Anatomopathological changes in laying quails.

The objective of the current study was to carry out a survey of the main anatomopathological alterations in raising quails and evaluate possible interference of these in the bone tissue. To obtain the data, 23 quails were collected from farm in the central Serrana region of Espírito Santo. Necropsies with macroscopic descriptions, microbiological, coproparasitological, radiographic and histomorphometric tests were carried out. It was done data descriptive analysis and average comparision using Student T test. It was found that they presented lesions predominantly in the digestive system, followed by urinary and reproductive, and muscular system, were the altered color of the liver (47%) was the most frequent lesion. In the parasitological exams, it was found oocysts of Eimeira sp. (39.13%). In the microbiological exams, it was detected predominantly Escherichia coli (83%). Moderate osteopenia in quails, but the percentage of trabecular bone on bones was similar between healthy and diseased quails, without bone changes in histology. Microscopically, it was observed lung congestion as predominant lesion. It is concluded that there was predominance of alterations in the digestive system and mild parasitic infection; and although there was moderate level of osteopenia, there wasn't bone change as a result of the observed infections.

Lab on a bead with oscillatory centrifugal microfluidics for fast and complete mixing enables fast and accurate biomedical assays.

Rapid mixing and precise timing are key for accurate biomedical assay measurement, particularly when the result is determined as the rate of a reaction: for example rapid immunoassay in which the amount of captured target is kinetically determined; determination of the concentration of an enzyme or enzyme substrate; or as the final stage in any procedure that involves a capture reagent when an enzyme reaction is used as the indicator. Rapid mixing and precise timing are however difficult to achieve in point-of-care devices designed for small sample volumes and fast time to result. By using centrifugal microfluidics and transposing the reaction surface from a chamber to a single mm-scale bead we demonstrate an elegant and easily manufacturable solution. Reagents (which may be, for example, an enzyme, enzyme substrate, antibody or antigen) are immobilised on the surface of a single small bead (typically 1-2 mm in diameter) contained in a cylindrical reaction chamber subjected to periodically changing rotational accelerations which promote both mixing and uniform mass-transfer to the bead surface. The gradient of Euler force across the chamber resulting from rotational acceleration of the disc, dΩdisc/dt, drives circulation of fluid in the chamber. Oscillation of Euler force by oscillation of rotational acceleration with period, T, less than that of the hydrodynamic relaxation time of the fluid, folds the fluid streamlines. Movement of the bead in response to the fluid and the changing rotational acceleration provides a dynamically changing chamber shape, further folding and expanding the fluid. Bead rotation and translation driven by fluid flow and disc motion give uniformity of reaction over the surface. Critical parameters for mixing and reaction uniformity are the ratio of chamber radius to bead radius, rchamber/rbead, and the product Trchamber(dΩdisc/dt), of oscillation period and Euler force gradient across the fluid. We illustrate application of the concept using the reaction of horse radish peroxidase (HRP) immobilised on the bead surface with its substrate tetramethylbenzidine (TMB) in solution. Acceleration from rest to break a hydrophobic valve provided precise timing for TMB contact with the bead. Solution uniformity from reaction on the surface of the bead in volumes 20-50 uL was obtained in times of 2.5 s or less. Accurate measurement of the amount of surface-bound HRP by model fitting to the measured kinetics of colour development at 10 s intervals is demonstrated.

Island myriads in periodic potentials.

A phenomenon of emergence of stability islands in phase space is reported for two periodic potentials with tiling symmetries, one square and the other hexagonal, inspired by bidimensional Hamiltonian models of optical lattices. The structures found, here termed as island myriads, resemble web-tori with notable fractality and arise at energy levels reaching that of unstable equilibria. In general, the myriad is an arrangement of concentric island chains with properties relying on the translational and rotational symmetries of the potential functions. In the square system, orbits within the myriad come in isochronous pairs and can have different periodic closure, either returning to their initial position or jumping to identical sites in neighbor cells of the lattice, therefore impacting transport properties. As seen when compared to a more generic case, i.e., the rectangular lattice, the breaking of square symmetry disrupts the myriad even for small deviations from its equilateral configuration. For the hexagonal case, the myriad was found but in attenuated form, mostly due to extra instabilities in the potential surface that prevent the stabilization of orbits forming the chains.

Direct laser writing of hydrophobic and hydrophilic valves in the same material applied to centrifugal microfluidics.

In this study, we utilize nanosecond and femtosecond direct laser writing for the generation of hydrophobic and hydrophilic microfluidic valves on a centrifugal microfluidic disk made of polycarbonate, without the need for wet-chemistry. Application of a femtosecond (fs) laser at 800 nm resulted in an increased contact angle, from ∼80° to ∼160°, thereby inducing the formation of a hydrophobic surface. In contrast, employing a nanosecond (ns) laser at 248 nm led to the formation of superhydrophilic surfaces. Morphological studies identified the enhancement in the surface roughness for the hydrophobic surfaces and the creation of smooth patterns for the hydrophilic surfaces. Chemical modifications in the laser-ablated samples were confirmed via Fourier-transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) analysis. These spectroscopic examinations revealed an increase of hydrophilic chemical groups on both surfaces, with a more pronounced increase on the nanosecond laser-modified surface. Furthermore, these surfaces were used as a case study for centrifugal microfluidic valves. These modified surfaces demonstrated peculiar pressure responses. Specifically, the hydrophobic valves necessitated a 29% increase in pressure for droplet passage through a microchannel. On the other hand, the superhydrophilic valves exhibited enhanced wettability, decreasing the pressure requirement for fluid flow through the modified area by 39%. However, similarly to the hydrophobic valves, the fluid exiting the hydrophilic valve area required an increased pressure. Overall, our study shows the potential for tailoring valve functionality in microfluidic systems through precise surface modifications using laser technology.

Pressure tuning of minibands in MoS2/WSe2 heterostructures revealed by moiré phonons.

Moiré superlattices of two-dimensional heterostructures arose as a new platform to investigate emergent behaviour in quantum solids with unprecedented tunability. To glean insights into the physics of these systems, it is paramount to discover new probes of the moiré potential and moiré minibands, as well as their dependence on external tuning parameters. Hydrostatic pressure is a powerful control parameter, since it allows to continuously and reversibly enhance the moiré potential. Here we use high pressure to tune the minibands in a rotationally aligned MoS2/WSe2 moiré heterostructure, and show that their evolution can be probed via moiré phonons. The latter are Raman-inactive phonons from the individual layers that are activated by the moiré potential. Moiré phonons manifest themselves as satellite Raman peaks arising exclusively from the heterostructure region, increasing in intensity and frequency under applied pressure. Further theoretical analysis reveals that their scattering rate is directly connected to the moiré potential strength. By comparing the experimental and calculated pressure-induced enhancement, we obtain numerical estimates for the moiré potential amplitude and its pressure dependence. The present work establishes moiré phonons as a sensitive probe of the moiré potential as well as the electronic structures of moiré systems.

The use of alkaline phosphatase as a bone turnover marker after spinal cord injury: A scoping review of human and animal studies.

BACKGROUND: Serum alkaline phosphatase (ALP) is measured as an indicator of bone or liver disease. Bone-specific alkaline phosphatase (B-ALP) is an isoform of ALP found in the bone tissue which can predict fractures and heterotopic ossification. OBJECTIVE: The aim of this scoping review was to explore the current use of ALP and B-ALP in studies using humans or animal models of SCI, and to identify ways to advance future research using ALP and B-ALP as a bone marker after SCI. RESULTS: HUMAN STUDIES: 42 studies were included. The evidence regarding changes or differences in ALP levels in individuals with SCI compared to controls is conflicting. For example, a negative correlation between B-ALP and total femur BMD was observed in only one of three studies examining the association. B-ALP seemed to increase after administration of teriparatide, and to decrease after treatment with denosumab. The effects of exercise on ALP and B-ALP levels are heterogeneous and depend on the type of exercise performed. ANIMAL STUDIES: 11 studies were included. There is uncertainty regarding the response of ALP or B-ALP levels after SCI; levels increased after some interventions, including vibration protocols, curcumin supplementation, cycles in electromagnetic field or hyperbaric chamber. Calcitonin or bisphosphonate administration did not affect ALP levels. CONCLUSION: Researchers are encouraged to measure the bone-specific isoform of ALP rather than total ALP in future studies in humans of animal models of SCI.

Electronic Band Tuning and Multivalley Raman Scattering in Monolayer Transition Metal Dichalcogenides at High Pressures.

Transition metal dichalcogenides (TMDs) possess spin-valley locking and spin-split K/K' valleys, which have led to many fascinating physical phenomena. However, the electronic structure of TMDs also exhibits other conduction band minima with similar properties, the Q/Q' valleys. The intervalley K-Q scattering enables interesting physical phenomena, including multivalley superconductivity, but those effects are typically hindered in monolayer TMDs due to the large K-Q energy difference (ΔEKQ). To unlock elusive multivalley phenomena in monolayer TMDs, it is desirable to reduce ΔEKQ, while being able to sensitively probe the valley shifts and the multivalley scattering processes. Here, we use high pressure to tune the electronic properties of monolayer MoS2 and WSe2 and probe K-Q crossing and multivalley scattering via double-resonance Raman (DRR) scattering. In both systems, we observed a pressure-induced enhancement of the double-resonance LA and 2LA Raman bands, which can be attributed to a band gap opening and ΔEKQ decrease. First-principles calculations and photoluminescence measurements corroborate this scenario. In our analysis, we also addressed the multivalley nature of the DRR bands for WSe2. Our work establishes the DRR 2LA and LA bands as sensitive probes of strain-induced modifications to the electronic structure of TMDs. Conversely, their intensity could potentially be used to monitor the presence of compressive or tensile strain in TMDs. Furthermore, the ability to probe K-K' and K-Q scattering as a function of strain shall advance our understanding of different multivalley phenomena in TMDs such as superconductivity, valley coherence, and valley transport.

Executive functions in school-aged children exposed to airborne manganese: A multilevel analysis.

Neuropsychological alterations have been identified in populations heavily exposed to metals with neurotoxic potential, such as manganese (Mn). This study examined the associations between Mn environmental exposure in school-aged children and executive functions, using structural equation modeling. Children, aged between 7 and 12 years (N = 181), were recruited from four elementary schools located in a region that is under the influence of atmospheric emissions from a ferro-manganese alloy plant in the municipality of Simões Filho, Bahia, Brazil. The following cognitive functions were evaluated: Intelligence, Inhibitory Control, Cognitive Flexibility, Verbal and Design Fluency, Verbal and Visual Working Memory and Attention. We performed structural equation modeling to identify the following executive functions latent variables: working memory, inhibitory control and cognitive flexibility. We further analyzed the relations between executive functions and Mn measured in hair (MnH) and toenails (MnTn) with linear mixed models, after controlling for co-variables. A positive effect at the individual level on working memory, inhibition control and cognitive flexibility was observed with MnTn after controlling for co-variables, but no association was found with MnH levels. However, children attending school most environmentally exposed to Mn emissions, which had the highest rate of Mn dust deposition, had the poorest scores on working memory. These findings suggest both benefits and risk of Mn on children's cognitive development.

Delta-Aminolevulinic Acid Dehydratase, Low Blood Lead Levels, Social Factors, and Intellectual Function in an Afro-Brazilian Children Community.

Delta-aminolevulinic acid dehydratase (ALAD) enzyme catalyzes the second phase of the heme biosynthesis and is involved in lead toxicokinetics. This research aimed to evaluate its influence on the relationship between blood lead (PbB) levels and intellectual performance in Afro-Brazilian children. PbB, hemoglobin concentration, ALAD activity, and polymorphism were determined in whole blood. Anthropometric, socioeconomic, and family environment stimuli data were collected with appropriate instruments. The non-verbal intelligence of children and their mothers or guardians was assessed using the correspondent Raven's Progressive Matrix versions. The medians (range) of PbB levels and ALAD activity were 1.0 µg/dL (0.1-21.3) and, 71 U/L (31-113), respectively. ALAD G177C was distributed as follows: 97.9% for ALAD1/1 and 2.1% for ALAD1/2 genotypes. The mean of Raven raw score was 19.3 (± 5.6) points and there were no differences according to sex or environmental Pb exposure. No statistically significant association was observed between PbB level and children's IQ. However, ALAD activity presented an inverse significant association with PbB levels, children's percentile IQ, and children's IQ/Age ratio, suggesting a neuroprotective role of ALAD1 genotype in those with low PbB level.

Individual vaccine efficacy variation with time since mRNA BNT162b2 vaccination estimated by rapid, quantitative antibody measurements from a finger-prick sample.

We show that an individuals immune status to Covid-19 can be monitored through quantitative antibody measurements using a method based on centrifugal microfluidics, specifically designed for speed to result (20 min), high throughput (8 samples simultaneously) and accuracy from a finger-prick blood sample. Anti-Receptor Binding Domain (RBD) IgG concentration showed a log-normal distribution with mean decreasing with time following the second vaccination with mRNA BNT162b2 (Pfizer). Using a model for an individuals antibody concentration-dependent vaccine efficacy allowed comparison with literature data on changing vaccine efficacy against symptomatic disease across a population. Even though the trial was small (n = 100) the computed population vaccine efficacy was in reasonable agreement with that obtained from a large population survey. The derived parameters for the vaccine efficacy model were in good agreement with those expected from previous studies and from a simple theoretical model. The results and modelling show that the major proportion of breakthrough infections are for people whose antibody concentration is in the tail of the distribution. The results provide strong support for personalized booster programmes that, by targeting people in the tail of the distribution, should be more effective at diminishing breakthrough infection and optimising booster dose supply than a program that simply mandates a booster at a specific post-vaccination time point.

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

OBJECTIVE: To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). METHOD: Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. RESULTS: The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. CONCLUSION: The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.

SalivaDirect: A simplified and flexible platform to enhance SARS-CoV-2 testing capacity.

BACKGROUND: Scaling SARS-CoV-2 testing to meet demands of safe reopenings continues to be plagued by assay costs and supply chain shortages. In response, we developed SalivaDirect, which received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). METHODS: We simplified our saliva-based diagnostic test by (1) not requiring collection tubes with preservatives, (2) replacing nucleic acid extraction with a simple enzymatic and heating step, and (3) testing specimens with a dualplex qRT-PCR assay. Moreover, we validated SalivaDirect with reagents and instruments from multiple vendors to minimize supply chain issues. FINDINGS: From our hospital cohort, we show a high positive agreement (94%) between saliva tested with SalivaDirect and nasopharyngeal swabs tested with a commercial qRT-PCR kit. In partnership with the National Basketball Association (NBA) and National Basketball Players Association (NBPA), we tested 3,779 saliva specimens from healthy individuals and detected low rates of invalid (0.3%) and false-positive (<0.05%) results. CONCLUSIONS: We demonstrate that saliva is a valid alternative to swabs for SARS-CoV-2 screening and that SalivaDirect can make large-scale testing more accessible and affordable. Uniquely, we can designate other laboratories to use our sensitive, flexible, and simplified platform under our EUA (https://publichealth.yale.edu/salivadirect/). FUNDING: This study was funded by the NBA and NBPA (N.D.G.), the Huffman Family Donor Advised Fund (N.D.G.), a Fast Grant from Emergent Ventures at the Mercatus Center at George Mason University (N.D.G.), the Yale Institute for Global Health (N.D.G.), and the Beatrice Kleinberg Neuwirth Fund (A.I.K.). C.B.F.V. is supported by NWO Rubicon 019.181EN.004.

Interplay between structural deformations and flat band phenomenology in twisted bilayer antimonene.

In this work we apply first principles calculations to investigate the flat band phenomenology in twisted antimonene bilayer. We show that the relatively strong interlayer interactions which characterize this compound have profound effects in the emergence and properties of the flat bands. Specifically, when the moiré length becomes large enough to create well defined stacking patterns along the structure, out-of-plane displacements take place and are stabilized in the regions dominated by the AB stacking, leading to the emergence of flat bands. The interplay between structural and electronic properties allows for detection of flat bands in higher twist angles comparable to other two-dimensional materials. We also show that their energy position may be modulated by noncovalent functionalization with electron acceptor molecules.

Nanomechanics of few-layer materials: do individual layers slide upon folding?

Folds naturally appear on nanometrically thin materials, also called "2D materials", after exfoliation, eventually creating folded edges across the resulting flakes. We investigate the adhesion and flexural properties of single-layered and multilayered 2D materials upon folding in the present work. This is accomplished by measuring and modeling mechanical properties of folded edges, which allows for the experimental determination of the bending stiffness (κ) of multilayered 2D materials as a function of the number of layers (n). In the case of talc, we obtain κ ∝ n 3 for n ≥ 5, indicating no interlayer sliding upon folding, at least in this thickness range. In contrast, tip-enhanced Raman spectroscopy measurements on edges in folded graphene flakes, 14 layers thick, show no significant strain. This indicates that layers in graphene flakes, up to 5 nm thick, can still slip to relieve stress, showing the richness of the effect in 2D systems. The obtained interlayer adhesion energy for graphene (0.25 N/m) and talc (0.62 N/m) is in good agreement with recent experimental results and theoretical predictions. The obtained value for the adhesion energy of graphene on a silicon substrate is also in agreement with previous results.

Neuromuscular determinants of explosive torque: Differences among strength-trained and untrained young and older men.

This study compared the differences in neural and muscular mechanisms related to explosive torque in chronically strength-trained young and older men (>5 years). Fifty-four participants were allocated into four groups according to age and strength training level: older untrained (n = 14; 65.6 ± 2.9 years), older trained (n = 12; 63.6 ± 3.8 years), young untrained (n = 14; 26.2 ± 3.7 years), and young trained (n = 14; 26.7 ± 3.4 years). Knee extension isometric voluntary explosive torque (absolute and normalized as a percentage of maximal voluntary torque) was assessed at the beginning of the contraction (ie, 50, 100, and 150 ms-T50, T100, and T150, respectively), and surface electromyogram (sEMG) amplitude (normalized as a percentage of sEMG recorded during maximal voluntary isometric contraction) at 0-50, 50-100, and 100-150 time windows. Supramaximal electrically evoked T50 was assessed with octet trains delivered to the femoral nerve (8 pulses at 300 Hz). Voluntary T50, T100, and T150 were higher for trained than untrained in absolute (P < 0.001) and normalized (P < 0.030) terms, accompanied by higher sEMG at 0-50, 50-100, and 100-150 ms (P < 0.001), and voluntary T50/octet T50 ratio for trained. Greater octet T50 was observed for the young trained (P < 0.001) but not for the older trained (P = 0.273) compared to their untrained counterparts. Age effect was observed for voluntary T50, T100, and T150 (P < 0.050), but normalization removed these differences (P > 0.417). Chronically strength-trained young and older men presented a greater explosive torque than their untrained pairs. In young trained, the greater explosive performance was attributed to enhanced muscular and neural mechanisms, while in older trained to neural mechanisms only.

Environmental exposure to lead and hematological parameters in Afro-Brazilian children living near artisanal glazed pottery workshops.

This study aimed to evaluate the exposure to environmental lead (Pb) of children from a traditional community of African descent in Brazil and the effects on hematological parameters. Children (n = 75) aged 5.5-13 years from the exposed areas classified as low (LEx) and moderately (MEx) exposed were compared with children (n = 75) of a control group (CG). Dust Pb loading rates (RtPbs) at children's homes were measured. Peripheral venous blood samples were collected to assess Pb biomarkers of exposure and effects. All Pb determinations were performed by graphite furnace atomic absorption spectrometry. The median (IQR) of RtPb, PbB level, and ALA-D activity were 65 (25-137) µgPb/m2/30 days, 1.0 (0.1-2.8) µg/dL, and 71 (55-86) U/L, respectively. Spearman correlation evidenced the relationship of PbB with RtPb (rho = 0.368, P < 0.001) and ALA-D activity (rho = -0.587; P ˂ 0.001). After adjusting for exposure degree and child's age, a decline of 7.4 U/L in ALA-D activity was associated with a 10-fold increase in PbB. The prevalence ratio of elevated PbB (>5 µg/dL) in LEx and MEx areas were 1.5 and 3.7, respectively. Indoor dust exposure, living near pottery workshops and the secondary exposure were the main determinants of elevated PbB levels, which were associated with hematological effects.

Oxidation-driven formation of precisely ordered antimonene nanoribbons.

The control of geometric structure is a key aspect in the interplay between theoretical predictions and experimental realization in the science and applications of nanomaterials. This is particularly important in one-dimensional structures such as nanoribbons, in which the edge morphology dictates most of the electronic behavior in low energy scale. In the present work we demonstrate by means of first principles calculations that the oxidation of few-layer antimonene may lead to an atomic restructuring with formation of ordered multilayer zig-zag nanoribbons. The widths are uniquely determined by the number of layers of the initial structure, allowing the synthesis of ultranarrow ribbons and chains. We also show that the process may be extended to other compounds based on group V elements, such as arsenene. The characterization of the electronic structure of the resulting ribbons shows an important effect of stacking on band gaps and on modulation of electronic behavior.

Development of Walking indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

Objective: To describe the development of structure, process and outcome indicators that will advance the quality of walking rehabilitation for Canadians with spinal cord injury or disease (SCI/D) by 2020. Method: A framework for the evaluation of the quality of walking rehabilitation was developed by experts in walking after SCI/D. A systematic literature review identified factors influencing walking outcomes and potential walking indicators. A Driver diagram analysis summarized the factors affecting walking outcomes and subsequently informed the selection of structure and process indicators. Psychometric properties and clinical utility of potential walking indicators were considered during the selection of outcome indicators. Results: The structure indicator is the number of physical therapists using evidence-based walking interventions per number of ambulatory individuals with SCI/D. The process indicator is the number of received hours of walking interventions during inpatient rehabilitation per number of ambulatory individuals with SCI/D. The intermediary outcome indicator, which is collected at discharge from inpatient rehabilitation, is either the modified Timed Up and Go or the 10-Meter Walk Test, the choice of measure is dictated by the stage of walking recovery, as defined by the Standing and Walking Assessment Tool. The final outcome indicator, collected at 18 months post-discharge, is the Spinal Cord Independence Measure III-Mobility subscale. Conclusion: The selected indicators align with current clinical practice in Canada. The indicators will direct the timing and enhance the volume of walking therapy delivered, to ultimately increase the proportion of patients who achieve their walking potential by 18 months post-rehabilitation.

Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project.

Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes. This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada. Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators. Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020. Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.

Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

Context: Spinal cord injury or disease (SCI/D) leads to unchanged low-density lipoprotein and cholesterol, very low high-density lipoprotein a form of dyslipidemia and physical inactivity which combine to increase risk of morbidity and mortality from cardiometabolic disease. Herein, we describe the selection of structure, process and outcome indicators for adults in the first 18 months post-SCI/D rehabilitation admission. Methods: A Pan-Canadian Cardiometabolic Health Working Group was formed to develop a construct definition. Cardiometabolic risk factors were summarized in a Driver diagram. Release of the Paralyzed Veterans of America "Identification and Management of Cardiometabolic Risk after Spinal Cord Injury" and the International Scientific Exercise Guidelines: "Evidence-based scientific exercise guidelines for adults with spinal cord injury", informed the group's focus on prevention strategies to advance this Domain of rehabilitation admission. Results: The structure indicator identifies during rehabilitation the presence of appropriate time and resources for physical exercise prescription. Process indicators are lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge. The outcome indicators track patient's knowledge retention regarding exercise prescription at discharge, current exercise adherence and lipid status 18 months after rehabilitation discharge. Conclusion: Routine national implementation of these indicators at the specified time points will enhance efforts to detect dyslipidemia and assure routine participation in endurance exercise. These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors specifically endurance exercising and optimal lipid profiles, crucial to augmenting cardiometabolic health after SCI/D.