Objectives/Goals: Substantial evidence supports the use of community engagement in CTS. Yet, there is a lack of empirical basis for recommending a particular level of community engagement over others. We aimed to identify associations between level of community involvement and study process outcomes, focusing on procedures to promote enrollment and inclusion. Methods/Study Population: Using manifest content analysis, we analyzed community engagement (CEn) strategies of studies indexed in ClinicalTrials.gov, focusing on studies 1) associated with 20 medical schools located in 8 southern states in the Black Belt, 2) conducted in 2015–2019, and 3) on 7 topics: cancer, depression, anxiety, hypertension, substance use disorder, cardiovascular disease, and HIV/AIDS. Data source was the ClinicalTrials.gov entry and publication for each study. We categorized each study on level of community involvement as described by the study protocol CTSA Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement continuum. Outcomes included recruitment and representativeness. Other codes included funder type, study phase, study status, and time to enrollment. Results/Anticipated Results: Of 890 studies that met inclusion criteria, only 493 had published findings. 286 studies (58%) met enrollment targets. Only 9 studies described any level of CEn (1 outreach, 3 consult, 1 involvement, 3 collaboration, and 1 shared leadership). Time to enrollment for these 9 studies (mean 28.78 mos.) was shorter than for studies without CEn (mean 37.43 months) (n.s.). CEn studies reached significantly higher enrollment (CEn mean  = 2395.11, non-CEn mean  = 463.93), p Discussion/Significance of Impact: Results demonstrate the substantial effect of CEn on enrollment and inclusion in clinical studies. However, the infinitesimal number of studies that reported CEn did not allow comparisons of level of engagement on the outcomes. Findings highlight ethical questions surrounding the lack of publishing incomplete studies.

Weeds belonging to the Amaranthus family are most problematic for soybean producers. With Palmer amaranth evolving resistance to multiple herbicides labeled for use in soybean, producers seek new sites of action to integrate into season-long herbicide programs. Bayer CropScience plans to launch a Convintro™ brand of herbicides, one being a premixture that will include diflufenican (categorized as a Group 12 herbicide by the Weed Science Society of America [WSSA]), metribuzin (WSSA Group 5), and flufenacet (WSSA Group 15), for use preemergence in soybean. Research trials were conducted in Fayetteville and Keiser, AR, and Holt, MI, in 2022 and 2023, to evaluate the premixture in a season-long program in a dicamba-resistant soybean system. A 0.17:0.35:0.48 ratio of a premixture of diflufenican:metribuzin:flufenacet (DFF-containing premixture) was applied preemergence with different combinations of glyphosate, glufosinate, dicamba, and acetochlor at 28 (early postemergence) and 42 (late postermergence) days after planting (DAP). At the early postemergence timing, the DFF-containing premixture provided >90% control of Palmer amaranth and prickly sida. However, common ragweed, common lambsquarters, morningglory ssp., and annual grass control was ≤80% at this timing. When the late postemergence applications occurred, treatments that had already received an early postemergence application controlled prickly sida, morningglory ssp., Palmer amaranth, and annual grasses to a greater extent than those that had not, indicating the preemergence application of the DFF-containing premixture was not sufficient to provide control of the weed spectrum through 42 DAP. By 70 DAP, all programs provided ≥93% control of all weeds evaluated. Herbicide programs that included the DFF-containing premixture preemergence followed by (fb) EPOST fb LPOST common ragweed, common lambsquarters, morningglory ssp., and annual grasses to a greater than the one-pass postemergence systems. In addition, all herbicide programs evaluated in this study reduced Palmer amaranth seed production by >99%. However, producers who plan to use the DFF-containing premixture may need two postemergence herbicide applications to obtain high levels of weed control throughout the growing season.

Bayer Crop Science anticipates launching several premixtures for use in soybean, targeted at control of Palmer amaranth. One of the premixtures will contain diflufenican (Weed Science Society of America [WSSA] Group 12), metribuzin (WSSA Group 5), and flufenacet (WSSA Group 15) (DFF-containing premixture), offering an alternative site of action for soybean producers. Field experiments were conducted in Arkansas and Michigan to evaluate application timings of the DFF-containing premixture for soybean tolerance and weed control and possible cultivar tolerance differences to diflufenican and the DFF-containing premixture. Soybean injury from the 1X and 2X rates of the DFF-containing premixture ranged from 0% to 60% 14 d after planting (DAP), with injury increasing the closer the herbicide was applied to soybean emergence. Excluding the 2X rate applied 3 DAP in Arkansas in 2023, soybean injury was <20% regardless of location, site-year, application timing, and rate. For weed control experiments, only a 1X rate of the DFF-containing premixture was applied at the various application timings. Control of five weed species, encompassing broadleafs and grasses, ranged from 81% to 98%, regardless of application timing, by 28 DAP. By 42 DAP, weed control ranged from 71% to 97%, with the 14-d preplant application timing typically being the least effective. The DFF-containing premixture and diflufenican alone were applied PRE at 1X and 2X rates for the soybean cultivar study. Soybean metribuzin sensitivity did not affect the degree of crop response, even in a high-pH soil, and injury to soybean never exceeded 20%. Overall, the DFF-containing premixture will be a tool that soybean producers can integrate into a season-long herbicide program for use across the United States regardless of soybean cultivar.

Background: There is growing evidence supporting the intraoperative use of an antifibrinolytic agent, tranexamic acid (TXA) to limit blood loss; however, use of TXA has not been widely adopted in cranial procedures. We aimed to determine the practice pattern regarding the use of TXA in craniotomy in Canada, and review the literature. Methods: A survey was conducted among the Canadian centres on TXA use during elective craniotomy. Online databases were searched for randomized controlled trials reporting the use of TXA in craniotomy for tumors. The results included the estimated blood loss and the dose used. Results: TXA was not routinely used in elective craniotomy but used selectively in 6 of 15 centres based on risk, intraoperative bleeding, or surgeon preference. The dose was 1 g with or without infusion. 6 studies were identified through literature search. The dose varied between 10–20 mg/kg bolus and 1 mg/kg/hr infusion, or a 2 g bolus alone. All studies reported a significant reduction in blood loss with TXA. Conclusions: We found widely divergent indications for intraoperative TXA use in elective craniotomy throughout Canada. This is in keeping with limited evidence in the literature. Further studies are needed to inform the decision regarding TXA use.

Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.

We present results from a pitcher-catcher experiment utilizing a proton beam generated with nanostructured targets at a petawatt-class, short-pulse laser facility to induce proton-boron fusion reactions in a secondary target. A 45-fs laser pulse with either 400 nm wavelength and 7 J energy, or 800 nm and 14 J, and an intensity of up to 5 × 1021 W/cm2 was used to irradiate either thin foil targets or near-solid density, nanostructured targets made of boron nitride (BN) nanotubes. In particular, for 800 nm wavelength irradiation, a BN nanotube target created a proton beam with about five times higher maximum energy and about ten times more protons than a foil target. This proton beam was used to irradiate a thick plate made of boron nitride placed in close proximity to trigger 11B (p, α) 2α fusion reactions. A suite of diagnostics consisting of Thomson parabola ion spectrometers, postshot nuclear activation measurements, neutron time-of-flight detectors, and differentially filtered solid-state nuclear track detectors were used to measure both the primary proton spectrum and the fusion products. From the primary proton spectrum, we calculated (p, n) and (α,n) reactions in the catcher and compare with our measurements. The nuclear activation results agree quantitatively and neutron signals agree qualitatively with the calculations, giving confidence that primary particle distributions can be obtained from such measurements. These results provide new insights for measuring the ion distributions inside of proton-boron fusion targets.

Background: Occult bacterial infection is a proposed etiology of low back pain (LBP). However, a causative link between LBP and bacteria remains unconfirmed. Herein, we determined the incidence of occult discitis in patients receiving surgery for LDH. Methods: Study Design: prospective cohort study. Inclusion criteria: consecutive adult patients undergoing discectomy for symptomatic LDH. Exclusion criteria: prior epidural steroid use, prior spinal surgery, and antibiotic use within 2 weeks of surgery. Tissue samples: Four nuclear tissue and ligamentum flavum (control) samples were obtained per patient using stringent aseptic protocol. Samples underwent 16S-PCR and culturing. Results: Eighty-one patients were enrolled (mean age 43.3±13.3 years). All (100%) of tissue samples were negative by 16S PCR and no virulent species were detected. Nuclear and ligament cultures were both negative in 51 (62.9%) cases. Cultures were positive for nuclear tissue only, ligament only, or both in 14.8%, 12.3%, and 9.9% of cases, respectively. Fifteen of 20 (75%) disc positive samples grew a single colony of an indolent species. Conclusions: The findings of this prospective cohort study of consecutive patients receiving surgery for LDH do not support the theory of occult discitis. All samples were 16S-PCR negative, and most cultures were negative or grew a single colony suggestive of contamination.

Background: Following craniotomy, there is widespread agreement that post-operative neurological impairments require specialized evaluation to evaluate fitness to drive. However, for patients who had a craniotomy and do not have neurological deficits or known seizures, there is less consensus as to when return to driving is safe. In this study, we aim to review existing guidelines regarding driving post-craniotomy and assess the current practices for post-craniotomy recommendations in Canada. Methods: Our study has three components: 1) systematic review of existing guidelines for return to driving after cranial procedure; 2) review of primary evidence (cohort studies) regarding seizure risk following a craniotomy, depending of the underlying pathology; 3) online questionnaire distributed to Canadian neurosurgeons by the Canadian Neurosurgery Collaborative (CNRC) network. Results: Our systematic review unveiled various sets of guidelines for driving after a craniotomy. For instance, UK Driving and Vehicle Licensing Agency writes into law specific guidelines for return to driving varying based on underlying pathology. Their results were drawn from large cohort studies measuring the occurrence of post-operative seizures after craniotomy for a variety of conditions. The questionnaire is currently being distributed to Canadian neurosurgeons. Conclusions: Our study lays the first steps towards the development of Canadian guidelines for return to driving post-craniotomy.

Background: Individuals with spinal cord injuries (SCI) are invariably faced with decisions around management of their injury; from life prolonging to palliating interventions. End-of-life (EOL) decision-making has recently come to include conversations around Medical Assistance in Dying (MAID), as legislation changes have expanded access. The intersection between SCI and MAID, and other EOL decision-making has yet to be explored. We sought to discuss awareness and perspectives on MAID and EOL decision-making. Methods: We conducted hour-long semi-structured interviews with 15 individuals living with cervical SCI. Interviews took place over the telephone or virtually, and transcripts were analyzed using an iterative coding process and thematic analysis. Results: There was a global lack of awareness of options, that changed with time as participants assumed more independent roles in decision making. Participants possessed general awareness of MAID, but variable understanding of who legislation applies to. The way individuals with SCI could interact with MAID legislation brought forth interesting discussions around bodily autonomy and self-determination. Some voiced their own desire initially for MAID, while others vacillated or were more strongly opposed. Conclusions: This study emphasizes the importance of engaging with difficult conversations, and striking the balance of respecting autonomy and self-determination, within the constraints of each individual’s situation.

Residents of rural areas are underrepresented in research. The aim of this narrative review was to explore studies describing the effectiveness of community engagement strategies with rural communities to promote participant recruitment and participation in clinical research. Following PRISMA guidelines, this narrative review was conducted in June 2020. Our search strategy was built around keywords that included community-engaged research, rural community, and recruitment strategies into clinical research. Content-related descriptive statistics were summarized. The selected articles were distributed into categories of levels of community engagement: inform, consult, involve, collaborate, or co-lead. The search resulted in 2,473 identified studies of which forty-eight met inclusion criteria. Of these, 47.1% were randomized controlled trials. The most common levels of engagement were consultation (n = 24 studies) and collaboration (n = 15), while very few focused on informing (n = 2) and co-leadership (n = 2). Strategies, limitations, and findings are discussed for each level of community engagement. This narrative addressed a gap in knowledge regarding participant recruitment in rural communities in relation to assistance from community members. Community engagement contributed to the success of the research, especially in recruitment, participation, and building trust and partnership.

COVID-19 has widened the existing digital divide, especially for people from socially and economically deprived communities. We describe a program evaluation using a community participatory approach to develop self-reported items of patient experience with technology inclusive of digital access and literacy. The feedback received from Community Advisory Boards and Community Engagement Studio members led to the evaluation and refinement of the individual items. The community-based participatory approach highlighted in our paper to develop these items could serve as a model for other screening tool development for enhancing equity and inclusiveness in clinical care and research.

Background: Spinal cord injuries invoke enormous life changes for the individual, with impacts not just on physical functioning, but social and psychological well-being. Individuals learn to deal with these changes, and handle these new stressors in different ways. Extant literature suggest the majority of people eventually attain a quality of life (QoL) simular to able-bodied individuals. We sought to validate these observations in a contemporary cohort and specifically explore how patients’ perceptions evolve over time. Methods: We conducted hour-long semi-structured interviews with 15 individuals living with cervical spinal cord injuries. Interviews took place over the telephone or virtually via MS Teams. Interview transcripts were then analyzed using an iterative coding process and thematic analysis (NVivo). Results: The over-arching journey that most participants described was a continuous evolution in QoL, as they learned to adapt and function with their injury. However, these trajectories were disparate and heavily reliant on personal supports and resources available, their psychosocial enviornment and inherent coping strategies. Conclusions: This study emphasizes the unique nature of each person’s journey, and not all people attain a satisfactory QoL. Our approach needs to be individualized, adjusting to specific circumstances, in order to provide more inclusive and supportive care.

Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.

Background: Lumbar disc herniation (LDH) is a risk factor for Modic change (MC) development on spinal MRI. MC has been associated with worse pre- and post-operative pain, disability, and health-related quality of life (HRQoL). We examined the relationship between pre-operative MC and post-operative assessment scores for patients receiving discectomy (LD) or transforaminal interbody fusion (TLIF) for LDH. Methods: We reviewed 285 primary single-level surgeries. Pre-operative and 12-month post-operative assessment scores: Visual Analog Scale Leg-Pain (VAS-LP), Oswestry Disability Index (ODI), and Short-Form-36 Physical Component Summary (SF-36-PCS). MC subgroup on pre-operative MRI was recorded by a single neuroradiologist. Results: 179 patients were included. The sample prevalence of MC on pre-operative MRI was 62%; MC2 was most common (35%). No differences in pre-operative scores were identified, regardless of present or absent MC. For the overall cohort, improvement in assessment scores were observed: SF-36 improved an average of 8.2 points (95% CI: [5.8, 10.7]), ODI by 11.3 points (95% CI: [8.7, 14.0]), and VAS by 2.8 points (95% CI: [2.1, 3.5]). In nearly all cases, MCID values were met. Conclusions: Clinically significant improvement in post-operative pain, disability, and HRQoL was observed for both procedures. Modic change on pre-operative MRI was not associated with worse clinical assessment scores.

Background: Enhanced Recovery After Surgery (ERAS) Protocols improve post-surgical outcomes through decreased length of hospital stay, reduced readmission rates, decreased post-operative pain, and greater patient satisfaction. ERAS also has significant benefits to the healthcare system through reduced cost of post-operative care. While ERAS protocols are well established in many surgical fields, a complete guideline for spine surgery is lacking. Early ERAS studies in spine surgery suggest up to a 50% reduction in length of stay (LOS) and decreased cost of care. Methods: Primary literature review followed by multidisciplinary critical appraisal for optimization and redesign of our current system of care for scheduled spine surgery (SSS), including patient experience and team logistics from initial consultation through post-operative care and follow up. Results: An evidence-based guideline, optimizing pre-, intra-, and post-operative phases of care was developed. Specific focus catered to pre-operative education and patient barriers to discharge. Further improvements in pre-admission patient goal setting, introduction of a patient care “passport”, post-operative reduction in narcotic administration, and increased same day post-operative mobilization were means to reduce LOS. Conclusions: A spine ERAS pathway was developed, allowing our care program to better facilitate patient recovery after SSS. Future work will aim to determine economic impact of the pathway.