Initial Review Research Articles

Social Determinants of Reproductive Age Women's Sexual Health: A Scoping Review

Background: Evidence, especially in the last two decades, indicates the effect of social factors on health. Social determinants of health (SDH) are the environmental conditions in which people are born, live, grow, educate, work, and age. Objectives: Hence, this study intended to identify the SDH of the reproductive age women's sexual health dimensions. Methods: To conduct this scoping review, the researchers searched the databases, including PubMed, Medline, ProQuest, Cochrane Library, Web of Sciences, Scientific Information Database (SID), and Magiran, disregarding language limit. They searched the original observational articles (cohort, cross-sectional, case-control) on social determinants of reproductive age women's sexual health, assessing at least one social determinant of health for sexual health between January 2010 and January 2023. Results: A total of 4704 articles were extracted in the initial review; however, 30 entered the scoping review. The results revealed that the social determinants of reproductive age women's sexual health in different societies are socioeconomic status (socio-economic constraints, economic gradient, poverty, lack of food at home, homelessness, low prospects, and poor educational and job outlook), personal determinants (age, gender, religious affiliation, marital status, education level, employment/unemployment status, economic status, age at the first sex, age over 40, dissatisfaction with the sexual potency of the spouse, high body mass index, partners' sexual education, sexual intimacy, relationship duration, frequent contact with a given partner, perceived social support, and perceived safe sex norms), social support (social networks of peers, friends, and family, emotional support and strong attachments to families), neighborhood, violence, addiction, migration, stress, early life experiences, and education that can affect different sexual health dimensions. The sexual health dimensions encompass sexual function, sexual satisfaction, risky sexual behaviors, receiving sexual health services, condom use, and forced sexual behavior. Conclusions: Considering each person's conditions and needs, health policymakers and health services providers should evaluate the various dimensions of the SDH to promote women's sexual health. Moreover, they should plan and implement the required strategies to eliminate the identified obstacles.

Neuropathic diabetic foot ulcers in the elderly: clinical outcomes and healing

There is little evidence on healing outcomes of neuropathic foot ulcers in elderly patients. Aims: To determine the healing rates of neuropathic diabetic foot ulcers at 12 and 24 weeks achieved by standard care provided at an established multidisciplinary diabetes foot clinic in patients aged 65 years and above. Data on the incidence of falls and hypoglycaemia were also collected due to their perceived clinical risk in the group studied. Methods: This was a retrospective observational study looking at clinical outcomes of neuropathic foot ulcers. Patients aged 65 years or more presenting with a non-infected neuropathic ulcer at the time of their initial review were identified and classified into two groups: Group E patients were aged above 80 years and Group Y patients 65-80 years. Results: A total of 97 patients, presenting with 106 ulcer episodes, were identified. Mean HbA1c was 60 mmol/mol in Group Y and 55 mmol/mol in Group E. Healing rates of all ulcers at 12 and 24 weeks in the elderly group lagged behind rates in the younger group (67.6% at 12 weeks and 73% at 24 weeks in Group E vs. 78.2% at both intervals in Group Y). The elderly group had more falls, 11% vs. 2% in Group Y. In all, 50% of the falls in Group E were attributed to their prescribed pressure relief (off-loading) devices. Conclusions: With standard foot care given in a multi- disciplinary foot service, neuropathic diabetic foot ulcers can heal in the elderly despite their age-related skin changes. The rate of healing of neuropathic ulcers noted in our study provides a benchmark for healing outcomes and enables comparison with other age groups and centres. Our study identifies a risk of falls associated with off-loading devices and highlights the need for structured falls risk and mobility assessments in this group.

Review of Community-Based Conservation Initiatives for Protecting a Primary Atlantic Forest Remnant: A Case Study

Effective forest conservation should go hand in hand with collaboration of the surrounding local communities. Bringing advancement and relief to marginalized communities is pivotal for conservation initiatives, with the objective of cultivating a sustainable ecosystem while protecting indigenous biodiversity. The linchpin for developing successful partnerships begins with fostering a shared understanding of the intricate relationship between humanity and the natural environment. This awareness can be nurtured by interactive education and tangible outcomes that illuminate the profound long-term benefits of conscientious environmental stewardship. Therefore, an emphasis on community-driven conservation and environmental education becomes imperative, serving as a conduit for disseminating crucial information, fostering practical knowledge, and nurturing the attitudes and skills essential in the quest for environmental protection and sustainable development. Education, in this context, operates as a reciprocal process, demanding that educators glean insights from the local populace to effectively tailor strategies that elevate and empower them toward sustainable advancement. This dynamic interaction is where capacity development (CD) becomes indispensable. This paper delves into the unfolding of a series of conservation endeavors, initially driven by Anita Studer’s commitment to preserving a fragment of the primary Atlantic Forest in northeastern Brazil. Evolving into a four-decade educational journey, the actions taken showcase enduring ripple effects across 14 states in Brazil, presenting a comprehensive survey of applied techniques in this unique context. The resources required to achieve collective conservation goals witness a continual upswing, a trend expounded in this paper. Hence, we have chronicled the history, methodology, and projects that transpired in response to the ever-evolving community needs. We will also look at the results and discuss the advancement that ensues following the CBD targets and goals presented at the 2022 UN Biodiversity Conference.

A 3-year Retrospective Review of Contraceptive Initiation, Continuation, Switching, and Pregnancy Among Adolescents and Young Adults

PurposeTo understand contraceptive use patterns (initiation, switching, discontinuation) as well as associations with pregnancy in adolescents and young adults attending a teen family planning clinic. MethodsWe performed a chart review of adolescent and young adult patients (ages 12–20) attending a teen family planning clinic in Atlanta, GA between January 1, 2017, and December 31, 2019. Using a standardized abstraction form with quality controls, we collected available data on contraceptive methods used and pregnancy test results during the 3-year period. We analyzed contraceptive use patterns descriptively. We calculated and compared pregnancy incidence according to different contraceptive switch patterns. ResultsOur sample included 2,798 individuals who initiated 2,358 prescribed methods. The most commonly prescribed methods of contraception were the contraceptive injection (28.3%), etonogestrel implant (23.5%) and combined hormonal pill (23.2%). There were 599 discontinuations of prescribed methods; side effects like bleeding and headache were the most cited reasons for discontinuation. Most (75.8%) initiated a moderately or highly effective method after discontinuing a moderately or highly effective method. The incidence rate of pregnancy was highest for those who had discontinued an intrauterine device or implant and started a shorter-acting contraceptive method. DiscussionEmploying patient-centered contraceptive counseling that incorporates contraceptive experiences in addition to facts and allows for exploration and change may be valuable for young people. Successful navigation of contraceptive switches may require additional attention, education, and strategy, which could include hypothetical problem solving, close follow-up, and telehealth or virtual care.

Pediatric Firearm Violence in America

We have a firearm public health crisis in the United States, with firearm injuries being the leading cause of death in children. The state of pediatric firearm violence will be summarized through a synopsis of an expert panel of pediatric-focused advanced practice registered nurses. A review of related statistics, policy initiatives, programs, screening tools, and resources to support providers to intervene with patients, parents, and caregivers is summarized. Strategies to identify and intervene with all youth and families are described. All pediatric providers must take action against pediatric firearm violence and work to develop care strategies and health policy changes to combat this growing epidemic.

Tool condition monitoring of diamond-coated burrs with acoustic emission utilising machine learning methods

AbstractWithin manufacturing there is a growing need for autonomous Tool Condition Monitoring (TCM) systems, with the ability to predict tool wear and failure. This need is increased, when using specialised tools such as Diamond-Coated Burrs (DCBs), in which the random nature of the tool and inconsistent manufacturing methods create large variance in tool life. This unpredictable nature leads to a significant fraction of a DCB tool’s life being underutilised due to premature replacement. Acoustic Emission (AE) in conjunction with Machine Learning (ML) models presents a possible on-machine monitoring technique which could be used as a prediction method for DCB wear. Four wear life tests were conducted with a $$\varnothing $$ ∅ 1.3 mm #1000 DCB until failure, in which AE was continuously acquired during grinding passes, followed by surface measurements of the DCB. Three ML model architectures were trained on AE features to predict DCB mean radius, an indicator of overall tool wear. All architectures showed potential of learning from the dataset, with Long Short-Term Memory (LSTM) models performing the best, resulting in prediction error of MSE = 0.559 $$\mu $$ μ m$$^{2}$$ 2 after optimisation. Additionally, links between AE kurtosis and the tool’s run-out/form error were identified during an initial review of the data, showing potential for future work to focus on grinding effectiveness as well as overall wear. This paper has shown that AE contains sufficient information to enable on-machine monitoring of DCBs during the grinding process. ML models have been shown to be sufficiently precise in predicting overall DCB wear and have the potential of interpreting grinding condition.

Map of scientific publications on administration in Latin America

This research focuses on characterizing the orientation of the research that shows the contributions in the field of administrative sciences in Latin America. To do this, publications on Administrative Sciences by researchers in the region reported in Scopus were analyzed. After an initial review of all these publications, the sample was reduced to 87%, identifying the functions or areas of knowledge towards which they were oriented, their evolution over time, the sectors and countries where they were published, the collaboration networks between countries based on the development of the research and the main journals where they have been published. The results show that the administrative sciences are present in the epistemological development of Latin America, its conception and evolution correspond to the theoretical and methodological principles that established it as a science; They also reflect the existence of a vast network of collaboration in research in this field between countries in the region and beyond. At the same time, they show the need to strengthen the ties of collaboration between the most prolific researchers to strengthen the existence of an autochthonous school that responds to the particularities of the socioeconomic environment where they develop.

How Patients who needed CT scans on an ambulatory basis are scanned and reviewed in a major teaching hospital

Abstract Aim This study focuses on the status of service provision for Emergency General Surgical patients requiring Ambulatory CT scans at a major teaching hospital. Method CT scans that took place between May 2023 – July 2023 where patients who received scans were reviewed and categorized between Urology and EGS. Results During the 13-week study, we were able to scan 233 patients (17.92 scans per week) in total between both specialties where 82 scans were for EGS patients (35%). All of these patients were reviewed by a member of the EGS team before they were booked for ambulatory scans at an allotted time and date where patients were scanned at an average of 2.15 days after initial review. After the scan, the patients are reviewed in the Ambulatory Clinic with their results where decisions were made. 93% of the patients were seen on the same day after the scan. Most wait was 11 days due to delay of scanning. Of all the scans 75% of the scans are for common indication for scans in an Ambulatory setting. Indication for scanNumberDiverticular20Post-operative collections14Appendicitis11Non-specific abdominal pain10Hernias8 Conclusion After symptomatic management, scanning and reviewing patients on an ambulatory pathway is effective in both receiving scans in a timely manner as well as making timely appropriate decisions regarding their cause of presentation. It also helps reducing the number of patients going into the acute team.

The special features of using the artificial intelligence in the matters of cybersecurity

The role and importance of artificial intelligence in the field of cyber security is determined. The methods of using artificial intelligence in cyber security are detailed. The advantages and priorities of the use of artificial intelligence in the sphere of cyber security are defined. The shortcomings and problematic issues related to the use of artificial intelligence technologies by hackers in the field of cyber security are summarized. The innovative achievements of the practical implementation of generative artificial intelligence technologies ChatGPT (Generative Pre-trained Transformer) are highlighted. The legal principles of the regulation of artificial intelligence in the field of cyber security in Ukraine are outlined. Threatening trends in the use of artificial intelligence technologies have been identified based on the Europol report 2023. A review of the legislative initiatives of the EU aimed at regulating the field of artificial intelligence, in particular in the issue of cyber security, was conducted. The directions of improvement of the legal framework and regulatory requirements regarding the use of artificial intelligence technologies in the field of cyber security are summarized, especially in the conditions of the legal regime of martial law in Ukraine.

The Outcome of Exercise for Adults and Older Adults with Visual Impairment: A Scoping Review Protocol

Introduction: Exercise programs provide numerous health benefits, including improved physical fitness, psychosocial status, and sense of well-being. Previous research has identified a range of positive outcomes as a result of exercise for most populations; however, the current understanding of the exercise outcomes for adults from 18 to 65 years and older adults over 65 years with visual impairment is limited. Objective: The proposed scoping review aims to allow a better understanding of current exercise outcomes for adults (including older adults) with visual impairment. This protocol enhances the research quality and the transparency of the proposed scoping review. It pre-defines the objective and methods of the scoping review, including details of the criteria of inclusion and exclusion for evidence sources and the way the data will be identified, extracted, and presented. Inclusion criteria: Articles involving participants with visual impairment aged 18 and over will be the focus of the proposed scoping review. All English-language peer-reviewed studies with a focus on outcomes of exercise programs and interventions for adults with visual impairment, including quantitative, qualitative, and mixed methods study designs, will be considered. In order to make the result more applicable for future research and practice, studies published from 2000 to present will be included, given consideration of the changing concept and format of exercise since 2000. The exercise-related programs and interventions to be included can be delivered via any format in any geographical area. Methods: The search strategy will aim to locate all eligible published studies in the following databases: Ovid MEDLINE, Embase, CINAHL Complete, PsycInfo, AMED, and SPORTDiscus. Full text review will be undertaken of articles that meet criteria on initial review of title and abstract. Reference lists and citations of studies selected for full text review will be further reviewed to identify any additional studies that meet inclusion. Data from the selected studies will be extracted and tabulated based on the exercise and the key findings relevant to the research question. Findings from this scoping review will be presented as a summary of the data from the selected studies in a tabular form, which will categorize exercise outcomes and the corresponding exercise along with a narrative summary. Conclusion: It is expected that the results of this scoping review will enable a better understanding of exercise for adults with visual impairments and inform future exercise programs for adults with visual impairment.

Demographic Disparities in Clinical Trial Enrollment of US Patients with Newly-Diagnosed Multiple Myeloma

Background: Racial, ethnic and gender disparities impact the real-world reproducibility of clinical trials leading to drug approvals for hematologic malignancies. Interestingly, a prior abstract (Boisclair et al., 2022) has shown an equitable enrollment between US demographic groups in frontline trials for newly-diagnosed non-Hodgkin lymphoma. Although disparities in multiple myeloma (MM) trial participation have been oftentimes demonstrated, prior studies (Kanapuru et al., 2022; Alqazaqi et al., 2022) predominantly involved patients with relapsed/refractory MM (RRMM). To further assess this gap, we conducted a cross-sectional analysis of US demographic representation in phase II or III trials for newly-diagnosed MM (NDMM). Methods: Clinicaltrials.gov was searched for completed NDMM trials with a recruitment period between 01/01/2007-12/31/2020. Studies limited to phase I data (n=10), enrolling <30 patients (n=35), including RRMM or other malignancies (n=18), and/or recruiting outside the US (n=93) were excluded. We subdivided patients according to gender, race, and ethnicity. For each subgroup, total new cases of MM from 2007-2020 were identified via the Surveillance, Epidemiology and End Results (SEER) Cancer Statistics Explorer Network, with subsequent calculation of a trial enrollment fraction (TEF; number of trial enrollees divided by incident US cases). Pearson's chi-square test was used to compare TEF between subgroups, yielding odds ratio (OR) and 95% confidence interval (95%CI) values, with P<0.05 deemed significant. Results: Among the 194 trials found on initial review, 25 met the established criteria for inclusion (Figure 1). All studies (n=3,559) described the participants' gender, while only 18 (72%; n=3,129) reported race and 9 (36%; n=2,319) reported ethnicity. Overall, women showed a significantly lower TEF compared to men (OR, 0.88; 95%CI, 0.82-0.94; P<0.001). When compared to White Americans, TEF was significantly lower for African Americans (OR, 0.71; 95%CI, 0.64-0.78; P<0.001) and Asian Americans/Pacific Islanders (AAPIs; OR, 0.64; 95%CI, 0.22-0.41; P<0.001). In studies reporting ethnicity, TEF was significantly lower for Hispanics compared to non-Hispanics (OR, 0.18; 95%CI, 0.14-0.24; P<0.001). Conclusion: Our cross-sectional analysis reveals an underrepresentation of women, African Americans, AAPIs, and Hispanics in NDMM trials conducted around the US. These findings are complementary to the enrollment disparities previously shown in RRMM trials. Through the implementation of a comprehensive diversity plan, MM trials must include a more inclusive representation of the US population affected by this blood cancer. Such an approach will not only enhance the external validity of these trials but also mitigate the impact of ascertainment bias and promote healthcare equity.

Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023

BackgroundLarge-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality,...

Displace Study Shows Poor Quality of Transcranial Doppler Ultrasound for Sickle Cell Stroke Screening: An Urgent Need for Standardized Reporting

Introduction Children with sickle cell anemia (SCA) are at increased risk of stroke as compared to age-matched peers (Ohene-Frempong et al, Blood, 1998). The Stroke Prevention Trial in SCA (STOP) demonstrated that with use of transcranial Doppler ultrasound (TCD), children at highest risk for stroke could be identified and started on chronic transfusion therapy, reducing stroke risk by > 90% (Adams et al, NEJM, 1998). This led to the adoption of the STOP protocol as standard of care. However, many sites use the transcranial Doppler imaging (TCDi) technique in place of the original non-imaging TCD technique used in STOP. Further, the NHLBI-funded DISPLACE (Dissemination and Implementation of Stroke Prevention in SCD) study demonstrated < 50% of children at participating sites had annual TCD screening (Kanter et al, JPHO, 2021). This sub-study used DISPLACE data to examine TCD report quality. We hypothesized there was high variability in TCD technique, unreliable reporting of variables, inconsistent definitions for diagnosing abnormal scans and that these inconsistencies would be worse with TCDi. Methods An IRB waiver was obtained. This sub-study used data manually extracted from TCD reports in the DISPLACE database. A computer-generated algorithm randomly selected 400 TCD/TCDi reports (200 of each type) from the 12,433 reports collected in DISPLACE for an alpha of 0.05. TCD type, patient age, vessels assessed, velocities measured, and diagnosis made (abnormal/normal) were extracted. Type of TCD was separately extracted from the DISPLACE database. We surveyed study site principal investigators regarding TCD methods used in the study period (2012 - 2016). Results Three hundred and ninety-one TCD/TCDi reports were reviewed from 26 institutions. The median patient age at time of TCD was 5 years (2 - 8 years) and the median year of TCD completion was 2013 (2000 - 2016). On initial review of the TCD/TCDi reports, there was significant variability in how results were classified as “abnormal”, and reports were often inconsistent with STOP definitions of normal/abnormal. Thus, we focused on the quality and completeness of reports. Table 1 details the information included in the reports. Notable findings: • Use of TCDi was not specifically stated in 96% of TCDi reports. • 52% did not clearly identify the time averaged mean maximum velocity (TAMMV) (the key variable required per STOP criteria). • 30% of reports did not assess/did not report assessment of the distal internal carotid artery (dICA). • 14 reports (3.6%) did not include any information about which vessels were assessed. • Only 42% of scans clearly stated that classification of normal vs. abnormal was based on the correct measure (TAMMV). Surveys sent to each site to assess TCD practices from 2012-2016 were evaluated (Table 2). There was substantial variability regarding which vessels were examined for both TCD and TCDi, ranging from 1 - 5 vessels. The type of provider interpreting scans varied and only 8 institutions (35%) had ultrasound technicians who underwent formal STOP training. Conclusion TCD results have critical implications for medical decision-making in SCA, but our study reveals a lack of quality assurance and consistency with sickle cell stroke risk screening using TCD/TCDi. Notably, many reports did not identify which vessels were used to assess stroke risk, did not report on the correct velocity measurement, neglected to measure or report the TAMMV, or made diagnoses based on the wrong measurements or wrong vessels. Additionally, a large percentage of reports did not note whether a TCD or TCDi was performed. Surveys from 23 DISPLACE sites showed significant variation in the method of training for those performing TCDs. With this extreme variation, we recommend creation of a standardized template for TCD reports to be utilized across institutions. We also recommend those interpreting the scans gain expertise in reading and evaluating TCD/TCDi specifically for people with SCA. National quality improvement studies are necessary to implement these recommendations and inform further refinements, especially in the use of TCDi, and assessment of vessels beyond the middle cerebral artery and dICA. This requires engagement of stakeholders, identification of barriers to implementation, and funding. With these interventions, we continue to work towards meeting the recommended screening and interventions instituted by the NHLBI over 25 years ago.

Nanopore Cas9-Targeted Long-Read Sequencing - a Fast and Flexible Diagnostic Tool for the Identification of B-Cell Acute Lymphoblastic Leukemia Associated Gene Rearrangements

B-cell acute lymphoblastic leukemia (B-ALL) is characterized by a multitude of recurrent genetic alterations, which drive malignant transformation. Besides their essential role in leukemia biology these aberrations also serve as predictors of treatment response and survival, making their reliable detection a prerequisite for risk stratification in state-of-the-art clinical trials. Currently, the genetic characterization of B-ALL in most diagnostic laboratories still relies on an integrative approach combining conventional cytogenetics, reverse transcription polymerase chain reaction (RT-PCR) and fluorescence in situ hybridization (FISH) assays as well as single nucleotide polymorphism (SNP) array analysis. However, these conventional diagnostic tools fail to identify a considerable number of genetic alterations, particularly cryptic rearrangements such as IGH::DUX4, IGH::EPOR or MEF2D involving fusions. Although next generation DNA- and RNA-based sequencing (NGS) assays have significantly improved the reliable detection of fusion genes, the need for large sample numbers to achieve acceptable turnaround times and cost effectiveness impairs their application in small- to medium-sized diagnostic laboratories. To address these issues, we developed a targeted sequencing assay, based on the commercially available combination of Cas9-mediated target enrichment and Nanopore long-read sequencing, which facilitates the identification of B-ALL associated gene rearrangements on the DNA level in a single sample format. The targeted panel design included an initial review of the literature to define the breakpoint-spanning regions involved in fusion gene formation followed by the design of specific guide RNAs (gRNA) to facilitate Cas9-mediated enrichment of these regions of interest (ROIs). We first conducted ROI enrichment and sequencing with a limited number of gRNAs targeting only ETV6, KMT2A and DUX4 fusions. Then we progressively extended the pool of gRNAs with each sequencing run until it comprised 91 gRNAs covering most B-ALL-associated rearrangements. This stepwise approach allowed us to identify negative effects of increasing panel size on overall enrichment efficacy and simplified the identification and replacement of poor performing gRNAs. Our initial cohort consisted of 12 well-characterized samples harboring 13 gene rearrangements, including ETV6::RUNX1, KMT2A::AFF1, MEF2D::BCL9, ZMIZ1::ABL1, SSBP2::CSF1R, PDGFRB::EBF1, IGH::EPOR, IGH::DUX4, IGH::CRLF2, IGH::CEBPE, IGH::MYC, and IGH::BCL2. To ensure easy implementation in diagnostic workflows, we used genomic DNA, isolated according to standard protocols. Cas9-based target enrichment and long-read sequencing on MinION flow cells (v9.4.1) were performed according to protocols provided by Oxford Nanopore and each sample was sequenced for 72 hours. On average, each run yielded 3.72±1.21 Gb, a mean read length of 7.40±1.00 kb with an N50 value of 12.87±1.71 kb and an average read quality (Q) score of 14.72±0.52. For data processing and analysis, we adapted the existing nextflow nf-core bioinformatics pipeline, nanoseq, to include publicly available structural variation callers and quality control tools. Our approach correctly identified 92.3% (12/13) of the rearrangements with a mean of 42 (range 2-97) breakpoint-supporting reads (BSR) per alteration. Only the IGH::MYC translocation was missed as the breakpoint was located outside of our predefined ROIs for MYC. To corroborate these results, we sequenced an additional cohort of 14 B-ALL samples, including ZNF384::DUX4, KMT2A::MLLT10, KMT2A::USP2, PAX5::SOX5, EP300::ZNF384, P2RY8::CRLF2, and IGH::DUX4 positive cases and were able to correctly identify 100% (14/14) of the fusion genes with an average of 83 (range 7-367) BSR. In conclusion, our newly developed targeted sequencing panel correctly identified 96.3% (26/27) analyzed gene rearrangements in B-ALL, including alterations evading standard diagnostic methodologies such as IGH::DUX4 or IGH::EPOR. Importantly, the assay allows individual analysis in a single sample format, thereby representing a valuable tool for B-ALL diagnostics in small to medium-sized laboratories.

Dismantling the education exclusion zone

Traditional textbook publishing magnifies some voices while silencing others, pushing consistently marginalised groups into an education exclusion zone. Open educational resources (OER) purportedly address this problem; however, without adequate guidance on inclusive design, OER fail to rise to the challenge. This paper undertakes an exploratory initial review of EmpoweredOER, a practical tool in first-phase iterative development, designed to unpack the complexities of inclusive OER. Emerging from a grant-funded international study tour, three best practice themes informed the design of EmpoweredOER: true accessibility, beyond technological; universal design for learning and inclusive open education nexus; and diverse perspectives and representation. Initial findings indicate EmpoweredOER meets its objective. Future research will analyse the impact and growth of EmpoweredOER as it matures.
 Implications for practice:
 
 There is appetite to dedicate further resources to developing inclusive OER tools.
 Advocates can instill a sense of community in their resources for increased engagement.
 Resource creators should incorporate interactivity and adaptability for greater contextualisation.

1660. Harnessing Handshake Rounds for Infection Prevention: Interventions and Great Catches in the First Year

Abstract Background There are national calls to engage Infection Preventionists (IPs) as antimicrobial stewards (AS), but it is unknown how this is translated into action and measurable outcomes. The Association of Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) 2012 joint position paper states that IPs can benefit ASPs. The paper summarizes key actions for IPs as promoting compliance with standard and transmission-based precautions, care bundle, hand hygiene, and educating staff, patients, and visitors. However, an initial review of the literature did not find any publications outlining IP actions or outcomes as participants in AS. Methods In August 2022 an IP was added as available to the existing handshake stewardship rounding team. During rounds the IP observed units for safe infection control practices, asked staff if there were any questions about IC policies or practices, and shared information about circulating illness and COVID-19 policy updates. Results Between August 2022 and March 2023, there were 201 interventions. The largest categories included environmental, education, and expired product. 42 (21%) were categorized as a “great catch”, defined as likely to have system-wide impact. Secure chat data was also collected as a baseline to assess change over time. IP interventions during ASP Handshake Rounds EHR Secure Chats to on call Infection Preventionists Conclusion The impact of including an IP during handshake stewardship was great. Impact includes environmental interventions: cleaning and disinfection processes, laundry, waste, damaged structures, construction, and ventilation issues. Educational impact: teaching providers how to access policies, answering questions about isolation and PPE, and the importance of standard precautions and policy changes surrounding COVID-19. Identifying and disposing of expired products and guidance on isolation precautions and PPE. Examples of a great catch included upgrading isolation status, identifying multiple expired products, correcting incorrect PPE or IC in real time, and educating large groups of staff members on critical IC topics. Health care teams and leadership expressed appreciation of education and support provided by the IP during rounds. Integration of IP into Handshake Stewardship will improve IC practices and Joint Commission readiness. Disclosures All Authors: No reported disclosures

Carbon Capture, Utilization and Storage tax credits and tax equity project financing in the USA: an assessment under bilateral tax treaties and BEPS actions

Abstract Carbon Capture, Utilization and Storage (CCUS) is a technology for capturing man-made CO2 emissions (carbon emissions) and either storing them, hopefully permanently, underground, generally in suitable saline formations or oil and gas fields, or utilizing them by, eg, converting them into commercially viable products. Because global energy demand and carbon emissions will continue to increase until 2050 by almost 50 per cent, CCUS projects (despite a current difficult business case per metric tonne stored or used), if deployed on a large scale, could help the world to limit global warming to 2.0°C, but preferably 1.5°C, as proposed by the Paris Agreement. For economic reasons, without government support, it will be difficult to have the required number and scale of CCUS projects to tackle global warming. The introduction section of this paper explains how, if we accept the urgency of the Paris Agreement’s thresholds, there is probably not sufficient time for introducing a global emissions trading scheme (ETS) or a global carbon tax, which are considered the two best approaches to reducing carbon emissions. The CCUS legal/regulatory/fiscal approach section analyses, first, the different legal/regulatory/fiscal approaches to CCUS taken by the US and the EU, secondly, the US federal tax credits available for CCUS projects as of May 2022, and thirdly, the powerful incentive mechanism created when the US CCUS tax credits work together with tax equity partnerships. The US CCUS tax credits and tax treaties section, after some initial literature review of tax incentives and how the US CCUS tax credits can be framed within the panoply of tax incentives, focuses on the first research question, ie, on understanding how the US CCUS tax credits interact in a tax treaty environment. The US CCUS tax credits and the BEPS project section plays a similar role in relation to whether the US CCUS tax credits align well with the requirements of the OECD/G20's Base Erosion and Profit Shifting (BEPS) Project, which is aimed at reducing tax avoidance and is more recent in its development. The last section concludes.

ASSESSMENT OF THE ISSUES AND OPPORTUNITIES OF THE TRADITIONAL BRASS AND BELL METAL CRAFTS OF BIRBHUM DISTRICT, WEST BENGAL

In ancient India, various bronze/brass objects were found in a plethora of forms, such as coins, ornaments, inscriptions, utensils, traditional and artistic artifacts, and even weapons. In Indian tradition, design and fabrication were never separated. Artists and artisans were both considered as artists. People who traditionally work with metals are called Karmakar and those who work especially with brass and bell metal are known as Pital Karmakar. An initial literature review and reconnaissance surveys have aided to identify the issues and the prospects of sustainability associated with the brass and bell metal crafts of Birbhum as follows,• Hand beaten brass-work is unique in shape and size, but the purpose of the material has transformed with rapidly with emerging technologies and changing markets• As traditional objects, brass utensils used to be part and parcel of regular life, which attests to the shift in the taste and cultural habits.• Studies suggests that rapidly emerging technologies, open market, and availability of comparatively cheaper materials (such as Aluminum, plastics, etc.) forwards a set of challenges to the traditional craftsmen to ensure sustainability.Based on the studies on the real situation of the metal crafts in Birbhum district, it can be stated that, this sector, which was once the pride of Bengal, has been suffering for long. Therefore, the present paper attempts to identify and assess the issues and opportunities associated with the brass and bell metal crafts of Birbhum district and delves into extensive fieldwork to collect information from the real situation. The methodology includes library study, interaction with craftsmen, collection of information from Govt. establishments like MSME, NGOs working with this segment, statistical interpretation of data etc. Finally, the paper forwards a systematic, in-depth study on the traditional metal crafts in Birbum that actually have enough potential to boost this sector and to uplift the rural economic scenario in the district.

Routine follow-up transjugular liver biopsy in Fontan patients: technical considerations and safety of an initial case series and literature review

Routine follow-up transjugular liver biopsy in Fontan patients: technical considerations and safety of an initial case series and literature review

Ileal metastasis masquerading as Crohn’s in lobular carcinoma of the breast, years after initial treatment and review of literature

Gastrointestinal (GI) metastases masquerading as Crohn’s years after treated lobular carcinoma of breast is a diagnostic challenge. In some cases, the interval between the primary breast cancer and gastrointestinal metastasis is so long (3-20 years) that the medical records for diagnosis including history might be missed. The susceptibility of invasive lobular cancer (ILC) to metastasize to gut is many times greater than invasive ductal carcinoma (IDC) (4.5% versus 0.2%, respectively). We report the case of lobular breast carcinoma metastasizing to the terminal ileum and ileocecal junction 7 years following treatment of right sided lobular breast cancer in 60 plus-year-old women. Radiological and endoscopic findings can be difficult to distinguish from inflammatory bowel disease or from primary carcinoma of the GI tract. Histopathological and immunochemistry assessments usually help in reaching the diagnosis. A high index of suspicion and awareness regarding such presentations can help in making an accurate diagnosis and subsequent treatment planning.