Background: Our aim was to develop a National Quality Indicators Set for the Care of Adults Hospitalized for Neurological Problems, to serve as a foundation to build regional or national quality initiatives in Canadian neurology centres. Methods: We used a national eDelphi process to develop a suite of quality indicators and a parallel process of surveys and patient focus groups to identify patient priorities. Canadian content and methodology experts were invited to participate. To be included, >70% of participants had to rate items as critical and <15% had to rate it as not important. Two rounds of surveys and consensus meetings were used identify and rank indicators, followed by national consultation with members of the Canadian Neurological Society. Results: 38 neurologists and methodologists and 56 patients/caregivers participated in this project. An initial list of 91 possible quality indicators was narrowed to 40 indicators across multiple categories of neurological conditions. 21 patient priorities were identified. Conclusions: This quality indicators suite can be used regionally or nationally to drive improvement initiatives for inpatient neurology care. In addition, we identified multiple opportunities for further research where evidence was lacking or patient and provider priorities did not align.

Two experiments were conducted to determine whether maximum eye temperature, measured using infrared thermography (IRT), could be a non-invasive technique for detecting responses of cattle to handling procedures. Experiment one used six crossbred heifers randomly assigned to two groups in a crossover design and subjected to i) being hit with a plastic tube on the rump and ii) being startled by the sudden waving of a plastic bag. Experiment two used 32 crossbred bulls randomly assigned to three treatments: i) control, restraint only; ii) electric prod, two brief applications of an electric prod or, iii) startled, as in experiment one, accompanied by shouting. Exit speed (m s−1) was recorded on release from the restraint. Maximum eye temperature was recorded continuously pre- and post-treatment. In experiment one, eye temperature dropped rapidly between 20 and 40 s following both treatments and returned to baseline between 60 and 80 s following hitting and between 100 and 120 s following startling. In experiment two, eye temperature dropped between 0 and 20 s, following both treatments, and returned to baseline by 180 s, following startling plus shouting, but did not return to baseline for five minutes following electric prod. Exit speed tended to be faster following the electric prod. In conclusion, IRT detected responses that were due possibly to fear and/or pain associated with the procedures and may therefore be a useful, non-invasive method for assessing aversiveness of handling practices to cattle.

We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005–2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.

OBJECTIVES/GOALS: Use an easily accessible medium to educate life science researchers and academic innovators interested in the commercialization of academic research at the University of Michigan (UM). METHODS/STUDY POPULATION: Life science research investigators and academic innovators interested in research commercialization and technology development from across the state of Michigan were invited to attend the Idea to Impact: The Translation & Commercialization of Academic Research webinar series, presented by Fast Forward Medical Innovation at the University of Michigan. The webinar series outlined the significance and critical milestones of developing novel therapeutics, medical devices, diagnostics, and digital health innovations, as well as essential collaborations with industry partners to translate a research-based idea into a product of impact. RESULTS/ANTICIPATED RESULTS: 113 investigators and innovators from 28 different institutions, organizations, and companies, registered for the webinar series. Results (N=24) of an evaluation immediately following each webinar revealed that 100% of respondents strongly agreed or agreed that the series was effective in helping them to identify and describe commercialization resources, including funding, education, and mentorship, available at the University of Michigan and within the state. Participants stated that they “loved the practical information” “shared” and that the series was a “great overview that inspired a lot more questions.” The Fast Forward Medical Innovation team was then able to consult with participants to connect them with additional resources. DISCUSSION/SIGNIFICANCE: The data suggests that easily accessible and digestible commercialization education can make navigating the academic entrepreneurial ecosystem easier for investigators and innovators. The recorded webinar series, Idea to Impact: The Translation & Commercialization of Academic Research, serves this purpose.

OBJECTIVES/GOALS: The University of Michigan Frankel Cardiovascular Center (FCVC) Innovation Challenge is an annual competition offering funding for innovative ideas to improve cardiovascular care. Due to the COVID-19 pandemic, administrators converted the recruitment process and pitch event to fully virtual. METHODS/STUDY POPULATION: We detail the process of converting the event from a hybrid process (virtual and in-person recruiting and in-person event) to a fully virtual one. Changes to the event included implementing a virtual recruiting process utilizing short video recordings as submission format; a new tool for storing and displaying submissions; fully virtual finalist selection and coaching; and a fully virtual pitch and judging event. The submission process tracked information about submissions that include the type of idea (process or product), role of team lead, and department of team lead. RESULTS/ANTICIPATED RESULTS: The FCVC Innovation Challenge was successfully converted to a fully virtual event. Methods and tools will be shared to allow similar institutions to replicate a successful virtual pitch event. These include methods and tools utilized to allow participants to describe their ideas, strategies to select and coach finalists, and to host a virtual pitch event. Data will be shared on the number of ideas and category (product/process) of projects submitted, and number and category of finalists selected. DISCUSSION/SIGNIFICANCE: This case review can demonstrate how institutions can use a similar virtual idea submission and pitch process to (1) catalyze innovative ideas that can impact patient care by accessing its communitys ideas and (2) fund innovative ideas that do not fit traditional mechanisms.

OBJECTIVES/GOALS: Ask the Experts: A Biomedical Innovation Forum, presented by Fast Forward Medical Innovation (FFMI) at the University of Michigan, provided an opportunity to educate biomedical innovators on life science investment trends and technology assessment criteria. METHODS/STUDY POPULATION: FFMI, in partnership with the U.S. Economic Development Administration, recruited an expert group of panelists to be featured at this virtual event. These life science investment experts provided insight on the strategy, timing, and best method for innovators to engaged investors, the specifics of what investors look for in technologies and project teams, and expectations of investors and project teams after the investment is secured. The panel presentation was followed by a poster presentation highlighting projects from the FFMI Hub at the University of Michigan, allowing innovators to have an open and constructive conversation with experts and attendees. RESULTS/ANTICIPATED RESULTS: There was a total of 73 registrants including academic faculty, biomedical innovators, and life science investment professionals from 21 different academic institutions, private companies, and other organizations. 50 attended the panel presentation and poster session. Results (N=5) of an evaluation of the event revealed that 100% of the respondents strongly agreed or agreed that the event met their expectations, while 80% strongly agreed or agreed that they would recommend the event to a colleague. Feedback from poster presenters was also strong with presenters exclaiming they “enjoyed the panel discussion and getting one-on-one time with the panelists,” as well as “a lot of great advice was given by the experts” and “I really liked the poster presentation part in which I got feedback from the investors.” DISCUSSION/SIGNIFICANCE: The data demonstrates how accelerating technology mining activities, proactively seeking and strengthening external partnerships with investors, and scaling commercialization education programs can have a positive impact on the development and launch of biomedical innovations.

Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.

The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.

The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

Lockdowns associated with the COVID-19 pandemic temporarily restricted human activity and removed people from many places of work and recreation. The resulting ‘Anthropause’ generated much media and research interest and has become an important storyline in the public history of the pandemic. As an ecological event, the Anthropause is fleeting and unlikely to alter the long-term human impact on the planet. But the Anthropause is also a cultural symbol whose effects may be more enduring. Will the Anthropause inspire people and governments to mobilize for meaningful reform, or does it present a misleading and too-comforting portrayal of resilient nature and wildlife that could ultimately discourage action? While it is too early to gauge the impact of the Anthropause on human behaviour and politics, we use existing research on environmental symbols and metaphors to identify factors that may influence long-term behavioural and political responses to this globally significant period of time.

The prespecification of the network is one of the biggest hurdles for applied researchers in undertaking spatial analysis. In this letter, we demonstrate two results. First, we derive bounds for the bias in nonspatial models with omitted spatially-lagged predictors or outcomes. These bias expressions can be obtained without prior knowledge of the network, and are more informative than familiar omitted variable bias formulas. Second, we derive bounds for the bias in spatial econometric models with nondifferential error in the specification of the weights matrix. Under these conditions, we demonstrate that an omitted spatial input is the limit condition of including a misspecificed spatial weights matrix. Simulated experiments further demonstrate that spatial models with a misspecified weights matrix weakly dominate nonspatial models. Our results imply that, where cross-sectional dependence is presumed, researchers should pursue spatial analysis even with limited information on network ties.

Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.

Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth.4

The concentration of radiocarbon (14C) differs between ocean and atmosphere. Radiocarbon determinations from samples which obtained their 14C in the marine environment therefore need a marine-specific calibration curve and cannot be calibrated directly against the atmospheric-based IntCal20 curve. This paper presents Marine20, an update to the internationally agreed marine radiocarbon age calibration curve that provides a non-polar global-average marine record of radiocarbon from 0–55 cal kBP and serves as a baseline for regional oceanic variation. Marine20 is intended for calibration of marine radiocarbon samples from non-polar regions; it is not suitable for calibration in polar regions where variability in sea ice extent, ocean upwelling and air-sea gas exchange may have caused larger changes to concentrations of marine radiocarbon. The Marine20 curve is based upon 500 simulations with an ocean/atmosphere/biosphere box-model of the global carbon cycle that has been forced by posterior realizations of our Northern Hemispheric atmospheric IntCal20 14C curve and reconstructed changes in CO2 obtained from ice core data. These forcings enable us to incorporate carbon cycle dynamics and temporal changes in the atmospheric 14C level. The box-model simulations of the global-average marine radiocarbon reservoir age are similar to those of a more complex three-dimensional ocean general circulation model. However, simplicity and speed of the box model allow us to use a Monte Carlo approach to rigorously propagate the uncertainty in both the historic concentration of atmospheric 14C and other key parameters of the carbon cycle through to our final Marine20 calibration curve. This robust propagation of uncertainty is fundamental to providing reliable precision for the radiocarbon age calibration of marine based samples. We make a first step towards deconvolving the contributions of different processes to the total uncertainty; discuss the main differences of Marine20 from the previous age calibration curve Marine13; and identify the limitations of our approach together with key areas for further work. The updated values for ΔR, the regional marine radiocarbon reservoir age corrections required to calibrate against Marine20, can be found at the data base http://calib.org/marine/.