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Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder, affecting 3% to 5% of school-aged children. Of the 3 subtypes--predominantly inattentive, predominantly hyperactive/impulsive, and a combined subtype--the latter is the most commonly represented group, accounting for 50% to 70% of all ADHD individuals. Stimulant medication is the cornerstone of management; however, stimulants with a short duration of action have been problematic for some patients. Recent technologic advances in delivery systems offer many patients the option of a once-daily dosage. [ABSTRACT FROM AUTHOR]

Context: The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL)., Objective: To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods., Study Design: Multi-center cohort study., Setting: Nineteen SCL units in 11 countries., Methods: SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis., Results: The study included inpatients aged 16-87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6-6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable., Conclusions: Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.

Context: Spinal cord injury or disease (SCI/D) can lead to health challenges that are exacerbated with aging. Adaptive sport is understood to provide health benefits for the SCI/D population. Prior literature investigating adaptive sport in this population pertains to adults with SCI/D who are <50 years of age. However, most Canadians with SCI/D are >50 years of age., Objectives: This study aimed to: (1) Compare demographics of those who do and do not participate in adaptive sport; (2) Describe the characteristics of adaptive sport that adults aged ≥50 years with SCI/D participate in; and (3) Identify barriers and facilitators to adaptive sport participation in this age group., Methods: This descriptive, cross-sectional survey was carried out using an online survey. Analytical statistics were used to address objective one, while descriptive statistics were employed for objectives two and three., Participants: Responses from 72 adults aged ≥50 years, residing in Canada, living with a SCI/D for >6 months were included in the analysis., Results: Findings revealed that adaptive sport participants aged ≥50 years with SCI/D were more likely to identify as men, be younger individuals (50-59 years), and report greater satisfaction with physical health ( P  < 0.05). Adaptive sport participants most commonly played individual sports at the recreational level. Common barriers pertained to physical capacity, travel, and COVID-19; common facilitators included social support, desire to improve health, and having friends/peers who also participate., Conclusion: Future research should investigate strategies to enhance facilitators and mitigate barriers to adaptive sport participation in order to improve access.

The increasing demand for novel natural compounds has prompted the exploration of innovative approaches in bioengineering. This study investigates the bioengineering potential of the marine diatom Phaeodactylum tricornutum through the introduction of cannabis genes, specifically, tetraketide synthase (TKS), and olivetolic acid cyclase (OAC), for the production of the cannabinoid precursor, olivetolic acid (OA). P. tricornutum is a promising biotechnological platform due to its fast growth rate, amenability to genetic manipulation, and ability to produce valuable compounds. Through genetic engineering techniques, we successfully integrated the cannabis genes TKS and OAC into the diatom. P. tricornutum transconjugants expressing these genes showed the production of the recombinant TKS and OAC enzymes, detected via Western blot analysis, and the production of cannabinoids precursor (OA) detected using the HPLC/UV spectrum when compared to the wild-type strain. Quantitative analysis revealed significant olivetolic acid accumulation (0.6-2.6 mg/L), demonstrating the successful integration and functionality of the heterologous genes. Furthermore, the introduction of TKS and OAC genes led to the synthesis of novel molecules, potentially expanding the repertoire of bioactive compounds accessible through diatom-based biotechnology. This study demonstrates the successful bioengineering of P. tricornutum with cannabis genes, enabling the production of OA as a precursor for cannabinoid production and the synthesis of novel molecules with potential pharmaceutical applications.

Objective: The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury., Methods: This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed., Results: At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers., Conclusion: The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community., Impact: The discharge SWAT is useful to optimize discharge planning., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Study Design: Psychometric study., Objectives: The Standing and Walking Assessment Tool (SWAT) is a standardized approach to the evaluation of standing and walking capacity following traumatic spinal cord injury (tSCI) in Canada. The SWAT classifies individuals with a tSCI into 12 stages of standing and walking capacity that are paired with well-established outcome measures, such as the Berg Balance Scale and 10-m Walk Test. Prior research has demonstrated the validity and responsiveness of the SWAT stages; however, the reliability remains unknown. The objective of this study was to evaluate the interrater reliability of the SWAT stages., Setting: Inpatient units of two Canadian rehabilitation hospitals., Methods: Adults with sub-acute tSCI were recruited. SWAT stage was evaluated for each participant by two physical therapists separately. The two therapists aimed to complete the evaluations within one day of each other. To evaluate interrater reliability, the percentage agreement between the SWAT stages rated by the two physical therapists was calculated, along with a linear weighted kappa statistic with a 95% CI., Results: Forty-five individuals with sub-acute tSCI (36 males, 9 females, mean (SD) age of 54.8 (17.9) years) participated. The percentage agreement in SWAT stages between the two physical therapists was 75.6%. A kappa statistic of 0.93 with a 95% CI, 0.81-1.05 was obtained. In cases where therapists disagreed (18% of participants), therapists differed by 1-2 stages only., Conclusions: The SWAT stages have high interrater reliability, providing further support for the use of the SWAT in rehabilitation practice in Canada., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)

Background: Wastewater surveillance (WWS) of pathogens is a rapidly evolving field owing to the 2019 coronavirus disease pandemic, which brought about a paradigm shift in public health authorities for the management of pathogen outbreaks. However, the interpretation of WWS in terms of clinical cases remains a challenge, particularly in small communities where large variations in pathogen concentrations are routinely observed without a clear relation to clinical incident cases., Methods: Results are presented for WWS from six municipalities in the eastern part of Canada during the spring of 2021. We developed a numerical model based on viral kinetics reduction functions to consider both prevalent and incident cases to interpret the WWS data in light of the reported clinical cases in the six surveyed communities., Results: The use of the proposed numerical model with a viral kinetics reduction function drastically increased the interpretability of the WWS data in terms of the clinical cases reported for the surveyed community. In line with our working hypothesis, the effects of viral kinetics reduction modeling were more important in small communities than in larger communities. In all but one of the community cases (where it had no effect), the use of the proposed numerical model led to a change from a +1.5% (for the larger urban center, Quebec City) to a +48.8% increase in the case of a smaller community (Drummondville)., Conclusion: Consideration of prevalent and incident cases through the proposed numerical model increases the correlation between clinical cases and WWS data. This is particularly the case in small communities. Because the proposed model is based on a biological mechanism, we believe it is an inherent part of any wastewater system and, hence, that it should be used in any WWS analysis where the aim is to relate WWS measurement to clinical cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rioux, Guillemette, Lemarchand, Doiron, Lemay, Maere, Dolcé, Quessy, Abonnenc, Vanrolleghem and Frigon.)

The worldwide proliferation of the SARS-CoV-2 virus in the past 3 years has allowed the virus to accumulate numerous mutations. Dangerous lineages have emerged one after another, each leading to a new wave of the pandemic. In this study, we have developed the THRASOS pipeline to rapidly discover lineage-specific mutation signatures and thus advise the development of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based diagnostic tests. We also optimized a strategy to modify loop-mediated isothermal amplification amplicons for downstream use with Cas12 and Cas13 for future multiplexing. The close ancestry of the BA.1 and BA.2 variants of SARS-CoV-2 (Omicron) made these excellent candidates for the development of a first test using this workflow. With a quick turnaround time and low requirements for laboratory equipment, the test we have created is ideally suited for settings such as mobile clinics lacking equipment such as Next-Generation Sequencers or Sanger Sequencers and the personnel to run these devices.

Study Design: This is a retrospective longitudinal study., Objective: The Standing and Walking Assessment Tool (SWAT) combines stages of standing and walking recovery (SWAT stages) with established measures (Berg Balance Scale (BBS), 10-m walk test (10MWT), 6-min walk test (6MWT), and modified Timed Up-and-Go (mTUG)). We evaluated the SWAT's validity (known-groups and convergent) and responsiveness among inpatients with sub-acute, traumatic spinal cord injury (SCI)., Setting: Ten Canadian rehabilitation hospitals., Methods: Upon admission, SWAT stage and core measures (BBS, 10MWT, 6MWT, and mTUG), International Standards for Neurological Classification of SCI sensory and motor scores, and Spinal Cord Independence Measure III (SCIM) were collected from 618 adults with SCI. Known-groups validity was evaluated by comparing SWAT stage distributions across American Spinal Injury Association Impairment Scale (AIS) classification. Convergent validity was evaluated by correlating SWAT stages with scores on other measures using Spearman's rho. The SWAT (stage and core measures) was re-administered at discharge. To evaluate responsiveness, SWAT stages at admission and discharge were compared. The standardized response mean (SRM) was used to evaluate the responsiveness of core SWAT measures., Results: The SWAT stage distribution of participants with AIS D injuries differed from those of participants with AIS A-C injuries (p ≤ 0.002). SWAT stages correlated strongly with BBS and motor scores (ρ = 0.778-0.836), and moderately with SCIM, mTUG, 10MWT, 6MWT, and sensory scores (ρ = 0.409-0.692). Discharge SWAT stage was greater than the admission stage (p < 0.0001). The BBS was the most responsive core SWAT measure (SRM = 1.26)., Conclusions: The SWAT is a valid and responsive approach to the measurement of standing and walking ability during sub-acute SCI., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)

Objective: We investigated the right Superior Frontal Gyrus (right-SFG) and Anterior Cingulate Cortex (ACC) in children with ADHD and their clinical relevance with Executive Function (EF) and ADHD symptom severity., Methods: About 26 children with ADHD and 24 typically developing children (TDC; 7‒16 years) underwent Magnetic Resonance Imaging (MRI) and completed an EF assessment battery., Results: Significantly thinner right-SFG in the ADHD group was found compared to the TDC group ( t (48) = 2.81, p = .007, Cohen's d = 0.84). Linear regression models showed that 12.5% of inattention, 13.6% of hyperactivity, and 9.0% of EF variance was accounted for by the right-SFG thickness., Conclusions: Differences in the right-SFG thickness were found in our ADHD group and were associated with parent ratings of inattentive and hyperactive symptoms as well with EF ratings. These results replicate previous findings of thinner right-SFG and are consistent with the delayed cortical maturation theory of ADHD.

Helix-destabilizing DNA lesions induced by environmental mutagens such as UV light cause genomic instability by strongly blocking the progression of DNA replication forks (RFs). At blocked RF, single-stranded DNA (ssDNA) accumulates and is rapidly bound by Replication Protein A (RPA) complexes. Such stretches of RPA-ssDNA constitute platforms for recruitment/activation of critical factors that promote DNA synthesis restart. However, during periods of severe replicative stress, RPA availability may become limiting due to inordinate sequestration of this multifunctional complex on ssDNA, thereby negatively impacting multiple vital RPA-dependent processes. Here, we performed a genome-wide screen to identify factors that restrict the accumulation of RPA-ssDNA during UV-induced replicative stress. While this approach revealed some expected "hits" acting in pathways such as nucleotide excision repair, translesion DNA synthesis, and the intra-S phase checkpoint, it also identified SCAI, whose role in the replicative stress response was previously unappreciated. Upon UV exposure, SCAI knock-down caused elevated accumulation of RPA-ssDNA during S phase, accompanied by reduced cell survival and compromised RF progression. These effects were independent of the previously reported role of SCAI in 53BP1-dependent DNA double-strand break repair. We also found that SCAI is recruited to UV-damaged chromatin and that its depletion promotes nascent DNA degradation at stalled RF. Finally, we (i) provide evidence that EXO1 is the major nuclease underlying ssDNA formation and DNA replication defects in SCAI knockout cells and, consistent with this, (ii) demonstrate that SCAI inhibits EXO1 activity on a ssDNA gap in vitro. Taken together, our data establish SCAI as a novel regulator of the UV-induced replicative stress response in human cells., Competing Interests: The authors have declared that no competing interests exist.

Background: Although much is known about cognitive dysfunction in attention-deficit/hyperactivity disorder (ADHD), few studies have examined the pathophysiology of disordered motor circuitry. We explored differences in neurometabolite levels and transcranial magnetic stimulation (TMS)-derived corticomotor representations among children with ADHD and typically developing children., Methods: We used magnetic resonance spectroscopy (MRS) protocols to measure excitatory (glutamate + glutamine [Glx]) and inhibitory (γ-aminobutyric acid [GABA]) neurometabolite levels in the dominant primary motor cortex (M1) and the supplementary motor area (SMA) in children with ADHD and typically developing children. We used robotic neuronavigated TMS to measure corticospinal excitability and create corticomotor maps., Results: We collected data from 26 medication-free children with ADHD (aged 7-16 years) and 25 typically developing children (11-16 years). Children with ADHD had lower M1 Glx ( p = 0.044, d = 0.6); their mean resting motor threshold was lower ( p = 0.029, d = 0.8); their map area was smaller ( p = 0.044, d = 0.7); and their hotspot density was higher ( p = 0.008, d = 0.9). M1 GABA levels were associated with motor map area ( p = 0.036). Limitations: Some TMS data were lost because the threshold of some children exceeded 100% of the machine output. The relatively large MRS voxel required to obtain sufficient signal-to-noise ratio and reliably measure GABA levels encompassed tissue beyond the M1, making this measure less anatomically specific., Conclusion: The neurochemistry and neurophysiology of key nodes in the motor network may be altered in children with ADHD, and the differences appear to be related to each other. These findings suggest potentially novel neuropharmacological and neuromodulatory targets for ADHD., Competing Interests: Competing interests: A. Kirton reports grants or contracts from the Canadian Institutes for Health Research, Alberta Innovates, the Cerebral Palsy Alliance Research Foundation and the Kids Brain Health Network; participation on an advisory board for the PumpKin trial; and membership on the board of the International Pediatric Stroke Organization. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Study Design: An exploratory descriptive study was conducted., Objective: To determine if and how occupational therapists (OTs) and physical therapists (PTs) in acute care hospital settings use activity-based therapy (ABT) and its associated technologies., Setting: Acute care hospital settings in Canada., Methods: Semi-structured interviews were conducted with physical and occupational therapists, licensed in Canada, who worked in an acute care neurological setting with individuals with spinal cord injury or disease (SCI/D). To analyze the data, interpretive description was used. NVivo 12 was used for data management., Results: Five physical therapists and two occupational therapists were interviewed (n = 7). Two therapists declined after reading a description of the study. Through analysis, the following themes were identified as affecting the delivery of ABT as part of SCI/D rehabilitation in the acute care setting: (1) Impact of patient acuity on ABT participation, (2) ABT approach unique to the acute care setting, and (3) Influence of acute care work environment and therapy practice. Throughout these themes, therapists referred to dosage as a limiting factor affecting ABT delivery., Conclusions: Our research reveals that implementing ABT in an acute care setting is challenging considering the high dosage of movement practice required for ABT. To increase dosage and the use of ABT in acute care, strategies could include early patient education on ABT, strategic use of social supports, and use of portable technology already incorporated in acute care., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)

Objective: To examine the fourth version of the Spinal Cord Independence Measure for reliability and validity., Design: Partly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations., Setting: A multicultural cohort from 19 spinal cord injury units in 11 countries., Participants: A total of 648 patients with spinal cord injury., Intervention: Assessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge., Main Outcome Measures: SCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness., Results: Total agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons., Conclusions: The validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III., (Copyright © 2021 The American Congress of Rehabilitation Medicine. All rights reserved.)

Background: Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit behaviour challenges and deficits in executive functions (EF). Psychostimulant medications [ e.g. , methylphenidate (MPH)] are commonly prescribed for children with ADHD and are considered effective in 70% of the cases. Furthermore, only a handful of studies have investigated the long-term impact of MPH medication on EF and behaviour., Aim: To evaluate behaviour and EF challenges in children with ADHD who were involved in an MPH treatment trial across three-time points., Methods: Thirty-seven children with ADHD completed a stimulant medication trial to study the short- and long-term impact of medication. Children with ADHD completed three neuropsychological assessments [Continuous Performance Test (CPT)-II, Digit Span Backwards and Spatial Span Backwards]. Parents of children with ADHD completed behaviour rating scales [Behaviour Rating Inventory of Executive Functioning (BRIEF) and Behaviour Assessment System for Children-Second Edition (BASC-2)]. Participants were evaluated at: (1) Baseline (no medication); and (2) Best-dose (BD; following four-week MPH treatment). Additionally, 18 participants returned for a long-term naturalistic follow up (FU; up to two years following BD)., Results: Repeated measure analyses of variance found significant effects of time on two subscales of BRIEF and four subscales of BASC-2. Neuropsychological assessments showed some improvement, but not on all tasks following the medication trial. These improvements did not sustain at FU, with increases in EF and behaviour challenges, and a decline in performance on the CPT-II task being observed., Conclusion: Parents of children with ADHD reported improvements in EF and behaviours during the MPH trial but were not sustained at FU. Combining screening tools and neuropsychological assessments may be useful for monitoring medication responses., Competing Interests: Conflict-of-interest statement: The authors declare no competing financial interests. No conflict of interest to report., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

We report on the development of surface plasmon resonance (SPR) sensors and matching ELISAs for the detection of nucleocapsid and spike antibodies specific against the novel coronavirus 2019 (SARS-CoV-2) in human serum, plasma and dried blood spots (DBS). When exposed to SARS-CoV-2 or a vaccine against SARS-CoV-2, the immune system responds by expressing antibodies at levels that can be detected and monitored to identify the fraction of the population potentially immunized against SARS-CoV-2 and support efforts to deploy a vaccine strategically. A SPR sensor coated with a peptide monolayer and functionalized with various sources of SARS-CoV-2 recombinant proteins expressed in different cell lines detected human anti-SARS-CoV-2 IgG antibodies in clinical samples. Nucleocapsid expressed in different cell lines did not significantly change the sensitivity of the assays, whereas the use of a CHO cell line to express spike ectodomain led to excellent performance. This bioassay was performed on a portable SPR instrument capable of measuring 4 biological samples within 30 minutes of sample/sensor contact and the chip could be regenerated at least 9 times. Multi-site validation was then performed with in-house and commercial ELISA, which revealed excellent cross-correlations with Pearson's coefficients exceeding 0.85 in all cases, for measurements in DBS and plasma. This strategy paves the way to point-of-care and rapid testing for antibodies in the context of viral infection and vaccine efficacy monitoring.

Study Design: Quantitative cross-sectional study., Objectives: Evaluate the test-retest reliability and the construct validity of inertial measurement units (IMU) to characterize spatiotemporal gait parameters in individuals with SCI., Setting: Two SCI rehabilitation centers in Canada., Methods: Eighteen individuals with SCI participated in two evaluation sessions spaced 2 weeks apart. Fifteen able-bodied individuals were also recruited. Participants walked 20 m overground under five conditions that challenged balance to varying degrees. Five IMU were attached to the lower-extremities and the sacrum to collect the mean and the coefficient of variation of five gait parameters (gait cycle time, double-support percentage, cadence, stride length, stride velocity). Intra-class correlation coefficients (ICC) were used to evaluate the test-retest reliability. Linear mixed-effects models were used to compare the five walking conditions to evaluate known-group validity while Spearman's correlation coefficients were used to characterize the level of association between gait parameters and the Mini BESTest (MBT)., Results: Cadence was reliable across all walking conditions. Reliability was higher for the mean (ICC = 0.55-0.98) of the parameters compared to their coefficient of variation (ICC = 0.16-0.97). Cadence collected with IMU had construct validity as their values differed across walking conditions and groups of participants. The coefficient of variation was generally better than the mean to show differences across the five walking conditions. The MBT was moderately to strongly associated with mean cadence (ρ ≥ 0.498) and its coefficient of variation (ρ ≤ -0.49) during most walking conditions., Conclusions: IMU provide reliable and valid measurements of gait parameters in ambulatory individuals with SCI.

Objectives: The COVID-19 pandemic created an environment of restricted access to health and recreation services. Lifestyle habits including sleep, eating, exercise, and screen use were modified, potentially exacerbating adverse mental health outcomes. This study investigates the impact of COVID-19 on lifestyle habits and mental health symptoms in paediatric attention-deficit/hyperactivity disorder (ADHD) in Canada., Methods: An online survey was distributed across Canada to caregivers of children with ADHD (children aged 5 to 18 years) assessing depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviours. Data were analyzed by gender (male/female) and age category (5 to 8, 9 to 12, and 13 to 18 years). Spearman's correlations between lifestyle habits and mental health outcomes were conducted., Results: A total of 587 surveys were completed. Mean child age was 10.14 years (SD 3.06), including 166 females (28.3%). The PHQ-9 and GAD-7 indicated that 17.4% and 14.1% of children met criteria for moderately severe to severe depression and anxiety symptoms respectively. Children met SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviours. Caregivers reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child, greatly impacting youth. Sleeping fewer hours/night, eating more processed foods, and watching TV/playing videogames >3.5 hours/day correlated with greater depression, anxiety and ADHD symptoms, and exercising <1 hour/day further correlated with depression symptoms (P < 0.01)., Conclusions: The COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD. Longitudinal studies to better understand the relationship between these factors are recommended., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The Alberta Children's Hospital-Autism Spectrum Disorder Diagnostic Clinic (ACH-ASDC) was restructured due to long wait times and unsustainable clinic workflow. Major changes included the initiation of pre- and post-ASD parent education sessions and distinct ASD screening appointments before the ASD diagnostic appointment., Methods: We conducted a parental program evaluation in summer 2018 of the ACH-ASDC. We used a cross-sectional survey to evaluate key outcomes including parental satisfaction, and the percentage of families obtaining access to government supports and early intervention programs., Results: For the 101 eligible patients diagnosed with ASD under 36 months of age 70 (69.3%) parents agreed to participate. The mean diagnostic age of the children diagnosed with ASD was 30.6 months (SD=4.1 months). There were no statistically significant age differences between biological sexes. Ninety-three per cent of parents felt that ASD educational sessions were useful, and 92% of parents were satisfied to very satisfied with the overall ASD diagnostic process. Ninety per cent of parents had access to at least one of the key resources available for ASD early intervention in our province following diagnosis. Parents reported a positive impact on intervention provided to their child in the areas of communication, social interaction, and behaviour., Conclusion: Parents of children diagnosed with ASD expressed a high level of satisfaction with the restructured ACH-ASDC process. Implementing parent education sessions was well received and met parents' needs. Parents were able to access intervention services following diagnosis and reported positive impacts for their child. Re-envisioning program approaches to incorporate novel strategies to support families should be encouraged., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Up to one-third of individuals with a recent spinal cord injury (SCI) and most of the individuals with an incomplete lesion are able to regain partial balance and walking ability after the first-year post-injury. However, most individuals experience injurious falls while standing and frequent losses of balance post-rehabilitation, which can result in physical injuries and a fear of falling., Research Question: Control of balance during quiet standing depends on the integration of sensory information. Since SCI causes sensory and motor impairments, understanding the underlying mechanisms of how postural control is regulated is of significant importance for targeted and guided rehabilitation post-SCI., Methods: We characterized the impact of a variety of challenging conditions on the standing balance for eight participants with incomplete SCI with walking ability compared to twelve age-matched able-bodied individuals using a waist-mounted inertial measurement unit (IMU). We compared balance biomarkers derived from IMUs' readouts under conditions that challenged balance by affecting somatosensory (i.e., standing on hard vs. foam surfaces) and visual (i.e., eyes open vs. closed) inputs. We performed a three-way ANOVA or a Kruskal-Wallis test to characterize changes in postural control post-SCI based on reliance on somatosensory and visual information using balance biomarkers., Results: We observed a reduced stability performance, an increased control demand, and a less effective active correction post-SCI in all standing conditions. Due to impaired somatosensory feedback, individuals with incomplete SCI showed a higher and lower reliance on visual and somatosensory information, respectively, for maintaining balance (p < 0.05)., Significance: Using a single waist-mounted IMU, the proposed method could characterize standing balance in individuals with incomplete SCI compared to able-bodied participants. Having high clinical utility and sufficient resolution with discriminatory ability, our method could be used in the future to objectively evaluate the effectiveness of rehabilitative interventions on the balance performance of individuals with SCI., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Postural control is affected after incomplete spinal cord injury (iSCI) due to sensory and motor impairments. Any alteration in the availability of sensory information can challenge postural stability in this population and may lead to a variety of adaptive movement coordination patterns. Hence, identifying the underlying impairments and changes to movement coordination patterns is necessary for effective rehabilitation post-iSCI. This study aims to compare the postural control strategy between iSCI and able-bodied populations by quantifying the trunk-leg movement coordination under conditions that affects sensory information., Methods: 13 individuals with iSCI and 14 aged-matched able-bodied individuals performed quiet standing on hard and foam surfaces with eyes open and closed. We used mean Magnitude-Squared Coherence between trunk-leg accelerations measured by accelerometers placed over the sacrum and tibia., Results: We observed a similar ankle strategy at lower frequencies (f ≤ 1.0 Hz) between populations. However, we observed a decreased ability post-iSCI in adapting inter-segment coordination changing from ankle strategy to ankle-hip strategy at higher frequencies (f > 1.0 Hz). Moreover, utilizing the ankle-hip strategy at higher frequencies was challenged when somatosensory input was distorted, whereas depriving visual information did not affect balance strategy., Conclusion: Trunk-leg movement coordination assessment showed sensitivity, discriminatory ability, and excellent test-retest reliability to identify changes in balance control strategy post-iSCI and due to altered sensory inputs. Trunk-leg movement coordination assessment using wearable sensors can be used for objective outcome evaluation of rehabilitative interventions on postural control post-iSCI.

Electro-MBR technology, which combines an electrocoagulation process inside the mixed liquor of a membrane bioreactor, was studied for the treatment of a high-strength ammonia leachate (124 ± 4 mg NH 4 -N L -1 ). A lab-scale aerobic Electro-MBR was operated with a solid retention time of 45 days, hydraulic retention times of 24h and 12h, and charge loading ranging from 100 to 400 mAh L -1 . At 400 mAh L -1 , with a combination of a Ti/Pt cathode and a sacrificial iron anode, removal percentages for ammonia nitrogen, total organic carbon, and total phosphorus were 99.8%, 38%, and 99.0%, respectively. At 400 mAh L -1 , the estimated ferric ion dosage was 325 mg Fe 3+ L -1 . Experiments conducted with different cathode materials showed that previously reported inhibition phenomena may result from a cathodic nitrate reduction into ammonia nitrogen. Conventional cathode materials, such as graphite, have electrochemical nitrate reduction rates of -0.03 mg NO 3 -N mAh -1 . By comparison, when using Ti/Pt, the rate was -0.0045 mg NO 3 -N mAh -1 (85% lower than graphite due to its low hydrogen overpotential). Charge loading tested in this study had no significant impact on both nitrification performance and microbial population diversity. However, the relative abundance of the mixed liquor's Nitrosomonas increased from 4.8% to 8.2% when the charge loading increased from 0 to 400 mAh L -1 . Results from this study are promising for future applications of the Ti/Pt - Iron Electro-MBR in various high-strength ammonia wastewater treatment applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

A MBR treating compost leachate was studied in order to link the operating parameters (solid and hydraulic retention time) to contaminant's specific bacterial catabolic activity. In this context, a lab-scale aerobic membrane bioreactor was operated for 200 days, at solid retention times (SRT) of 30 and 45 days and four different contaminant load rates. Results showed that increasing the food to microorganism ratio (F/M) by increasing the contaminant load rates lessened the selectivity pressure, which allowed the proliferation of subdominant operational taxonomic units (OTU) (relative abundance >3%) that were otherwise inhibited by highly adapted dominant OTUs (relative abundance >10%). Subsequently, increasing the SRT resulted in a lower species richness and the selection of two dominant types of bacteria: 1) genera with low growth rates that feed on non-limiting substrates or substrates with few competitors, and 2) genera with metabolisms that are highly specific to the available substrates and that can outcompete the other genera by using the substrate more efficiently. The bacterial population evolution observed during this study suggests that the mixed liquor population diversity and structure can be modulated with the operating conditions for the bioenhancement of contaminant specific catabolic activity. Identified dominant and subdominant genera were linked to the MBR's NH 4 + and COD removal performances. Interestingly, nitrification performances were unaffected by the organic load rate and the Nitrosomonas relative abundance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder with no known biomarkers. The objectives of this study were 1) to investigate spectroscopic biomarkers in the right prefrontal cortex (R-PFC) and left striatum; 2) to evaluate Executive Function (EF) performance; and, 3) to examine the clinical relevance of glutamate in EF tasks., Methods: A total of 21 children with ADHD ( M = 10.41 years, SD = 1.41) and 15 controls without ADHD ( M = 9.90 years, SD = 1.54 years) were enrolled. Short echo proton magnetic resonance spectroscopy (1H-MRS; TE = 30ms) was used to study the changes in the R-PFC and left striatum. Both groups completed an EF assessment battery, including working memory, inhibition, cognitive flexibility and verbal fluency tasks., Results: In the R-PFC, independent t-tests found decreased concentration of glutamate ( p = 0.009), NAA ( p = 0.029) and choline ( p = 0.016) in ADHD participants compared to controls. No significant differences were seen in the left striatum. Multivariate analysis of variance did not indicate overall EF challenges in the ADHD sample ( p < .05). Positive correlations with glutamate concentration and EF performance in the control group were observed, however, no such correlations were reported in the ADHD group., Conclusions: The results indicated a subgroup of children with ADHD who presented with hypo-glutamatergic signalling in the R-PFC. Additionally, findings suggested a decoupling effect of glutamate in EF related tasks in children with ADHD compared to controls. Thus, glutamate concentration may be a possible ADHD biomarker and novel treatments target., (Copyright © 2020 Canadian Academy of Child and Adolescent Psychiatry.)

Objective: To examine the psychometric properties of the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) in an autism spectrum disorder (ASD) clinic for children aged 18 to 36 months., Methods: The RITA-T (level 2 screening instrument) was integrated into an ASD screening and diagnostic process for evaluating children aged 18 to 36 months who were referred to a pediatric tertiary care center. Scoring of the RITA-T to differentiate ASD from non-ASD developmental concerns was evaluated. Screening instrument measurements included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-)., Results: From a total of 239 participants aged 18 to 36 months (males = 78% and females = 22%), 201 (84%) were diagnosed with ASD (4:1 male-to-female ratio). An ASD diagnosis was significantly associated with RITA-T scores, with ASD patients scoring higher than non-ASD patients [F (1,235) = 170, mean difference: males 9.21, mean difference: females 12.4, p < 0.001]. The RITA-T score was not statistically correlated with age or sex. The optimal cutoff score of ≥14 was determined from a receiver operator curve analysis (area under the curve = 0.953). In the study group, with a cutoff score of ≥14, the RITA-T showed a sensitivity of 0.97, specificity of 0.71, PPV of 0.95, NPV of 0.79, LR+ of 3.33, and LR- of 0.05., Conclusion: The RITA-T, as a level 2 screening instrument for ASD, exhibits discriminative psychometric properties similar to previously published results. When integrated into an ASD screening and diagnostic process for families for whom concerns about ASD have been raised with their children aged 18 to 36 months, the RITA-T helps to predict a best-estimate clinical diagnosis of ASD.

Context/Objective: The Spinal Cord Injury (SCI) Standing and Walking Assessment Tool (SWAT) combines stages of walking recovery with measures of balance and walking. It standardizes the timing and content of walking assessment in inpatient rehabilitation. The study aims were: (1) Evaluate the content validity of the SWAT stages of walking recovery, and (2) Understand physical therapists' (PTs) experiences using the SWAT to gauge acceptance, implementation and impact. Design: Qualitative, exploratory study. Setting: Nine Canadian rehabilitation hospitals. Participants: Thirty-four PTs who had used the SWAT ≥10 times. Interventions: Seven focus group meetings were completed. Semi-structured questions queried the content, order and spacing of SWAT stages, and current SWAT use (i.e. processes, challenges, facilitators, impact on practice). Meetings were audio-recorded and transcribed. Themes and categories were derived through a conventional content analysis. Outcome Measure: Not applicable. Results: PTs agreed with the ordering and content of the SWAT stages, but reported unequal spacing between stages. Three themes related to PTs' use of the SWAT were identified: (1) Variable process: SWAT implementation varied across sites, PTs and patients. (2) Implementation challenges: unfamiliarity of the SWAT, lack of time, not required by place of work, and patients who are outliers or have poor gait quality. (3) Potential to influence clinical decision-making: the SWAT did not influence clinical decisions, but PTs recognized the potential of the tool to do so. Conclusions: Content validity of the SWAT stages was supported and implementation challenges identified. Variability in SWAT implementation may reflect the heterogeneity and person-centeredness of SCI rehabilitation.

The Mini BESTest has been developed to comprehensively examine postural control in individuals with various pathologies treated by rehabilitation professionals. However, no formal French version of the Mini BESTest is available. This study aimed to translate and transculturally adapt the Mini BESTest to French and verify its intra- and inter-rater reliability. Translation and transcultural adaptation was performed in accordance with established guidelines, which included 2 initial translations and transcultural adaptations of the Mini BESTest to French that were then merged, a backward English translation, a subsequent adapted French version resolving discrepancies between the English versions, and pilot testing the final version by French-speaking physical therapists. In total, 20 participants with sensorimotor impairments with various etiologies and able to stand for at least 30sec without human or technical assistance were video-recorded during evaluation with the Mini BESTest. From this video-recording, we calculated inter-rater and intrarater reliability (intraclass correlation coefficient=0.974-0.988), internal consistency (Cronbach alpha=0.895-0.929), standard error of measurement (1.05 and 1.63), and minimal detectable change at the 95% confidence interval (2.91 and 4.51). All values were comparable to those previously reported for the original version of the Mini BESTest. Furthermore, no significant ceiling or floor effect was detected. Therefore, the translated and transculturally adapted version of the Mini BESTest in French compares well to the original version and can be used by French-speaking rehabilitation professionals to examine postural control., (Copyright © 2018. Published by Elsevier Masson SAS.)

The ability to isolate rare live cells within a heterogeneous population based solely on visual criteria remains technically challenging, due largely to limitations imposed by existing sorting technologies. Here, we present a new method that permits labeling cells of interest by attaching streptavidin-coated magnetic beads to their membranes using the lasers of a confocal microscope. A simple magnet allows highly specific isolation of the labeled cells, which then remain viable and proliferate normally. As proof of principle, we tagged, isolated, and expanded individual cells based on three biologically relevant visual characteristics: i) presence of multiple nuclei, ii) accumulation of lipid vesicles, and iii) ability to resolve ionizing radiation-induced DNA damage foci. Our method constitutes a rapid, efficient, and cost-effective approach for isolation and subsequent characterization of rare cells based on observable traits such as movement, shape, or location, which in turn can generate novel mechanistic insights into important biological processes., Competing Interests: LB, FB, MU, JL, JP, JR, EA, ED, HW, SC No competing interests declared, (© 2019, Binan et al.)

Intrinsic and acquired resistance to cisplatin remains a primary hurdle to treatment of high-grade serous ovarian cancer (HGSOC). Cisplatin selectively kills tumor cells by inducing DNA crosslinks that block replicative DNA polymerases. Single-stranded DNA (ssDNA) generated at resulting stalled replication forks (RF) is bound and protected by heterotrimeric replication protein A (RPA), which then serves as a platform for recruitment and activation of replication stress response factors. Cells deficient in this response are characterized by extensive ssDNA formation and excessive RPA recruitment that exhausts the available pool of RPA, which (i) inhibits RPA-dependent processes such as nucleotide excision repair (NER) and (ii) causes catastrophic failure of blocked RF. Here, we investigated the influence of RPA availability on chemosensitivity using a panel of human HGSOC cell lines. Our data revealed a striking correlation among these cell lines between cisplatin sensitivity and the inability to efficiently repair DNA via NER, specifically during S phase. Such defects in NER were attributable to RPA exhaustion arising from aberrant activation of DNA replication origins during replication stress. Reduced RPA availability promoted Mre11-dependent degradation of nascent DNA at stalled RF in cell lines exhibiting elevated sensitivity to cisplatin. Strikingly, defective S-phase NER, RF instability, and cisplatin sensitivity could all be rescued by ectopic overexpression of RPA. Taken together, our findings indicate that RPA exhaustion represents a major determinant of cisplatin sensitivity in HGSOC cell lines. Significance: The influence of replication protein A exhaustion on cisplatin sensitivity harbors important implications toward improving therapy of various cancers that initially respond to platinum-based agents but later relapse due to intrinsic or acquired drug resistance. Cancer Res; 78(19); 5561-73. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Long noncoding RNAs (lncRNAs), which are longer than 200 nucleotides but often unstable, contribute a substantial and diverse portion to pervasive noncoding transcriptomes. Most lncRNAs are poorly annotated and understood, although several play important roles in gene regulation and diseases. Here we systematically uncover and analyze lncRNAs in Schizosaccharomyces pombe. Based on RNA-seq data from twelve RNA-processing mutants and nine physiological conditions, we identify 5775 novel lncRNAs, nearly 4× the previously annotated lncRNAs. The expression of most lncRNAs becomes strongly induced under the genetic and physiological perturbations, most notably during late meiosis. Most lncRNAs are cryptic and suppressed by three RNA-processing pathways: the nuclear exosome, cytoplasmic exonuclease, and RNAi. Double-mutant analyses reveal substantial coordination and redundancy among these pathways. We classify lncRNAs by their dominant pathway into cryptic unstable transcripts (CUTs), Xrn1-sensitive unstable transcripts (XUTs), and Dicer-sensitive unstable transcripts (DUTs). XUTs and DUTs are enriched for antisense lncRNAs, while CUTs are often bidirectional and actively translated. The cytoplasmic exonuclease, along with RNAi, dampens the expression of thousands of lncRNAs and mRNAs that become induced during meiosis. Antisense lncRNA expression mostly negatively correlates with sense mRNA expression in the physiological, but not the genetic conditions. Intergenic and bidirectional lncRNAs emerge from nucleosome-depleted regions, upstream of positioned nucleosomes. Our results highlight both similarities and differences to lncRNA regulation in budding yeast. This broad survey of the lncRNA repertoire and characteristics in S. pombe, and the interwoven regulatory pathways that target lncRNAs, provides a rich framework for their further functional analyses., (© 2018 Atkinson et al.; Published by Cold Spring Harbor Laboratory Press for the RNA Society.)

Background: A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D)., Objective: To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD)., Methods: Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017., Results: From 61 749 patients, 150 (0.24%) were identified as T1D-ASD. Non-adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D-ASD: 85.3%; T1D-non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P-value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D-ASD 6.0 [4.4-7.0]; T1D-non ASD 5.0 [4.4-7.0]; P-value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P-value .003). T1D-ASD used psycho-stimulants (15.3% vs 2.2%; P-value < .001), antipsychotics (10.7% vs 0.6%; P-value < .001), and antidepressive medications (3.6% vs 0.7%; P-value < .001) more frequently., Conclusion: Metabolic control was similar in the T1D-ASD group compared to T1D-non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long-term multi-disciplinary medical follow-up for optimal outcomes., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Diagnosing autism spectrum disorder (ASD) is challenging, resource-intense and time-consuming due to clinical and etiologic heterogeneity. With the rapid increase in prevalence of ASD, higher demand for diagnostic assessment often means long waitlists for families, and limited access to specialized intervention and support. In 2013, the Alberta Children's Hospital-Autism Spectrum Disorder Diagnostic Clinic (ACH-ASDC) experienced a significant waitlist in the 12 to 36 months' population. A Quality Improvement Project was started in 2014; one program aim was to create an efficient, sustainable and evidence-based ASD diagnostic evaluation process. The redesigned diagnostic process included: 1) pre- and postassessment parent information sessions, 2) a screening appointment and 3) standardized clinical appointment pathways. Within its first year, the new process reduced wait times to under a month without an increase in resources, leading to an efficient diagnostic process being sustained since its implementation.

Competing Interests: Competing interests: None declared.

Alternative polyadenylation (APA) is a widespread mechanism that generates mRNA isoforms with distinct properties. Here we have systematically mapped and compared cleavage and polyadenylation sites (PASs) in two yeast species, S. cerevisiae and S. pombe Although >80% of the mRNA genes in each species were found to display APA, S. pombe showed greater 3' UTR size differences among APA isoforms than did S. cerevisiae PASs in different locations of gene are surrounded with distinct sequences in both species and are often associated with motifs involved in the Nrd1-Nab3-Sen1 termination pathway. In S. pombe, strong motifs surrounding distal PASs lead to higher abundances of long 3' UTR isoforms than short ones, a feature that is opposite in S. cerevisiae Differences in PAS placement between convergent genes lead to starkly different antisense transcript landscapes between budding and fission yeasts. In both species, short 3' UTR isoforms are more likely to be expressed when cells are growing in nutrient-rich media, although different gene groups are affected in each species. Significantly, 3' UTR shortening in S. pombe coordinates with up-regulation of expression for genes involved in translation during cell proliferation. Using S. pombe strains deficient for Pcf11 or Pab2, we show that reduced expression of 3'-end processing factors lengthens 3' UTR, with Pcf11 having a more potent effect than Pab2. Taken together, our data indicate that APA mechanisms in S. pombe and S. cerevisiae are largely different: S. pombe has many of the APA features of higher species, and Pab2 in S. pombe has a different role in APA regulation than its mammalian homolog, PABPN1., (© 2017 Liu et al.; Published by Cold Spring Harbor Laboratory Press.)

Introduction: Script concordance testing (SCT) is a method of assessment of clinical reasoning. We developed a new type of SCT case design, the evolving SCT (E-SCT), whereby the patient's clinical story is "evolving" and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear., Objectives: We aimed to: (1) determine whether an E-SCT could differentiate clinical reasoning ability among junior residents (JR), senior residents (SR), and pediatricians, (2) evaluate the reliability of an E-SCT, and (3) obtain qualitative feedback from participants to help inform the potential acceptability of the E-SCT., Methods: A 12-case E-SCT, embedded within a 24-case pediatric SCT (PaedSCT), was administered to 91 pediatric residents (JR: n = 50; SR: n = 41). A total of 21 pediatricians served on the panel of experts (POE). A one-way analysis of variance (ANOVA) was conducted across the levels of experience. Participants' feedback on the E-SCT was obtained with a post-test survey and analyzed using two methods: percentage preference and thematic analysis., Results: Statistical differences existed across levels of training: F = 19.31 (df = 2); p < 0.001. The POE scored higher than SR (mean difference = 10.34; p < 0.001) and JR (mean difference = 16.00; p < 0.001). SR scored higher than JR (mean difference = 5.66; p < 0.001). Reliability (Cronbach's α) was 0.83. Participants found the E-SCT engaging, easy to follow and true to the daily clinical decision-making process., Conclusions: The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real-life clinical reasoning and decision-making processes. We suggest that further refinement and utilization of the evolving style case will enhance SCT as a robust, engaging, and relevant method for the assessment of clinical reasoning.

Competing Interests: Competing interests: None declared.