Background: Intravenous Immunoglobulin (IVIg) use for Central Nervous System (CNS) conditions has increased over the last decade. In many CNS disorders, robust evidence for IVIg efficacy is still lacking. Building on the success of the British Columbia (BC) Neuromuscular IVIg utilization initiative, Guidelines for IVIg use in CNS conditions were developed. A provincial screening program was launched in 2023. Methods: For CNS IVIg, requests, diagnosis, dosing, consultation letters and treatment questionnaires were reviewed. Patient management was compared to provincial guidelines. A letter was sent to the ordering physician with the results of the review and treatment recommendations when management differed significantly from guidelines. Review of the first year’s cases was conducted. Results: Over the first 11 months of the program, 79 IVIg renewal requests were reviewed. The most common diagnoses were antibody mediated autoimmune encephalitis, severe drug resistant non-surgical epilepsy and Susac’s syndrome. Recommendations included dose reduction, discontinuation of IVIg, or initiation of alternative therapies for many of the requests. Conclusions: IVIg may be effective in the management of some CNS inflammatory conditions. A physician-led utilization program in BC with targeted education to ordering physicians promotes best practice. Review of year one data will inform a quality improvement cycle to optimize the guidelines.

Since the theme of this issue is ‘back to the future,’ especially to the ways in which information formats before the age of printing anticipate and perhaps even may give some guidance to principles of organization and cognitive layouts for the ‘new’ science of information design, I am going to focus in my presentation on the design of memory storage, as it was taught and practiced in the Middle Ages. It is important to recognize that ‘memory-art’ accompanied every aspect of education in the ancient trivium, though different aspects and capacities of human memory were emphasized as appropriate to its various disciplines. What is commonly now taken to be ‘the art of memory,’ namely the advice to link powerful images of ‘content’ (imagines rerum) together in dramatic scenes conceived within a mental location (locus) (as described most completely in the early first century B.C. Rhetorica ad Herennium) is not a universal technique but specifically a device of Rhetoric, and thus of composition. There is also an ‘art of memory’ associated with Dialectic, and this is the device of the ‘topics’ or ‘seats’ (topoi) of argument, syllogism and enthymeme arranged in an orderly schematic of specific mental ‘places.’ Aristotle expounded this scheme as a variety of mnemonic art in his treatise Peri Topoi, and in turn it was further disseminated to later antiquity and the Middle Ages in works by Cicero and Boethius.

Members of the cat family are highly motivated to hunt, but in captivity are unable to do so for a variety of reasons. This inability to hunt may reduce their welfare. In this study we used a moving bait to stimulate and release hunting motivation in two captive cheetahs (Acinonyx jubatus). Essentially our enrichment device consisted of a dead rabbit, hung from a pulley, just above the ground, moving down a 34 metre length of wire by the force of gravity. We observed the cheetahs for 140 minutes per day over three sequential food presentation periods: Baseline (10 consecutive days), Device (10 consecutive days) and Post-device (5 consecutive days). The moving bait significantly increased the frequency of sprinting (hunting) and time spent performing observations. It significantly decreased time spent in affiliation and feeding. These effects were also observed at times other than when the moving bait was presented. Thus, a moving bait allows captive cheetahs to perform ‘natural-looking’ hunting in captivity.

Background: Intravenous immunoglobulin (IVIG) may benefit many inflammatory central nervous system (CNS) disorders based on multiple immunomodulatory effects. IVIg is being used in inflammatory CNS conditions however robust evidence and guidelines are lacking in many disorders. Over the last 5 years, the percentage of IVIg used for CNS indications within neurology almost doubled in British Columbia (BC), Canada. Clear local guidelines may guide rational use. Methods: Consensus guidelines for IVIG use for CNS indications were developed by a panel of subspecialty neurologists and the Provincial Blood Coordinating Office, informed by focused literature review. Guidelines were structured similarly to existing BC peripheral nervous system guidelines and Australian Consensus Guidelines. Utilization and efficacy will be monitored provincewide on an ongoing basis. Results: Categories of conditions for Conditionally Approved (N=11) and Exceptional Circumstance Use (N=5) were created based on level of evidence for efficacy. Dosing and monitoring recommendations were made and outcomes measures defined. Rationale for Not Indicated conditions (N=2) was included. Guidelines were distributed to BC neurologists for feedback. This system will be re-evaluated after 1 year. Conclusions: IVIG use in CNS inflammatory conditions has an emerging role. Guidelines for use and monitoring of outcomes will help improve resource utilization and provide further evidence regarding effectiveness.

Contact with livestock and consumption of unpasteurised dairy products are associated with an increased risk of zoonotic and foodborne infection, particularly among populations with close animal contact, including pastoralists and semi-pastoralists. However, there are limited data on disease risk factors among pastoralists and other populations where livestock herding, particularly of dromedary camels, is common. This cross-sectional study used a previously validated survey instrument to identify risk factors for self-reported symptoms. Adults (n = 304) were randomly selected from households (n = 171) in the Somali Region of Ethiopia, a region characterised by chronic food insecurity, population displacement, recurrent droughts and large semi-pastoralist and pastoralist populations. Multivariable logistic regression assessed associations between self-reported symptoms and type of milk consumed, controlling for demographics and human-animal interaction. Consumption of days-old unrefrigerated raw camel milk was significantly associated with symptoms in the 30 days prior to the survey (AOR = 5.07; 95% CI 2.41–10.66), after controlling for age, refugee status, sanitation, camel ownership and source of drinking water and accounting for clustering. Consumption of days-old unrefrigerated raw ruminant milk was significantly associated with symptoms (AOR = 4.00, 95% CI 1.27–12.58). Source of drinking water and camel ownership, a proxy for camel contact, were significantly associated with the outcome in each model. There were no significant associations between self-reported symptoms and fresh or soured animal milk consumption. Research is needed to identify pathogens and major routes of transmission. Tailored communication campaigns to encourage safe food preparation should also be considered.

Background: Autoimmune encephalitis (AE) is a recently described entity that presents with seizures, neuropsychiatric manifestations, and movement disorders. This observational chart review of AE aims to assess the burden of AE and related disorders at two Vancouver academic medical centers. Methods: All patients with Mitogen Laboratory AE antibody testing in 2018 were identified. Electronic hospital records were used to determine patient characteristics. Results: 1266 unique tests were ordered on 315 inpatients and outpatients. Of 37/315 (11.7%) seropositive patients, 26/37 (70.2%) patients had clinical data. Seropositive results included autoantibodies to NMDA (n=3), LG1 (n=2), CASPR2 (n=1) and paraneoplastic autoantibodies included GAD65 (n=2), PNMA2 (n=5), recoverin (n=3). There were four AE cases in 14 seronegative patients based on discharge diagnosis. 15/30 of patients had seizures and three developed status epilepticus. 15 had neuropsychiatric manifestations. 14 had a movement disorder. For inpatients, average length of stay was 24.3 days and there were 5 intensive care unit (ICU) admissions. Immunotherapies used included corticosteroids, PLEX, rituximab, IVIg, and cyclophosphamide. Conclusions: In two hospitals serving approximately two million people in 2018, there were 30 cases of AE in 2018. AE presents with a broad range of neurologic symptoms and seronegative testing does not preclude AE.

Background: Intravenous immunoglobulin (IVIG) may benefit many inflammatory central nervous system (CNS) disorders based on multiple immunomodulatory effects. IVIG is being used in inflammatory CNS conditions however robust evidence and guidelines are lacking in many disorders. Over the last 5 years, the percentage of IVIG used for CNS indications within neurology almost doubled in British Columbia (BC), Canada. Clear local guidelines may guide rational use. Methods: Consensus guidelines for IVIG use for CNS indications were developed by a panel of subspecialty neurologists and the Provincial Blood Coordinating Office, informed by focused literature review. Guidelines were structured similarly to existing BC peripheral nervous system guidelines and Australian Consensus Guidelines. Utilization and efficacy will be monitored provincewide on an ongoing basis. Results: Categories of conditions for Possible Indication (N=11) and Exceptional Circumstance Use (N=4) were created based on level of evidence for efficacy. Dosing and monitoring recommendations were made and outcomes measures defined. Rationale for Not Indicated conditions (N=3) was included. Guidelines will be distributed to BC neurologists for feedback and re-evaluated after 1 year. Conclusions: IVIG use in CNS inflammatory conditions has an emerging role. Guidelines for use and monitoring of outcomes will help improve resource utilization and provide further evidence regarding effectiveness.

Background: Susac Syndrome (SuS) is a rare autoimmune disorder of the cerebral, retinal, and inner ear microvasculature. One of the cardinal manifestations of central nervous system (CNS) involvement is encephalopathy, however the cognitive profile in SuS is poorly characterized in the literature. Methods: In this cross-sectional case series of seven participants diagnosed with Susac Syndrome in remission in British Columbia, we use a battery of neuropsychological testing, subjective disease scores, and objective markers of disease severity to characterize the affected cognitive domains and determine if any disease characteristics predict neuropsychological performance. We also compare this battery of tests to neuroimaging markers to determine if correlation exists between radiographic markers of CNS disease and clinical evaluation of disease severity. Results: There were a variety of cognitive deficits, with memory and language dysfunction being the most common. Despite the variability, performance on some neuropsychological tests (MoCA) correlated to markers of functional disability (EDSS). Additionally, MoCA and EDSS scores correlated with neuroimaging findings of both corpus callosum and white matter changes. Finally, psychiatric scores correlated with participant reported scores of disease severity. Conclusions: There is a relationship between cognitive deficits, subjective and objective disease disability, and neuroimaging findings in Susac Syndrome.

Objectives: The Wisconsin Card Sorting Test (WCST) is a complex measure of executive function that is frequently employed to investigate the schizophrenia spectrum. The successful completion of the task requires the interaction of multiple intact executive processes, including attention, inhibition, cognitive flexibility, and concept formation. Considerable cognitive heterogeneity exists among the schizophrenia spectrum population, with substantive evidence to support the existence of distinct cognitive phenotypes. The within-group performance heterogeneity of individuals with schizophrenia spectrum disorder (SSD) on the WCST has yet to be investigated. A data-driven cluster analysis was performed to characterise WCST performance heterogeneity. Methods: Hierarchical cluster analysis with k-means optimisation was employed to identify homogenous subgroups in a sample of 210 schizophrenia spectrum participants. Emergent clusters were then compared to each other and a group of 194 healthy controls (HC) on WCST performance and demographic/clinical variables. Results: Three clusters emerged and were validated via altered design iterations. Clusters were deemed to reflect a relatively intact patient subgroup, a moderately impaired patient subgroup, and a severely impaired patient subgroup. Conclusions: Considerable within-group heterogeneity exists on the WCST. Identification of subgroups of patients who exhibit homogenous performance on measures of executive functioning may assist in optimising cognitive interventions. Previous associations found using the WCST among schizophrenia spectrum participants should be reappraised. (JINS, 2019, 25, 750–760)

Objectives: Antisaccade error rate has been proposed to be one of the most promising endophenotypes for schizophrenia. Increased error rate in patients has been associated with working memory, attention and other executive function impairments. The relationship between antisaccade error rate and other neuropsychological processes in patients compared to healthy controls has not been explored in depth. This study aimed to replicate the finding of heightened antisaccade error rate in patients and determine which cognitive processes were most strongly associated with antisaccade error rate in both patients and controls. In addition, the study investigated whether different antisaccade task paradigms engage different cognitive processes. Methods: One hundred and ninety-one participants (54 patients with schizophrenia/schizoaffective disorder and 137 controls) completed the antisaccade task, which included both gap and step task parameters. Neuropsychological measures were obtained using the MCCB and the Stroop task. Results: The current study replicated a pronounced antisaccade error rate deficit in patients. In patients, working memory variance was most significantly associated with antisaccade errors made during the step condition, while attentional processes were most associated with errors made during the gap condition. In controls, overall global cognitive performance was most associated with antisaccade rates for both gap and step conditions. Conclusions: The current study demonstrates that in schizophrenia patients, but not controls, elevated antisaccade error rate is associated with attention and working memory, but not with global cognitive impairment or psychopathological processes. Our novel findings demonstrate that the gap and step conditions of the antisaccade task engage different cognitive processes. (JINS, 2019, 25, 174–183)

Objectives: The aim of this study was to evaluate the impact of computer-assisted “drill-and-strategy” cognitive remediation (CR) for community-dwelling individuals with schizophrenia on cognition, everyday self-efficacy, and independent living skills. Methods: Fifty-six people with schizophrenia or schizoaffective disorder were randomized into CR or computer game (CG) playing (control), and offered twenty 1-hr individual sessions in a group setting over 10 weeks. Measures of cognition, psychopathology, self-efficacy, quality of life, and independent living skills were conducted at baseline, end-group and 3 months following intervention completion. Results: Forty-three participants completed at least 10 sessions and the end-group assessment. Linear mixed-effect analyses among completers demonstrated a significant interaction effect for global cognition favoring CR (p=.028). CR-related cognitive improvement was sustained at 3-months follow-up. At end-group, 17 (77%) CR completers showed a reliable improvement in at least one cognitive domain. A significant time effect was evident for self-efficacy (p=.028) with both groups improving over time, but no significant interaction effect was observed. No significant effects were found for other study outcomes, including the functional measure. Conclusions: Computer-assisted drill-and-strategy CR in schizophrenia improved cognitive test performance, while participation in both CR and CG playing promoted enhancements in everyday self-efficacy. Changes in independent living skills did not appear to result from CR, however. Adjunctive psychosocial rehabilitation is likely necessary for improvements in real-world community functioning to be achieved. (JINS, 2018, 24, 549–562)

Integrated weed management strategies (IWM) are being advocated and employed to control invasive plants species. In this study, we compared three management strategies (biological control alone [BC], BC with fire [BC + F], and BC with mowing [BC + M]) to determine if physical controls reduce seed production by Scotch broom and interfere with the action of the biological control agent—the Scotch broom seed weevil. We measured seed production and seed predation by the weevil at both pod and plant scale, and seed bank density over two field seasons. We found no difference in the number of seeds per pod among management strategies. However, combining management strategies (BC + M and BC + F) resulted in significant reductions in pods per plant, mature seeds per plant, and seed bank density relative to biological control alone. We did not find differences among management strategies in number of weevils per pod or proportion of seeds predated by the weevil at either pod or whole-plant scale. However, combining management strategies (BC + M and BC + F) resulted in a significant reduction in healthy mature seeds per plant relative to biological control alone. Although both integrated strategies outperformed biological control alone in reducing seed production and the seed bank, with no statistical difference between them, we propose that short-rotation prescribed fire could prove to be a more effective strategy for long-term management of Scotch broom due to its potential for slightly greater depletion of the seed bank.

Dystonic torticollis has been treated with local injections of botulinum toxin in a single blind study of 12 patients. A significant decrease of abnormal movements was recorded, and pain improved. Further studies are desirable to define the optimum dosage and site for injections, and the long term effects of repeated injections.

In order to determine the usefulness of Computerized Tomography (CT) scanning in making a diagnosis of dementia of the Alzheimer type, a group of patients diagnosed by NINCDS - ADRDA criteria (n = 22) were compared to a group of normal subjects (n = 49) using certain defined linear CT scan measurements. These measurements included specific measurements of the temporal lobes (temporal horns). Subjects were classified correctly 91.5% of the time with a high degree of probability. A diagnostic equation is presented which will allow testing of these methods in a prospective fashion.

Metal-catalyzed graphitization from vapor phase sources of carbon is now an established technique for producing few-layer graphene, a candidate material of interest for post-silicon electronics. Here we describe two alternative metal-catalyzed graphene formation processes utilizing solid phase sources of carbon. In the first, carbon is introduced as part of a cosputtered Ni-C alloy; in the second, carbon is introduced as one of the layers in an amorphous carbon (a-C)/Ni bilayer stack. We examine the quality and characteristics of the resulting graphene as a function of starting film thicknesses, Ni-C alloy composition or a-C deposition method (physical or chemical vapor deposition), and annealing conditions. We then discuss some of the competing processes playing a role in graphitic carbon formation and review recent evidence showing that the graphitic carbon in the a-C/Ni system initially forms by a metal-induced crystallization mechanism (analogous to what is seen with Al-induced crystallization of amorphous Si) rather than by the dissolution-upon-heating/precipitation-upon-cooling mechanism seen when graphene is grown by metal-catalyzed chemical vapor deposition methods.