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Background: Parents with intellectual disability, like all other parents, are embedded in networks of capability-enhancing and/or capability-inhibiting relationships. This study investigated links between how parents with intellectual disability experienced their upbringing, continuity and discontinuity in familial relationships, and their assessments of their own parenting. Method: Structured interviews, incorporating scales and open-ended questions, were conducted with 91 parents in receipt of specialist services for people with intellectual disability, including 82 mothers and 9 fathers. Results: Most participants (81%) had experienced at least one form of childhood abuse or household adversity. Participants who recalled a more positive upbringing, including less adversity and more parental care, tended to have stronger support networks and reported greater parenting role satisfaction and emotional warmth in their interactions with their own children. Conclusion: The results highlight the need to understand parenting by people with intellectual disability in biographical and relational context.

Objectives: To measure and compare distress in entry-level masters occupational therapy (OT) and physical therapy (PT) students; to evaluate distress levels relative to existing data; and to explore factors that cause stress, effects of stress, and coping strategies. Participants: Ninety-eight OT and PT students (75 females, 23 males) from two cohorts at a Canadian university. Methods: Sequential mixed-methods including questionnaires and inductive analysis of focus group discussions. Results: OT and PT students from one cohort reported higher levels of stress, anxiety and/or depression compared to the following academic year and compared to undergraduate and general population samples. The overall theme was "the unrelenting tug of war" between school and other aspects of students' lives. Factors related to academic workload negatively affected mental health. Coping strategies included physical activity, strategic selection of peers, and modifying expectations. Conclusions: Wellness in OT and PT students is an important concern that deserves attention.

Key Points: Question: Does aspirin at 300 mg/d improve invasive disease–free survival among survivors of nonmetastatic breast cancer? Findings: This randomized, placebo-controlled clinical trial included 3020 patients with high-risk nonmetastatic breast cancer. The trial was terminated early because of lack of benefit from aspirin (hazard ratio for invasive disease–free survival for aspirin vs placebo, 1.27 [not statistically significant]). Meaning: There was no benefit of aspirin at 300 mg/d on breast cancer recurrence and survival. Importance: Observational studies of survivors of breast cancer and prospective trials of aspirin for cardiovascular disease suggest improved breast cancer survival among aspirin users, but prospective studies of aspirin to prevent breast cancer recurrence are lacking. Objective: To determine whether aspirin decreases the risk of invasive cancer events among survivors of breast cancer. Design, Setting, and Participants: A011502, a phase 3, randomized, placebo-controlled, double-blind trial conducted in the United States and Canada with 3020 participants who had high-risk nonmetastatic breast cancer, enrolled participants from 534 sites from January 6, 2017, through December 4, 2020, with follow-up to March 4, 2023. Interventions: Participants were randomized (stratified for hormone receptor status [positive vs negative], body mass index [≤30 vs >30], stage II vs III, and time since diagnosis [<18 vs ≥18 months]) to receive 300 mg of aspirin (n = 1510) or placebo once daily (n = 1510) for 5 years. Main Outcomes and Measures: The primary outcome was invasive disease–free survival. Overall survival was a key secondary outcome. Results: A total of 3020 participants were randomized when the data and safety monitoring committee recommended suspending the study at the first interim analysis because the hazard ratio had crossed the prespecified futility bound. By median follow-up of 33.8 months (range, 0.1-72.6 months), 253 invasive disease–free survival events were observed (141 in the aspirin group and 112 in the placebo group), yielding a hazard ratio of 1.27 (95% CI, 0.99-1.63; P =.06). All invasive disease–free survival events, including death, invasive progression (both distant and locoregional), and new primary events, were numerically higher in the aspirin group, although the differences were not statistically significant. There was no difference in overall survival (hazard ratio, 1.19; 95% CI, 0.82-1.72). Rates of grades 3 and 4 adverse events were similar in both groups. Conclusion and Relevance: Among participants with high-risk nonmetastatic breast cancer, daily aspirin therapy did not improve risk of breast cancer recurrence or survival in early follow-up. Despite its promise and wide availability, aspirin should not be recommended as an adjuvant breast cancer treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT02927249 This study examines the potential benefits of aspirin as adjuvant therapy for survivors of early breast cancer. [ABSTRACT FROM AUTHOR]

As young workers prefer urban labors and migrate to USA and Canada, mango harvesting is becoming scarce on Mexican coasts. This seasonal labor is becoming expensive and when many orchards produce fruit simultaneously, grower losses increase. In this research, an innovative fruit detachment method was tested after applying a viscous paste to the pedicel of mango fruits hanging in the tree. Activated carbon or charcoal (AC), was mixed with different amounts of nitric acid to provide three AC composite blends named: light, medium, and dense. The nanomaterial was applied with a brush to the fruit pedicel/peduncle taking up to 4 h before the mango fruits felt to a net below the tree canopy. Mango detachment experiments indicated that the medium blend was the most efficient in releasing the fruit, taking an average of 2 h. The dense nano-material decreased latex exudation to 7% of the fruits. Fruit maturity emerged as a crucial factor for detachment time, followed by mango weight. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Ankle Introduction/Purpose: Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims. Consequently, medical malpractice lawsuits can impose significant economic and psychological burden on orthopedic surgeons. This study aims to investigate malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. Methods: The Westlaw legal database was queried for all cases involving hindfoot arthrodesis using the terms "malpractice" and either "ankle fusion," "arthrodesis," "subtalar fusion," "tibiotalar fusion," "tibiotalocalcaneal fusion," "TTC fusion," or "tibiofibular fusion" from 1987 to present day. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Results: Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (± 456,179). The most commonly alleged category of negligence was procedural/intraoperative error (75%) followed by post-surgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Conclusion: This study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality. Given the frequency of hindfoot arthrodesis performed, it is imperative for orthopedic surgeons to prioritize surgical goals, patient expectations, and complication profiles to reduce the risk of malpractice litigation and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Context.--: Resident physicians face a higher rate of burnout and depression than the general population. Few studies have examined burnout and depression in Canadian laboratory medicine residents, and none during the COVID-19 pandemic. Objective.--: To identify the prevalence of burnout and depression, contributing factors, and the impact of COVID-19 in this population. Design.--: An electronic survey was distributed to Canadian laboratory medicine residents. Burnout was assessed using the Oldenburg Burnout Inventory. Depression was assessed using the Patient Health Questionnaire 9. Results.--: Seventy-nine responses were collected. The prevalence of burnout was 63% (50 of 79). The prevalence of depression was 47% (37 of 79). Modifiable factors significantly associated with burnout included career dissatisfaction, below average academic performance, lack of time off for illness, stress related to finances, lack of a peer or staff physician mentor, and a high level of fatigue. Modifiable factors significantly associated with depression further included a lack of access to wellness resources, lack of time off for leisure, and fewer hours of sleep. Fifty-five percent (41 of 74) of participants reported direct impacts to their personal circumstances by the COVID-19 pandemic. Conclusions.--: Burnout and depression are significant issues affecting Canadian laboratory medicine residents. As the COVID-19 pandemic continues, we recommend the institution of flexible work arrangements, protected time off for illness and leisure, ongoing evaluation of career satisfaction, formal and informal wellness programming with trainee input, formal mentorship programming, and a financial literacy curriculum as measures to improve trainee wellness. [ABSTRACT FROM AUTHOR]

Background: With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation. Methods: In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used. Results: Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively. Conclusions: Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

Background: Patient experience when transitioning home from hospital is an important quality metric linked to improved patient outcomes. We evaluated the impact of a hospital-based care transition intervention, patient-oriented discharge summary (PODS), on patient experience across Ontario acute care hospitals. Methods: We used a repeated cross-sectional study design to compare yearly positive (top-box) responses to four questions centered on discharge communication from the Canadian Patient Experience Survey (2016–2020) among three hospital cohorts with various levels of PODS implementation. Generalized Estimating Equations using a binomial likelihood accounting for site level clustering was used to assess continuous linear time trends among cohorts and cohort differences during the post-implementation period. This research had oversight from a public advisory group of patient and caregiver partners from across the province. Results: 512,288 individual responses were included. Compared to non-implementation hospitals, hospitals with full implementation (>50% discharges) reported higher odds for having discussed the help needed when leaving hospital (OR = 1.18, 95% CI = 1.02–1.37) and having received information in writing about what symptoms to look out for (OR = 1.44, 95% = 1.17–1.78) post-implementation. The linear time trend was also significant when comparing hospitals with full versus no implementation for having received information in writing about what symptoms to look out for (OR = 1.05, 95% CI = 1.01–1.09). Interpretation: PODS implementation was associated with higher odds of positive patient experience, particularly for questions focused on discharge planning. Further efforts should center on discharge management, specifically: understanding of medications and what to do if worried once home. [ABSTRACT FROM AUTHOR]

Objective: Clozapine is presently the sole antipsychotic with an indication for treatment‐resistant Schizophrenia, but is associated with significant weight gain and other metabolic aberrations. This retrospective chart review aimed to evaluate the effectiveness of adjunctive metformin in preventing clozapine‐induced weight gain. Methods: We conducted a retrospective chart review of patients newly initiated on clozapine at the Centre for Addiction and Mental Health in Canada, from November 2014 to April 2021. Our primary outcome was body weight at 6 and 12 months after clozapine initiation. Other metabolic parameters served as secondary outcomes. Results: Among 396 patients (males: 71.5%, mean age: 42.8 years) initiated on clozapine, 69 were on metformin or prescribed it ≤3 months after clozapine initiation. The clozapine+metformin group demonstrated less weight gain compared with the clozapine‐only group at 6 months (clozapine+metformin: −0.15 kg [SE = 1.08] vs. clozapine‐only: 2.99 kg, SE = 0.54) and 12 months after clozapine initiation (clozapine+metformin: −0.67 kg, SE = 1.22 vs. clozapine‐only: 4.72 kg, SE = 0.67). Adaptive changes were also observed for fasting glucose (F = 3.10, p = 0.046) and triglycerides (F = 8.56, p < 0.001) in the clozapine+metformin group compared with clozapine only. Conclusion: In this large retrospective naturalistic cohort study, co‐prescription of clozapine and metformin was associated with less weight gain and related metabolic dysfunction at 6 and 12 months after initiation versus clozapine alone. These findings provide evidence for the effectiveness of metformin in preventing clozapine‐induced weight gain; larger randomized controlled trials are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Sustainable global energy production is back-stopped by hydropower which is responsible for a significant share of the green energy produced worldwide. Hydropower, however, does not come without some environmental impacts but has worked to reduce those impacts. Here, we discuss the historical, legislative, and design configurations of hydropower facilities located in three of the world's most important producers: Brazil, Canada, and Norway. The background is intended to inform the collection of scientific papers from each country aimed at assessing and improving the sustainability of hydropower production that form the core of this special issue on sustainable hydropower. We review the development and key legislative history for hydropower in each country and point out the common backgrounds and interests each nation has in the continued sustainable development of its hydropower resources. [ABSTRACT FROM AUTHOR]

Introduction Eating disorders are often under-detected, which poses a serious threat to the health of individuals with eating disorder symptoms. There is evidence to suggest that the military represents a subpopulation that may be susceptible to high prevalence of eating disorders and vulnerable to their underdiagnosis. Underreporting of eating disorder symptoms in the military could lead to this underdiagnosis of individuals with eating disorder symptoms. The purpose of this study was to examine the association between military affiliation and eating disorder symptoms among college students and the likelihood of eating disorder diagnosis among those with eating disorder symptoms using a large, diverse college-aged sample of both military-involved and civilian students. Materials and Methods Participants for this study were from the 2015-2016, 2016-2017, and 2017-2018 Healthy Minds Study (HMS). Healthy Minds Study is a large, cross-sectional cohort study of both undergraduate and graduate students from universities and colleges across the United States and Canada. The Healthy Minds Study survey questions include assessment of demographic information, military status, self-reported eating disorder symptoms using the SCOFF questionnaire, and self-reported eating disorder diagnosis. Univariate analysis, chi-square analysis, and logistic regression with an unadjusted and covariate adjusted model were used to examine the association between eating disorder symptoms and military affiliation. These analyses were also used to examine the association between eating disorder diagnosis among those with eating disorder symptoms and military affiliation. All analyses were conducted using SPSS. Results The prevalence of eating disorder symptoms was high among both the civilian (20.4%) and military-involved (14.4%) students. Among females, there was a significantly higher (P value = .041) prevalence of eating disorder symptoms among civilian college students (24.7%) compared to military-involved students (21.3%). Among those with eating disorder symptoms, the prevalence of diagnosis was low in both military and civilian students. Specifically, the prevalence of diagnosis was significantly lower (P value = .032) among military-involved college students (10.8%) compared to civilian college students (16.4%). Differences in sociodemographic characteristics (e.g. gender, race/ethnicity, and age) among military-involved and civilian college students appear to explain this association. Conclusions The underdiagnosis of eating disorders is far too common, and this represents a threat to the health of military and civilian populations alike. Underdiagnosis of eating disorders within military environments may be due to underreporting, particularly among men and racial/ethnic minority groups. [ABSTRACT FROM AUTHOR]

Parents with intellectual disability, like all parents, need support with childrearing. Early identification of parental intellectual disability may be key to the planning and delivery of appropriately adapted, inclusive family supports and services. The purpose of this study was to investigate the performance of a brief screener for parental intellectual disability. A total of 185 parents, including 91 parents in receipt of specialist intellectual disability services and 94 parents utilizing generic family support services, completed an interview/survey which incorporated candidate screening questions. The results of logistic regression and ROC curve analysis showed that a simple four-item screener performed well (accuracy 90.44%, sensitivity 92.31%, specificity 90.43%, AUC.96). The potential benefits of screening have to be weighed up against the risks of potential misuse. We therefore suggest that screening be introduced in the context of continuing professional education and initiatives to build system's capacity to support parents with intellectual disability and their families. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to examine glycaemic control and safety of insulin degludec (degludec) in patients with either type 1 diabetes (T1D) or type 2 diabetes (T2D) under routine care settings in Canada. Methods: Data were extracted from medical records of adults with T1D or T2D who switched to degludec (± prandial insulin) from another basal insulin (± prandial insulin) ≥ 6 months prior to data collection. The primary endpoint was change in glycated haemoglobin (HbA1c) at 6 ± 3 months after degludec initiation. Secondary endpoints included change in hypoglycaemia rate in the 6 months before versus the 6 months after switching, and change in mean total daily insulin dose. Results: Of 667 patients assessed for eligibility, 626 were included. After 6 ± 3 months, HbA1c decreased from baseline in patients with T1D (− 0.3% [− 0.42, − 0.14]95% CI; p < 0.001) and in patients with T2D (− 0.4% [− 0.55, − 0.30]95% CI; p < 0.001). In patients with T1D, there were significant reductions in the rates of overall (rate ratio [RR] 0.70), non-severe (RR 0.69), non-severe nocturnal (RR 0.36), and severe nocturnal hypoglycaemia (RR 0.12; all p ≤ 0.004). In patients with T2D there was a significant reduction in non-severe nocturnal hypoglycaemia (RR 0.22; p < 0.001). Mean daily basal insulin dose decreased in patients with T1D (− 1.6 units [− 2.8, − 0.4]95% CI; p = 0.008); there was no significant change in patients with T2D (− 0.6 units [− 2.7, 1.4]95% CI; p = 0.543). Conclusion: In routine clinical practice, improved glycaemic control was observed in patients with T1D or T2D switching to insulin degludec from other basal insulins, with either improvement or no change in hypoglycaemia rates. Trial Registration: ClinicalTrials.gov NCT03674866 [ABSTRACT FROM AUTHOR]

Aim To investigate the implementation of amplitude-integrated electroencephalography (aEEG) as bedside monitoring tool of cerebral function in tertiary Canadian Neonatal Intensive Care Units (NICU) over the past decade. Methods Longitudinal study consisting of online surveys of neonatologists on the use of aEEG in 2009 and 2018. Results The response rate to the survey was 72 of 149 (49%) in 2009 and 18 of 30 (60%) in 2018, respectively. aEEG has been implemented in almost all (2009: 62.5%; 2018: 94%) tertiary Canadian NICUs. Two-thirds (2009: 67%; 2018: 71%) of the respondents considered information from aEEG tracing helpful in clinical practice. The main indications for aEEG were term neonates with hypoxic ischemic encephalopathy (2009 and 2018: 76%) and seizure detection/surveillance (2009: 88%; 2018: 94%). Teaching on aEEG has been implemented for neonatologists (2018: 100%) and health care providers (2018: 50%) in tertiary Canadian NICUs but there is a lack of standardization of training. Use of aEEG in preterm neonates (2009: 37%, 2018: 33%) and application of aEEG in research (18% reported occasional use) is less common. Conclusion aEEG is well established in tertiary Canadian NICUs to monitor cerebral function and detect seizure activity. There is a need to develop formalized aEEG training programs and methods to assess competence. Further implementation of aEEG in preterm neonates and research is desirable. [ABSTRACT FROM AUTHOR]

Indigenous children are overrepresented in child protection systems in the United States and to an even greater degree in Canada. Canada has recently passed federal child welfare legislation, Bill C-92, with the goal of affirming the rights of Indigenous Peoples and establishing guidelines with respect to child and family services for Indigenous children. The aim of this article is to contribute to ongoing discussions about the recently passed Canadian legislation, drawing on lessons learned in the United States context. The Indian Child Welfare Act (ICWA), passed in the United States in 1978, has created a legislative paradigm, which in some cases has been bolstered by statelevel provisions. The ICWA can provide helpful lessons to consider in Canada as the new legislation is implemented and amended over time. Specifically, we examine elements of the ICWA related to accessibility and compliance with the law, along with deeper analysis of state-level statutes related to adoption provisions in light of the phenomenon of transracial adoption of Indigenous children. As reactions to the Canadian federal law have been mixed, this policy analysis may be supportive of conversations regarding its further development, particularly related to funding and enforcement. On a broader level, considerations of Indigenous community jurisdiction over child and family policies within our discussion are relevant to various settler-colonial contexts. [ABSTRACT FROM AUTHOR]

This article, based on interviews with key informants, reports the constitutional and historical background of implications of the inclusion of the disabled in the Canadian Charter of Rights and Freedoms on efforts by organizations and persons to adapt the environment to minimize handicapping effects on the disabled in Canada. (Author/DB)

Mexico and Canada successfully challenged the U.S. mandatory country of origin labeling (COOL) requirements for beef and pork as inconsistent with World Trade Organization (WTO) rules, which ultimately led to arbitration over the level of trade lost due to the COOL measure. During this phase of the dispute, Mexico, Canada, and the United States provided the Arbitration Panel with estimates of the trade losses caused by COOL that were produced using different quantitative methods. The U.S. estimates were based on an equilibrium displacement model (EDM). This article presents a version of the EDM used by the U.S. Government to calculate trade losses due to COOL. The Panel developed its own analysis combining econometric analysis and an EDM that used only supply‐side information to calculate changes in Canadian and Mexican livestock trade. The U.S. EDM includes both the supply and demand sides of the market. We use the U.S. EDM and the Panel's assumptions to re‐estimate the value of lost trade due to COOL. The inclusion of demand‐side effects and domestic COOL costs produces lower estimated trade damages than those produced using the Panel's analysis, validating the EDM as a useful quantitative tool for this type of trade policy analysis. [ABSTRACT FROM AUTHOR]

Despite affirmation that students with disabilities should have equal access to education, individuals with disabilities are still not participating to the same degree as individuals without disabilities, particularly within postsecondary institutions. Students in Health and Human Service (HHS) programs experience many unique challenges and disadvantages. In-depth focus groups and interviews were conducted with 14 university stakeholders in HHS programs regarding their perceptions and experiences of working with students with disabilities. We found that the rhetoric of citizenship, specifically notions of rationality, autonomy, and productivity, interacts with beliefs about students with disabilities to allow stakeholders to justify their exclusion or limited participation. Our findings demonstrate how taken-for-granted beliefs can limit the inclusion of students with disabilities in ways that seem natural and unproblematic. [ABSTRACT FROM AUTHOR]

Abstract: Ice‐sheets flowing over soft sediments produce undulations in the bed, typically of metres in relief, of which drumlins are the most abundant and widely investigated. Consensus regarding their mechanism of formation has yet to be achieved. In this paper we examine the spatial organization of drumlins in order to provide an improved description of the phenomenon and to guide hypotheses of their formation. We review the literature highlighting contradictory findings regarding drumlin spatial organization and then use this to motivate our study based on a large sample (42 488) of drumlins from Canada, Britain and Norway. Are there typical arrangements in drumlin positioning and are they organized in a regular spatial manner (patterned) or are they distributed randomly? We recognize that drumlin fields are inherently patchy and therefore apply inhomogeneous spatial statistics in order to study their distribution. This shows that whilst drumlins are occasionally randomly placed, their main state is non‐ random. They exhibit a strong and statistically significant signal of regularity across lengths scales of 100 to 1200 m. We conclude that patterning is a near ubiquitous property of drumlins. This finding of regularity demonstrates spatial self‐organization in the bedforming process with drumlins as an emergent manifestation of sub‐glacial sediment mobility. Kilometre‐scale interactions between drumlins must occur as they evolve, or interactions may arise as a consequence of growth or migration. Hypotheses or models are required that can explain the regular spacing of drumlins. We highlight three suggestions for such self‐organization: instability in the coupling of ice flow–sediment flux–bed shape; local feedback between sediment mobility and relief; and coarsening by growth or migration. © 2017 The Authors. Earth Surface Processes and Landforms published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The Mesoproterozoic Ikpiarjuk Formation (Borden Basin, Nunavut) consists of a series of very large (>200 m thick; kms diameter) dolostone mounds that accumulated on the floor of a restricted basin. The mounds are isolated from contemporaneous shallow-water carbonate rocks, accumulated at the same time as black shale in deep-water regions of the basin, and are geographically limited to the vicinity of basin-scale fault zones. The mounds contain extensive deposits of benthic thrombolites, a microbial texture that is not common in Mesoproterozoic carbonate rocks. Field relationships of individual mounds indicate that mound growth was initiated during regional deposition of organic-rich black shale, mounds developed significant relief above the basin floor, and some mound tops were eventually exposed and karsted during differential uplift. The mounds accumulated in a deep-water, sub-photic-zone setting as a result of fluid venting along basin-scale faults. Interpreted basin depths indicate that the thrombolitic mound texture is probably not related to cyanobacteria. Chemosynthetic microbes exploited the chemical gradient in the vicinity of the vents and built a mound framework of thrombolites. Framework voids contain both carbonate mud and isopachous linings of fibrous cement, indicating that the mixing of vent fluid with basin water favoured production of abiogenic carbonate minerals in addition to providing a chemical gradient for microbes to exploit. Proterozoic deep-water carbonates and thrombolites are rare, and the Ikpiarjuk Formation mounds represent microbial buildups that are fundamentally different from other examples in the Precambrian rock record. [ABSTRACT FROM AUTHOR]

Purpose: Increasingly, patient- and family-centered care (PFCC) is recognized as a valuable component of healthcare reform with rich opportunities for improvement within oncology. Shifting toward PFCC requires physician buy-in; however, research examining their perspectives on PFCC is lacking. We sought to explore oncologists' perspectives on PFCC to identify factors that influence their ability to practice PFCC.Methods: We conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using thematic analysis and principles drawn from grounded theory. Subsequently, focus groups consisting of the interviewed participants were facilitated to confirm and elaborate on our findings. Constant comparisons were used to identify recurring themes.Results: Three dominant themes emerged. First, physicians displayed cautious engagement in their approach to PFCC. Collectively, participants understood the general principles of PFCC. However, there was a limited understanding of the value, implications, and motivation for improving PFCC which may create reluctance with physician buy-in. Second, both individual and system barriers to practicing PFCC were identified. A lack of physician acknowledgement and engagement and competing responsibilities emerged as provider-level challenges. System barriers included impaired clinic workflow, physical infrastructure constraints, and delays in access to care. Third, physicians were able to identify existing and potential PFCC behaviors that were feasible within existing system constraints.Conclusions: Advancing PFCC will require continued physician education regarding the value of PFCC, acknowledgement and preservation of effective patient- and family-centered strategies, and creative solutions to address the system constraints to delivering PFCC. [ABSTRACT FROM AUTHOR]

This study investigated prevalence and risk factors for suicidal ideation among adults with self-reported disability in Western Canada. The method was secondary data analysis utilising the Canadian Community Health Survey. The odds of 12-month suicidal ideation are 3.5 times greater for adults with self-reported disability compared with non-disabled adults, controlling for age, sex, ethnicity, and psychiatric morbidity. The heightened risk of ideation among adults with self-reported disability is partially explained by social adversity, including food insecurity and low sense of community belonging. Reducing suicide risk among adults with disability requires a broad-spectrum approach, including mental health care, and strategies to ameliorate social and economic hardship. [ABSTRACT FROM AUTHOR]

Abstract: Late Paleoproterozoic basins of Canada's north, including the Thelon, Athabasca, and Hornby Bay basins, can be broadly correlated based on similarities in age, sequence stratigraphy, paleocurrents, and detrital zircon provenance, but their detailed evolution is poorly understood and their age and lateral equivalencies are poorly constrained. This study contributes to the understanding of sedimentary basins during a critical interval of time, representing the latest stages of amalgamation of the supercontinent Laurentia/Nuna, through a detailed study of the Hornby Bay Basin. The Hornby Bay Basin strata have been divided into four unconformity-bounded subsequences, A1, A2, A3, A4, that belong to the first of three unconformity-bounded post-Hudsonian Proterozoic stratigraphic packages in northwestern Canada. Subsequences A2 (>1600Ma) and A3 (<1600–1270Ma) of the Hornby Bay Basin were intersected during diamond drilling for uranium exploration. Sequence stratigraphic interpretations reveal that the subsequence A2–A3 boundary lies below the LeRoux Formation, which forms the base of the Dismal Lakes Group, a critical relationship that was previously disputed. Stratigraphic patterns in the late stages of development of the Hornby Bay Basin are considered to have been largely controlled by the Paleoproterozoic Forward Orogeny (∼1600Ma), rather than by global eustasy. Analysis of Sm–Nd isotopes on mudrocks yielded isotopic compositions in the range −8.2 to −2.3 (ɛ Nd(1600Ma)) in subsequence A2 and −9.8 to −5.0 (ɛ Nd(1400Ma)) in subsequence A3. An ɛ Nd versus time graph illustrates two distinct groupings that plot within known isotopic evolution fields of the Taltson-Thelon Tectonic Zone, and the Great Bear Magmatic Zone. Sediment provenance was strongly influenced by the Paleoproterozoic Forward Orogeny, but there are no significant changes in sedimentary provenance across the A2–A3 sequence boundary. Stable isotope analyses of C and O in the dolomitic East River Formation of subsequence A2 reveal a relatively monotonous signal with an average of −0.5‰ δ 13C and −8.76‰ δ 18O, which is consistent with global values of other late Paleoproterozoic carbonate successions. Enriched Mn values and depleted Sr values, however, suggest that the East River carbonate rocks experienced some degree of meteoric alteration; it is unknown how much this alteration affected stable isotope compositions. Based on similarities in sedimentary provenance, age, and sequence stratigraphy, subsequence A2 of the Hornby Bay Group is correlated with the Wernecke Supergroup (Yukon). The latter is interpreted to represent the deep-water distal equivalent of the upper Hornby Bay Group in a westward-deepening basin. Deposition of subsequence A2 is recorded across North America and is mirrored by deep-water sedimentation along the eastern margin of the North Australian craton. The tectonic evolution of subsequence A2 in Laurentia is therefore remarkably similar to that of the North Australian craton up to ∼1600Ma, the age of the Forward Orogeny, and this has implications for interpretation of the latest stages of accretion of the supercontinent Nuna. [Copyright &y& Elsevier]

. The Canadian Physiotherapists in Hemophilia Care (CPHC) sought to learn about attitudes and behaviours of young male adults with mild haemophilia towards their condition and care. Semi-structured in-person or telephone interviews were conducted with 18 young men from and across Canada. This report summarizes the participants' attitudes towards their haemophilia, previous injuries, perceived barriers to seeking treatment, as well as their decision-making process when self-assessing injury. The interviews demonstrated that communication between the young adults and the health care team was not optimal, with common reference to the ineffectiveness of lecture style education. Gaps in knowledge also emerged regarding bleed identification and management. [ABSTRACT FROM AUTHOR]

Abstract: Study Objectives: To determine the lengths of the first and second stages of labor in a group of Canadian adolescents; to compare this timeline to the estimates from a general population, and to a heterogeneous group of adolescents from a previous study. Design: Retrospective chart review. Setting: Kingston General Hospital, Kingston, Ontario, Canada. Participants: This study included women 19 years old and under at the time of delivery, having had spontaneous labor and a term singleton cephalic vaginal delivery between 2000 and 2005. Main Outcome Measures: The primary outcome is the length of the first and second stages of labor. Impact of epidural use will be determined. Results: In adolescents undergoing spontaneous labor at term (n = 177), the median duration of the first stage was 6.8 and 3.2 hours for nulliparous and multiparous teens respectively, compared to 10.0 and 5.9 hours in a mostly adult population. The duration of the second stage, in term spontaneous vaginal deliveries, was 54 minutes for nulliparous and 10 minutes for multiparous adolescents, similar to the teens in Greenberg''s 2007 study. Comparatively, median lengths of second stage for the general population were 92 minutes and 20 minutes for nulliparous and multiparous women respectively. Epidural analgesia had a significant influence on lengthening the second stage in adolescents, however second stages in teens were still shorter, when controlling for regional analgesia, than in a general population. Conclusions: Adolescents do have shorter both first and second stages when compared to a general group. These differences demonstrate the importance of determining a distinct timeline for evaluating the course of labor in teens. [Copyright &y& Elsevier]

Abstract: Various brominated flame retardants (BFRs), including polybrominated diphenyl ethers (PBDEs) and current-use, non-PBDE BFRs, as well as organochlorine (OC) pesticides and polychlorinated biphenyls (PCBs), were measured in winter flounder, harp and hooded seals, and North Atlantic right whales from the Eastern United States and Canada. The concentrations of PBDEs in winter flounder and right whales were similar in magnitude to the levels of PCBs, which was unlike the pattern observed in seals. In these marine mammals, the levels of PBDEs were orders of magnitude lower than the levels of OCs and PCBs detected. Evidence existed for the accumulation of methoxylated (MeO)-PBDEs of natural origin in seals and right whales. Current-use, non-PBDE BFRs (including hexabromocyclododecane, pentabromoethylbenzene, hexabromobenzene, and pentabromotoluene) were detected in winter flounder and marine mammals. Future research should focus on monitoring PBDEs, current-use, non-PBDE BFRs, and MeO-BDEs of natural origin in marine organisms from Massachusetts and Cape Cod Bays. [ABSTRACT FROM AUTHOR]

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Objective: This survey was conducted to determine the practice patterns of gynecologists in Canada regarding the discontinuation of oral contraceptives before gynecologic surgical procedures.Study Design: In May and June of 1997, surveys were sent to all obstetricians and gynecologists on the mailing list of the Society of Obstetricians and Gynaecologists of Canada.Results: Of the 1472 surveys that were sent, 702 of the surveys were completed and returned, for a response rate of 48%. More than 90% of the gynecologists who were surveyed would advise their patients to continue using oral contraceptives before relatively minor surgical procedures and <1% of them would use low-dose heparin before these procedures. Rates of oral contraceptive discontinuation increased as the extent of the surgical intervention increased: Prolonged laparoscopy (39.8%), vaginal repairs and hysterectomy (54.7%), and abdominal hysterectomy or adnexectomy (56.1%). Just over one half of the gynecologists (56.1%) indicated that they would advise discontinuation > or =4 weeks before the surgical procedure, which is the minimum time required for the prothrombotic changes that are associated with oral contraceptive use to return to baseline. Less than 10% of the surgeons indicated that they would use low-dose heparin even when the patient was advised to continue taking oral contraceptives before major surgical procedures.Conclusion: The controversy over whether young healthy women should discontinue oral contraceptive use before major surgical procedures that are associated with immobility is reflected by a lack of consensus among gynecologists in Canada. [ABSTRACT FROM AUTHOR]

Introduction: The annual economic burden of chronic homelessness in the U.S. is estimated to be as high as $3.4 billion. The Permanent Supportive Housing with Housing First (Housing First) program, implemented to address the problem, has been shown to be effective. This paper examines the economic cost and benefit of Housing First Programs.Methods: The search of peer-reviewed and gray literature from inception of databases through November 2019 yielded 20 evaluation studies of Housing First Programs, 17 from the U.S. and 3 from Canada. All analyses were conducted from March 2019 through July 2020. Monetary values are reported in 2019 U.S. dollars.Results: Evidence from studies conducted in the U.S. was separated from those conducted in Canada. The median intervention cost per person per year for U.S. studies was $16,479, and for all studies, including those from Canada, it was $16,336. The median total benefit for the U.S. studies was $18,247 per person per year, and it was $17,751 for all studies, including those from Canada. The benefit-to-cost ratio for U.S. studies was 1.80:1, and for all studies, including those from Canada, it was 1.06:1.Discussion: The evidence from this review shows that economic benefits exceed the cost of Housing First Programs in the U.S. There were too few studies to determine cost-benefit in the Canadian context. [ABSTRACT FROM AUTHOR]

: ObjectivesTo evaluate Canadian women'' s knowledge of the risks, benefits and side effects of oral contraceptives (OCs) and the effect of counseling.: Study designSix-hundred and forty-nine Canadian women filling an OC prescription at Shopper''s Drug Mart stores completed the survey. Respondents recorded whether or not they had discussed 12 separate issues about OC use with their healthcare provider. Optimal responses to multiple-choice questions were compared between those reporting counseling to those reporting no counseling, using Fisher''s Exact Tests. Women were also questioned on what they were told about associated cancer risks.: ResultsEighty percent or more of the women selected the optimal response for the questions relating to dysmenorrhea, leg pain and co-medication. Less than half of survey respondents identified the optimal response for nausea, breakthrough bleeding, breast tenderness, acne, headaches and weight change. Counseling made a significant impact on selection of the optimal response for 7 of the 12 questions (p < 0.004, adjusted significance level). Fifty-two percent indicated that they did not know what they were told about the risk of uterine and ovarian cancer when on the pill. A significant proportion of women said they would phone their physician for relatively minor problems such as breakthrough bleeding (65%), breast tenderness (55%) and acne (54%).: ConclusionsThe knowledge level of Canadian women on the pill regarding risks, benefits and side effects of the pill remains deficient in several key areas. Adequate counseling by healthcare providers can help women recognize the pill''s positive health benefits, and may result in fewer unnecessary physician contacts and unwanted pregnancies. [Copyright &y& Elsevier]

Background: Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis.Objectives: The authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).Methods: Baseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups.Results: Among the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in ≥1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01).Conclusions: In the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 [PII S3HR/NR7]; NCT03222141). [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance of commercially available seizure detection algorithms in critically ill children.Design: Diagnostic accuracy comparison between commercially available seizure detection algorithms referenced to electroencephalography experts using quantitative electroencephalography trends.Setting: Multispecialty quaternary children's hospital in Canada.Subjects: Critically ill children undergoing electroencephalography monitoring.Interventions: Continuous raw electroencephalography recordings (n = 19) were analyzed by a neurophysiologist to identify seizures. Those recordings were then converted to quantitative electroencephalography displays (amplitude-integrated electroencephalography and color density spectral array) and evaluated by six independent electroencephalography experts to determine the sensitivity and specificity of the amplitude-integrated electroencephalography and color density spectral array displays for seizure identification in comparison to expert interpretation of raw electroencephalography data. Those evaluations were then compared with four commercial seizure detection algorithms: ICTA-S (Stellate Harmonie Version 7; Natus Medical, San Carlos, CA), NB (Stellate Harmonie Version 7; Natus Medical), Persyst 11 (Persyst Development, Prescott, AZ), and Persyst 13 (Persyst Development) to determine sensitivity and specificity in comparison to amplitude-integrated electroencephalography and color density spectral array.Measurements and Main Results: Of the 379 seizures identified on raw electroencephalography, ICTA-S detected 36.9%, NB detected 92.3%, Persyst 11 detected 75.9%, and Persyst 13 detected 74.4%, whereas electroencephalography experts identified 76.5% of seizures using color density spectral array and 73.7% using amplitude-integrated electroencephalography. Daily false-positive rates averaged across all recordings were 4.7 with ICTA-S, 126.3 with NB, 5.1 with Persyst 11, 15.5 with Persyst 13, 1.7 with color density spectral array, and 1.5 with amplitude-integrated electroencephalography. Both Persyst 11 and Persyst 13 had sensitivity comparable to that of electroencephalography experts using amplitude-integrated electroencephalography and color density spectral array. Although Persyst 13 displayed the highest sensitivity for seizure count and seizure burden detected, Persyst 11 exhibited the best trade-off between sensitivity and false-positive rate among all seizure detection algorithms.Conclusions: Some commercially available seizure detection algorithms demonstrate performance for seizure detection that is comparable to that of electroencephalography experts using quantitative electroencephalography displays. These algorithms may have utility as early warning systems that prompt review of quantitative electroencephalography or raw electroencephalography tracings, potentially leading to more timely seizure identification in critically ill patients. [ABSTRACT FROM AUTHOR]

Abstract This article describes the new primary proton beamline 1U at TRIUMF. The purpose of this beamline is to produce ultracold neutrons (UCN) for fundamental-physics experiments. It delivers up to 40 µA of 480 MeV protons from the TRIUMF cyclotron to a tungsten spallation target and uses a fast kicker to share the beam between the Center for Molecular and Materials Science and UCN. The beamline has been successfully commissioned and operated with a beam current up to 10 µA, facilitating first large-scale UCN production in Canada. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between adiposity, physical activity (PA), and fecundability.Design: Prospective cohort study.Setting: Not applicable.Patient(s): A total of 2,062 female pregnancy planners from the United States and Canada who were enrolled during the preconception period.Intervention(s): None.Main Outcome Measure(s): Self-reported pregnancy. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were estimated using proportional probabilities models that adjusted for potential confounders.Result(s): Relative to body mass index (BMI) 18.5-24 kg/m(2), FRs for BMI <18.5, 25-29, 30-34, 35-39, 40-44, and ≥45 kg/m(2) were 1.05 (95% CI 0.76-1.46), 1.01 (95% CI 0.89-1.15), 0.98 (95% CI 0.82-1.18), 0.78 (95% CI 0.60-1.02), 0.61 (95% CI 0.42-0.88), and 0.42 (95% CI 0.23-0.76), respectively. Reduced fecundability was observed among women with the largest waist-to-hip ratios (≥0.85 vs. <0.75; FR = 0.87, 95% CI 0.74-1.01) and waist circumferences (≥36 vs. <26 inches [≥90 vs. <66 cm]; FR = 0.80, 95% CI 0.59-1.01). Tendency to gain weight in the chest/shoulders (FR = 0.63, 95% CI 0.36-1.08) and waist/stomach (FR = 0.90, 95% CI 0.79-1.02), relative to hips/thighs, was associated with lower fecundability. Moderate PA was associated with increased fecundability (≥5 vs. <1 h/wk; FR = 1.26, 95% CI 0.96-1.65), but there was no dose-response relation. Among overweight/obese women (BMI ≥25 kg/m(2)), fecundability was 27% higher for vigorous PA of ≥5 versus <1 h/wk (95% CI 1.02-1.57).Conclusion(s): Various measures of overall and central adiposity were associated with decreased fertility among pregnancy planners. Vigorous PA was associated with improved fertility among overweight and obese women only; moderate PA was associated with improved fertility among all women. [ABSTRACT FROM AUTHOR]

Vineyards in wine regions around the world are reservoirs of yeast with oenological potential. Saccharomyces cerevisiae ferments grape sugars to ethanol and generates flavor and aroma compounds in wine. Wineries place a high-value on identifying yeast native to their region to develop a region-specific wine program. Commercial wine strains are genetically very similar due to a population bottleneck and in-breeding compared to the diversity of S. cerevisiae from the wild and other industrial processes. We have isolated and microsatellite-typed hundreds of S. cerevisiae strains from spontaneous fermentations of grapes from the Okanagan Valley wine region in British Columbia, Canada. We chose 75 S. cerevisiae strains, based on our microsatellite clustering data, for whole genome sequencing using Illumina paired-end reads. Phylogenetic analysis shows that British Columbian S. cerevisiae strains cluster into 4 clades: Wine/European, Transpacific Oak, Beer 1/Mixed Origin, and a new clade that we have designated as Pacific West Coast Wine. The Pacific West Coast Wine clade has high nucleotide diversity and shares genomic characteristics with wild North American oak strains but also has gene flow from Wine/European and Ecuadorian clades. We analyzed gene copy number variations to find evidence of domestication and found that strains in the Wine/European and Pacific West Coast Wine clades have gene copy number variation reflective of adaptations to the wine-making environment. The "wine circle/Region B", a cluster of 5 genes acquired by horizontal gene transfer into the genome of commercial wine strains is also present in the majority of the British Columbian strains in the Wine/European clade but in a minority of the Pacific West Coast Wine clade strains. Previous studies have shown that S. cerevisiae strains isolated from Mediterranean Oak trees may be the living ancestors of European wine yeast strains. This study is the first to isolate S. cerevisiae strains with genetic similarity to nonvineyard North American Oak strains from spontaneous wine fermentations., Competing Interests: Conflicts of interest The author(s) declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Genetics Society of America.)

Red blood cell (RBC) fatty acid (FA) patterns are becoming recognized as long-term biomarkers of tissue FA composition, but different analytical methods have complicated inter-study and international comparisons. Here we report RBC FA data, with a focus on the Omega-3 Index (EPA + DHA in% of total FAs in RBC), from samples of seven countries (USA, Canada, Italy, Spain, Germany, South Korea, and Japan) including 167,347 individuals (93% of all samples were from the US). FA data were generated by a uniform methodology from a variety of interventional and observational studies and from clinical laboratories. The cohorts differed in size, demographics, health status, and year of collection. Only the Canadian cohort was a formal, representative population-based survey. The mean Omega-3 Index of each country was categorized as desirable (>8%), moderate (>6% to 8%), low (>4% to 6%), or very low (≤4%). Only cohorts from Alaska (treated separately from the US), South Korea and Japan showed a desirable Omega-3 Index. The Spanish cohort had a moderate Omega-3 Index, while cohorts from the US, Canada, Italy, and Germany were all classified as low. This study is limited by the use of cohorts of convenience and small sample sizes in some countries. Countries undertaking national health status studies should utilize a uniform method to measure Omega-3 FA levels., (Copyright © 2022. Published by Elsevier Ltd.)

Expanding on conflicting theoretical conceptualizations of implicit bias, 6 studies tested the effectiveness of different procedures to increase acknowledgment of harboring biases against minorities. Participants who predicted their responses toward pictures of various minority groups on future implicit association tests (IATs) showed increased alignment between implicit and explicit preferences (Studies 1-3), greater levels of explicit bias (Studies 1-3), and increased self-reported acknowledgment of being racially biased (Studies 4-6). In all studies, effects of IAT score prediction were significant even when participants did not actually complete IATs. Effects of predicting IAT scores were moderated by nonprejudicial goals, in that IAT score prediction increased acknowledgment of bias for participants with strong nonprejudicial goals, but not for participants with weak nonprejudicial goals (Study 4). Mere completion of IATs and feedback on IAT performance had inconsistent effects across studies and criterion measures. Instructions to attend to one's spontaneous affective reactions toward minority group members increased acknowledgment of bias to the same extent as IAT score prediction (Study 6). The findings are consistent with conceptualizations suggesting that (a) implicit evaluations are consciously experienced as spontaneous affective reactions and (b) directing people's attention to their spontaneous affective reactions can increase acknowledgment of bias. Implications for theoretical conceptualizations of implicit bias and interventions that aim to reduce discrimination via increased acknowledgment of bias are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rolandic epilepsy (RE) and its atypical variants (atypical rolandic epilepsy, ARE) along the spectrum of epilepsy-aphasia disorders are characterized by a strong but largely unknown genetic basis. Two genes with a putative (ELP4) or a proven (SRPX2) function in neuronal migration were postulated to confer susceptibility to parts of the disease spectrum: the ELP4 gene to centrotemporal spikes and SRPX2 to ARE. To reexamine these findings, we investigated a cohort of 280 patients of European ancestry with RE/ARE for the etiological contribution of these genes and their close interaction partners. We performed next-generation sequencing and single-nucleotide polymorphism (SNP)-array based genotyping to screen for sequence and structural variants. In comparison to European controls we could not detect an enrichment of rare deleterious variants of ELP4, SRPX2, or their interaction partners in affected individuals. The previously described functional p.N327S variant in the X chromosomal SRPX2 gene was detected in two affected individuals (0.81%) and also in controls (0.26%), with some preponderance of male patients. We did not detect an association of SNPs in the ELP4 gene with centrotemporal spikes as previously reported. In conclusion our data do not support a major role of ELP4 and SRPX2 in the etiology of RE/ARE., (Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.)

Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of IVIG for neurologic conditions. The mandate of the expert panel was to review evidence regarding use of IVIG for 22 neurologic conditions and formulate recommendations on IVIG use for each. A panel of 6 clinical experts, one expert in practice guideline development and 4 representatives from the NAC met to review the evidence and reach consensus on the recommendations for the use of IVIG. The primary sources used by the panel were 2 recent evidence-based reviews. Recommendations were based on interpretation of the available evidence and, where evidence was lacking, consensus of expert clinical opinion. A draft of the practice guideline was circulated to neurologists in Canada for feedback. The results of this process were reviewed by the expert panel, and modifications to the draft guideline were made where appropriate. This practice guideline will provide the NAC with a basis for making recommendations to provincial and territorial health ministries regarding IVIG use management. Recommendations for use of IVIG were made for 14 conditions, including acute disseminated encephalomyelitis, chronic inflammatory demyelinating polyneuropathy, dermatomyositis, diabetic neuropathy, Guillain-Barré syndrome, Lambert-Eaton myasthenic syndrome, multifocal motor neuropathy, multiple sclerosis, myasthenia gravis, opsoclonus-myoclonus, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, polymyositis, Rasmussen's encephalitis, and stiff person syndrome; IVIG was not recommended for 8 conditions including adrenoleukodystrophy, amyotropic lateral sclerosis, autism, critical illness polyneuropathy, inclusion body, myositis, intractable childhood epilepsy, paraproteinemic neuropathy (IgM variant), and POEMS syndrome. Development and dissemination of evidence-based clinical practice guidelines may help to facilitate appropriate use of IVIG.

Objectives: To characterize the specific autonomic disturbances underlying the cold-induced sweating syndrome (CISS), and to describe a novel genetic variant of this rare recessive disorder. The two not previously reported patients had similar dysmorphic features: abnormal facial appearance, high arched palate, low set rotated ears, flexion deformities of elbows and fingers and scoliosis. Most noticeable were their paradoxical sweat responses: cold ambient temperature induced a profuse sweating over the face, arms and trunk but not over the lower limbs; while in the heat very little sweating occurred primarily on the legs. Testing of autonomic functions demonstrated normal cardiovascular reflexes and postganglionic sympathetic efferent functions. Sural nerve morphology and number of unmyelinated fibers was normal and skin biopsies showed normal appearing eccrine sweat glands. MRI scans revealed no structural brain abnormalities. Oral clonidine, prescribed in one patient, completely suppressed cold-induced sweating. Observed clinical features matched those of two sisters reported from Israel and of two brothers reported from Norway. All six cases presented a similar phenotype. The Norwegian, Israeli and Canadian cases were homozygous or compound heterozygous, respectively, for mutations in the CRLF1 gene on chromosome 19p12 (CISS1). The Australian case, however, had no pathogenic sequence variants in the CRLF1 gene, but was compound heterozygous for mutations in the CLCF1 gene on chromosome 11q13.3 (CISS2)., Conclusion: The rare cold-induced sweating syndrome is genetically heterogeneous and is probably caused by central and peripheral impairment of sudomotor functions. This is the first detailed report on the clinical consequences of mutations in the CLCF1 gene in humans. Directions for medical therapies are outlined to achieve long term symptom control.