Background: Pain in a common symptom in adult-onset idiopathic dystonia (AOID). An appropriate tool to understand this symptom is needed to improve AOID patients’ care. We developed a rating instrument for pain in AOID and validated it in cervical dystonia (CD). Methods: Development and validation of the Pain in Dystonia Scale (PIDS) in three phases: 1. International experts and participants generated and evaluated the preliminary items for content validity; 2. The PIDS was drafted and revised, followed by cognitive interviews to ensure suitability for self-administration; and 3. the clinimetric properties of the final PIDS were assessed in 85 participants. Results: PIDS evaluates pain severity (by body part), functional impact and external modulating factors. It showed high test-retest reliability the total score (0.9, p<0.001), intraclass correlation coefficients higher than 0.7 for all items and high internal consistency (Cronbach’s alpha 0.9). Convergent validity analysis revealed a strong correlation between the PIDS severity score and the TWSTRS pain subscale (0.8, p<0.001), the brief pain inventory short form (0.7, p<0.001) and impact of pain on daily functioning (0.7, p<0.001). Conclusions: The PIDS is the first specific questionnaire developed to evaluate pain in patients with AOID with high-level clinimetric properties in people with CD.

In this paper, we study how a combination of random ballot ordering and concurrent elections can increase invalid votes in the context of South Korea. In South Korea, elections for the nonpartisan superintendent of education are held concurrently with other partisan races. Whereas the ballot order for candidates in the nonpartisan superintendent of education elections is randomized and rotated, this order for other partisan races is determined according to the number of seats each party has in the national legislature. In this study, we found that a match between candidates’ partisan preferences and their ballot positions decreases invalid votes. Our findings suggest that combining two different ballot-order schemes for concurrently held elections can confuse voters and increase invalid votes.

From April 1, 2016, through March 31, 2022, growth of Stenotrophomonas maltophilia from clinical specimens at our academic medical center was significantly more likely during July–September than during other calendar quarters.

Morphological data and the first molecular data are provided for four species of the trematode family Bucephalidae Poche, 1907 from marine and freshwater teleost fish species of East Asia. A new species, Rhipidocotyle husi n. sp., was isolated from Huso dauricus from the Amur River, Russia. Adult worms of this species were distinguished from their congeners Rhipidocotyle illense and Rhipidocotyle kovalai by morphological analysis. Three other known species were identified: Bucephalus skrjabini and Prosorhynchus cf. squamatus were detected in Siniperca chuatsi from the Amur River and in Myoxocephalus spp. from the Okhotsk Sea, Russia, respectively, while Prosorynchoides karvei was extracted from Strongylura strongylura from Halong Bay, Vietnam. The 28S ribosomal DNA (rDNA)-based phylogenetic analysis showed that the new species formed a shared polytomy clade with Rhipidocotyle fennica. Phylogenetic analysis of all available molecular data showed that four genera, namely Rhipidocotyle, Bucephalus, Prosorynchoides and Prosorhynchus, are para- or polyphyletic. Molecular-based phylogenetic analysis of morphologically validated bucephalid species indicated that three genera – Rhipidocotyle, Bucephalus and Prosorynchoides – were monophyletic. The genus Prosorhynchus maintained paraphyly, and P. cf. squamatus was more closely related to Dollfustrema spp. than to other Prosorhynchus spp. These findings do not exclude the possibility that representatives of Dollfustrema and P. cf. squamatus belong to the same genus.

OBJECTIVES/GOALS: The current opioid epidemic has placed post-operative pain management under scrutiny. Limiting post-operative pain can decrease overall opioid usage in the recovery period, especially after orthognathic surgery. Several studies have illustrated the efficacy of pregabalin in decreasing postoperative pain and opioid usage in adults undergoing orthognathic surgery. We aim to study the effects of a single dose of preoperative pregabalin on postoperative pain and total opioid consumption after orthognathic surgery in individuals with cleft lip and palate. METHODS/STUDY POPULATION: This was a retrospective cohort study of consecutive patients who received Le Fort I midface advancement between June 2012 and July 2019 by one of two surgeons at a single institution. We took advantage of our institution’s implementation, beginning in 2016, of a one-time dose of preoperative pregabalin for LeFort I midface advancement. All patients had diagnosed cleft lip and palate. The treatment group received a one-time preoperative dose of pregabalin. The control group did not receive pregabalin. Total morphine milligram equivalents (MME) consumption was calculated by adding intraoperative opioid administration and postoperative opioid consumption during admission. Postoperative pain control during admission consisted of oral oxycodone and intravenous (IV) hydromorphone or morphine. Duration of hospitalization and pain intensity assessed with the numeric pain rating scale (0-10) were also recorded. The mean postoperative pain assessment scores during admission was calculated for each patient. The median of these individual mean pain assessment scores for each group was subsequently computed. RESULTS/ANTICIPATED RESULTS: Twenty-three patients (14 males, 9 females) were included in this study; 12 patients received pregabalin (median dose: 150mg, range: 100-200mg). Mean age (years) at operation of the pregabalin (18.3 ± 1.9) and control groups (17.8 ± 1.9) were also equivalent (p = 0.571). Median hospital stay for both groups was 1.0 day. The pregabalin group had significantly lower consumption of total opioids during admission (total MME 70.95 MME; IQR: 24.65-150.17) compared to the control group (138.00 MME; IQR: 105.00-232.48) (MU = 31.00, p = 0.031). Although pain scores in the treatment group (3.21 ± 2.03) were lower than in the control group (3.71 ± 2.95), the difference was not statistically significant (p = 0.651, 95% Cl [−1.75, 2.75]). DISCUSSION/SIGNIFICANCE OF IMPACT: Based on the results, a one-time preoperative oral dose of pregabalin before orthognathic surgery in patients with cleft lip and palate reduced total opioid consumption during admission. However, there was no difference in length of stay or pain scores within the two groups. A single preemptive oral dose of pregabalin should be considered an effective adjunct to pain management protocols in patients undergoing orthognathic surgery.

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.

This study examines the ways political events can affect the stock prices of politically connected firms by studying one of the biggest corruption scandals in modern South Korean history, which led to the first-ever impeachment of a sitting president. We analyzed the stock returns of firms that donated money to foundations allegedly controlled by the president's confidante. We found that the abnormal stock returns of politically connected firms decreased when the president was removed from office. Using tick-by-tick stock price data, we were able to pinpoint the exact moments when the stock prices of firms that donated money fluctuated, as the president's fate was determined by the justices of the Constitutional Court.

Introduction: Simulation has assumed an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High quality simulation-based research (SBR) is required to ensure the effective and efficient use of this tool. This study sought to establish national SBR priorities and describe the barriers and facilitators of SBR in Emergency Medicine (EM) in Canada. Methods: Simulation leads (SLs) from all fourteen Canadian Departments or Divisions of EM associated with an adult FRCP-EM training program were invited to participate in three surveys and a final consensus meeting. The first survey documented active EM SBR projects. Rounds two and three established and ranked priorities for SBR and identified the perceived barriers and facilitators to SBR at each site. Surveys were completed by SLs at each participating institution, and priority research themes were reviewed by senior faculty for broad input and review. Results: Twenty SLs representing all 14 invited institutions participated in all three rounds of the study. 60 active SBR projects were identified, an average of 4.3 per institution (range 0-17). 49 priorities for SBR in Canada were defined and summarized into seven priority research themes. An additional theme was identified by the senior reviewing faculty. 41 barriers and 34 facilitators of SBR were identified and grouped by theme. Fourteen SLs representing 12 institutions attended the consensus meeting and vetted the final list of eight priority research themes for SBR in Canada: simulation in CBME, simulation for interdisciplinary and inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology. Conclusion: Conclusion: This study has summarized the current SBR activity in EM in Canada, as well as its perceived barriers and facilitators. We also provide a consensus on priority research themes in SBR in EM from the perspective of Canadian simulation leaders. This group of SLs has formed a national simulation-based research group which aims to address these identified priorities with multicenter collaborative studies.

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises eleven tertiary, urban community and rural community emergency departments (EDs) that represents over three hundred emergency physicians. We report the initial stakeholder and site leadership needs assessment used to inform the development of a comprehensive continuing professional development (CPD) procedural skills curriculum for the Edmonton Zone. Methods: A list of procedural skills was distributed to the two Edmonton Zone Clinical Department Heads of Emergency Medicine (EM). This list was based on a previous Canadian study that utilized procedures from the Objectives of Training in EM. Based on perceived needs, twenty-five procedures were chosen by consensus from zone leadership and study authors as the initial focus for a skills curriculum. This list was sent via survey to the physician site leads of all EDs in the zone. Each site lead was asked to indicate the fifteen procedure curriculum they felt would most benefit their respective physician groups. Responses were collated to look at all departments as a group and stratified by the type of ED (tertiary, urban and rural community). Results: Every site chief of Edmonton Zone EDs completed the survey (100% response rate). Cricothyrotomy and pediatric intubation were the two procedures prioritized by every site. One procedure (ultrasound guided central lines) was prioritized by 10/11 sites while three procedures (ultrasound guided central lines, adult intubation and chest tube insertion) were specified by 9/11 sites as needs. Two procedures (pericardiocentesis and thoracotomy) were named as priorities only by tertiary centers. Conversely, three procedures (extensor tendon repair, anterior and posterior nasal packing) were highlighted by all rural sites, but not consistently by any urban sites. Conclusion: Over the next few years, competency-based CPD will emerge for physicians in practice. Our preliminary needs assessment showed that while a common zone-wide curriculum will be possible, targeted curricula tailored to the unique needs of the various types of EDs will also be necessary. This has implications for the resources and teaching requirements needed to deliver effective and recurring CPD courses to an entire health region. A targeted needs assessment to all Edmonton Zone physicians will be the next step to verify and further elaborate on these preliminary results.

Recent results of three astrophysically relevant experiments at Caltech are summarized. In the first experiment magnetohydrodynamically driven plasma jets simulate astrophysical jets that undergo a kink instability. Lateral acceleration of the kinking jet spawns a Rayleigh–Taylor instability, which in turn spawns a magnetic reconnection. Particle heating and a burst of waves are observed in association with the reconnection. The second experiment uses a slightly different setup to produce an expanding arched plasma loop which is similar to a solar corona loop. It is shown that the plasma in this loop results from jets originating from the electrodes. The possibility of a transition from slow to fast expansion as a result of the expanding loop breaking free of an externally imposed strapping magnetic field is investigated. The third and completely different experiment creates a weakly ionized plasma with liquid nitrogen cooled electrodes. Water vapour injected into this plasma forms water ice grains that in general are ellipsoidal and not spheroidal. The water ice grains can become quite long (up to several hundred microns) and self-organize so that they are evenly spaced and vertically aligned.

The present study compared the effects of feeding uncooked pea fractions (embryo v. seed coat) on glucose homeostasis in glucose-intolerant rats and examined potential mechanisms influencing glucose homeostasis. Rats were made glucose intolerant by high-fat feeding, after which diets containing both high-fat and pea fractions were fed for 4 weeks. Rats fed diets containing uncooked pea seed coats low (non-coloured seed coat; NSC) or high (coloured seed coat; CSC) in proanthocyanidins but not embryos had improved oral glucose tolerance (P < 0·05). NSC also lowered fasting and glucose-stimulated insulin secretion (P < 0·05), decreased β-cell mass by 50 % (P < 0·05) and lowered levels of malondialdehyde, a marker of oxidative stress. Furthermore, NSC decreased the mucosal thickness of the colon by 25 % (P < 0·05), which might affect fibre fermentation and other gut functions. Small but statistically significant (P < 0·05) effects consistent with enhanced glucose transport or metabolism were observed in the skeletal muscle of rats fed NSC or CSC, for example, increased levels of AMP-dependent kinase or akt. We conclude that pea seed coats are the fraction exerting beneficial effects on glucose tolerance. Most of the changes were small in amplitude, suggesting that additive effects on multiple tissues may be important. NSC content appeared to have the most beneficial effects in improving glucose homeostasis but our ability to detect the effect of flavonoids may have been limited by their low concentration in the diet.

The first record of Gobius couchi for the Ligurian Sea and the second record of this rare gobiid fish for the western Mediterranean are reported.

Nanoporous electrodes, such as those made from carbon or gold, can capture and release ionic analytes at concentrations near 1 mole per liter of pore volume through capacitive charging or electrochemically reversible adsorption. In vitro studies suggest that this phenomenon can be the basis for a noninvasive, precise, and programmable drug delivery method. It would eliminate the need for bulk fluid delivery to target tissue and require only a thin electrical connection, minimizing pain and tissue disruption. We have designed effective gold electrode assemblies and observed the depletion and release phenomena using electrochemical methods and charged dyes.

The thickness dependence of the dielectric properties of epitaxial BaTiO3 thin films was investigated for thicknesses ranging from 15 to 320 nm. The films were deposited by low-pressure metalorganic chemical vapor deposition on (100) MgO substrates. The relative dielectric permittivity and the loss tangent values decreased with decreasing thickness. High-temperature dielectric measurements showed that with decreasing film thickness, the ferroelectric-to-paraelectric transition temperature decreased, the relative dielectric permittivity decreased, and the phase transition was diffuse. The c/a ratio also decreased with decreasing film thickness. The observed behavior for epitaxial films of BaTiO3 was attributed to the presence of strain in the films.