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The Met Office in the United Kingdom has developed a completely new probabilistic postprocessing system called IMPROVER to operate on outputs from its operational numerical weather prediction (NWP) forecasts and precipitation nowcasts. The aim is to improve weather forecast information to the public and other stakeholders while better exploiting the current and future generations of underpinning kilometer-scale NWP ensembles. We wish to provide seamless forecasts from nowcasting to medium range, provide consistency between gridded and site-specific forecasts, and be able to verify every stage of the processing. The software is written in a modern modular framework that is easy to maintain, develop, and share. IMPROVER allows forecast information to be provided with greater spatial and temporal detail and a faster update frequency than previous postprocessing. Independent probabilistic processing chains are constructed for each meteorological variable consisting of a series of processing stages that operate on predefined grids and blend outputs from several NWP inputs to give a frequently updated, probabilistic forecast solution. Probabilistic information is produced as standard, with the option of extracting a most likely or yes–no outcome if required. Verification can be performed at all stages, although it is only currently switched on for the most significant stages when run in real time. IMPROVER has been producing real-time output since March 2021 and became operational in spring 2022.

Purpose: Introduce a clinical variant of the Wright table both to teach at the upper undergraduate/graduate level and to model pathologies at the graduate/residency level of clinical training. Introduction:The cardiac cycle is taught in cardiovascular units and used by health professionals. The original Wright table (1) models this process’ events using four flow phases and four compartments. Its use of pressures in each compartment to drive blood from veins to arteries, with valve openings, closings, and heart sounds, was applied at the preclinical level. Improvements in the Wright table (2) include those for a right heart, a left heart with pulmonary wedge pressures, and some comparisons (e.g., right-vs-left heart). Preclinical medical students used these to model valvular pathologies (3). We hypothesized that if the Wright table included isovolumetric phases, it could be a clinical instrument to be used by cardiologists to help solidify key concepts necessary to understand pathology. Methods:A variant of this table was developed using five columns of “compartments” to model the cardiac cycle in the left heart: pulmonary veins, left atrium, left ventricle, aorta, and a pulmonary wedges concept that illustrates when blood backs up into pulmonary capillaries. The right heart’s includes a jugular venous compartment. This variant was pilot-demonstrated via zoom to a group of cardiologists to explore its potential use as an instrument to model pathologies. Results:The clinical variant of the Wright table displays all seven phases of the cardiac cycle typically depicted in the Wiggers diagram. The first phase, 1) rapid ventricular filling, begins when the A-V valve opens. This is followed by 2) slow ventricular filling [a.k.a. diastasis], 3) active ventricular filling during atrial systole, 4) isovolumetric contraction, 5) rapid ventricular ejection, 6) slow ventricular ejection [and protodiastole], and 7) isovolumetric relaxation. Each phase occupies one row from 1) top to 7) bottom, resulting in a 5-compartment, 7-phase (5x7) table of the cardiac cycle. The clinical variant of the Wright table puts all three ventricular filling phases together at the top prior to ventricular emptying. It introduces a system for pathophysiological modeling for both clinical professionals and advanced medical students. The model is constructed in a way that allows for a variety of comparisons including right-vs-left heart; physiological vs. pathological; early vs. late progression of a pathological condition; and earlier-to-later times. It also can display atrial and/or septal defects and their pathological effects within the heart. Conclusion:We present a clinical variant of the Wright table that was successfully tested with cardiologists. This all-phase variant shows its potential as a tool to deepen physiological and pathophysiological insight on the cardiac cycle to both advanced medical students and clinical professionals in a cardiology context. Funding: None This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Objective: To explore parental perceptions of psychosocial screening in the paediatric emergency department and identify post-screening barriers to accessing mental health care. Methods: We conducted a qualitative study during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian first completed psychosocial self/proxy-screening using the MyHEARTSMAP tool and then received a standardized clinical mental health assessment. If the MyHEARTSMAP assessment provided youth with mental health resources recommendations, their parents were invited to a follow-up session. Thirty days (±5 days) after their ED visit, parents participated in a virtual interview to reflect and share their attitudes, perceptions and thoughts around the screening and mental health care-seeking process. Results: Of the 171 participants who received resource recommendations during their ED visit, 124 parents (72.5%; 95% CI 65.2–79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an ‘eye-opening’ process that ‘sparked conversation’. Most participants (74.2%; 95% CI 65.6–81.6) agreed with the resource recommendations they received. In terms of resources-seeking, only 41 participants (33.1%; 95% CI 24.9–42.1) attempted to access recommended supports. Families generally felt identified concerns were mild and ‘not serious enough’ to warrant resource-seeking, though many expressed an intention to seek care if concerns escalated. Conclusion: Perceptions of psychosocial screening in the ED were favourable and encouraging among participating parents of youth screened positive for psychosocial issues. Despite positive attitudes, only a fraction of the families invited to follow-up attempted to access care. Mental health may be perceived as low priority for many families, signifying the need for improved education and awareness building on the importance of early intervention.

Objective & Hypothesis Assess the impact of universal mental health screening with MyHEARTSMAP on emergency department (ED) flow, an important aspect of feasibility. We hypothesized that the difference in departmental level ED length of stay (LOS) for screening and matched non-screening days is less than 30 minutes. Methods We conducted a two-center, retrospective cohort study between December 2017 and June 2019. At each center, random mental health screening days were assigned over the course of 15 consecutive months. We matched each 24-hour screening day to a unique non-screening day based on: location (Center 1 or Center 2); day type (weekday: Monday-Thursday or weekend: Friday-Sunday); date (+/- 28 days); and 24-hour volume (+/- 15 patients). We collected retrospective patient flow data, including LOS, across all ED visits to determine the difference in departmental level median LOS between matched screening and non-screening days. Results There was not a statistically significant difference in departmental LOS between screening and non-screening days. Overall, the difference in departmental LOS was -4.0 minutes (95% CI: -9.8, 1.8) for screening days compared to non-screening days, with a difference of -2.0 minutes (-9.0, 4.9) at Center 1 and -6.0 minutes (-15.4, 3.4) at Center 2. Conclusion Our findings show that universal mental health screening with MyHEARTSMAP can be implemented without a significant impact of ED LOS.

Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement.We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis.Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample.Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.

Objectives To evaluate the utility of a digital psychological self-assessment tool, MyHEARTSMAP (scores on 10 sections: home, education and activities, alcohol and drugs, relationships and bullying, thoughts and anxiety, safety, sexual health, mood, abuse, and professional resources), in youth presenting to the pediatric emergency department (ED) with a mental health concern. Study design We conducted a prospective cohort study in 2 tertiary care pediatric EDs from December 2017 to October 2019. Youth 10-17 years old triaged for a mental health concern were screened and enrolled to complete MyHEARTSMAP on a mobile device. A clinician blinded to the MyHEARTSMAP assessment conducted their own assessment which was used as the reference standard. Utility was quantified as the sensitivity and specificity of MyHEARTSMAP in detecting psychiatric, social, youth health, and functional concerns. Results Among 379 eligible youth, 351 were approached and 233 (66.4%) families were enrolled. Sensitivity for youth MyHEARTSMAP self-assessments ranged from 87.4% in the youth health domain to 99.5% in the psychiatric domain for identifying any concern, and 33.3% in the social domain to 74.6% in the psychiatric domain for severe concerns. Specificity ranged from 66.7% in the psychiatric domain to 98.2% in the youth health domain for no or only mild concerns. Conclusions Youth and guardian MyHEARTSMAP assessments are sensitive for detecting psychosocial concerns requiring follow-up beyond pediatric ED evaluation. Specificity for no or only mild concerns was high in the nonpsychiatric domains.

IMPROVER (Integrated Model Post-Processing and Verification) has been developed by the Met Office as an open-source probability-based post-processing system to fully exploit our convection permitting, hourly cycling ensemble forecasts. Post-processed MOGREPS-UK model forecasts are blended with deterministic UKV model forecasts and data from the coarser resolution global ensemble, MOGREPS-G, to produce seamless probabilistic forecasts from now out to 7 days ahead. For precipitation, an extrapolation nowcast is also blended in at the start. Forecasts are converted to probabilities at the start, and all initial stages of post-processing are performed on gridded data, with site-specific forecasts extracted as a final step, helping to ensure consistency. Data are processed on a 10km global grid and on a 2km UK-centred grid.This talk will briefly describe the post-processing sequence from raw NWP model data to fully-blended, gridded and spot forecasts as probabilities and percentiles of a broad range of meteorological diagnostics, with the application of physical and statistical post-processing techniques. The system became operational in early May 2022, and the this talk will focus on some of the work that has been undertaken in the last year to achieve this, including ensemble calibration of temperature and wind speed data at observed and non-observed sites. There will be discussion of some of the verification used to prove this system, as well as a brief look at the technical aspects of this complex system, the initial customers and collaborators and the planned future work, including the use of ECMWF forecast data to extend the range of IMPROVER out to 14 days.

The UK Met Office is developing an open-source probability-based post-processing system called IMPROVER to exploit convection permitting, hourly cycling ensemble forecasts. The system is tasked with blending these forecasts with both deterministic nowcast data, and coarser resolution global ensemble model data, to produce seamless probabilistic forecasts from the very short to medium range.A majority of the post-processing within IMPROVER is performed on gridded forecasts, with site-specific forecasts extracted as a final step, helping to ensure consistency. IMPROVER delivers a wide range of probabilistic products to both operational meteorologists and as input to automated forecast production. and this presentation will detail some of the work that has been undertaken in the past year to prepare, with a focus on the use of statistical post-processing.Statistical post-processing plays two complimentary roles within IMPROVER; ensuring forecasts better reflect reality, and in so doing, bringing different models into better alignment, which improves the seamlessness of model transitions. For a selection of diagnostics, the gridded forecasts from different source models are calibrated independently using ensemble model output statistics (EMOS). Results of experiments looking at the calibration of gridded forecasts will be discussed briefly.More recently calibration of site forecasts has been introduced as a final step for temperature and wind speed forecasts. Results of experiments using EMOS to perform calibration in a variety of different ways will be presented, including justifications and trade-offs made in choosing a final approach.This will include some discussion of the remaking of weather symbol products as period, rather than instantaneous, forecasts and the implications for their verification.

Beluga whales (Delphinapterus leucas) occur broadly throughout the polar and subpolar regions of the Northern Hemisphere, and as a whole, the species is of low conservation concern. However, some populations, including Alaska’s Cook Inlet beluga whales (CIBW), are in decline for reasons that remain poorly understood. Currently, information on population-specific reproductive parameters of CIBW is non-existent. To address this data gap, we examined long-term photo-identification data of CIBW for insight into the reproductive natural history of this endangered subarctic population. Data are from 438 photo-ID surveys conducted 2005–2017 and over 400 identified individuals, augmented with data from strandings, biopsies, and tagging. During the April–October ice-free field season, we observed neonates July–October but never April-June. We photo-documented three suspected births during July–September. Neonates were present in 30% of groups and encountered and comprised 2% of all belugas observed. Over the course of the 13-year study, the number of calves seen with an individual mother ranged from 1 to 5, with inter-birth intervals ranging from 2 to 13 years. This corresponds to rates of 0.08–0.38 calves per year per mother. Known-aged mothers ranged in age from 13 to 31 years. Skin color was not a reliable indicator of sexual maturity. Calves photographed alongside their mothers were estimated to be 1–8 years old, although most were 1–4 years old. Some mothers (6%) were accompanied by a neonate and an older calf. These summaries of observational data provide critical insight into CIBW reproductive natural history that will inform future population modeling and management decision-making.

Background: Over the past decade, the number of children presenting to emergency departments (ED) with mental health (MH) concerns has increased substantially. EDs struggle to respond to this increase with approaches that comprehensively address patient needs. The lack of standardized processes to perform risk stratification, assess severity, and ensure access to follow-up care pose barriers to the provision of safe MH care. Our team addressed this gap by introducing an evidence-based care bundle to Alberta’s two pediatric EDs. This report presents the quality improvement (QI) approach used to ensure fidelity of implementation at one of the EDs. This initiative was funded by Alberta Innovates (Partnership for Research and Innovation in the Health System; PRIHS). Methods: We used the Model for Improvement to test and implement each bundle element: suicide risk screening (Ask Suicide-Screening Questions [ASQ]) at ED triage; a tool (HEADS-ED) to streamline and standardize MH assessments by ED-based MH nurse); and an urgent, single-session ‘Choice Appointment’ with a MH professional within 96 hours of the ED visit for patients lacking access to appropriate and timely MH follow-up care. The two ED-based bundle elements did not require additional resources or funding and are expected to reduce length of stay. The follow-up clinic option for ED patients without resources is intended to prevent crisis escalation and match patients with supports. Each new practice was introduced sequentially over a 2-week period. For each practice, we identified 1 to 2 improvement aims, developed key driver diagrams, and selected primary outcomes and measures. Each practice was implemented using Plan-Do-Study-Act (PDSA) cycles with initial tests of change starting small and becoming larger as learning accrued from previous cycles. Our QI team included families with lived experience, patient care and unit managers, nurse educators, frontline healthcare providers, content experts, and clinical leaders who supported staff and led change management strategies. A nurse was hired as a QI lead to support execution of PDSA cycles. We developed a sustainability plan which included embedding education regarding new practices in new healthcare staff orientation, having a measurement strategy to ensure that improvement was maintained, and planning for transition of responsibility for these processes to operational and medical leadership. Evaluation Methods: Primary aims included: 80% of targeted patients would receive the ASQ and HEADS-ED and 100% of children eligible for an Urgent, single-session ‘Choice Appointments’ would be offered it within 96 hours. We used clinical data from the electronic health record (Epic/Connect Care) as well as patient experience data collected via parent/caregiver surveys to determine if the aims for each practice were achieved. We included balancing measures to test whether changes in care in one part of the system introduced unintended consequences in other parts. We evaluated results for the primary aims using run charts to rapidly detect change according to established rules for detecting special cause. We discussed the results from each PDSA cycle in the context of existing healthcare resources to support implementation of each element of the bundle. Results: Tests of change to introduce suicide risk screening began February 1st, 2021. Performance was measured in weekly intervals. The median initial use of ASQ by triage nurses was with 77% of MH patients (686/901 patients), and over time, improved to 93% (319/350 patients), with special cause (shift) in noted September 2021. Tests of change to introduce the HEADS-ED tool began February 16th, 2021. Initial use of the HEADS-ED by MH nurses was 81% (440/555) and improved to 87% (201/227) with special cause (shift) noted August 2021. Urgent, single-session ‘Choice Appointments’ were offered to all patients who did not have timely and access to urgent follow-up with an existing mental healthcare provider with 89.1% having an appointment booked within 96 hours of the ED visit (139/156). Advice and Lessons Learned: Three plans were viewed as crucial to the success of this initiative: 1) a robust strategy to develop proposed changes based on best evidence combined with patient and staff engagement; 2) a comprehensive QI strategy to test, measure, and implement changes; and 3) regular communication and collaboration among ED staff, mental healthcare staff, patients/families, and hospital leadership. There were also lessons learned regarding what could have further enhanced project success: 1) enhanced communication strategies using multiple methods to ensure that project communications reached all stakeholders, including those not regularly present in the ED; 2) hiring the QI lead earlier to begin change management prior to bundle implementation; and 3) outlining a transition plan for clinical data management and bundle monitoring earlier to ease the QI transition to clinical leadership.

Background Parents/caregivers strongly influence their child’s experience in the pediatric emergency department (PED). Understanding their needs can improve families’ PED experience and care. Objectives To describe caregivers’ perceived emotional, practical, and informational needs in the PED and how well these needs were met Design/Methods This descriptive, cross-sectional survey with medical record review was conducted at 10 Canadian PEDs from October 2018 to March 2020, over a 1-week period every season, for a total of 4 weeks per site. Digital surveys available in English or French were completed by caregivers in the PED and 7 days after their visit. Health literacy was evaluated by the Newest Vital Sign tool. Results A total of 2005 caregivers participated; mean age was 37.8 (SD 7.7) years, and 74.3% (1462/1969) were mothers. The mean child age was 5.9 (5.1) years and 51.9 % (1040/2003) were male. Caregivers’ main spoken language was mostly English [72.6% (1425/1964)] or French [10.5% (206/1964)]. Over half of caregivers had a university/professional degree [51.0% (997/1956)]; 37.4% (746/1998) had possible/probable limited health literacy. 77.9% (1132/1454) of caregivers reported that their overall care needs were met. 71.7% (1081/1507) of caregivers reported that their emotional needs were met; they reported most emotional support by doctors [(35.6%, 535/1510)] and bedside nurses [(24.2%, 364/1507)]. The median (IQR) length of stay was 3.9 (2.6, 6.1) hours; 36.7% (546/1487) of caregivers felt they waited ‘too long’, and 77.8% (1158/1489) did not know how long they would have to wait. 11.7% of families were dissatisfied with the care updates provided. A safe PED was the top overall identified practical need [(45.1%, 602/1336)]. Internet access was the most important practical need throughout the visit [(28.1%, 378/1345)], while more space was the most reported [(49.8%, 696/1398)] need in the waiting room. The most desired improvements in the PED were better communication of wait times and delays [(41.1%, 745/1812)], shorter wait times [(38.8%, 699/1801)] and faster diagnosis [(24.9%, 449/1803)]. Conclusion Almost one quarter of Canadian caregivers report that their overall needs were not fully met when attending the PED. Safety during the PED visit was of utmost importance. Nationally, caregivers value shorter wait times, rapid diagnosis, and better communication about perceived delays. Top practical needs included internet access and more waiting room space. Creating innovative waiting systems, better methods to share wait time information, free internet access, and improved physical spaces could better address identified caregiver needs in the PED.

Humans have a unique ability to engage in different modes of thinking. Intuitive thinking (coined System 1, see Kahneman, 2011) is fast, automatic, and effortless whereas analytical thinking (coined System 2) is slow, contemplative, and effortful. We extend seminal pupillometry research examining these modes of thinking by using electroencephalography (EEG) to decipher their respective underlying neural mechanisms. We demonstrate that System 1 thinking is characterized by an increase in parietal alpha EEG power reflecting autonomic access to long-term memory and a release of attentional resources whereas System 2 thinking is characterized by an increase in frontal theta EEG power indicative of the engagement of cognitive control and working memory processes. Consider our results in terms of an example - a child may need cognitive control and working memory when contemplating a mathematics problem yet an adult can drive a car with little to no attention by drawing on easily accessed memories. Importantly, the unravelling of intuitive and analytical thinking mechanisms and their neural signatures will provide insight as to how different modes of thinking drive our everyday lives.

IntroductionPatient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial.Methods and analysisUsing a mixed-methods study design, we will evaluate patient partners’ engagement activities across set time-points during the trial and after trial completion. In this study, the term ‘patient partner’ is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15–24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis.Ethics and disseminationApproval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly.Trial registration numberNCT04902391.

Primary Subject area Mental Health Background Mental health concerns among children and adolescents presenting to the emergency department (ED) are on the rise. Universal screening can facilitate early identification and management of these concerns, mitigating significant long-term morbidity and mortality. The efficacy of psychosocial screening in the ED is not only determined by accurate identification of concerns, but by downstream resource-seeking behaviours to address these concerns. For many children and adolescents, parents hold a key role in determining their access to care. Thus, parental attitudes and perceptions of psychosocial screening may influence resource-seeking behaviours and predict a youth’s ability to access support. Objectives Given the limited understanding of parental perceptions of psychosocial screening in the ED, we aimed to qualitatively explore parents’ attitudes towards screening with MyHEARTSMAP, an electronic self/proxy administered psychosocial screening tool. We also quantified resource-seeking behaviours and explored barriers to seeking care. Design/Methods This was a nested qualitative study conducted during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian completed a self/proxy psychosocial screen using MyHEARTSMAP. Youth who screened positive were provided with recommendations and resources for support. 30 days (+ 5 days) after their ED visit, parents participated in semi-structured follow-up interviews to share their attitudes, perceptions, and thoughts around the screening and care-seeking process. Results Of the 171 participants requiring resources for support, 124 (72.5%; 95% CI 65.2-79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an “eye-opening” process that “sparked conversation”.74.2% (95% CI 65.6-81.6%) of participants also agreed with the support recommendations they received during their ED visit. In terms of resource seeking, as displayed in Figure 1, only 41 participants (33.1%; 95% CI 24.9-42.1%) attempted to access support services. Other families felt identified concerns were mild and “not serious enough” to warrant resources, though many expressed an intention to seek care if the concerns escalated. Conclusion Parental perceptions of psychosocial screening in the ED were favourable and encouraging, with a majority of participants expressing an understanding and appreciation of the process. This lends support to the implementation of universal psychosocial screening in the ED. Despite positive attitudes towards screening, only a fraction actually attempted to access care. This incongruence may reflect the persisting view that mental health holds low priority and suggests a need for increased education on the importance of seeking timely mental health care.

The advent of mobile electroencephalography (mEEG) has created a means for large scale collection of neural data thus affording a deeper insight into cognitive phenomena such as cognitive fatigue. Cognitive fatigue – a neural state that is associated with an increased incidence of errorful performance – is responsible for accidents on a daily basis which at times can cost human lives. To gain better insight into the neural signature of cognitive fatigue in the present study we used mEEG to examine the relationship between perceived cognitive fatigue and human-event related brain potentials (ERPs) and electroencephalographic (EEG) oscillations in a sample of 1,000 people. As a secondary goal, we wanted to further demonstrate the capability of mEEG to accurately measure ERP and EEG data. To accomplish these goals, participants performed a standard visual oddball task on an Apple iPad while EEG data were recorded from a Muse EEG headband. Counter to traditional EEG studies, experimental setup and data collection was completed in less than seven minutes on average. An analysis of our EEG data revealed robust N200 and P300 ERP components and neural oscillations in the delta, theta, alpha, and beta bands. In line with previous findings we observed correlations between ERP components and EEG power and perceived cognitive fatigue. Further, we demonstrate here that a linear combination of ERP and EEG features is a significantly better predictor of perceived cognitive fatigue than any ERP or EEG feature on its own. In sum, our results provide validation of mEEG as a viable tool for research and provide further insight into the impact of cognitive fatigue on the human brain.

IntroductionChildren and youth with mental health and addiction crises are a vulnerable patient group that often are brought to the hospital for emergency department care. We propose to evaluate the effect of a novel, acute care bundle that standardises a patient-centred approach to care.Methods and analysisTwo paediatric emergency departments in Alberta, Canada are involved in this prospective, pragmatic, 29-month interventional quasi-experimental study. The acute care bundle comprises three components, applied when appropriate: (1) assessing self-harm risk at triage using the Ask Suicide-Screening Questionnaire (ASQ) to standardise the questions administered, enabling risk stratification; (2) use of the HEADS-ED (Home, Education, Activities/peers, Drug/alcohol, Suicidality, Emotions and behaviour, Discharge Resources) to focus mental health evaluations for those who screen high risk on the ASQ; and (3) implementation of a Choice And Partnership Approach to enable shared decision making in care following the emergency department visit. The overarching goal is to deliver the right care at the right place and time for the patients. The study design involves a longitudinal collection of data 12 months before and after the introduction of the bundle and the use of quality improvement strategies such as Plan-Do-Study-Act cycles during a 5-month run-in period to test and implement changes. The primary study end-point is child/youth well-being 1 month after the emergency department visit. Secondary outcomes include family functioning, child/youth well-being at 3 and 6 months, satisfaction with emergency department care, and health system outcomes (hospital admissions, length of emergency department stays, emergency department revisits).Ethics and disseminationThe study is registered at www.ClinicalTrials.gov and has received ethics and operational approvals from study sites. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be shared broadly with key policy and decision makers and disseminated in peer-reviewed academic journals and presentations at conferences.Trial registration numberNCT04292379.

RATIONALE Hepcidin is a peptide hormone that plays a central role in regulating iron metabolism. It is a potential biomarker for the diagnosis, monitoring and treatment of iron metabolism disorders. Serum hepcidin level can differ by 3 orders of magnitude depending on the patient's condition. Existing liquid chromatography/mass spectrometry (LC/MS) assays lack clinical sensitivity or require costly sample preparation steps. A simple, sensitive, robust and cost-effective assay for serum hepcidin quantitation in routine clinical laboratories is needed. METHODS A high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS/MS) method was developed to quantify hepcidin in human serum using chemically synthesized hepcidin as a standard and stable-isotope-labeled hepcidin as the internal standard. The method was validated according to CLSI-C62A guidelines. Calibrators were prepared with hepcidin-free serum. Clinical samples were separately processed and compared using solid-phase extraction (SPE) and acetonitrile (ACN) protein precipitation. RESULTS The calibration curve was validated over the range of 0.1-100 nmol/L with R2 >0.99. Both the SPE and the ACN precipitation methods had excellent and comparable reproducibility. The intra-day and inter-day coefficients of variation (CVs) were

Evidence ranging from behavioural adaptations to neurocognitive theories has made significant advances into our understanding of feedback-based learning. For instance, over the past twenty years research using electroencephalography has demonstrated that the amplitude of a component of the human event-related brain potential - the reward positivity - appears to change with learning in a manner predicted by reinforcement learning theory (Holroyd and Coles, 2002; Sutton and Barto, 1998). However, while the reward positivity (also known as the feedback related negativity) is well studied, whether the component reflects an underlying learning process or whether it is simply sensitive to feedback evaluation is still unclear. Here, we sought to provide support that the reward positivity is reflective of an underlying learning process and further we hoped to demonstrate this in a real-world medical education context. In the present study, students with no medical training viewed a series of patient cards that contained ten physiological readings relevant for diagnosing liver and biliary disease types, selected the most appropriate diagnostic classification, and received feedback as to whether their decisions were correct or incorrect. Our behavioural results revealed that our participants were able to learn to diagnose liver and biliary disease types. Importantly, we found that the amplitude of the reward positivity diminished in a concomitant manner with the aforementioned behavioural improvements. In sum, our data support theoretical predictions (e.g., Holroyd and Coles, 2002), suggest that the reward positivity is an index of a neural learning system, and further validate that this same system is involved in learning across a wide range of contexts.

In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.With leadership by two senior academics and the Transitions Implementation Committee, three working groups helped implement these transitions projects, which addressed (1) the medical-school-to-residency transition, (2) career planning and the residency matching process, and (3) the residency-to-practice transition. Work products include the development of a learner education handover protocol and the establishment of pan-Canadian entrustable professional activities to be used nationally to help define expectations for new graduates entering residencies. A postmatch boot camp tool and a simulated night on-call tool were developed and are available to all medical schools. National standards are being promoted for career services counseling and best practices in residency selection. A practice management curriculum framework, mentorship resources, resiliency training for graduating residents, and the entry-level disciplines of residency are also being explored.Ultimately, with system-wide change and better integration of all players, transitions for Canada's learners will greatly improve.

Background Mental health concerns in childhood and adolescence are prevalent, affecting nearly one million Canadian youth. In the absence of screening, up to 98% of these concerns can go undiagnosed, leading to significant health, educational, and social consequences. Consequently, the American Academy of Pediatrics recommends the development of screening tools to facilitate early identification and access to treatment. The Emergency Department (ED) represents a unique environment to implement such universal screening, as it is immediately accessible and may be the only point of contact for some vulnerable youth with undiagnosed illness. However, there are few existing instruments which take into account commonly cited barriers such as time constraints, disruption of ED flow, limited resources, and patient privacy. Objectives To facilitate efficient screening with minimal impact on ED flow, our team developed MyHEARTSMAP, an electronic self-administered screening tool. The tool is adapted from HEARTSMAP, a previously validated computerized assessment and management tool used by ED clinicians. MyHEARTSMAP has previously been evaluated for face validity and inter-rater reliability. Here, we measured the sensitivity and specificity of MyHEARTSMAP in identifying mental health concerns in youth. Design/Methods A prospective cohort study was conducted at two tertiary care pediatric EDs. Eligible youth aged 10-17 years presenting for a non-mental health complaint were invited to self-screen using MyHEARTSMAP. An accompanying parent/guardian could also complete an assessment of their child. The sensitivity and specificity was measured as the proportion of screened youth with mental health concerns identified through self-assessment by MyHEARTSMAP compared to assessment performed by a clinician (criteron standard). Results 760 youth and/or parents completed the study intervention. The sensitivity at identifying any psychiatric concerns was comparable between youth and guardian assessments: 92.7% (95%CI: 89.1, 95.4%) and 93.1% (95%CI: 89.5, 95.8%) respectively. The specificity at identifying youth without any psychiatric issues was also comparable between youth and their guardians: 42.2% (95%CI: 37.3, 47.3) and 37.0% (95%CI: 32.2,42.1), respectively. Conclusion MyHEARTSMAP is sensitive for identifying youth with mental health concerns. While it showed only modest specificity, false positives were almost entirely (98%) mild issues identified by youth and deemed to be normal by clinicians. This would not place a burdensome demand on mental health services and could be effectively assessed without specialized psychiatric training. Thus, MyHEARTSMAP may be an effective tool for early identification and management of mental health concerns.

Objectives To evaluate the utility of universal psychosocial screening in the emergency department (ED) using MyHEARTSMAP, a digital self-assessment and management guiding tool. Study design We conducted a cohort study of youth 10-17 years of age with nonmental health related presentations at 2 pediatric EDs. On randomly selected shifts (December 2017-February 2019), participants completed their psychosocial self-assessments using MyHEARTSMAP on a mobile device, then underwent a standardized clinical mental health assessment (criterion standard). We reported the sensitivity and specificity of respondents' self-assessment, against a clinician's standard emergency psychosocial assessment, and the frequency of psychosocial issues and recommended mental health resources identified by screening. Results We approached 1432 eligible youth, among which 795 youth consented to participate (55.5%). Youth and guardians' sensitivity at self-identifying psychiatric concerns was 92.7% (95% CI 89.1, 95.4%) and 93.1% (95% CI 89.5, 95.8%), respectively. In cases where clinicians had determined to be no psychiatric issues, 98.5% (95% CI 96.7, 99.4%) of youth and 98.9% (95% CI 97.3, 99.7%) of guardians identified the youth as having no or only mild issues. Screening identified 36.4% of youth as having issues in at least 1 psychosocial domain which warranted further follow-up. Conclusions Psychosocial screening in EDs using MyHEARTSMAP can reliably be conducted using the MyHEARTSMAP self-assessment tool and over one-third of screened youth identified issues which can be directed to further care.

The experimental animated virtual reality short "a kite's tale" required cgi and hand-drawn characters to interact in a highly art-directed environment made of spectacular clouds. In this talk we'll examine the workflows developed to create the short, with particular emphasis on the integration of hand-drawn animation and performant real-time cloud rendering.

Walt Disney Animation Studios presents "a kite's tale," an experimental animated short combining classic hand-drawn animation with virtual reality. A kite with the spirit of a playful puppy tangles with a pompous dragon-kite in a short that brings the audience into a breathtaking world.