Established Practice Research Articles

Walnut in Sweden: effects of nurse trees, weed control and fertilization on five-year survival and growth of planted Juglans × intermedia NG23 and NG38

ABSTRACT This study quantified the effects of different establishment practices on survival, dieback and early growth of Juglans × intermedia NG23 and NG38 planted in a statistically designed field experiment on glacial till in southern Sweden. Establishment practices included the use or absence of nurse trees (Populus maximowiczii × trichocarpa var. OP42 planted one year before J. × intermedia), weed control (2 m2·tree−1) and fertilization (+25 g N·tree−1·year−1). NG23 transplants were smaller than NG38 at the time of planting. The overall survival rate was 97%. NG23 suffered marginally more mortality than NG38. Leader shoot dieback occurred in all treatment combinations but was most severe in the presence of nurse trees. NG23 suffered less dieback than NG38. Annual height growth of trees unaffected by dieback increased with increasing levels of precipitation during the growing season (194–407 mm) and with increasing soil quality in terms of nitrogen (94·10−3–607·10−3 g·g−1), base saturation (14–99%) or available soil water capacity (8.6–30.6 l·m−3). It was negatively influenced by poplar nurse trees and positively by fertilization. Weed control had no impact on height growth, possibly due to inefficient implementation. With nurse trees, NG23 had stronger growth than NG38. The opposite was true without nurse trees. It was hypothesized that less growth and more dieback resulted from competition for water.

Man, or Machine? Artificial Intelligence Language Systems in Plastic Surgery.

Artificial intelligence (AI) language models are computer programs trained to understand and generate human-like text. The latest AI language models available to the public have impressive language generation capability with immediate applications in both academia and private practice. Plastic surgeons can immediately leverage this technology to more efficiently allocate valuable human capital to higher-yield tasks. This can ultimately translate to higher patient volume, higher research output, and improved patient communication. Commercially available models offer business solutions that should not be ignored by plastic surgeons hoping to establish, optimize, or grow their practices. In this paper, the authors review the current state of AI language systems, discuss potential applications, and explore the risks and limitations of this technology.

Норми орхуської конвенції в аспекті дуалізму права на безпечне довкілля і обов’язку його захищати

By ratifying the Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters (Aarhus Convention) Ukraine has committed itself to a change of established practices regarding the provision of environmental information and the right of the public to appeal to the court with claims for environmental protection. The implementation of the norms of this Convention has become quite problematic, not least due to the insufficient level of environmental awareness of Ukrainian society. However, positive changes in this area are still taking place, not least due to the active work of various public environmental organizations. It seems that the scientific study of the norms of the Aarhus Convention will also to some extent contribute to the progress of our state and society in the field of environmental protection. We consider it necessary to enshrine the "automatic" recognition of legal interest (i.e. the right to sue in matters relating to environmental protection) for any non-governmental environmental organization registered and operating in accordance with Ukrainian law. This will meet the requirements of Part 4 of Art. 3 of the Aarhus Convention, according to which our state ensures "proper recognition of associations, organizations or groups that contribute to the protection of the environment, and provides them with appropriate support and ensures compliance of its national legal system with this obligation" Among the trends that can be considered extremely positive is the recent legal conclusion of the Supreme Court in the case of banning the dolphinarium. In this case, the Supreme Court stressed that "the right to protection of the violated constitutional right to a safe environment belongs to everyone and can be exercised both personally and with the participation of a public representative". Given the binding nature of the Supreme Court's legal conclusions, we hope that this case will be a significant milestone in bringing domestic legislation and the practice of its application to the requirements of the Aarhus Convention.

Change of Ownership of the Waqf in the area of Gornji Rahic in the Socialist period (1945-1990)

One of the important measures of the communist government after the Second World War was the change of ownership of private property and the property of religious communities. For the mentioned changes in the field of ownership, numerous regulations were passed, which related to the nationalization, confiscation and expropriation of real estate. The regulations were for the purpose of the legitimate action of the state in terms of changing the ownership of real estate. With these measures, the entire waqf property, which until then was outside the scope of state interventions regarding the change of ownership, came under attack. The aforementioned processes were carried out in a short period of time and very radically, whereby in many cases the established legal procedures adopted by the communist authorities were not followed. Through nationalization, confiscation and expropriation, significant property of the Islamic community in Bosnia and Herzegovina was usurped. The usurpation of property significantly weakened the Islamic community economically, which had an impact on the work of its most important institutions. Due to additional government measures, the most important religious and educational institutions of the Islamic community, such as madrasahs and sharia courts, ceased to exist, while the number of schools was significantly reduced. With the usurpation of property, the Islamic community lost a significant economic support, which had an impact on its further functioning and influence on the wider masses, which to a good extent were very quickly affected by the process of atheism, which was one of the important goals of the communist government. The Islamic community in the Brcko region had significant waqf property at its disposal. It was about various properties, which were of great importance in the religious, educational, economic and social segments in the places where the waqfs were located. The Islamic community in the area of the municipality of Gornji Rahic, which was located in the Brcko region at the time, had significant waqf real estate, especially land holdings. Until the establishment of the communist government, they were used to support religious buildings in this area. With the establishment of the new government, according to the available data of a significant land area, four waqfs in this area were hit by the measures of the new communist government. It was about the foundation of the Gornji Rahic mosque, the foundation of the Ograđenovac mosque, the foundation of the Iptidaija school in Gornji Rahic and the Fatima Kujundzic foundation. The aforementioned waqfs came under attack based on the Law on Agrarian Reform and Colonization, because they had more land than was determined by the said regulation. Therefore, already in 1946, the government carried out the process of expropriation of the land of the mentioned waqfs and took a total of 66 dunums of land and 320 m2 from them, while leaving a total of 17 dunums and 532 m2 of land to the Islamic community, i.e. the mosque waqf in Gornji Rahic. The Islamic community sent a series of complaints to the competent institutions regarding this attitude of the authorities, which were not accepted. So it was left without an important economic basis necessary for its continued existence. The aforementioned expropriated land was included in the land fund as state property, which was allocated to various users: agrarian interests, agricultural cooperatives and other state institutions. It is interesting that the waqf property, which had the status of a cemetery (cemetery), was the subject of expropriation in this case. In the process of cadastral marking of expropriated land, numerous mistakes were made, which in the later period represented a problem in the implementation of the process of registering the allocated land in the ownership of agrarian stakeholders. The mentioned problem in the paper is treated on a micro level, but the available facts indicate that it was an established practice of the communist government, which was widely used immediately after the Second World War, related to the change of property ownership of religious communities, including the Islamic community. In this way, the economic strength of the Islamic community was significantly reduced, which will have an impact on its overall status in the time of socialism, which was also shown in the example of the usurpation of the Islamic community's waqf in the municipality of Gornji Rahic in Brcko county.

P06 Improving antibiotic prescribing practice in a tertiary burns and plastic surgery department

Abstract Background Antimicrobial resistance is an ever-emerging global public health issue. In the healthcare setting, it is essential to use antimicrobials appropriately and manage infections effectively to help tackle antimicrobial resistance. Objectives To review local antibiotic resistance data, update the plastic surgery infection guidelines based on this data, implement interventions to facilitate compliance with the guidelines and re-audit to assess if these interventions have been effective. Methods A review was undertaken of the previous 3 months of antibiotic susceptibility results for significant staphylococci and streptococci species isolated from blood cultures and wound swabs, and the microbiology results of all local cases of necrotizing fasciitis over a 5-year period. The plastic surgery infection guidelines were updated to reflect the changes in local antibiotic resistance rates. Following implementation of the new guideline, various interventions were undertaken including provision of departmental teaching sessions, ensuring availability of appropriate antibiotics in the burns and plastics theatres and redesigning the guideline to include all plastic surgery and infection guidelines within the one document (previously multiple specific guidelines). Between each intervention, compliance with the guideline was measured to establish if the intervention had made a difference. Results Changes to the guideline included using clindamycin rather than doxycycline for the treatment of cellulitis in penicillin allergic patients, as 44% of Group A Streptococcus isolates identified in wound swabs were resistant to doxycycline. Other changes included the introduction of linezolid if the patient had received a recent or failed course of clindamycin, and the use of cefazolin rather than clindamycin for patients with severe cellulitis with a penicillin allergy, due to the increase in rates of clindamycin resistance. After the three intervention cycles, prescriber compliance with the guideline increased from 50% to 71% demonstrating the need for ongoing intervention and re-evaluation. Conclusions Co-amoxiclav and clindamycin were the most commonly prescribed antibiotics in those patients whose antibiotic prescriptions did not comply with the guidelines. The main reason for this is historical usage of these antibiotics within the specialty; this project demonstrates the challenges in changing established practices in individual clinicians. Interventions to ‘make it easy’ for prescribers to follow antibiotic guidelines (for example, the right antibiotic being easily available at the site of prescription), along with targeted education, can be effective but long-standing prescribing habits within specialist areas may be difficult to change.

The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury.

The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.

Prospects and directions of digital transformation in foundry

The time of information technology determines its priorities, which are a prerequisite for building a competitive production and economy. The ubiquitous spread of digitalization is one of the basic principles of new economy, a new type of socio–economic structure that is gradually being formed in the modern world through the introduction of scientific and technological progress and innovative methods of management, intellectualization and capitalization of human knowledge, the use of advanced new information and material technologies, accelerated development of knowledge-intensive sectors of the economy, the formation of creative, efficient, rational information and material production. Currently, at large foundries with mass and large-scale production of castings, the task of automating the control of technological processes using digital control systems was solved in general. They implement algorithms for controlling technological processes of casting in closed circuits (locally). The systems under consideration allow to implement optimal control strategies and automatically perform sequences of operations (start and stop of equipment; calculation and input of metal charge; calculation of formulations, dosing and mixing of molding and core mixtures) of multi-stage periodic casting processes. Digital transformation can significantly change the established practice of foundry production (from direct control and management of technological processes to business planning and document management). The transformation will have an impact on all parameters of the enterprise: economic efficiency of production (productivity, operating costs); reliability (operational readiness); safety (number of incidents); compliance with legislative norms on ecology. The technological criterion for success of the digital transformation of foundry production will be the release of a nomenclature of castings with a minimum level of defect, commercial – the release of a nomenclature of castings in demand on the market (machine parts and mechanisms), with a minimum self-cost, which is determined by the technological level of preparation of the production and its implementation and, as a consequence, low costs and optimal quality of molds, metal and castings.

Universal health coverage in India and health technology assessment: current status and the way forward.

In India, there is a renewed emphasis on Universal Health Coverage (UHC). Alongside this, Health Technology Assessment (HTA) is an important tool for advancing UHC. The development and application of HTA in India, including capacity building and establishing institutional mechanisms. We emphasized using the HTA approach within two components of the Ayushman Bharat programme, and the section concludes with lessons learned and the next steps. The UHC has increased the importance of selecting and implementing effective technologies and interventions within national health systems, particularly in the context of limited resources. To maximize the use of limited resources and produce reliable scientific assessments, developing and enhancing national capacity must be based on established best practices, information exchange between different sectors, and collaborative approaches. A more potent mechanism and capacity for HTA in India would accelerate the country's progress toward UHC.

Utilization of the ketogenic diet for adults with status epilepticus

BackgroundThe ketogenic diet (KD) is a high-fat, low-carbohydrate diet with therapeutic potential in refractory seizures, both in outpatient and inpatient settings. Successful implementation of KD involves a multifaceted, interdisciplinary approach to address anticipated challenges. We sought to characterize the utilization of KD among healthcare providers caring for adults with status epilepticus (SE). MethodsWe distributed a web-based survey through professional societies, including the American Academy of Neurology (AAN), Neurocritical Care Society (NCS), American Epilepsy Society (AES), Neuro Anesthesia and Critical Care Society (NACCS), and the Academy of Nutrition and Dietetics (AND), and via research contacts. We asked respondents about practice experience and experience using KD as a treatment for SE. Descriptive statistics and Chi-square tests were used to analyze the results. ResultsOf 156 respondents, 80% of physicians and 18% of non-physicians reported experience with KD for SE. Anticipated difficulty in achieving ketosis (36.3%), lack of expertise (24.2%), and lack of resources (20.9%) were identified as the most important barriers limiting the utilization of KD. The absence of dietitians (37.1%) or pharmacists (25.7%) support was the most important missing resource. Reasons for stopping KD included perceived ineffectiveness (29.1%), difficulty achieving ketosis (24.6%), and side effects (17.3%). Academic centers had more experience with the use of KD and greater EEG monitoring availability and fewer barriers to its implementation. The need for randomized clinical trials supporting efficacy (36.5%) and better practice guidelines for implementation and maintenance of KD (29.6%) were cited most frequently as factors to increase utilization of KD. ConclusionThis study identifies important barriers to the utilization of KD as a treatment for SE despite evidence supporting its efficacy in the appropriate clinical context, namely lack of resources and interdisciplinary support, and lack of established practice guidelines. Our results highlight the need for future research to improve understanding of the efficacy and safety of KD along with better interdisciplinary collaborations to increase its utilization.

Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study.

The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.

MSR11 A Multi-Method Approach to an Indirect Treatment Comparison of Eplontersen and Vutrisiran for the Treatment of Hereditary Transthyretin-Mediated Amyloidosis with Polyneuropathy

Hereditary transthyretin-mediated amyloidosis with polyneuropathy (ATTRv-PN) is a rare, fatal neuropathy caused by TTR gene mutations leading to accumulation of amyloid deposits composed of TTR protein in multiple tissues, including the peripheral nervous system. Targeted gene silencers include vutrisiran (recently approved by the FDA and EMA) and eplontersen, which is in development. Eplontersen met its co-primary efficacy endpoints and was well tolerated in a planned week 35 interim analysis of the phase III NEURO-TTRansform trial (NCT04136184). In the absence of head-to-head trials, indirect treatment comparisons (ITCs) may help compare efficacy and safety of eplontersen vs vutrisiran. However, challenges include use of different external placebo arms in each pivotal trial, differences in the primary endpoint assessment scale version, endpoint timepoints and missing data handling. There is no established ITC practice in ATTRv-PN to address these challenges, therefore this study evaluated multiple ITC methods.

HER2 testing in the MOUNTAINEER trial: Analysis of treatment response based on central HER2 assessment using IHC/ISH and NGS.

3528 Background: Tucatinib (TUC) is a highly selective HER2-directed TKI approved by the FDA in combination w/trastuzumab (Tras) for treatment (tx) of pts w/ RAS wild-type HER2+ unresectable or metastatic colorectal cancer (mCRC) that has progressed following tx w/ fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy. There are currently no established best practices for HER2 testing/interpretation in mCRC. Here we present results of central HER2 testing across multiple platforms and response to tx for MOUNTAINEER pts treated w/ TUC + Tras based on central HER2 status. Methods: MOUNTAINEER (NCT03043313) enrolled pts w/ local HER2+ mCRC using ≥1 method: IHC, ISH, and/or NGS testing; retrospective central assessment of HER2 status was performed on multiple platforms. Pts in cohorts A+B were treated w/ TUC + Tras; pts in cohort C were treated w/ TUC monotherapy. Confirmed objective response rates (cORRs) using RECIST v1.1 per BICR, DOR, and PFS were calculated for pts treated w/ TUC + Tras based on each central testing method. Results: 114 pts were enrolled in cohorts A (n = 45), B (n = 39), and C (n = 30) w/ HER2+ tumors per ≥1 local testing method. Of samples submitted for central testing for Cohorts A and B, 70 per IHC/FISH, 50 per tissue NGS, and 71 per blood NGS had evaluable results. In all cohorts, there was 81.0% (95% CI, 68.6-90.1) agreement between blood and tissue NGS, 92.6% (95% CI, 83.7-97.6) between IHC/FISH and tissue NGS, and 79.5% (95% CI, 69.2-87.6) between IHC/FISH and blood NGS. In cohorts A and B, pts w/ HER2+ tumors by central IHC/ISH had a mDOR of 16.4 months (95% CI: 10.6-25.5) and mPFS of 10.1 months (95% CI: 4.2-15.2). cORR was 41.1% to 47.7% for the 3 assays. Detailed HER2 results are presented in the Table. Conclusions: Percent agreement of HER2 status was highest w/ tissue-based platforms. Detection of HER2 amplification by ctNDA NGS is useful; however, pts w/o HER2 amplification should be confirmed w/ a tissue-based assay. HER2 status by all 3 platforms predicted tx response to TUC + Tras. cORR in IHC2+/ISH+ was numerically lower but remained clinically relevant. These data support use of the above methods to identify HER2+ mCRC patients that may benefit from TUC + Tras. Clinical trial information: NCT03043313 . [Table: see text]

Neuroleadership in Transforming Educational Leaders

The paper aimed to transform Filipino educational leaders by integrating neuroscience and leadership development. The paper examined and assessed 18 scientific research papers on Neuroleadership techniques and effectiveness, as well as 12 articles on the functions of the brain and its application to educational leadership. From the major results, it appears that social science and neuroscience may be used to comprehend and improve human behavior as an individual and as part of an organization. Neuroleadership also revolutionizes established leadership theories and practices since all of its principles and strategies are scientifically grounded.

Conventionalism about Property and the Outsider Challenge

Abstract Conventionalism about property is the view that all moral duties correlative to property rights depend essentially either on the existence of a convention that assigns conventional ownership of objects, or on the existence of a body of positive law that confers legal property rights. It has been objected that, if Conventionalism about property is true, then it is impossible for someone to have her property right violated by someone who is not a member of the community in which her conventional property right is assigned. But it is possible. When Christopher Columbus sailed up to the island of Hispaniola in 1492, he and his sailors wronged the inhabitants by forcing them off their land. So, Conventionalism is false. This is the Outsider Challenge for Conventionalism. The Outsider Challenge (and its first premise, in particular) receives support from the Benefit Condition, according to which one can be morally obligated to comply with a conventional rule only if one benefits or has one’s interests protected by the convention of which it is a part. Despite its provenance and plausibility, however, I think that the Benefit Condition should be rejected. Doing so in a principled way allows us to square Conventionalism with our moral intuitions and, thus, address the Outsider Challenge. My main aim in this essay is to reject the Benefit Condition in one such principled way by providing a Contractualist answer to the question of when, and why, someone is morally required to respect another’s conventional property right. One is morally required to respect the conventional property rights of another when and because failing to do so would run afoul of the Principle of Established Practices (pep) – a principle for which I give a Contractualist justification. Roughly, the pep requires us to comply with sufficiently just social practices in the absence of special justification, and the fact that one’s interests are not protected by a property convention is not always a sufficiently strong reason for one to violate the duties assigned by that convention. Since the fact that one’s interests are not protected by a property convention is not necessarily a special justification for violating the pep, the pep gives us reason to reject the Benefit Condition and, thus, the Outsider Challenge, too.

Ein Erfahrungsbericht zur Wortbildung im Studium für Deutsch als Fremdsprache an der Karls-Universität Prag

For years, the theory of word formation in contemporary German has been a fixed part of the course Lexicology and Word Formation in Contemporary German at the Bachelor of German Language Studies at the Department of Germanic Studies of the Faculty of Arts, Charles University. The author describes the established practice and presents types of exercises designed to promote the development of passive vocabulary and to provide insight into the systemic relations of German word formation.

Individualized assessment and optimization of post myocardial infarction care by introducing a hybrid clinic - A DGH experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Optimal secondary prevention remains key in improving cardiovascular outcomes post myocardial infarction. Barriers to achieving timely and individualized medical optimization include unavailability of close follow up’s, compliance to secondary prevention, and more recently, the impact of COVID pandemic on outpatient face to face clinic appointments. With the recent emphasis from the European Society of Cardiology on secondary prevention in addition to optimizing lipid therapy, a dedicated service for post MI patients to address individualized risks can provide a timely opportunity to improve holistic cardiovascular care. Purpose To assess established secondary prevention practices, we initially audited 52 patients who presented with ACS between Jan 2020 and July 2020. These patients were assessed for post MI care optimization at 6 weeks post discharge. Utilizing ESC guidelines as audit targets, in our 6-week post discharge audit, we identified that there was scope of ACE-inhibitor up titration in 55.8% of the patients, beta-blocker optimization in 9.6%, Lipid lowering agents in 15.4%, mineralocorticoid receptor antagonist addition in patients with impaired LV systolic function in 5.8% of the patients. 5% of patients with new diagnosis of diabetes required referral to specialist teams for diabetic medication initiation or optimization. These results provided an opportunity to introduce a structured post MI clinic that will allow individualized risk assessment on an outpatient basis. Method We proposed a one stop hybrid clinic where all patients discharged following a myocardial infarction received a consultation 6 – 8 weeks following a discharge. These patients were sent blood forms 2-3 weeks prior to their appointment for full blood count levels, renal functions, liver profile, HBa1c levels and lipid profile. Focus of this consultation was to assess and educate the patient on risk factors (smoking, diabetes, cardiac rehab program), assess and address compliance to secondary prevention medications and finally titrate medications to maximum tolerated doses whilst achieving ESC defined targets for secondary prevention (post MI target systolic BP<140mmHg in non diabetics and <130mmHg in diabetics, LDLc <1.4, smoking cessation, HBa1c <49). Where appropriately identified, referral to lipid specialist and diabetes specialist teams were made to provide holistic multi-disciplinary management. Results To understand the Impact made by the clinic we obtained patient list through local electronic records to filter those discharged with a primary diagnosis of myocardial infarction in 2022. An audit tool was created and data collection was performed including baseline characteristics as per table 1 and interventions made Table 2. Conclusion(s) By establishing the post MI clinic we were able to demonstrate efficient individualized assessment and optimization of secondary prevention risk factors and pharmacotherapy.

(502) Arista™ Hemostat Associated with Decreased Odds of Infection and Reoperation Following Inflatable Penile Prosthesis Surgery in a Diverse, Multiethnic Academic Center

Abstract Introduction Using hemostatic agents to manage intraoperative bleeding or assist in surgical closures is well established practice. Currently, several hemostatic agents such as Arista™, Surgiflo®, and Surgicel® are available for surgeon use when placing inflatable penile prosthesis (IPP). However, the effect of these agents on postoperative infection remains to be seen. Thus, we conducted a study to compare postoperative infection and reoperation rates of Arista™ to other hemostatic agents. Objective Primary objective was to determine if use of Arista™, when compared to other hemostatic agents, was associated with decreased rates of infection and reoperation in patients from a diverse, multiethnic population undergoing a primary IPP implantation. Methods A single institution retrospective study of patients who underwent IPP implantation between December 2015 and February 2022 from a single surgeon was conducted. Patients were sorted into groups based on use of intraoperative hemostatic agents. Demographic data, intra- and peri-operative patient characteristics, reoperation, and post-operative infection information was extracted from electronic medical records. Results A total of 434 patients undergoing primary IPP (95.4% Coloplast and 4.6% AMS devices) met inclusion criteria; of which, 158 (36.4%) received Arista™ and 276 (63.6%) received other hemostats such as Surgiflo®, and Surgicel®. There was no significant difference between age, race, preferred language, BMI, or smoking status between the Arista™ and other hemostat groups. Cardiovascular disease (CVD) and diabetes were prevalent in 76.7% and 56.3% of our sample, respectively. A vast majority (84%) of CVD patients had concomitant diabetes. Median Operative time was significantly shorter in the other hemostat group compared to the Arista™ group (62 minutes vs. 75, P <0.001). There was no significant difference in post-operative instances of urinary retention, emergency department visits, or readmission between the two hemostat groups. Multivariable model controlling for age and CVD (Table 1) revealed that Arista™ was associated with significantly decreased odds of postoperative infection and reoperation when compared to other hemostats (OR = 0.36; 95% CI (0.14 – 0.97), P=0.04). Conversely, active smoking were associated with significantly higher odds (OR = 3.92; 95% CI (1.39 – 11.04), P=0.01). Conclusions Our retrospective study indicates that use of Arista™, regardless of patient CVD status, may lead to decreased infections and subsequent reoperations. Prospective randomized control trials should be pursued to adequately assess the benefits of Arista™ compared to other hemostatic agents. Disclosure No

Pandemic-Induced Telework Challenges and Strategies.

The online version contains supplementary material available at 10.1007/s41542-023-00151-1.

Early outcomes following integration of computed tomography (CT) coronary angiography service in an established cardiology practice in disease management

BackgroundComputed tomography coronary angiography (CTCA) is an established modality for the diagnosis and assessment of cardiovascular disease. However, price and space pressure have mostly necessitated outsourcing CTCA to external radiology providers. Advara HeartCare has recently integrated CT services within local clinical networks across Australia. This study examined the benefits of the presence (integrated) or absence (pre-integrated) of this “in-house” CTCA service in real-world clinical practice. MethodsDe-identified patient data from electronic medical records were used to create an Advara HeartCare CTCA database. Data analysis included clinical history, demographics, CTCA procedure, and 30-day outcomes post-CTCA from two age-matched cohorts: integrated (n ​= ​495) and pre-integrated (n ​= ​456). ResultsData capture was more comprehensive and standardised across the integrated cohort. There was a 21% increase in referrals for CTCA from cardiologists observed for the integration cohort vs. pre-integration [n ​= ​332 (72.8%) pre-integration vs. n ​= ​465 (93.9%) post-integration, p ​< ​0.0001] with a parallel increase in diagnostic assessments including blood tests [n ​= ​209 (45.8%) vs. n ​= ​387 (78.1%), respectively, p ​< ​0.0001]. The integrated cohort received lower total dose length product [Median 212 (interquartile range 136–418) mGy∗cm vs. 244 (141.5, 339.3) mGy∗cm, p ​= ​0.004] during the CTCA procedure. 30-days after CTCA scan, there was a significantly higher use of lipid-lowering therapies in the integrated cohort [n ​= ​133 (50.5%) vs. n ​= ​179 (60.6%), p ​= ​0.04], along with a significant decrease in the number of stress echocardiograms performed [n ​= ​14 (10.6%) vs. n ​= ​5 (11.6%), p ​= ​0.01]. ConclusionIntegrated CTCA has salient benefits in patient management, including increased pathology tests, statin usage, and decreased post-CTCA stress echocardiography utilisation. Our ongoing work will examine the effect of integration on cardiovascular outcomes.

Making science public: a review of journalists' use of Open Access research.

Science journalists are uniquely positioned to increase the societal impact of open research outputs by contextualizing and communicating findings in ways that highlight their relevance and implications for non-specialist audiences. Yet, it is unclear to what degree journalists use open research outputs, such as open access publications or preprints, in their reporting; what factors motivate or constrain this use; and how the recent surge in openly available research seen during the COVID-19 pandemic has affected this. This article examines these questions through a review of relevant literature published from 2018 onwards-particularly literature relating to the COVID-19 pandemic-as well as seminal articles outside the search dates. We find that research that explicitly examines journalists' engagement with open access publications or preprints is scarce, with existing literature mostly addressing the topic tangentially or as a secondary concern, rather than a primary focus. Still, the limited body of evidence points to several factors that may hamper journalists' use of these outputs and thus warrant further exploration. These include an overreliance on traditional criteria for evaluating scientific quality; concerns about the trustworthiness of open research outputs; and challenges using and verifying the findings. We also find that, while the COVID-19 pandemic encouraged journalists to explore open research outputs such as preprints, the extent to which these explorations will become established journalistic practices remains unclear. Furthermore, we note that current research is overwhelmingly authored and focused on the Global North, and the United States specifically. We conclude with recommendations for future research that attend to issues of equity and diversity, and more explicitly examine the intersections of open access and science journalism.