Background: Our prior six-year review (n=2165) revealed 24% of patients undergoing posterior decompression surgeries (laminectomy or discectomy) sought emergency department (ED) care within three months post-surgery. We established an integrated Spine Assessment Clinic (SAC) to enhance patient outcomes and minimize unnecessary ED visits through pre-operative education, targeted QI interventions, and early post-operative follow-up. Methods: We reviewed 13 months of posterior decompression data (n=205) following SAC implementation. These patients received individualized, comprehensive pre-operative education and follow-up phone calls within 7 days post-surgery. ED visits within 90 days post-surgery were tracked using provincial databases and compared to our pre-SAC implementation data. Results: Out of 205 patients, 24 (11.6%) accounted for 34 ED visits within 90 days post-op, showing a significant reduction in ED visits from 24% to 11.6%, and decreased overall ED utilization from 42.1% to 16.6% (when accounting for multiple visits by the same patient). Early interventions including wound monitoring, outpatient bloodwork, and prescription adjustments for pain management, helped mitigate ED visits. Patient satisfaction surveys (n=62) indicated 92% were “highly satisfied” and 100% would recommend the SAC. Conclusions: The SAC reduced ED visits after posterior decompression surgery by over 50%, with pre-operative education, focused QI initiatives, and its individualized, proactive approach.

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.

Background: Duchenne muscular dystrophy (DMD) typically presents with painless weakness which may contribute to its delayed recognition. Methods: Retrospective chart review was performed for patients with DMD at CHEO over 15 years (2009-2023). Our data will later be combined with that from two other centers. Inclusion criteria: 1) confirmed DMD; 2) symptom onset <6 yo. Exclusion criteria: incomplete records or family history of DMD. Results: We identified 72 DMD patients. Total of N=49 were analyzed. Subjects were excluded for: incomplete data N=10 (e.g. diagnosis at another centre); symptom onset ≥6 yo (N=4); family history (N=9). First symptoms were reported at a mean age of 2.7 yo (range: 0-5.9 yo) with diagnosis at mean age of 5.2 yo (range: 0.5 to 9.6 yo), representing a mean delay of 2.5 years (range: 0-6.8 yrs). Initial symptoms included: weakness (61.2%), sports difficulty (61.2%), calf pseudohypertrophy (10.2%), language difficulties (8.2%) or muscle pain (2.0%). Learning disability was reported in 36 (73.5%) subjects with 7 (14.3%) having autistic spectrum disorder. Conclusions: The mean delay to diagnosis of patients followed at our centre was similar to the United Kingdom (MDSTARnet). We advocate for increased education to identify DMD earlier, particularly given emerging therapies for this disorder.

Objectives/Goals: We describe the prevalence of individuals with household exposure to SARS-CoV-2, who subsequently report symptoms consistent with COVID-19, while having PCR results persistently negative for SARS-CoV-2 (S[+]/P[-]). We assess whether paired serology can assist in identifying the true infection status of such individuals. Methods/Study Population: In a multicenter household transmission study, index patients with SARS-CoV-2 were identified and enrolled together with their household contacts within 1 week of index’s illness onset. For 10 consecutive days, enrolled individuals provided daily symptom diaries and nasal specimens for polymerase chain reaction (PCR). Contacts were categorized into 4 groups based on presence of symptoms (S[+/-]) and PCR positivity (P[+/-]). Acute and convalescent blood specimens from these individuals (30 days apart) were subjected to quantitative serologic analysis for SARS-CoV-2 anti-nucleocapsid, spike, and receptor-binding domain antibodies. The antibody change in S[+]/P[-] individuals was assessed by thresholds derived from receiver operating characteristic (ROC) analysis of S[+]/P[+] (infected) versusS[-]/P[-] (uninfected). Results/Anticipated Results: Among 1,433 contacts, 67% had ≥1 SARS-CoV-2 PCR[+] result, while 33% remained PCR[-]. Among the latter, 55% (n = 263) reported symptoms for at least 1 day, most commonly congestion (63%), fatigue (63%), headache (62%), cough (59%), and sore throat (50%). A history of both previous infection and vaccination was present in 37% of S[+]/P[-] individuals, 38% of S[-]/P[-], and 21% of S[+]/P[+] (P<0.05). Vaccination alone was present in 37%, 41%, and 52%, respectively. ROC analyses of paired serologic testing of S[+]/P[+] (n = 354) vs. S[-]/P[-] (n = 103) individuals found anti-nucleocapsid data had the highest area under the curve (0.87). Based on the 30-day antibody change, 6.9% of S[+]/P[-] individuals demonstrated an increased convalescent antibody signal, although a similar seroresponse in 7.8% of the S[-]/P[-] group was observed. Discussion/Significance of Impact: Reporting respiratory symptoms was common among household contacts with persistent PCR[-] results. Paired serology analyses found similar seroresponses between S[+]/P[-] and S[-]/P[-] individuals. The symptomatic-but-PCR-negative phenomenon, while frequent, is unlikely attributable to true SARS-CoV-2 infections that go missed by PCR.

To facilitate and sustain community-engaged research (CEnR) conducted by academic-community partnerships (ACPs), a Clinical Translational Science Award (CTSA)-funded Community Engagement Core (CEC) and Community Partner Council (CPC) co-created two innovative microgrant programs. The Community Health Grant (CHG) and the Partnership Development Grant (PDG) programs are designed to specifically fund ACPs conducting pilot programs aimed at improving health outcomes. Collectively, these programs have engaged 94 community partner organizations while impacting over 55,000 individuals and leveraging $1.2 million to fund over $10 million through other grants and awards. A cross-sectional survey of 57 CHG awardees demonstrated high overall satisfaction with the programs and indicated that participation addressed barriers to CEnR, such as building trust in research and improving partnership and program sustainability. The goal of this paper is to (1) describe the rationale and development of the CHG and PDG programs; (2) their feasibility, impact, and sustainability; and (3) lessons learned and best practices. Institutions seeking to implement similar programs should focus on integrating community partners throughout the design and review processes and prioritizing projects that align with specific, measurable goals.

The global population and status of Snowy Owls Bubo scandiacus are particularly challenging to assess because individuals are irruptive and nomadic, and the breeding range is restricted to the remote circumpolar Arctic tundra. The International Union for Conservation of Nature (IUCN) uplisted the Snowy Owl to “Vulnerable” in 2017 because the suggested population estimates appeared considerably lower than historical estimates, and it recommended actions to clarify the population size, structure, and trends. Here we present a broad review and status assessment, an effort led by the International Snowy Owl Working Group (ISOWG) and researchers from around the world, to estimate population trends and the current global status of the Snowy Owl. We use long-term breeding data, genetic studies, satellite-GPS tracking, and survival estimates to assess current population trends at several monitoring sites in the Arctic and we review the ecology and threats throughout the Snowy Owl range. An assessment of the available data suggests that current estimates of a worldwide population of 14,000–28,000 breeding adults are plausible. Our assessment of population trends at five long-term monitoring sites suggests that breeding populations of Snowy Owls in the Arctic have decreased by more than 30% over the past three generations and the species should continue to be categorised as Vulnerable under the IUCN Red List Criterion A2. We offer research recommendations to improve our understanding of Snowy Owl biology and future population assessments in a changing world.

Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.

The Durness Group of NW Scotland records deposition on the Laurentian margin from the basal Miaolingian (Cambrian, 509 Ma) to the Dapingian–Darriwilian boundary interval (Middle Ordovician, 470.3–468.9 Ma). The 930 m thick succession of peritidal and subtidal carbonates was deposited on the Scottish promontory, a nearly 120° deflection in the Palaeozoic continental margin between the Appalachian and Greenland sectors. These sediments were deposited as part of the Great American Carbonate Bank, a non-uniformitarian, continent-scale carbonate platform developed on the peneplaned craton. Measurement and description of a bed-by-bed composite section through the Durness Group provide a high-resolution reference framework that integrates conodont biostratigraphy, chemostratigraphy and sequence stratigraphy, including correlation with the Sauk megasequence and its subdivisions. The Sauk II–Sauk III sequence boundary marks the base of the group. The top of the group is faulted against rocks of the Moine thrust zone, generated by the Scandian orogeny, but sedimentation was probably terminated by the earlier Grampian arc–continent collision at 470–469 Ma. The highly mature quartz arenites of the underlying Ardvreck Group (Cambrian Series 2) indicate that there was no source-to-sink depositional continuity from the Hebridean foreland to the Dalradian Supergroup, which has coeval clastic sedimentary rocks of contrasting composition.

Herbicide drift to sensitive crops can result in significant injury, yield loss, and even crop destruction. When pesticide drift is reported to the Georgia Department of Agriculture (GDA), tissue samples are collected and analyzed for residues. Seven field studies were conducted in 2020 and 2021 in cooperation with the GDA to evaluate the effect of (1) time interval between simulated drift event and sampling, (2) low-dose herbicide rates, and (3) the sample collection methods on detecting herbicide residues in cotton (Gossypium hirsutum L.) foliage. Simulated drift rates of 2,4-D, dicamba, and imazapyr were applied to non-tolerant cotton in the 8- to 9-leaf stage with plant samples collected at 7 or 21 d after treatment (DAT). During collection, plant sampling consisted of removing entire plants or removing new growth occurring after the 7-leaf stage. Visual cotton injury from 2,4-D reached 43% to 75% at 0.001 and 0.004 kg ae ha−1, respectively; for dicamba, it was 9% to 41% at 0.003 or 0.014 kg ae ha−1, respectively; and for imazapyr, it was 1% to 74% with 0.004 and 0.03 kg ae ha−1 rates, respectively. Yield loss was observed with both rates of 2,4-D (11% to 51%) and with the high rate of imazapyr (52%); dicamba did not influence yield. Herbicide residues were detected in 88%, 88%, and 69% of samples collected from plants treated with 2,4-D, dicamba, and imazapyr, respectively, at 7 DAT compared with 25%, 16%, and 22% when samples were collected at 21 DAT, highlighting the importance of sampling quickly after a drift event. Although the interval between drift event and sampling, drift rate, and sampling method can all influence residue detection for 2,4-D, dicamba, and imazapyr, the factor with the greatest influence is the amount of time between drift and sample collection.

The 7th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners, and intended to drive healthcare excellence, improved outcomes and more integrated health systems. This edition includes a new module on the management of cerebral venous thrombosis (CVT). Cerebral venous thrombosis is defined as thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins. Cerebral venous thrombosis is a rare but potentially life-threatening type of stroke, representing 0.5–1.0% of all stroke admissions. The reported rates of CVT are approximately 10–20 per million and appear to be increasing over time. The risk of CVT is higher in women and often associated with oral contraceptive use and with pregnancy and the puerperium. This guideline addresses care for adult individuals who present to the healthcare system with current or recent symptoms of CVT. The recommendations cover the continuum of care from diagnosis and initial clinical assessment of symptomatic CVT, to acute treatment of symptomatic CVT, post-acute management, person-centered care, special considerations in the long-term management of CVT, including pregnancy and considerations related to CVT in special circumstances such as trauma and vaccination. This module also includes supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.