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.

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.

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.

Long-term care facilities (LTCFs) and their residents are especially susceptible to disruptions associated with natural disasters and often have limited experience and resources for disaster planning and response. Previous reports have offered disaster planning and response recommendations. We could not find a comprehensive review of studied interventions or facility attributes that affect disaster outcomes in LTCFs and their residents. We reviewed articles published from 1974 through September 30, 2015, that studied disaster characteristics, facility characteristics, patient characteristics, or an intervention that affected outcomes for LTCFs experiencing or preparing for a disaster. Twenty-one articles were included in the review. All of the articles fell into 1 of the following categories: facility or disaster characteristics that predicted preparedness or response, interventions to improve preparedness, and health effects of disaster response, most often related to facility evacuation. All of the articles described observational studies that were heterogeneous in design and metrics. We believe that the evidence-based literature supports 6 specific recommendations for facilities, governmental agencies, health care communities and academia. These include integrated and coordinated disaster planning, staff training, careful consideration before governments order mandatory evacuations, anticipation of the increased medical needs of LTCF residents following a disaster, and the need for more outcomes research. (Disaster Med Public Health Preparedness. 2017;11:140–149)

A case of motor neuron disease with clinical and pathological resemblance to amyotrophic lateral sclerosis (ALS) in a woman who was severely bitten on the ankle by a cat is described. Weakness first appeared at the ankles and relentlessly advanced proximally, terminating in death from pulmonary failure in a year. A number of unusual features that are uncharacteristic of ALS were found that included a markedly elevated antinuclear antibody titre in the serum and the presence of prominent oligoclonal bands in the cerebrospinal fluid. The spinal cord showed loss of anterior horn cells and pyramidal degeneration that are characteristic of ALS, but an extraordinary finding was the presence of transmural granulomatous inflammation of numerous small and medium sized vessels, especially veins, in the subarachnoid space around the cord. There were also inflammatory changes in the brainstem and spinal cord consisting of microglial and astrocytic nodules and perivenous cuffing by mononuclear cells. Ill-defined hyaline eosinophilic cytoplasmic inclusions were seen in some remaining anterior horn cells. No viral particles were found by electron microscopy despite an extensive search. Virological studies were inconclusive but there is reason to believe that this patient's illness was caused by an as yet unidentified virus.

Anxious mothers' parenting, particularly transfer of threat information, has been considered important in their children's risk for social anxiety disorder (SAnxD), and maternal narratives concerning potential social threat could elucidate this contribution. Maternal narratives to their preschool 4- to 5-year-old children, via a picture book about starting school, were assessed in socially anxious (N = 73), and nonanxious (N = 63) mothers. Child representations of school were assessed via doll play (DP). After one school term, mothers (Child Behavior Checklist [CBCL]) and teachers (Teacher Report Form) reported on child internalizing problems, and child SAnxD was assessed via maternal interview. Relations between these variables, infant behavioral inhibition, and attachment, were examined. Socially anxious mothers showed more negative (higher threat attribution) and less supportive (lower encouragement) narratives than controls, and their children's DP representations SAnxD and CBCL scores were more adverse. High narrative threat predicted child SAnxD; lower encouragement predicted negative child CBCL scores and, particularly for behaviorally inhibited children, Teacher Report Form scores and DP representations. In securely attached children, CBCL scores and risk for SAnxD were affected by maternal anxiety and threat attributions, respectively. Low encouragement mediated the effects of maternal anxiety on child DP representations and CBCL scores. Maternal narratives are affected by social anxiety and contribute to adverse child outcome.

Evidence is presented for the presence of a sex attractant in female Vitula edmandsae (Packard). The ability of the virgin female to attract the male varies with age, reaching a maximum 2 days after emergence.

The pheromone-producing gland is a ring-shaped structure formed by modification of the epidermal cells in the intersegmental membrane between the eighth and ninth abdominal segments.

Western false hemlock looper, Nepytia freemani Munroe, is a cyclical pest in British Columbia which defoliates mainly Douglas-fir, Pseudotsugata menziesii (Mirb.) Franco, often near residential areas. Outbreaks were recorded from 1947 to 1949, 1963 to 1964, and 1972 to 1976; the current outbreak started in 1980 and, in 1982, covered 1,100 ha near Tappen, Canoe, Enderby, and Carquile (Ferris and Woensdregt 1983).

Morphological and histological details of the sex pheromone glands of male Vitula edmandsae (Packard) are reported. Several hypotheses concerning the functions of these glands are discussed.

Antonina Nortoni, Parrott and Ckll.

Sac white, subglobular, cottonlike, completely enveloping female.

♀ oval, plump, cream-coloured, with slight tinge of brown on margin. Boiled in caustic potash, becomes transparent, with the exception of the antennae, the two pairs of spiracles, and ultimate segment, including anal region, which are a dark yellowish-brown. There are many single glands, especially towards and about posterior segments; they are less numerous anteriorly. On outer side of each spiracle there is a crescentic group of rather large circular glands, placed very close together. Antennae aborted, short, thick, composed of three segments measuring respectively 18–25, 13–16 and 27-28 mm. Mouth-parts large Spiracles chitinous, large and extended. Anal orifice circular, situated in a depression, surrounded by a strong chitinous ring. Anal ring with six long, stout hairs measuring from 53 to 89 mm. in length.

The results of behavioural, chemical, and histological studies are reported showing the presence of a sex attractant in female Orgyia leucostigma J. E. Smith. A method of bioassaying the attractancy of the female moths by the use of 4-ft-long glass tubes is given. Extraction of female abdominal tips with dichloromethane yields material biologically active when tested against male O. leucostigma.The pheromone-producing gland is a dorsally situated, crescent-shaped structure formed by modification of the epidermal cells in the intersegmental membrane between the eighth and ninth abdominal segments. The glandular cells are goblet-shaped and are arranged in an unusual manner.

♀ scale 1.6 to 1.8 mm. in diameter, .5 to .6 mm. in altitude, circular, quite convex, roughish, a light brown with slight tinge of pink; ventral scale thick, white at centre with brown on margin, not easily separated from scale, when detached from host plant leaves but a very slight trace of white; exuviae sublateral, often nearly marginal, orange, covered with whitish secretion.

♀ oval, deep yellow, with dark brown on margin of posterior segment, and yellowish brown about mesal lobes and region of proboscis. When boiled in caustic potash becomes transparent, with mesal lobes a yellowish brown, and region of proboscis a reddish brown.

♀ scale nearly circular, somewhat flattened, little convex, roughish, dark gray above bark, reddish-brown below bark, 2 mm. diameter; exuviæ little exposed, often concealed by whitish secretion, orange, placed to one side of centre; ventral scale, delicate and white; old scales dark brown, often almost black. Scales are thickly massed.

♀ oval, white, marked with irregular light yellow spots; first and second lobes, and margin of last segment, yellowish.

The morphology and histology of the sex pheromone-producing gland in the females of Choristoneura fumiferana (Clemens), C. pinus (Freeman) (Tortricidae), and Malacosoma disstria (Hubner) (Lasiocampidae) is reported. A review of the literature relevant to such a study is presented in tabular form.

Commission 46 had held two sessions of business meetings during the General Assembly in Rio de Janeiro. Both of them were chaired by Magda Stavinschi.

The opinion has recently been expressed1 that the poisonous action of ordinary coal-gas and carburetted water-gas is probably in part due to the “Illuminant” hydro-carbons, of which ethylene is the chief, and not simply to carbonic oxide. In consequence of the doubt existing on this point one of us was asked by the recent Departmental Committee of the Home Office on Water-Gas to investigate the matter, and the results of the experiments which we were then able to make appeared in the Committee's Report2. In the main series of observations the animal was placed in a respiration chamber through which a current of air was passing at a known rate. With the current, before it entered the chamber, a known percentage of coal-gas or carburetted water-gas was mixed. It was found that whether ordinary coal-gas or carburetted water-gas was used the symptoms observed were those of carbonic oxide poisoning, and corresponded exactly to the percentages of carbonic oxide present. We also found that Benzene, which is one of the “illuminants,” is present in proportions far too small to contribute to the toxic effects of coal-gas or carburetted water-gas. Finally, we endeavoured to investigate separately the action of ethylene. The ethylene we then used was prepared in the ordinary way from sulphuric acid and alcohol, and when about 10% of the gas was mixed with air and supplied to an animal very distinct toxic symptoms were produced.

Aims: Recent years have seen an expansion of UK radiotherapy treatment capacity with a drive to reduce radiotherapy waiting times. Consequently, the time available for planning patients is decreasing. In this context, management of treatment planning workflow in the Princess Royal Hospital is described and monthly planning times are presented from September 2003 onwards.

Materials and Methods: After patients are imaged, patient name, unit number and appointments are available to the planning spreadsheet via a link to the radiotherapy information system. The planning spreadsheet is in descending order of appointment date. Treatment planning staff select the first available task, taking account of individual competencies. At plan completion, the patient record is moved to the completed list.

Results: Since September 2003, patient numbers through treatment planning steadily increased from around 90 a month to about 130 currently. Planning times decreased from 11 to 7 workdays.

Conclusions: Workflow through treatment planning is indirectly managed and the approach allows for day-to-day staffing fluctuations and competency levels. There is instant information on planning status for all patients throughout the department, building up a record as part of the work process. Bottlenecks and staff training needs can be analysed by reviewing the historic patient workload.

Commission 46 continues its task in the triennium, which started in September 2006. It seeks to further contribute to the development and improvement of astronomical education at all levels all over the world through various projects initiated, maintained and to be developed by the Commission, and by disseminating information concerning astronomy education.

Epibiotic interactions between macroalgae and crustaceans have rarely been described. We examined the interaction between the mole crab, Emerita analoga and the opportunistic algae Enteromopha spp. in a sandy beach of the central coast of Peru. Enteromorpha spp. was found fouling the carapace of the mole crab that provides the only stable substrate to spore settlement in the beach environment. Epibiosis prevalence was up to 2.1%, and affected mainly larger, ovigerous females. Prevalence presented a seasonal pattern, with peaks during summer. Mole crab body condition was higher when fouled, whereas fecundity was not affected. Fouled mole crabs burrowed at lower speed, which was reversible by the removal of epibiotic algae. The burrowing depth was not affected by epibiosis. Contrary to the expected, the effects of algal epibiosis on demographic and life history parameters of mole crabs, with the exception of body condition, were mainly neutral but important on behavioural traits.