Improvement Efforts Research Articles

Genetic diversity of Rhododendron dauricum based on morphological traits and SSR markers

Rhododendron dauricum L. is one of the most important ornamental plants in Northeast China for its beautiful flowers. Wild R. dauricum populations are mainly distributed in Greater and Lesser Khingan Mountains in Heilongjiang, China. The diversity of R. dauricum germplasm resources in these areas has not been determined and it can be dynamic due to increasing climate change and human activities, which poses a challenge to effective conservation efforts. To promote genetic diversity conservation and develop new R. dauricum varieties, we performed a systematic morphological and molecular evaluation of R. dauricum populations in the in 13 populations. The results showed significant inter- and intra-population variations. Clustering revealed 3 major groups. Importantly, plants showing extreme variations in flower color and flower number were used to further develop two new cultivars 'Ao Xue' and 'Yanricai', respectively. In addition, nine SSR markers exhibited polymorphism among the 13 populations, and 25 alleles were found. The Shannon information index (I) was 0.6359, and the polymorphism information index (PIC) was 0.3460. The genetic diversity index (Nei's) was 0.3575, and the observable heterozygosity (Ho, 0.2514) was lower than the expected heterozygosity (He, 0.3722). The average genetic differentiation coefficient (Fst) among populations was 0.6556. Several populations with relatively high genetic diversity including Huzhong, Tahe, and Hongxing were identified. We also found that SSR-based clustering generally follows the geographical distances among the populations. Lastly, we identified two SSR markers that were highly correlated with flower color and leaf aspect ratio. Together, our data provided useful information on the germplasm distribution and variation evolution of R. dauricum, which will be valuable for cultivar improvement, protection, and future diversity conservation efforts.

Lack of robustness of hydrological models: a large-sample diagnosis and an attempt to identify hydrological and climatic drivers

Abstract. The transferability of hydrological models over contrasting climate conditions, also identified as model robustness, has been the subject of much research in recent decades. The occasional lack of robustness identified in such models is not only an operational challenge – since it affects the confidence that can be placed in projections of climate change impact – it also hints at possible deficiencies in the structures of these models. This paper presents a large-scale application of the robustness assessment test (RAT) for three hydrological models with different levels of complexity: GR6J, HYPE and MIKE SHE. The dataset comprises 352 catchments located in Denmark, France and Sweden. Our aim is to evaluate how robustness varies over the dataset and between models and whether the lack of robustness can be linked to some hydrological and/or climate characteristics of the catchments (thus providing a clue as to where to focus model improvement efforts). We show that, although the tested models are very different, they encounter similar robustness issues over the dataset. However, models do not necessarily lack robustness in the same catchments and are not sensitive to the same hydrological characteristics. This work highlights the applicability of the RAT regardless of model type and its ability to provide a detailed diagnostic evaluation of model robustness issues.

Strategic Practices and Operational Efficiency at Kenya Revenue Authority: A Case of Sameer Park Tax Service Office

The Kenya Revenue Authority (KRA) is faced with challenges in optimizing efficiency in tax administration, such as technology, globalization, and tax evasion. Changing economic times and evolving public expectations add to these issues. Despite improvement efforts, KRA struggles to meet revenue goals and stakeholder satisfaction, with existing research lacking insights into effective strategic practices for operational efficiency. This study focused on KRA's strategic practices to enhance operational efficiency. It aimed to evaluate the influence of technology integration, training and skill development, client-centric services, and inter-agency collaboration on operational efficiency within KRA. The study was influenced by four theories namely; Information System Success Model, Dynamic Capability Model, Stakeholder Theory and Resources Dependency theory. The target population comprised KRA management and operational staff in the Sameer Park tax service office, with a sample of 105 employees in both management and operations selected using stratified proportional sampling. Data were collected through questionnaires and analyzed with the help of SPSS version 30.0. The study presented findings in tables and interpreted them in line with its objectives, utilizing a multiple regression model to assess the relationship between key factors and operational efficiency at KRA. The findings of this study showed that integrating technology is crucial to increasing productivity and simplifying procedures. The improvement of personnel capacity and overall operational performance was also found to be significantly influenced by training and skill development programs. By better meeting the demands of their clients, client-centric services have been shown to maximize service delivery. The study also underlined the value of interagency collaboration, which enhances productivity in tax administration by facilitating greater coordination. Therefore, KRA focus on integrating technology by creating thorough regulations, modernizing IT infrastructure, and holding frequent training sessions to raise employee knowledge and awareness on technological changes. Training programs should be put in place to fill up certain skill gaps, along with opportunities for professional growth and mentoring. In order to develop client-centric services, there is need for KRA to provide tailored tax guidance, upgrade web portals, and set up feedback systems to better meet the expectations of the clients. Finally, in order to improve tax administration and streamline procedures, KRA should adopt enhanced inter-agency cooperation through the creation of digital platforms for coordination, the adoption of universal data standards, and the creation of collaborative task groups.

The Markers of Body Size and Shape of Bali Cattle and its Crosses with Exotic Bulls

One of the genetic improvement efforts to improve the performance of Bali cattle offspring production is crossbreeding Bali cattle with exotic bulls. This study aimed to identify markers of body size and shape of Bali cattle and its crosses with exotic bulls using principal component analysis. The materials used in this study were 91 heads of Bali, Simbal, Brahmbal, Limbal, and Pobal cattle, consisting of 34 males and 57 females. The variables observed were body measurements (morphometrics) consisting of shoulder height, body length, chest circumference, chest depth, chest width, hip height, and hip width. Data analysis used Principal Component Analysis in the Minitab Release 19 statistical application. The results showed that Bali, Simbal, Brahmbal, Limbal, and Pobal male cattle had the same body size markers, namely chest circumference. The body shape markers of male cattle are hip height for Bali cattle, chest length for Simbal and Pobal cattle, chest depth for Brahmbal cattle, and hip width for Limbal cattle. The body shape markers in female cattle are body length for Bali, Simbal, Brahmbal, and Pobal cattle, and hip height for Limbal cattle. These body size and shape markers have a strong correlation with the first principal component and the second principal component, so they can be used as selection criteria to improve the production performance of Bali and Bali crossbred cattle.

Measuring Well-Being Influencers: Development and Validation of the WISH Inventory.

Improving healthcare professional well-being and reducing burnout requires improving work ecosystems and cultures. Current well-being metrics focus on distal outcomes within individuals (e.g., professional fulfillment or burnout). In this study, we developed and evaluated the performance of an inventory measuring perceptions of modifiable workplace dimensions-termed influencers-that shape healthcare professionals' well-being. A core team developed the Well-Being Influencers Survey for Healthcare (WISH), an inventory designed to measure these systemic, occupational well-being influencers (e.g., leadership support, psychological safety, working conditions). Following content validation and refinement, 223 healthcare professionals from an academic department of anesthesiology completed WISH alongside established well-being measures, including the Maslach Burnout Inventory (MBI), Professional Fulfillment Index (PFI), Perceived Stress Scale (PSS), PROMIS short forms for meaning, purpose, and life satisfaction, as well as standard items of affective commitment (AC, a measure of engagement) and a standard item assessing intention to leave (ITL). Factor analysis was used to assess WISH's internal structure, while correlation and regression analyses assessed its criterion-related validity using the above established measures. WISH showed expected relationships with established well-being measures, and outperformed established metrics in predicting AC and ITL after adjusting for those measures and/or covariates. Factor analysis indicated that most WISH variance reflects a single common factor, supporting the use of an instrument-level score. Unique variance at the influencer level highlights the added value of examining influencer scores. WISH fills a key gap in healthcare professional well-being improvement science by assessing causal factors of well-being and burnout, rather than the conditions themselves. Here, we established initial validity of this unique inventory and further reinforce the relevance of system-level and cultural factors in influencing healthcare professionals' well-being. WISH is well suited to assist healthcare professional well-being improvement efforts driven by system-improvement mindsets.

Teacher Turnover, Social Capital, and Improvement: How Instability Disrupts Schools

Teacher turnover is a persistent policy concern in public education. Researchers have documented negative impacts of turnover on student outcomes; yet we know little about the causal mechanisms by which turnover influences, or disrupts, schools’ efforts to improve. In our longitudinal qualitative study, we examined how turnover affects relationships, trust, and shared knowledge in organizations—that is, organizational social capital—in ways that can impede school improvement efforts. We found that teacher turnover depletes organizational social capital by disrupting networks and relationships between teachers working in teams, weakening shared meanings and goals in schools, and impeding teachers’ ability to collectively engage in problem-solving and learning. We illuminate the hidden ways in which instability undermines improvement efforts and strains organizations.

Developing and piloting a peer quality improvement coaching protocol for front-line healthcare staff

BackgroundImproving the quality of patient care remains a global necessity. Despite system and professional benefits, current evidence indicates that the spread of improvement principles among front-line healthcare workers remains poor.While...

Technology performance of Indonesia tsunami early warning system: technometric approach

Indonesia tsunami early warning system (Ina TEWS) is used for detecting earthquakes and tsunamis. The system currently is still under development and the government really needs information regarding the technological capabilities of the system in order to provide protection to the community from the threat of tsunamis and earthquakes. To produce the system and its components on an industrial scale, it is important to assess the extent of performance and readiness for technological development. The assessment used the technometric method which groups technological components into technoware, humanware, infoware, and orgaware, integrated with analytic hierarchy process. The results showed that the highest technology component contribution is technoware, and the lowest is infoware. Based on the magnitude of the contribution of technology components and intensity of technology, the priority order is technoware, humanware, orgaware, and infoware. The technology contribution coefficient is 0.522 (Good). The technology level is semi modern. Infoware is the lowest technological component, therefore improvement efforts are needed, namely structuring an integrated document system and improving standard operating procedures for manufacturing operational activities, especially in the testing and data validation.

Abstract WP98: Temporal Trends and Predictors of Door-in-Door-out Times for Interhospital Stroke Transfers in the Greater Cincinnati Northern Kentucky Stroke Study

Introduction: Acute treatment for stroke often requires emergent interhospital transfer for access to advanced therapies not available at the initial hospital. Prolonged transfer times have been associated with worse outcomes. Door-in-door-out time (DIDO: the amount of time a patient spends in the transferring emergency department [ED]) is an important quality metric in acute stroke care, with current recommendations for DIDO times ≤ 120 minutes. We sought to characterize trends and predictors of DIDO times for interhospital stroke transfers using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: We utilized data from the GCNKSS, a population-based epidemiologic stroke study, from the following time points: 1999, 2005, 2010, 2015, and 2020. Patients ≥18 years with acute ischemic stroke (AIS) or hemorrhagic stroke (HS) who presented to an initial ED and were not admitted but were transferred to another hospital were included. The primary outcome was DIDO time. Temporal trends in DIDO time were tested using the Mann-Kendall trend test. Generalized linear mixed effects models with hospital-specific random intercepts were constructed to evaluate the associations between patient- and hospital-level covariates and DIDO time. Results: Of 13,678 stroke cases over the time periods studied, 1574 patients met inclusion criteria for the overall stroke group (mean age 64.7 [SD: 15.6], 51.6% female), with 851 (54.1%) having AIS and 723 (45.9%) HS. Over the time periods examined, the median DIDO time for the overall stroke group was 213 minutes (IQR 142-305), and DIDO times significantly increased over time (Figure 1; P<.0001). In the overall stroke group, hospital-level factors explained 4.0% of the variation in DIDO time. In the multiple regression model, factors associated with increased DIDO time included: history of prior stroke (+33.6 minutes; P<.0001) and receipt of MRI prior to transfer (+165.7 minutes; P<.0001); whereas EMS transport (-30.0 minutes; P<.001) and increasing NIHSS score (P<.0001) were associated with decreased DIDO time. Results were similar for AIS and HS subgroups (Table 2). Conclusions: In this population-based epidemiologic study, DIDO times exceeded recommended time targets and increased over time. Hospital-level factors accounted for only a minor proportion of the overall variation in DIDO times, suggesting that future quality improvement efforts should target modifiable clinical and systems factors to improve DIDO times.

Improving UK data on avoidable perinatal brain injury: review of data dictionaries and consultation.

High quality data is important to understanding epidemiology and supporting improvement efforts in perinatal brain injury. It is not clear which data items relevant to brain injury are captured across UK sources of routinely collected data, nor what needs to be done to ensure that those sources are fit for purpose in improving care. We reviewed data dictionaries of four main UK perinatal data sources and consulted a multi-professional group (N = 27) with expertise in neonatal/maternity care, statistics, and clinical negligence. None of the data sources we reviewed currently captures, on its own, the range of items relevant to brain injury. Data items lack common definitions and ongoing linkage across the different sources. Our consultation identified the need for standardising the definition of avoidable perinatal brain injury, resolving inconsistencies in capturing data, improving linkage of data across existing data sources, and co-designing a strategy for meaningful use of data. Limited standardisation and linkage across UK data sources are key problems in using data to guide improvement efforts aimed at reducing risk of avoidable perinatal brain injury. A programme involving co-design with healthcare professionals and families to improve capture and use of data is now needed. Limited standardisation and linkage across UK data sources currently challenge the use of data as the basis of efforts to reduce risk of avoidable perinatal brain injury. A harmonisation programme involving consultation and co-design with healthcare professionals, families, and other specialists is needed to enable better capture and use of data in this key area. There is need to standardise the definition of avoidable perinatal brain injury, resolve inconsistencies in capturing data, improve linkage of data collected across existing data sources, and co-design a strategy for meaningful use of data.

Evaluation of Proposed New Measures for the Hospital CAHPS Survey

Background: Since its 2006 launch, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become the most used hospital patient experience survey, included in public reporting and accountability systems. Responding to emerging evidence of possible gaps in survey content, the Centers for Medicare & Medicaid Services undertook extensive efforts to develop and test new HCAHPS measures. Objectives: Describe the development and testing of new HCAHPS measures. Research Design: Activities supporting the development and refinement of survey items and measures included 4 patient focus groups, 27 cognitive interviews, and a 12-member technical expert panel. Psychometric testing of proposed survey items and measures used data from a 2021 large-scale randomized experiment. Results: Patient focus groups, cognitive testing, psychometric analyses, and a technical expert panel supported the addition of 2 new multi-item measures (Care Coordination and Restfulness of Hospital Environment), a new single-item measure (Information about Symptoms), and the placement of one current HCAHPS item (Quietness) within one of the new composite measures. All proposed measures had strong psychometric properties, including good construct validity and hospital-level reliabilities that ranged from 0.73 for the Information about Symptoms standalone measure to 0.87 for Restfulness of Hospital Environment. Cronbach alpha for the 3 new or modified composite measures ranged from 0.74 to 0.76. Conclusions: The new content would broaden HCAHPS by adding new aspects of care that are important to patients. The public reporting of the new measures and their role in payment may support hospital quality improvement efforts.

P-1412. HIV Retention in Care and Viral Suppression among Transgender Women in a Large Ryan White Clinic

Abstract Background Transgender women (TW) are disproportionately affected by HIV with 1 in 5 TW in the United States living with HIV. TW with HIV (TWH) have lower rates of retention and viral suppression than cisgender women and cisgender men, resulting in worse health outcomes and increased HIV transmission. The aim of this quality improvement initiative was to identify TWH at a large urban Ryan White clinic in New Orleans to guide future quality improvement efforts to improve retention and viral suppression of TWH.Table 1.Characteristics of Transgender Clinic Patients Reviewed Methods A list of established clinic patients with a gender identity of transgender was generated to create a database with basic demographic information, viral suppression, retention in care, and potential barriers to viral suppression or retention from April 1, 2023-March 31, 2024. Insurance status, mental health or substance use disorder, and prescription of gender affirming hormone therapy (GAHT) were documented for each patient. Patients were further subdivided into three categories “In Care and Virally Suppressed,” “Out of Care,” and “Not Virally Suppressed” for further analysis. Results Out of 1393 established clinic patients, 28 patients were identified as transgender (2%). 27/28 of these patients are black/African American, 1 is Hispanic/Latino. 64% were retained in care, compared to 81% of all clinic patients. 75% were virally suppressed, compared to 84% of all clinic patients. Detailed characteristics are displayed in Table 1. Patients who were out of care or not virally suppressed were younger and had higher rates of mental health diagnoses. 70% of patients who were out of care carried a mental health diagnosis. There was no correlation between GAHT, substance use, or insurance status and retention in care or viral suppression. Conclusion As suggested by previous studies, a significantly lower percentage of TWH were retained in care and virally suppressed when compared to the total clinic population, thus highlighting the need to focus on this disproportionately affected group. This TWH database will be used to track retention in care and viral suppression, and data regarding potential barriers will be used to guide quality improvement efforts among TWH, with a plan to focus on mental health services. Disclosures All Authors: No reported disclosures

P-239. Leveraging Preliminary Blood Culture Reports at an Academic Medical Center: A Real-time Central Line-Associated Bloodstream Infection (CLABSI) Reduction Strategy

Abstract Background CLABSIs have been shown to result in adverse outcomes including increased morbidity and mortality, length of hospital stays, and healthcare costs. The National Healthcare Safety Network (NHSN) surveillance criteria are meant to be applied in a standardized manner, but this can result in discordance between clinical diagnoses and the surveillance definitions of secondary bloodstream infections (2° BSI). We hypothesized that routine review of preliminary positive blood cultures (B/Cs) in patients with central lines would result in the identification of possible CLABSI events in real-time and promote dissemination of feedback, thus reducing CLABSI cases and increasing 2° BSI attribution.Figure 1:CLABSI Case DeterminationClassification of cases identified by review of a preliminary blood culture report for patients with a central line eligible for CLABSI surveillance Methods An automated electronic medical record (EMR) report was developed to capture preliminary B/C results for patients with a central line eligible for CLABSI surveillance. Daily EMR review was performed to identify opportunities contributing to the event or evidence of a clinical 2° BSI without corresponding elements needed to meet NHSN definitions. Possible B/C contamination, gaps in care and, if clinically appropriate, necessary elements required to meet NHSN 2° BSI definitions were communicated to the care team. Secondary BSI Attribution Categorization of cases with a final determination of secondary BSI attribution Results Confirmed CLABSI cases with no intervention indicated were 35.5% of cases reviewed; 38.1% were determined to meet CLABSI exclusion criteria. Evidence of 2° BSI was identified in 26.5% of cases, which prompted queries to the care team to consider additional imaging, cultures, or documentation needed to clarify the clinical assessment. Feedback related to possible B/C contamination was given in 17.5% of cases. (Fig. 1-3) CLABSI Standardized Infection Ratio (SIR) Standardized infection ratio (SIR) trend: Tactic was adopted in May 2023 Conclusion CLABSI reduction requires a comprehensive approach that addresses various aspects of care including appropriate line selection, safe insertion practices, care bundles, and prompt line removal. The EMR can be used to hard-wire best practices, facilitate real-time communication, and identify CLABSI cases in a timely manner. We have shown that prompt review of positive B/Cs of patients with eligible central lines facilitates opportunities to align the clinical impression with the surveillance definitions for 2° BSI while bolstering quality improvement efforts and staff education. Disclosures All Authors: No reported disclosures

Implementation of a Malignant Hematology Education Intervention and its Impact on Hematology Nurse Practitioner Knowledge and Self-Efficacy to Practice

Background: Nurse practitioners (NPs) entering the malignant hematology specialty often lack hematology-specific knowledge needed for practice; many have reported they want and need more hematology education. Deficiencies in hematology education stem from the minimal amount of hematology content included in NP programs and during job orientation. Knowledge deficits among NPs are associated with unpreparedness to practice and feelings of anxiety, insecurity, inadequacy, and guilt. Self-efficacy (SE) is a correlate to NP knowledge acquisition and competency development. Purpose: This was a process improvement effort to examine the impact of a malignant hematology education module on NP knowledge and SE to practice in malignant hematology. Methods: A convenience sample of 11 NP participants were recruited during onboarding to a hematology department in a tertiary care cancer hospital in Southern California. Participants completed an online learning module containing education about hematological malignancies. A pretest and posttest design using questionnaires was employed for data collection. Knowledge and SE scores obtained before and after the intervention were compared to assess for improvement. Results: Posttest NP knowledge scores increased by a mean of 2.4 points (20%; mean pretest: 7.1/12, posttest: 9.5/12), p < .05. Posttest scores for NP SE were similar to baseline (mean pretest: 32.6/40 points, posttest: 32.3/40), p > .05. Participants reported that the intervention was helpful in the onboarding process. Implications/Conclusion: The findings help establish the feasibility of a malignant hematology learning module in increasing knowledge for NPs during onboarding. Integrating an education module into NP job training may increase knowledge and preparedness to practice in malignant hematology.

158. Hepatitis B Screening Among Persons With HIV Receiving Care from the U.S. Department of Veterans Affairs

Abstract Background In the United States, around 8% of persons with HIV (PWH) are coinfected with Hepatitis B (HBV), influencing antiretroviral choice and conferring higher mortality. Despite recommendations for universal HBV screening in PWH, small US and international studies found 52-68% were ever screened. National US data on HBV screening in PWH that could inform quality improvement efforts is lacking. Hepatitis B Screening in Persons with HIV Receiving Care in the US Veterans Health Administration Methods We used the Veterans Health Administration (VHA) Corporate Data Warehouse to conduct a service evaluation of longitudinal operational data collected during routine care in the integrated electronic health record. We assessed the proportion of PWH receiving HIV care through VHA (at least one encounter in the current or previous year) who have complete HBV serologic screening, defined as at least one result for each of hepatitis B surface antigen (sAg), core antibody (cAb) and surface antibody (sAb). We conducted two multivariate logistic regressions on complete HBV serologic screening using (1) demographic and comorbidity variables, and (2) geographic and facility variables. Hepatitis B Screening Amongst Persons with HIV by Geographic and Facility Factors Results Of 30,412 PWH receiving VHA care, 24,913 (81.9%) had complete HBV serologic screening. Adjusted odds ratios (AOR) for complete HBV screening were significantly higher in PWH who were black or Hispanic, born from 1961 onwards, were homeless, or had comorbidities such as hepatitis C, mental health and substance use disorders, as shown in Table 1, but did not differ significantly by sex. AOR for complete HBV screening were significantly lower for PWH seen at rural and lower complexity (smaller) facilities as shown in Table 2. Among non-immune PWH without hepatitis B (sAg negative, no prior reactive sAg), 55% subsequently received at least 1 dose of hepatitis B vaccine after a median 370-day interval (IQR 75-1512) as shown in Figure 1. Time to Administration of At Least One Dose Of Hepatitis B Vaccine in Persons with HIV with Negative Hepatitis B Surface Antigen Lacking Prior Positive Surface Antibody Results. Conclusion Our data provide insight into current HBV screening practices for PWH in a nationwide US health system. Overall HBV screening rates were high, but 18.1% of PWH had incomplete HBV screening with cAb most frequently missing. Lower odds of HBV screening in smaller facilities and rural populations underscore the need for tailored strategies to ensure equitable access. Our data will inform quality improvement efforts to enhance screening practices for HBV among Veterans living with HIV. Disclosures All Authors: No reported disclosures

Sex Differences in Textbook Outcomes among Adults Undergoing Elective Abdominal Aortic Aneurysm Repair

Background: Female patients with abdominal aortic aneurysms (AAA) undergoing repair have worse outcomes than males. Textbook outcomes (TO) have been described as a metric to direct quality improvement efforts and assess institutional performance. We investigated sex differences among patients achieving a TO after open (OAR) and endovascular aortic aneurysm repair (EVAR). Study design: Vascular Quality Initiative registry data from 80,948 patients undergoing elective AAA repair was reviewed. TO was defined as absence of major medical/surgical complication, prolonged postoperative length of stay (based on 75th percentile of the cohort), reintervention, or mortality and non-home discharge. EVAR and OAR cohorts were analyzed separately, stratified by TO and sex, and compared based on patient demographics, outcomes, and one-year survival. Results: More males had a TO compared to females (EVAR: 80% vs 67%; OAR: 54% vs 47%, p<0.001, respectively). Obstacles for achieving TO for females were prolonged POLOS, surgical complications, and non-home discharge. TO was associated with improved one-year survival in EVAR and OAR. High volume center status (based on case volume quartiles) was not associated with TO for EVAR but was associated with TO for males undergoing OAR. Conclusions: Females are less likely to achieve a TO regardless of surgical approach and have a lower one-year survival than males when they do not. Importantly, when females do achieve a TO, there are no sex differences in one-year survival. TO is as a patient- centered quality standard and provides objective support for patient-provider decision- making and expectations and may serve as a quality metric that should be implemented to mitigate sex disparities. Further investigation utilizing multi-level modeling to examine patient, provider, and facility variables that impact TO is warranted.

Establishing robust infection control at a new hospital: the AIIMS Rajkot experience

The establishment of robust infection control practices is crucial in any new healthcare facility to ensure patient safety and prevent healthcare-associated infections (HAIs). All India Institute of Medical Sciences (AIIMS) Rajkot, a newly inaugurated medical institution in Western India, faced the significant challenge of implementing these practices from the ground up, beginning with its Outpatient Department services initiation on 31 December 2021. The AIIMS Rajkot initiated its infection control program by forming a Hospital Infection Control Committee and appointing dedicated Infection Control Officers and Infection Control Nurses. This initiative was supported by comprehensive training programs, the implementation of advanced infection control measures such as bundle care, HAI surveillance, and the development of outbreak investigation teams. Furthermore, the hospital focused on the continuous improvement of these practices through routine audits and the use of a digital Infection Control Risk Assessment form. The institution successfully integrated a structured infection control framework that includes rigorous training sessions, the implementation of a Hospital Infection Control Manual, and the establishment of a robust needle stick injury management team. These measures have led to improved compliance with infection prevention protocols, as evidenced by hand hygiene audits and reduced incidence of HAIs. The journey of establishing infection control practices at AIIMS Rajkot highlights the importance of a structured approach in new healthcare settings. The successful integration of these practices not only enhances patient and staff safety but also sets a standard for future healthcare facilities. The AIIMS Rajkot’s proactive measures and continuous improvement efforts serve as a model for effectively addressing the challenges of infection control in a dynamic healthcare environment.

Genetic diversity and environmental adaptation in Ethiopian tef.

Orphan crops serve as essential resources for both nutrition and income in local communities and offer potential solutions to the challenges of food security and climate vulnerability. Tef [Eragrostis tef (Zucc.)], a small-grained allotetraploid, C4 cereal mainly cultivated in Ethiopia, stands out for its adaptability to marginal conditions and high nutritional value, which holds both local and global promise. Despite its significance, tef is considered an orphan crop due to limited genetic improvement efforts, reliance on subsistence farming, and its nutritional, economic, and cultural importance. Although pre-Semitic inhabitants of Ethiopia have cultivated tef for millennia (4000-1000 BCE), the genetic and environmental drivers of local adaptation remain poorly understood. To address this, we resequenced a diverse collection of traditional tef varieties to investigate their genetic structure and identify genomic regions under environmental selection using redundancy analysis, complemented by differentiation-based methods. We identified 145 loci associated with abiotic environmental factors, with minimal geographic influence observed in the genetic structure of the sample population. Overall, this work contributes to the broader understanding of local adaptation and its genetic basis in tef, providing insights that support efforts to develop elite germplasms with improved environmental resilience.

Somatic Hybrids and Cybrids: Innovations in Vegetable Improvement

Somatic hybridization through protoplast fusion is indeed a promising method for producing asymmetrical and unbalanced polyploid somatic hybrids in various plant species. This technique involves merging protoplasts from different plant species to create hybrids that possess desirable traits for both scion and rootstock improvements. By circumventing the limitations of sexual hybridization, such as male/female sterility and sexual incompatibility, somatic hybridization enables the incorporation of beneficial genes from closely related or even distantly related species. The success of somatic hybridization in horticulture is evident in various crops such as citrus, potato, brinjal (eggplant), tomato, mango, avocado, banana, strawberry, pear, and cherry. It facilitates the transfer of numerous uncloned genes that confer resistance to biotic and abiotic stresses, thereby enhancing crop resilience and productivity. Unlike transgenic technology, which is often subject to regulatory constraints, somatic hybridization allows for the exchange of genetic material without the same legal formalities. Despite its potential benefits, somatic hybridization faces challenges and constraints compared to sexual hybridization. These include technical difficulties in protoplast isolation and fusion, as well as limitations in generating fertile hybrids and maintaining genome stability. However, advancements in genomic technologies provide optimism for overcoming these challenges. Improved understanding of plant genomes enables more precise manipulation and selection of desired traits through somatic hybridization. In conclusion, somatic hybridization is a crucial tool in modern plant breeding and crop improvement efforts. It expands the gene pool available for breeding programs by incorporating genetic variability from diverse sources, thus offering new opportunities to enhance agricultural productivity and sustainability. As research and technology continue to advance, somatic hybridization holds promise for addressing current and future challenges in global agriculture.

Predictive model of intrahepatic collateral vessels among hepatic veins in patients with liver tumors involving the caval confluence.

Communicating vessels among hepatic veins in patients with tumors invading/compressing hepatic veins at their caval confluence facilitate new surgical solutions. Although their recognition by intraoperative ultrasound has been described, the possibility of preoperative detection still remains uncertain. We aimed to develop a model to predict their presence before surgery. Patients with caval confluence-located tumors who underwent surgery between 2010 and 2022 were collected and analyzed. A total of 136 eligible patients were assigned randomly into the derivation (n= 96) and validation (n= 40) cohorts. Communicating vessels were recorded as visible or not considering the intraoperative ultrasound findings as reference. A predictive model was built and graphically represented as nomogram. Of 136 patients included, 106 (78%) had communicating vessels. Of patients with communicating vessels, a parenchyma-sparing hepatectomy was performed in 98 (92%; 77% with hepatic vein amputation, 75/98). Of 30 patients without communicating vessels, all underwent an R1 vascular parenchyma-sparing hepatectomy. Operative mortality was nil. No liver congestion occurred. In the former, presence of communicating vessels at the intraoperative ultrasound was detected in 75 (78%) patients, whereas in the validation cohort it was detected in 31 (78%). No differences in the distribution of the variables were found in the 2 cohorts. The model included tumor size at the confluence, tumor number, degree of hepatic vein infiltration, and density of hepatic tissue at contrast-computed tomography, as predictors of communicating vessels in derivation cohort (discrimination was area under the receiver operating characteristic curve= 0.82). Identification of communicating vessels in patients with tumors at the caval confluence opens new surgical options, expanding resectability. The present predictive model may play a useful role in facilitating surgical decision-making, developing and implementing surgical strategies, and guiding resectability improvement efforts.