverse events. There were no clinically meaningful laboratory changes. Conclusions: Nipocalimab demonstrated efficacy and safety in this 6-month trial in seropositive adolescents with gMG.

Background: Predicting neurological recovery in patients with severe brain injury remains challenging. Continuous EEG monitoring can detect malignant patterns but is resource-intensive, and its role in long-term functional outcome prediction is unclear. This study evaluates the utility of parameterized short-segment EEG, acquired via EEG cap, in predicting neurological recovery. Methods: We analyzed short-segment high-density EEGs from 42 patients in the NET-ICU cohort with acute neurological injury. EEGs were pre-processed into standard clinical formats and parameterized using five visual EEG features associated with outcome prediction. Random Forest Classifier (RFC) models were trained and cross-validated to predict recovery of responsiveness (following 1-2 step commands during or after ICU admission) using: EEG features alone; clinician prediction combined with EEG features. Results: EEG-based prediction outperformed clinician bedside assessment (AUC ROC: 0.80 vs. 0.67) under the RFC model. Combining clinician Glasgow Outcome Scale–Extended (GOSE) scores with EEG features improved overall predictive performance (AUC ROC: 0.91). Conclusions: Standardized EEG features obtained using EEG caps can improve the accuracy of neurological recovery predictions in patients with acute severe brain injury. This suggests that automated extraction of background brain signals has the potential to provide clinically meaningful prognostic information in critical care settings, enhancing accessibility and resource efficiency.

Background: The consistency of effects of lemborexant (LEM), a dual orexin-receptor antagonist, on sleep maintenance variables across 2 phase 3 studies with contrasting populations was compared. Methods: E2006-G000-304 (Study 304; NCT02783729) and E2006-J086-311 (Study 311; NCT04549168) were 1-month, randomized, double-blind, placebo (PBO)-controlled studies evaluating LEM 10mg (LEM10) in adults with insomnia disorder. Global Study 304 (N=1006; PBO, n=208; LEM10, n=269) enrolled participants of any race (≥55y); Study 311 (N=193; PBO, n=100; LEM10, n=93) participants were exclusively Chinese (≥18y). Pairs of polysomnograms were conducted at baseline and after the first/last 2 doses of the 1-month treatment. Change from baseline in sleep efficiency (SE [%]), wake-after-sleep-onset (WASO [min]), and total-sleep-time (TST [min]) were analyzed. Results: Mean baseline sleep parameters: Study 304: SE, 67.9–68.9; WASO, 111.8–114.8; TST, 325.1–330.7; Study 311: SE, 69.4–70.3; WASO, 79.3-–85.8; TST, 333.2–336.7. Least squares mean [standard error] increases from baseline were significantly larger with LEM10 vs PBO (P<0.001) for SE (Study 304, 8.0 [0.7]; Study 311, 7.1 [1.4]) and TST (38.9 [3.7]; 32.8 [6.9]), as were decreases in WASO (-25.4 [3.1]; -17.8 [4.8]). Most treatment-emergent adverse events were mild–moderate. Conclusions: Short-term LEM10 treatment consistently improved objective sleep maintenance in patients with insomnia of different races.

Background: This study aimed to assess the clinical features, Electroencephalography (EEG) findings, and brain imaging results in psychiatric patients diagnosed with epilepsy at Razi Psychiatric Hospital. Methods: This retrospective descriptive-analytical study was carried out on patients with epilepsy and psychiatric disorders admitted to Razi Psychiatric Hospital over two years. A total of 94 patient files seizure and epilepsy comorbidity, recorded in the hospital’s health information system (HIS), were reviewed. Data collection involved a demographic checklist and an epilepsy scale; the latter, developed by DiIorio, Colleen, et al., encompassed personal characteristics, mental disorders, epilepsy, and seizures. The Kruskal-Wallis and MannWhitney non-parametric tests were utilized to compare the mean scores of variables, with SPSS software, version 21 facilitating the analysis Results: Out of 94 patients with seizure and epilepsy, 9.6% had focal seizure, 26.6% had generalized epilepsy, 36.1% had focal-generalized seizure, and 26.8% had unknown seizure. About 12% had a structural etiology, while the remaining 88% had an etiology that remained unidentified. Conclusions: The findings indicate that epilepsy, affecting individuals from adolescence through to old age, can lead to psychiatric disorders. For many patients, the etiology of their condition remains elusive, and EEG findings and brain imaging appear normal in the majority of cases

Background: Medulloblastoma (MB), the most common malignant pediatric brain tumor, is often incurable upon recurrence, largely driven by treatment-resistant quiescent cells. While quiescent SHH MB populations have been identified, the mechanisms driving their chemoresistance remain unclear. Here, we investigate the role of the cell cycle inhibitor p57 in inducing quiescence and show that dexamethasone, widely used in MB management, promotes p57-mediated quiescence, potentially reducing treatment efficacy. Methods: To assess p57’s role, we introduced a TMP-inducible p57 construct into Ptch1+/- SHH MB cells and treated them with vincristine. We also treated Ptch1+/- SHH MB cells with dexamethasone and quantified p57 levels and cell cycle states using high-throughput immunofluorescence imaging. Results: In culture, nuclear p57 was enriched in Sox2+ and Nestin+ stem-like SHH MB cells relative to rapidly-cycling Atoh1+ cells. Stabilizing p57 with TMP increased G0-phase cells six-fold, exhibiting survival to vincristine doses that caused complete cell death in controls. Dexamethasone treatment increased nuclear p57 by 40% and G0-phase cells by 15% in Ptch1+/- cells, while doubling G0-phase cells in Ptch1+/-;Trp53-/- cells. Conclusions: These findings suggest dexamethasone promotes p57-mediated quiescence, potentially contributing to chemoresistance in SHH MB. This raises critical concerns about the use of dexamethasone in MB treatment, as it may inadvertently enhance tumor recurrence.

Background: Antibodies directed against acetylcholine receptor (AChR) are absent in approximately 15% of patients with gMG. Approved treatment options represent an unmet need in the AChR-antibody (Ab)- gMG population. Efgartigimod is an immunoglobulin G1 (IgG1) antibody Fc fragment that selectively reduces IgG levels by blocking neonatal Fc receptor (FcRn)-mediated IgG recycling. Here, we describe efgartigimod efficacy in AChR-Ab- participants with gMG receiving either efgartigimod IV or subcutaneous (SC) efgartigimod PH20 (coformulated with recombinant human hyaluronidase PH20) across clinical studies. Methods: Post hoc analyses were conducted to examine efficacy and safety of efgartigimod IV and/or efgartigimod PH20 SC in AChR-Ab- participants in ADAPT/ADAPT+ and ADAPT-SC/ADAPT-SC+ trials. Results: Among pooled AChR-Ab- participants (n=56), mean (SE) MG-ADL total score improvement from baseline to Week 3 was -3.7 (Cycle 1: 0.44 [n=55]). Consistent MG-ADL improvements occurred with repeated cycles. Clinically meaningful improvements (CMI; ≥2-point MG-ADL decrease) occurred in 76.4% (n=42/55) of participants (Cycle 1, Week 3). In Cycle 1, 23.2% (n=13/56) of participants achieved minimal symptom expression (MG-ADL 0-1). Similar efficacy results occurred across all cycles. Overall safety profile was similar between AChR-Ab+ and AChR-Ab- participants. Conclusions: Both efgartigimod IV and efgartigimod PH20 SC were well tolerated and led to CMI in participants with AChR-Ab- gMG.

Background: Increased availability of genetic testing has led to increased burden of follow up of variants of uncertain significance (VUS). As of January 2025, 327 VUS were identified patients at BC Children’s Hospital. We propose a pipeline to triage and follow up of patients with identified VUS to clarify diagnosis through paternal testing. Methods: Of the 327 patients with VUS, 13 patients with high clinical suspicion for a genetic disorder were identified by their neurologist. Initial chart review for each patient was performed. Clinical phenotype data and the patient’s variant were inputted into the online tool Franklin. This program generates a variant interpretation based on 17/ 28 criteria in ACMG scoring. For each patient the variant would be assumed to be de novo in order to determine if parental testing could change variant classification. Results: 5/13 of the patients had suggested reclassification of variants. 6/13 of the patients would have reclassification of variant to likely pathogenic/pathogenic if the variant was found to be de novo, suggesting a need for paternal testing. Conclusions: This highlights a novel clinical pipeline to improve expediency and triaging of VUS reclassification for paternal testing in epilepsy genomics.

Background: While efgartigimod usage is expected to reduce immunoglobulin (IG) utilization, evidence in clinical practice is limited. Methods: In this retrospective cohort study, patients with gMG treated with efgartigimod for ≥1-year were identified from US medical/pharmacy claims data (April 2016-January 2024) and data from the My VYVGART Path patient support program (PSP). The number of IG courses during 1-year before and after efgartigimod initiation (index date) were evaluated. Patients with ≥6 annual IG courses were considered chronic IG users. Myasthenia Gravis Activities of Daily Living (MG-ADL) scores before and after index were obtained from the PSP where available. Descriptive statistics were used without adjustment for covariates. Results: 167 patients with ≥1 IG claim before index were included. Prior to efgartigimod initiation, the majority of patients (62%) received IG chronically. During the 1-year after index, the number of IG courses fell by 95% (pre: 1531, post: 75). 89% (n=149/167) of patients fully discontinued IG usage. Mean (SD) best-follow up MG-ADL scores were significantly reduced after index (8.0 [4.1] to 2.8 [2.1], P<0.05, n=73/167, 44%). Conclusions: Based on US claims, IG utilization was substantially reduced among patients who continued efgartigimod for ≥1-year, with patients demonstrating a favorable MG-ADL response.

Background: Computed tomography (CT) is common imaging modality, though its utilization of iodinated contrast media (ICM) has been historically associated with adverse effects on the kidneys including nephropathy. This study aims to investigate whether administration of ICM in critically ill patients is associated with reduced kidney function and acute kidney injury (AKI). Methods: Data was used from two prospective cohort studies- ACT-TBI and CANCCAP, where patients underwent a whole head CT perfusion with additional CT scans. Serum creatinine (CR) and glomerular filtration rate (eGFR) were sequentially collected for five days of their ICU stay. AKI was evaluated following the KDIGO criteria. Results: Of the 291 patients enrolled, a stratified trend analysis for eGFR could be conducted in 158 patients. No AKI was identified in any of these patients in our study. A significant upward trend in eGFR was observed in those older than 40 years (p=0.027), those with hypertension (p=0.027), diabetes (p=0.027) and history of smoking (p=0.027), The volume of ICM received was not significantly associated with patients’ eGFR. Conclusions: AKI was not identified in critically ill patients who received ICM but significant upward trend of eGFR was seen in older individuals and those with diabetes, hypertension, and a history of smoking.

Rodney M. Feldmann (1939–2024) had a remarkable scientific career. Publishing primarily in paleontology and geology during seven decades, his legacy includes more than 500 journal articles, conference proceedings, books, book chapters, field guides, and laboratory manuals, in addition to many abstracts of talks presented at conferences. His published work has considerable breadth, but much of it concerns the paleobiology of decapods and other crustaceans. He supervised 47 M.S. theses and 14 Ph.D. dissertations and served in multiple societies and organizations and on editorial boards. Prof. Feldmann was an inspiration to his many students and colleagues around the globe and has left a lasting impact on science.

Background: Although the history of the ketogenic diet dates back centuries, with the advancement of anti-seizure medications, the use of the diet for epilepsy declined. It was not until the early 1990s that there was a resurgence of the diet as an adjunct therapy to anti-seizure medication. In 1998, the Montreal Children’s Hospital introduced the ketogenic diet to a child with drug resistant epilepsy. Shortly after, a presentation of the ketogenic diet at hospital Grand Rounds met much skepticism. However, over time the diet has developed into a well-established treatment option for children with drug resistant epilepsy. Two hundred children have since utilized the diet at the Montreal Children’s Hospital. Methods: A review of patient files since the initiation of the program was undertaken. Data was extracted regarding adverse effects, common errors in both hospital and home setting, risks for unfavorable outcomes and parental concerns Results: The development of a rigorous protocol has reduced potential adverse effects, inadvertent complications from errors have improved and parent satisfaction enhanced. Conclusions: This poster will demonstrate how an interdisciplinary approach for a ketogenic diet protocol, involving an advanced Practice Nurse, nutritionist, neurologist and parent, resulted in improved care.