Empirical tests of the “cycle of maltreatment” hypothesis have typically focused on the presence or absence of child maltreatment across generations. However, this narrow focus does not account for diverse intergenerational pathways of maltreatment. This systematic review and meta-analysis synthesizes data to determine the distribution of cycle maintainers, breakers, initiators, and unaffected families (i.e., controls). Of the 65 independent studies (80 samples), 30 examined intergenerational cycles of maltreatment broadly, while 27 reported data for physical abuse, 17 sexual abuse, 5 neglect, and 1 emotional abuse specifically. For maltreatment, 17.1% (95%CI: 12.1%, 22.1%) were cycle maintainers, 23.6% (95%CI: 18.0%, 29.2%) were cycle breakers, 11.4% (95%CI: 7.8%, 15.1%) were cycle initiators and 47.8% (95%CI: 39.7%, 55.9%) controls. Thus, although a parent’s maltreatment history is a risk factor, results suggest that a greater proportion of parents break the cycle of maltreatment versus maintain it. Moderator analyses showed that study design, assessment methods, and demographic characteristics influence maltreatment transmission rates. Intergenerational patterns of physical, sexual, and emotional abuse and neglect are also detailed. Our findings underscore the complexity of intergenerational maltreatment, highlighting the need to explore not only its maintenance but also the protective factors that help break cycles and the risk factors that drive its initiation.

The hemlock woolly adelgid, Adelges tsugae Annand (Hemiptera: Adelgidae), has distinct native and invasive populations in Canada. On the country’s west coast, the adelgid is a native insect that feeds on western hemlock, Tsuga heterophylla (Rafinesque-Schmaltz) Sargent, and mountain hemlock, Tsuga mertensiana (Bongard) Carrière (Pinaceae). In eastern Canada, the adelgid is an invasive species that attacks and kills eastern hemlock, Tsuga canadensis (Linnaeus) Carrière (Pinaceae). We obtained all Canadian records of A. tsugae in institutional and public databases, developed updated range maps and phenologies for the species in British Columbia and eastern Canada, and developed dispersal estimates for populations in Nova Scotia. In British Columbia, A. tsugae’s observed distribution is centred around the Lower Mainland and on Vancouver Island but with populations in the British Columbia Interior and along the Pacific coast that have been poorly explored. In eastern Canada, the adelgid has invaded southern Nova Scotia, portions of the Niagara region in Ontario as far west as Hamilton, and at least one site on the north shore of Lake Ontario. No populations have been found in New Brunswick, Quebec, or Prince Edward Island, Canada. Finally, we estimated the rate of spread in Nova Scotia at 12.6 ± 8.2 to 20.5 ± 27.21 km/year.

OBJECTIVES/GOALS: Untargeted metabolomics platforms are powerful biomarker discovery tools. However, the absence of uniform study design, data analysis, and reporting standards limits translation of this research into the clinical lab. The goal was to critically appraise existing untargeted metabolomics platforms that analyzed inborn errors of metabolism. METHODS/STUDY POPULATION: A search strategy was conducted in MEDLINE via PubMed from January 16, 2013, to January 16, 2023. The search strategy was limited to primary literature articles written in English that evaluated human subjects with inborn errors of metabolism (IEMs). Articles that performed targeted metabolomic analysis or analyzed non-human samples were excluded. Information on patient cohorts analyzed, sample types, and method design were extracted using a template. Categorical data are summarized as frequencies and percentages. RESULTS/ANTICIPATED RESULTS: A total of 96 distinct IEMs were evaluated by the different untargeted metabolomics methods included in this review. However, most IEMs (55/96, 57%) were evaluated by a single platform, in a single study, with a limited cohort size. Only one study validated their results using a separate, validation cohort. There was considerable diversity in the separation techniques and mass spectrometry instrumentation used by the studies to create their untargeted metabolomics methods. Slightly over half (59%) of the studies identified at least some of the metabolites detected in their samples with the highest level of confidence. Importantly, most of the included studies reported adherence to quality metrics, including use of quality control material (65%) and internal standards in their analysis (61%). DISCUSSION/SIGNIFICANCE: Future studies analyzing IEM patient samples with untargeted metabolomics platforms should progress beyond single-subject studies and evaluate the reproducibility of the research using a prospective, or validation cohort as well as confirm metabolite annotations with reference metabolites standards to generate clinically useful data.

Certaines études suggèrent que le projet de Charte des valeurs du PQ et la loi 21 ont nourri un sentiment d'exclusion chez les membres des religions minoritaires. Cependant, aucune étude ne permet à ce jour de comparer le sentiment d'appartenance des minorités religieuses avant et après la mise à l'agenda de ces projets législatifs. Ancrée dans la recherche sur les « événements focalisateurs » et reposant sur des données de trois sondages réalisés en 2012, 2014 et 2019, notre étude examine l'impact des débats sur laïcité sur le sentiment d'appartenance des immigrants racisés au Québec. Nos résultats démontrent qu'un déficit d'appartenance au Québec par rapport au Canada existait déjà en 2012, mais qu'il était circonscrit à certains groupes, notamment ceux de dénominations non chrétiennes et les non francophones. Nos analyses montrent aussi qu'avec les débats sur la laïcité, le déficit d'appartenance au Québec s'est étendu aux minorités non religieuses et aux francophones.

OBJECTIVES/GOALS: To develop an untargeted metabolomics assay that can holistically characterize the small molecule signatures of different inborn errors of metabolism (IEM) for biomarker discovery and identification of novel IEMs, with the goal of implementing the assay into the clinical laboratory to improve testing efficiency. METHODS/STUDY POPULATION: A hydrophilic interaction liquid chromatography (HILIC) column and reverse phase (RP) column were assembled in tandem on a SCIEX X500B quadrupole time-of-flight (QTOF) system to create a dual liquid chromatography (LC), tandem mass spectrometry method. The X500B was operated in data-independent acquisition mode with both positive and negative ionization. A mixture of 165 reference standards from eleven compound classes common to IEMs were used to evaluate the capability of the assay to resolve small molecules. Chromatographic resolution for each standard was determined qualitatively by comparison to a reference spectral database. External validation of the assay will be performed by analyzing a commercial library of reference metabolites. RESULTS/ANTICIPATED RESULTS: A total of 88% (146/165) of the standards were detected by the assay. The RP column alone resolved 71% (117/165) of the standards, the HILIC column resolved 33% (55/165), while 17% (29/165) of the standards were resolved by both columns. The HILIC column resolved standards that were more polar, while the RP column resolved more non-polar compounds. To evaluate matrix effects, the reference standard mixture was spiked into pooled plasma. In the presence of plasma 6/146 (4%) of the standards were suppressed to levels below the limit of detection. We expect external validation with the commercial metabolite library will corroborate these results, and that the high-quality spectral data attained from this reference library can be used to improve identification of unknown metabolites in patient samples. DISCUSSION/SIGNIFICANCE: We have shown our untargeted metabolomics assay can detect known biomarkers for IEMs. Clinical implementation of this method could streamline diagnosis of IEMs while simultaneously improving patient outcomes by leveraging the metabolome for biomarker discovery, and improved understanding of IEM mechanisms to inform novel treatment strategies.

A reproductive population of the Asian longhorned beetle, Anoplophora glabripennis (Motschulsky) (Coleoptera: Cerambycidae), an adventive insect from Asia, was discovered in 2003 in an urban landscape in Ontario, Canada. This polyphagous beetle, which attacks maples, Acer spp. (Sapindaceae), had the potential to seriously and permanently alter the composition and structure of forests in eastern North America. The Canadian Food Inspection Agency (CFIA) developed and implemented an eradication programme, with partners from various agencies in both Canada and the United States of America. Surveys were used to delineate the infestation and establish a regulated area around it. Treatment consisted of removing and destroying both trees with signs of A. glabripennis injury and trees assumed at high risk of being injured within the regulated area. After nine years of monitoring the regulated area, the CFIA declared A. glabripennis eradicated on 5 April 2013. Herein, we detail the response undertaken, summarise lessons learned, and provide preliminary observations and results pertaining to the arrival, establishment, and spread of A. glabripennis in Ontario.

Background: CT-angiography is an ancillary test used to diagnose death by neurological criteria (DNC), notably in cases of unreliable neurological examinations due to clinical confounders. We studied whether clinical confounders to the neurological examination modified CT-angiography diagnostic accuracy. Methods: Systematic review and meta-analysis of studies including deeply comatose patients undergoing DNC ancillary testing. We estimated pooled sensitivities and specificities using a Bayesian hierarchical model, including data on CT-angiography (4-point, 7-point, 10-point scales, and no intracranial flow), and performing a subgroup analysis on clinical confounders to the reference neurological examination. Results: Of 40 studies included in the meta-analysis, 7 involve CT-angiography (n=586). There was no difference between subgroups (Table). The degree of uncertainty involving sensitivity estimates was high in both subgroups. Conclusions: Statistical uncertainty in diagnostic accuracy estimates preclude any conclusion regarding the impact of clinical confounders on CT-angiography diagnostic accuracy. Further research is required to validate CT-angiography as an accurate ancillary test for DNC.

Table. Pooled sensitivities and specificities of CT-angiography for death by neurological criteria

Table.

Pooled sensitivities and specificities of CT-angiography for death by neurological criteria

Background: Ancillary tests are indicated to diagnose death by neurological criteria whenever clinical neurological examination is unreliable, but their use is variable and subject to debate. Methods: Survey of Canadian intensivists providing care for potential organ donors. We included closed-ended questions and different clinical scenarios regarding the use of ancillary tests. Results: Among 550 identified intensivists, 249 completed the survey. Respondents indicated they would be comfortable diagnosing death based on neurological examination without ancillary tests in the following scenarios: movement in response to stimulation (48%), spontaneous peripheral movement (31%), inability to evaluate upper/lower extremity responses (34%) or both oculocephalic and oculo-caloric reflexes (17%), presence of high cervical spinal cord injury (16%) and within 24 hours of hypoxemic-ischemic brain injury (15%). Furthermore, 93% agreed that ancillary tests should always be conducted when a complete neurological examination is impossible, 89% if there remains possibility of residual sedative effect and 59% in suspected isolated brainstem death. Conclusions: Our findings suggest that Canadian intensivists have different perceptions on what constitutes a complete and reliable clinical neurological examination for determining death by neurologic criteria. Some self-reported practices also diverge from national recommendations. Further investigation and education are required to align and standardize medical practice across physicians and systems.

Coxiella burnetii is a zoonotic agent responsible for human Q fever, a potentially severe disease that can lead to persistent infection. This cross-sectional study aimed to estimate the seroprevalence to C. burnetii antibodies and its association with potential risk factors in the human population of five regions of Québec, Canada. A serum bank comprising sera from 474 dog owners was screened by an enzyme-linked immunosorbent assay followed by confirmation of positive or equivocal sera by an indirect immunofluorescence assay. Observed seroprevalences of 1.2% (95% confidence interval (CI): 0.0–6.6), 2.6% (95% CI: 0.5–7.4) and 5.9% (95% CI: 3.4–9.6) were estimated in the regions of Montréal, Lanaudière and Montérégie, respectively, which all included at least 83 samples. Having lived or worked on a small ruminant farm (prevalence odds ratio (POR) = 5.4; 95% CI: 1.6–17.7) and being a veterinarian or veterinary student (POR = 6.1; 95% CI: 1.6–24.0) were significantly associated with C. burnetii seropositivity. Antibodies against C. burnetii were detected in the human population of Québec. Although seropositivity to this agent was associated with occupational contact with domestic animals, antibodies were also detected in people with no reported professional exposure. No associations with ruminant farm proximity were identified.

Adelges tsugae Annand (Hemiptera: Adelgidae), a nonindigenous insect pest of hemlock (Tsuga spp.) (Pinaceae) in eastern North America, spends most of its life cycle within an ovisac, which resembles a woolly white mass on twigs. We evaluated the probability of detecting adelgid wool with Velcro®-covered balls when taking an increasing number of samples per tree (field sampling) and number of trees per simulated stand. We examined the relationship between the detection of adelgid wool using this technique and the incidence of A. tsugae-infested twigs by sampling lower-crown branch tips of the same trees. We found that the probability of detecting wool with ball sampling increased with number of ball samples per tree, with number of trees per simulated stand, and with increasing incidence of ovisacs in the lower crown. When sampling an individual tree, we found that 20 ball samples per tree achieved a targeted precision level of 0.75, but when sampling a stand, we found that 10 ball samples per tree took the least time for the range of simulated A. tsugae infestations we tested. These sample sizes are recommended for detection of A. tsugae infestations on an individual tree and in a hemlock stand.

Cet article fait l'analyse des discours homonationalistes dans un contexte qui a été peu exploré à ce jour, soit celui d'une nation minoritaire (le Québec) à l'intérieur d'un État multinational (le Canada). Dans la mesure où le nationalisme se construit souvent en opposition avec un « Autre », nous tentons de cerner qui est cet « Autre » dans l'homonationalisme québécois. En particulier, nous explorons si cet « Autre » peut également prendre la forme de la nation majoritaire par l'entremise d'une analyse d'articles publiés entre 1990 et 2017 dans différents journaux québécois (La Presse, Le Devoir et le Journal de Montréal). Nos résultats démontrent que si c'est le « Canada anglais » qui était plus susceptible dans la première moitié des années 2000 d’être « l'Autre » du nationalisme sexuel québécois, depuis la fin des années 2000, ce sont davantage les musulman/es (ici et ailleurs) et les immigrant/es qui font l'objet d'une altérisation dans les discours homonationalistes au Québec.

We study the impact of compulsory voting in Brazil, where voting is mandatory from age 18 to 70 and voluntary for those aged 16, 17 and 70+. Using a survey sample of 8008 respondents, we document voter confusion about how the age criterion applies. Some people falsely believe that what matters is one's age in an election year rather than on Election Day. Next, we perform a regression discontinuity (RD) analysis of compulsory voting among young voters with register-based data from six Brazilian elections (2008–2018). We find that the effect of compulsory voting is seriously underestimated if we focus solely on the discontinuities prescribed by the law. Our findings carry important implications for studies adopting the RD design where knowledge of the cutoff is expected of the units of interest (like those about compulsory voting) and confirm that compulsory voting is a strong institutional arrangement that promotes greater electoral participation.

We examined the quality of care provided to older persons with frailty in five Canadian provinces, using administrative health data. In each province, we identified two cohorts of older persons with frailty: decedents and living persons. Using decision rules, we considered individuals to be frail if they were long-term care residents, terminally ill, or met at least two of seven domains, which were based on frailty scales, geriatrician discussions, and health service utilization indicators. We assessed quality of care using selected quality indicators: decrease in length of hospital stay, decrease in the number of in-patient readmissions, decrease in the number of emergency department visits, increase in the level of family physician continuity of care, decrease in the use of mechanical ventilation, and decrease in the number of admissions to intensive care. Using regression analyses, we also found male sex and older age were associated with poorer quality of care in both cohorts. This study provides baseline data for evaluating future efforts to improve the quality of care provided to older persons with frailty.

Introduction: Endotracheal intubation (EI) is frequently performed in the emergency department (ED). Although this procedure is generally life-saving, EI is also known to cause adverse effects, such as hemodynamic alterations. A systolic blood pressure <90 mmHg is the most commonly accepted definition of hypotension; however systolic blood pressure naturally increases with age. The National Trauma Triage Protocol now states that this threshold could be raised to 110 mmHg in older patients. Objective: to determine the impact of increasing the post-intubation hypotension (PIH) threshold to 110 mmHg on hospital length of stay and mortality in older patients. Methods: Design: A historical cohort of patients admitted in a level-1 trauma center ED between 06/2011 and 05/2016 was constituted. Population: Patients were included if pre-EI vital signs were available, their intubation was performed in the resuscitation room, were aged ≥65, if no surgical access was needed and if EI was performed in ≤3 attempts. Measures: All clinical data including vitals were prospectively recorded using the software ReaScribe. Main outcome was in-hospital mortality. Analyses: Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: A total of 181 patients were included. When using the 90-mmHg threshold, 92 patients suffered from PIH. Mean length of stay for these PIH patients was 18.9 days, compared to 12.0 days for non-hypotensive patients (P = 0.06). Mortality rate at 24 hours was 9.78% and 15.83% for PIH and non PIH patients, respectively (p = 0.2). The 110-mmHg threshold identified 33 additional PIH patients (n = 125) and their mean length of stay was 17.8 compared to 10.2 days for non PIH patients (P = 0.02). Mortality rate at 24 hours was 9.90% for PIH patients and 21.43% for non PIH patients (p = 0.02). Conclusion: PIH was associated with a significant increase in LOS when the PIH threshold is set at 110. Mortality rate is high in the intubated ED older patient and that increasing hypotension threshold for older patient seem to have no impact on patient mortality at 24 hours. Since our sample is limited, more research is needed to confirm these results.

Introduction: The vast majority of patients presenting with dizziness to the emergency department (ED) are due to a benign self-limiting process. However, up to 5% have a serious central neurological cause. Our goal was to assess the sensitivity of clinical exam for a central cause in adult patients presenting to the emergency department with dizziness. Methods: At a tertiary care ED we performed a medical records review (Sep 2014- Mar 2018) including adult patients with dizziness (vertigo, unsteady, lightheaded), excluding those with symptoms >14days, recent trauma, GCS < 15, hypotensive, or syncope/loss of consciousness. 5 trained reviewers used a standardized data collection sheet to extract data. Individual patient data were linked with the Institute of Clinical Evaluation Science (ICES) database. Our outcome was a central cause defined as: ischemic stroke (IS), transient ischemic attack (TIA), brain tumour, intra cerebral haemorrhage (ICH), or multiple sclerosis (MS) diagnosed on either neurology assessment, computed tomography, magnetic resonance imaging, or diagnostic codes related to central causes found within ICES. A sample size of 1,906 was calculated based on an expected prevalence of 3% with an 80% power and 95% confidence interval to detect an odds ratio greater than 2. Univariate analysis and logistic regression were performed. Results: 3,109 were identified and 2,307 patients included (mean 57 years SD ± 20, Female 59.1%, Kappa 0.91). 62 central causes (IS 56.5%, TIA 14.5%, Tumour 11.3%, MS 9.7%, ICH 6.5%) of dizziness were identified. Imaging was performed in 945(42%) and neurology assessment in 42 (1.8%). ICES yielded no new diagnoses of a central cause for dizziness. Multivariate logistic regression found 11 high-risk findings associated with a central cause; history of IS/TIA (OR 3.8 95%CI 1.7-8.2), cancer (OR 3.2 95%CI 1.4-7.2), dyslipidemia (OR 2.3 95%CI 1.2-4.4), symptoms of visual changes (OR 2.1 95%CI 1.5-6.3), dysarthria (OR 9.1 95%CI 3-27.4), vomiting (OR 2 95%CI 1-3.7), motor deficit (OR 7.7 95%CI 2.9-20.2), sensory deficit (OR 28.9 95%CI 7.4-112.9), nystagmus (OR 3.3 95%CI 1.6-6.7), ataxia (OR 2.5 95%CI 1.3-4.9) and unable to walk 3 steps unaided (OR 3.4 95%CI 1.4-8.5). Absence of these findings had a sensitivity of 100% (95%CI 92.5-100%) for ICH, IS, Tumour and 95.2% (86.5-98.9) if including TIA and MS. Specificity was 51.5% (95%CI 49.4-53.6%). Conclusion: Clinical exam is highly sensitive for identifying patients without a central etiology for their dizziness.

Introduction: Identification of severe bacterial infections (SBI) among infants presenting to the emergency department (ED) for fever without a source (FWS) remains challenging. Controversies persist on the usefulness of blood biomarkers, especially when used for assessing infants 22 to 60 days old. Although C-reactive protein (CRP) and white blood cells count (leucocytes) are commonly prescribed, this practice relies on poor and conflicting evidence. Our objective was to determine the performance of those two markers at identifying SBI. Methods: This is a sub-analysis of an ongoing retrospective cohort study conducted in an academic pediatric ED in Quebec City, that aims to determine whether a lumbar puncture should routinely be performed in the FWS workup of 22 to 60 days old infants. All consecutive charts of eligible febrile infants were reviewed. Premature infants (<37 weeks), as well as infants with chronic diseases, immunodeficiency, previous antimicrobial therapy, in-dwelling catheters, or septic shock were excluded. Among others, data related to final diagnosis and investigations were gathered. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios were estimated for each blood biomarkers. Results: Out of 1261 charts reviewed, 920 patients were included in this analysis. SBI prevalence was 13.0% (95%CI: 10.9-15.2) among infants of our cohort. The sensitivity, specificity, PPV, NPV, LR+ and LR- of the leucocytes <5000 or≥15000/□L were 43% (95%CI: 34-53%), 80% (95%CI: 77-83%), 25% (95%CI: 21-30%), 90% (95%CI: 88-91%), 2.1 (95%CI: 1.7-2.8), and 0.72 (95%CI: 0.61-0.84), respectively. The sensitivity, specificity, PPV and NPV of CRP >= 25 mg/L were 46% (95%CI: 37-56%), 96% (95%CI: 94-97%), 65% (95%CI: 55-73%), and 91% (95%CI: 89-92%), respectively. ROC curves analysis indicates that a CRP≥25 mg/L offers the best LR+ (10.4; 95%CI: 6.9-15.6) with a corresponding LR- of 0.56 (95%CI: 0.47-0.67). Conclusion: When evaluating febrile infants in the ED, leucocytes appear to have limited added value, while CRP≥25 mg/L significantly increases the pre-test probability of SBI. CRP should be considered for inclusion in the workup of FWS for infants of 22 to 60 days of age.