Access Initiative Research Articles

Enhancing Rwanda's Global Competitiveness: Evaluating the Impact of 'Made in Rwanda' Policies on Local Manufacturing Growth and Innovation

The study aimed at Enhancing Rwanda's Global Competitiveness: Evaluating the Impact of 'Made in Rwanda' Policies on Local Manufacturing Growth and Innovation. The specific objectives of the study were: to establish the impact of ‘Made in Rwanda’ policies on the growth of local manufacturers in Kenya sectors between 2017 and 2023; and to examine the extent to which ‘Made in Rwanda’ policies have improved the competitive advantage of local manufacturers in regional and international markets. Descriptive research, a method of gathering data, was used in this study to address inquiries about the present state of the research participants. The sample size of 246 respondents was proportionally distributed across the different sectors. The main instrument that was used for data collected was a semi-structured questionnaire. Descriptive statistics was used to show trends and inferential statistics was used to anlyse the relation between the various variables with multiple regression analysis crowing the hypothesis testing. Crucially insightful results came from the regression study done to investigate the link between the 'Made in Rwanda' policies and local manufacturers' competitive advantage. Here, the regression equation could be shown as Y=2.5+0.7X1+0.5X2+ε. With an intercept (β0) at 2.5, local manufacturers' competitive advantage is expected to be 2.5 units should both independent variables equal zero. With β1=0.7, the coefficient for Growth 'Made in Rwanda' Policies shows a direct link whereby competitive advantage rises by 0.7 units for every unit increase in growth policies. With p < 0.001, this is statistically significant and indicates rather strong evidence on the favorable impact of growth policy on company competitive advantage. With β2=0.5, the coefficient Competitive Advantage "Made in Rwanda" Policies also shows that, alongside every unit increase in competitive advantage policies, each caused a 0.5 unit increase in competitive advantage of manufacturers. This is statistically significant (p = 0.01) and once more shows to be especially crucial for raising competitiveness. For local producers, the correlated independent variables explain 68 percent of the variance in competitive advantage. All things considered, 'Made in Rwanda' policies have greatly helped the local manufacturer to grow over the past few years. According to the study's findings, strategic actions including policy incentivizing, infrastructure access, and capacity-building initiatives have improved production capability and market positioning. Thanks to these policies, local producers will not only develop but also be more suited to compete against foreign players on their path into regional and worldwide markets. This rightly emphasizes the need of a constant and adequate government support as well as an ongoing assessment of these policies to guarantee they remain relevant and efficient in handling the problems encountered in the manufacturing sector Keywords: 'Made in Rwanda' policies, local manufacturers, competitive advantage, production output, employment growth, export volume, product differentiation, policy incentives, infrastructure, government support programs, trade agreements, and capacity building.

Sustainable mobility challenges – case study of the offshore center in Gdansk transport accessibility

Urban mobility planning is one of the key elements in building a sustainable future. Strategic management of urban transport traffic not only reduces congestion and minimises the negative impact on the environment but also positively affects the improvement of residents' quality of life. Furthermore, following the Corporate Sustainability Reporting Directive approved by the European Union in 2023, companies are obliged to submit annual reports on their environmental impact. One of its elements is the calculation of the organization's carbon footprint, which includes emissions caused by means of transport, including emissions from commuting to work. This case study investigates the impact of transport accessibility on employee preferences and behaviour in the context of changing the premises location, using the example of the Maritime Institute of Gdynia Maritime University (GMU), located at the newly opened Offshore Center in Gdansk seaport. The research hypothesis states that the relocation to new premises with limited transport accessibility may, as a consequence, influence the choice of commuting transportation methods among employees, potentially leading to a shift towards less sustainable means of transport. The results of the research survey prove that there is a complex interconnection between transport accessibility, commuting behaviours, and sustainable mobility initiatives. This pilot study aims to contribute to urban mobility planning by exploring how to transport accessibility influences employee behaviour and by proposing strategies to improve commuting conditions and promote more sustainable solutions.

Socio-Economic Impacts of Fruit Crop Production in the Mungo Corridor, Littoral Region, Cameroon

Purpose: Agriculture, particularly fruit crop production, serves as a vital driver of economic growth worldwide. In Cameroon, the Mungo Corridor plays a substantial role in the agricultural sector, particularly in fruit crop production. This study aims to assess the socio-economic impacts of fruit crop production within the Mungo Corridor, a region known for cultivating bananas, pineapples, and mangoes. By evaluating the economic contributions and challenges, the study seeks to provide insights for policies that could enhance the sustainability and development of fruit production in the area. The study adopted a multi-stage sampling technique to select respondents and resource persons. Materials and Methods: Data collection involved the use of structured and pre-tested questionnaires along with an interview guide. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0 and Microsoft Excel, while qualitative data from interviews was subjected to thematic analysis. Six subdivisions from the Mungo Division were purposely chosen to represent the agricultural activities within the region. Findings: The study confirms that fruit crop production has significant socio-economic benefits in the Mungo Corridor. Over a 10-year period, banana production reached 195,000 tons, while pineapple production rose from 6,543 tons in 2012 to 28,141 tons in 2022. Papaya production increased from 36 tons to 86 tons during the same period. The income from fruit sales enabled stakeholders to develop socio-economic activities, fostering regional development. Fruit crop production contributed to the construction of 12 schools (primary and secondary), 21 health centers, the rehabilitation of 8 fruit markets, 3 bus stations, and growth in the informal sector. However, the study also identified several challenges with Farmers face limited access to markets. Poor infrastructure affects production and distribution. The looming threat of climate change presents long-term risks to fruit farming. Implications to Theory, Practice and Policy: To address the challenges and ensure sustainable fruit crop production in the Mungo Corridor, the study recommends the implementation of policies that promote local products and support farmers through market access initiatives. Invest in transport, storage, and market infrastructure to improve efficiency. Develop interventions to mitigate the impact of climate change on fruit production and strengthen cooperation among farmers, government, and private actors to maximize the benefits of fruit crop production and foster sustainable development. By highlighting the essential role of fruit farming in the socio-economic development of the Mungo Corridor, the study emphasizes the need for renewed efforts to support the sector and enhance its contributions to regional growth.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology.

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization. From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization. On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR]=3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR]=4.05, 95% CI: 1.72-9.11). While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious. Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed. Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable. Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

The global and regional disease burden of breast cancer from 1980 to 2021: An analysis of GBD study 2021.

146 Background: Breast cancer (BC) is the most common malignancy in women and presents a huge disease burden worldwide. Early detection, via mammographic screening, improves outcomes significantly. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, delineating the trajectory of BC from 1980 - 2021. This analysis considers the impact of screening practices on the incidence and mortality of patients worldwide, offering comprehensive examination of trends over the past 4 decades. Methods: Data were methodically retrieved from GBD study, which included age-standardized death rates and Disability-Adjusted Life Years (DALY). Dataset was stratified globally and by continent, with further regional analysis of the African continent into Northern, Southern, Eastern, Western, and Central, and by World Bank income classifications of countries. We examined global age-standardized mortality rates (ASMR), followed by an analysis of global disability-adjusted life years (DALY). Finally, we identified which countries, stratified by income levels, demonstrate the highest rates. Analytical processing was conducted using Joinpoint regression to determine average annual percentage changes (AAPC). Results: Globally, Age Adjusted Death Rates (ASDR) continuously declined from 1980-2021. In 1980, the ASDR was 16.33 (95% UI: 15.39-17.22) and it declined continuously to 14.54 (AAPC: -0.28; 95% CI: -0.3, -0.27) in 2021. Globally, DALYs rate was 503.8 (95% UI: 475.9-532.2) per 100,000 people in 1990 and it decreased to 455.5 (AAPC: 3.22; 95% CI: -0.33, -0.30) in 2021. In geographical analysis, America and Europe had uniformly declining ASDRs while Africa and Asia had a steady rise in ASDR. From 1980 to 2021, America had decreasing death rates with an AAPC of -0.78 (95% CI: -0.80, -0.76). Europe also had a declining trend, albeit nonsignificant, with an AAPC of -0.53 (95% CI: -0.55, -0.49). Conversely, the AAPC for Asia was 0.42 (95% CI: 0.41-0.43) showing a continuous incline in deaths related to BC from 1980 to 2021. The highest increase in ASDRs was observed in Africa with an AAPC of 0.90 (95% CI: 0.89-0.91). Upon sub-analysis of Africa, we observed Western and Southern Africa had highest ASDRs compared to other parts of Africa. According to World Bank income levels, high income countries had declining death rates while upper-middle, lower-middle, and low-income countries all had increasing deaths rates with the highest rise in lower middle income countries. Conclusions: Asia and Africa have limited implementation of BC screening protocols and correspondingly exhibit higher BC associated mortality. Enhanced screening programs are imperative for the timely diagnosis and management of BC, ultimately improving survival rate. The enormous discrepancy in mortality rates underscores the critical importance of accessible and comprehensive BC screening initiatives globally.

Correction: Elementary flow mapping across life cycle inventory data systems: A case study for data interoperability under the global life cycle assessment data access (GLAD) initiative

Correction: Elementary flow mapping across life cycle inventory data systems: A case study for data interoperability under the global life cycle assessment data access (GLAD) initiative

Increasing access to biomarker-driven treatment for lung cancer in Alabama: The Alabama Access initiative.

159 Background: Lung cancer is the leading cause of cancer death in Alabama, with an estimated 2,550 deaths in 2024. Non-small cell lung cancer (NSCLC) represents 85% of these cases. Despite national guidelines recommending comprehensive biomarker testing (CBT) for metastatic NSCLC, significant disparities persist in the utilization of CBT and targeted therapies among Alabama residents. Methods: In March 2024, we launched the "Alabama Access" initiative – a partnership between the LUNGevity Foundation and the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham – to foster academic and community oncology partnerships to increase access to biomarker-driven treatments. We used a population health science and geospatial mapping approach to visualize oncology practices serving counties with Alabama's highest lung cancer burden. Practices in Walker, Dothan, Marengo, Morgan, Jackson, Marshall, and Montgomery counties were identified as the highest priority based on annual mortality rates. Key interventions will include virtual molecular tumor boards and oncology navigation to facilitate the integration of resources and expertise and ensure that patients in nonacademic practices benefit from the latest advances in precision oncology. After roll-out, we will collect feasibility and acceptability data around program integration. Results: Our analysis revealed that 62.0% of the state’s population resides in Primary Care Health Professional Shortage Areas (HPSAs), and 58 out of 67 counties are classified as Medically Underserved Areas. The poverty rate in 89.6% of counties surpasses the national average, contributing to higher lung cancer incidence and mortality rates, with 62.0% of cases diagnosed at advanced stages. The state also shows a higher smoking prevalence, affecting 97.0% of counties compared to national figures. We will present practice-level testing data, including barriers to CBT. Conclusions: This pilot aims to mitigate disparities in CBT through enhanced collaboration between academic and community oncology settings. Integrating molecular navigation into community practices will be pivotal in disseminating program information and collecting data on current testing practices to improve overall lung cancer care quality in Alabama.

DEIA: On Paper or in Practice? A Study on the Impact of Authentic and Inauthentic Diversity, Equity, Inclusion, and Accessibility (DEIA) Initiatives in Indian Organizations

This study explores the influence of Diversity, Equity, Inclusion, and Accessibility (DEIA) practices on employees, focusing on the distinction between authentic and inauthentic DEIA initiatives. Through a survey of 212 participants, the study evaluates organizational commitment, motivation, and team dynamics in workplaces with varying levels of DEIA authenticity. Results demonstrate that employees in organizations with authentic DEIA practices report significantly higher levels of organizational commitment, motivation, and positive team dynamics compared to those in inauthentic organizations. These findings underscore the importance of genuine DEIA efforts for enhancing employee experience and organizational performance. Future research should focus on the leadership's role in fostering authentic DEIA practices.

Recommendations from the ABA Commission on Youth at Risk Convening – “Renewal and Revolution: Recommitting the Legal Profession to Serve Children and Youth, their Families, and Communities”

AbstractYouth and families impacted by legal systems now resoundingly attest to the systems' lasting harm, echoed by interdisciplinary research. Lawyering thus requires a vastly renewed outlook, boldness, and honest inquiry about the limits of what the law and public systems can (and should) attempt as purported problem‐solving amidst broader socioeconomic forces and injustice. This report synthesizes recommendations from a groundswell of diverse, dedicated voices following an October 2023 convening hosted by the American Bar Association Commission on Youth at Risk, the ABA Center on Children and the Law, and Hofstra University's Maurice A. Deane School of Law. Entitled “Renewal and Revolution: Recommitting the Legal Profession to Serving Children and Youth, Their Families, and Communities,” the convening engaged various professionals—many with firsthand experience in foster and justice systems— and other advocates. Since the 2006 ABA Youth At Risk Initiative Planning Conference, the ABA Commission on Youth At Risk has elevated the representation and voice of youth through ethical practice standards, expanded access, and national initiatives. This report recounts findings of the 2023 convening's four working groups which met for two‐days of (often tense) discussions to chart a path for the legal profession, law, and policy for the next decade and beyond. Priorities include: transcending conceptions of youth “at risk” towards recognition of harms done, a strengths‐based lens, and lived experience leadership and expertise; cultivating next generation attorneys; prioritizing early family defense and diversion; divesting from systems and re‐investing directly with youth and families; and further eliminating racial disparities.

A Scoping Review of Factors Affecting COVID-19 Vaccination Uptake and Deployment in Global Healthcare Systems.

Introduction: COVID-19 vaccines were rapidly developed and deployed on a large scale during a global crisis. A range of deployment strategies were used globally to maximize vaccine uptake. In this scoping review, we identify and analyze the main healthcare system and policy factors that guided and influenced COVID-19 vaccination deployment and uptake globally. Materials and Methods: JBI guidelines, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the population, concept, and context (PCC) framework were applied. Studies on individual COVID-19 vaccination factors, such as vaccine hesitancy, were excluded. The search was last conducted in May 2024 yielding 26,686 articles from PubMed, Embase, CINAHL, Scopus, and COVID-19 websites. A total of 47 articles and 3 guidance documents were included. The results of the thematic analysis were mapped to the Consolidated Framework for Implementation Research (CFIR). Results: The results found the following healthcare system and policy factors as integral to COVID-19 vaccination: types of vaccine products, healthcare workforce capacity, procurement strategies, distribution and cold-chain capacity, partnership, coordination, and leadership, information, communication, and registration strategies, delivery models, organizations, the existing health systems and policies on prioritization of at-risk groups and deployment plans. Discussion: Globally, COVID-19 vaccination programs responded to the pandemic by leveraging and reforming the existing healthcare systems, relying on strong leadership and global cooperation (such as the COVID-19 Vaccines Global Access Initiative). Deployment was enabled by effective communication and adoption of innovative technologies using data-driven policies to create high vaccine demand while overcoming limited vaccine supply and rapidly adapting to uncertainties.

THE IMPACT OF HAIR LOSS IN CAMBODIA: CAUSES, PREVENTION METHODS, AND TREATMENT SOLUTIONS

Hair loss is a significant global problem, affecting individuals' quality of life physically and psychologically. In Cambodia, this issue remains understudied despite genetic, environmental, and lifestyle factors contributing to its prevalence. This research investigates hair loss prevention and treatment in Cambodia aiming to develop a comprehensive strategy tailored to the local population. The study evaluates pharmaceutical interventions, such as Minoxidil and Finasteride, surgical options, including Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE), along with natural remedies and lifestyle modifications. Methodology involves an extensive literature review, surveys, and clinical trials with a diverse sample from across Cambodia. Advanced data analysis assesses the effectiveness and side effects of different treatments, while qualitative methods, including interviews and focus groups, explore the psychological impact of hair loss and support systems available. Results indicate that a combined approach—integrating medical treatments, natural remedies, dietary guidance, and stress management—achieves the best outcomes in hair regrowth and patient satisfaction. The research highlights the need for accessible public health initiatives, such as educational campaigns and financial aid, to ensure broad community benefits. In conclusion, a multifaceted strategy combining medical interventions, lifestyle changes, and robust public health policies is advocated. This holistic approach effectively addresses both physical and psychological aspects of hair loss, providing a tailored solution for the Cambodian population.

Proceedings of the 2024 Third Annual ASTCT-NMDP ACCESS Initiative Workshop

The Third Annual Workshop of the American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative occurred on July 23 and 24, 2024. Content from the workshop is provided to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting are reviewed, including the inaugural Corporate Roundtable and Advocacy Day, new partnerships with non-profit organizations, and updates on projects from the Awareness, Poverty and Race and Ethnicity Inequity Committees. In addition, the Junior Faculty and Trainee Immersion Program-sponsored efforts in workforce diversity and physician advocacy are also presented. Lastly, continued education was provided on patient and caregiver participation as well as community engagement. As it enters its third year, the ASTCT-NMDP ACCESS Initiative will transition from foundation-building as a grass roots collaborative to intentional impact in reducing barriers and improving outcome disparities for all patients in need of HCT/CT. Enthusiasm for and participation in the ACCESS Initiative remain high and both are needed to sustain progress in achieving its goal in enabling all patients in need to receive HCT/CT.

Oral Health in Tanzania: Unmasking Its Neglected Dimension

ABSTRACTThe World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub‐Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.

Dehumanizing air travel: a scoping review on accessibility and inclusion of people with disabilities in international airports.

Worldwide, one in six individuals live with a disability. Many people continue to experience disabling situations, particularly when travelling. Travel can be an important part of the lives of many people, including people with disabilities. Barriers to accessing air travel can lead to a reluctance to travel for these potential passengers. As early as the flight planning stage, options to facilitate accessibility are limited. At airports, passengers must travel long distances in areas where navigation is complex, and accessibility limited. Furthermore, few aircraft are accessible. The travel experience can have adverse effects on the health of people with disabilities. Practices are sometimes not inclusive, not always available, and may not address the full spectrum of possible needs. The objective of this study is to provide a state of art on accessibility features available to people with disabilities in the busiest international airports. A scoping review of practices in airport accessibility was done. A search strategy was deployed in 4 databases (Avery index to architectural periodicals, Medline, CINAHL, and Web of science). The official websites of the 35 busiest airports were exhaustively consulted. All information regarding accessibility measures and inclusive services were extracted. 31 scientific articles, out of 3,640 screened, and all extracted data from airports' website were considered for synthesis. While efforts are made in major airports, there is a great inconsistency in accessibility features. Both facilitators and challenges are encountered by people with disabilities at every stage of air travel. These stages include journey planning; getting to and from the airport, obtain human assistance, navigate in the premises, check in, security screening, using facilities, boarding and disembarking, customs and immigration procedures, and luggage management. Services need to be extensively planned, placing a significant burden on passengers. The disability-centric perspective disregard passengers' unique needs and capabilities, leading to a sense of dehumanization. The complexity of airport organizations, shared responsibilities, limited communication, training challenges can deter accessibility initiatives and create discomfort during travel. This study is the first step of a broader project supported by Canadian Accessibility Standards, focusing on enhancing inclusive accessibility in Canadian airports.

Web accessibility and CMS. Moodle as case study

<p>The advance of ICT can be appreciated in a range of synchronous and asynchronous tools for communication that facilitate the interaction without spatio-temporal restrictions. The Web Accessibility Initiative defines guidelines to let people with disabilities access ICT. The article presents the method and the results obtained from web accessibility evaluation applied to Moodle CMS, using guidelines WCAG 2.0. The results of this study provided data to guide further research and development focused on test processes on web accessibility using specific tools, in order to improved user´s experience.</p>

Innovations in Aquaculture Technology and Market Access in Sub-Saharan Africa

Aquaculture refers to the farming of aquatic organisms such as fish, shellfish, and plants in controlled environments, addressing global demands for seafood while supplementing natural fish stocks and supporting food security initiatives worldwide. Aquaculture in Sub-Saharan Africa is pivotal for addressing food security challenges and fostering economic growth amidst a rapidly growing population. This article reviews the transformative role of technological innovations, sustainable practices, and market access strategies in advancing aquaculture across the region. Technological advancements such as recirculating aquaculture systems (RAS) and improved breeding techniques are enhancing productivity and sustainability. Sustainable practices like integrated multitrophic aquaculture (IMTA) promote resource efficiency and environmental integrity. Market access initiatives, including infrastructure development and value chain innovations, are critical for connecting small-scale producers with markets and improving economic returns. The methodology employed in writing this review article involved synthesizing recent literature on aquaculture innovations, sustainability practices, and market dynamics in Sub-Saharan Africa, drawing from peer-reviewed sources and recent publications to present a comprehensive overview of the subject matter. By embracing these innovations and practices, Sub-Saharan Africa can strengthen food security, support economic development, and promote sustainable aquaculture while conserving natural resources. Keywords: Aquaculture, Sub-Saharan Africa, Technological innovations, Sustainable practices, Market access.

The Student Empowerment through Narrative, Storytelling, Engagement, and Identity Framework for Student and Community Empowerment: A Culturally Affirming Pedagogy

For people from communities experiencing poverty and oppression, education, particularly higher education, is a means to ensure upward socioeconomic mobility. The access to and attainment of education are issues of social and economic justice, built upon foundational experiences in primary and secondary settings, and impacted by students’ cultural and socio-political environments. 6. The 2020 murder of George Floyd, the Black Lives Matter movement, ongoing discourse around immigration, and COVID-19-related hate targeting people of Asian American descent prompted national calls to dismantle social and systemic racism, spurring diversity, equity, inclusion, and accessibility (DEIA) initiatives, particularly in education. However, these efforts have faced opposition from teachers who have told students that all lives matter, and racism does not exist in many American classrooms Loza. These comments negate students’ experiences, suppress cultural and identity affirmation, and negatively impact student wellness and academic performance. Forged in this polarized environment, two longtime community organizers and educators, an indigenous person living away from her ancestral lands and a multiracial descendant of Japanese Americans interned during WWII, whose identities, experiences, and personal narratives shape the course of their work in and outside of the physical classroom, call on fellow educators to exercise y (2018) component of the archeology of self, a “profound love, a deep, ethical commitment to caring for the communities where one works”, by adopting a framework to encourage this profound love in students, acting not just as a teacher, but as a sensei. The word sensei is commonly understood in reference to a teacher of Japanese martial arts. The honorific sensei, however, in kanji means one who comes before, implying intergenerational connection. Sensei is an umbrella expression used for elders who have attained a level of mastery within their respective crafts—doctors, teachers, politicians, and spiritual leaders may all earn the title of sensei. The sensei preserves funds of knowledge across generations, passing down and building upon knowledge from those who came before. The Student Empowerment through Narrative, Storytelling, Engagement, and Identity (SENSEI) framework provides an asset-based, culturally affirming approach to working with students in and beyond the classroom. The framework builds on tools and perspectives, including Asset-based Community Development (ABCD), the Narrative Theory, Yosso’s cultural community wealth, cultural continuity, thrivance, community organizing tenets, and storytelling SENSEI provides a pedagogy that encourages students to explore, define, and own their identities and experiences and grow funds of knowledge, empowering them to transform their own communities from within. The SENSEI framework begins by redefining a teacher as not simply one who teaches in a classroom but rather one who teaches valuable life lessons that transcend colonial conceptualizations of the teacher. In colonized contexts, teachers function to maintain hegemony and assert dominance over marginalized populations. In the SENSEI framework, teachers are those who disrupt colonial patterns and function to reclaim the strengths and voices of the communities they serve. In the SENSEI framework, students are not relegated to those enrolled in classrooms. As with a sensei, a student exists to counter hegemony by embracing and enacting their cultural wealth Educators must help counter harmful narratives and encourage students to identify the strengths that lie within themselves and their communities. Collective forms of narrative that value identity can ensure the continuity of a community or a people. The stories of students’ histories, traditional practices, and resilience can help disrupt harms, many that have lasted for generations, so they may not just survive, but thrive.

550 Implementation of Inclusive Initiatives at a Grassroot Level to Ensure Long-Term Equality, Diversity, and Inclusivity in Surgery

Abstract Aim Promoting equality, diversity and inclusion in surgery begins at ensuring accessible initiatives are executed at a grassroot level for prospective students. The Royal College of Surgeons illustrated that 20% of their surgical leadership positions were from BAME communities. SGUL MedEd Society aims to support students from widening participation (WP) backgrounds in their medical application by addressing disparities and providing support within these areas. Method We conducted free sessions aimed at different aspects of the medicine application with the intention of facilitating understanding and support for WP students. Multiple domains were covered such as a UCAT webinar, an ‘Experience into medicine’ simulated workshop covering the key learning styles employed in university as well as multiple mini-interview (MMI) preparation through an online webinar and in-person mock. Feedback forms were implemented before and after sessions using 5-Point Likert scales to measure changes in confidence. Results An increase in confidence applying to medical school was observed in the ‘Experience into medicine’ workshop (n=25) with a 60% rise in students rating 4/5. Statistical analysis was carried out on the results obtained from the MMI webinar (n=169) using the Wilcoxon signed-rank test which suggested the initiative significantly improved students’ confidence (w=14, a=0.005). This was followed by a practice MMI session (n=68) whereby 50% of students reported feeling more prepared for a real MMI. Conclusions These results suggest there is a substantial improvement in confidence in WP students after the event, increasing the likelihood of inclusivity in medicine. This has wider implications in supporting applications into surgery in the future.

Initiation of Buprenorphine in the Emergency Department: A Survey of Emergency Clinicians.

Initiation of buprenorphine for opioid use disorder (OUD) in the emergency department (ED) is supported by the American College of Emergency Physicians and is shown to be beneficial. This practice, however, is largely underutilized. To assess emergency clinicians' attitudes and readiness to initiate buprenorphine in the ED we conducted a cross-sectional, electronic survey of clinicians (attendings, residents, and non-physician clinicians) in a single, academic ED of a tertiary-care hospital, which serves a rural population. Our survey aimed to assess emergency clinicians' attitudes toward and readiness to initiate buprenorphine in the ED and identify clinician-perceived facilitators and barriers. Our survey took place after the initiation of the IMPACT (Initiation of Medication, Peer Access, and Connection to Treatment) project. Our results demonstrated the level of agreement that buprenorphine prescribing is within the emergency clinician's scope of practice was inversely correlated to average years in practice (R2 = 0.93). X-waivered clinicians indicated feeling more prepared to administer buprenorphine in the ED R2 = 0.93. However, they were not more likely to report ordering buprenorphine or naloxone in the ED within the prior three months. Those who reported having a family member or close friend with substance use disorder (SUD) were not more likely to agree buprenorphine initiation is within the clinician's scope of practice (P = 0.91), nor were they more likely to obtain an X-waiver (P = 0.58) or report ordering buprenorphine or naloxone for patients in the ED within the prior three months (P = 0.65, P = 0.77). Clinicians identified availability of pharmacists, inpatient/outpatient referral resources, and support staff (peer recovery support specialists and care managers) as primary facilitators to buprenorphine initiation. Inability to ensure follow-up, lack of knowledge of available resources, and insufficient education/preparedness were primary barriers to ED buprenorphine initiation. Eighty-three percent of clinicians indicated they would be interested in additional education regarding OUD treatment. Our data suggests that newer generations of emergency clinicians may have less hesitancy initiating buprenorphine in the ED. In time, this could mean increased access to treatment for patients with OUD. Understanding clinician-perceived facilitators and barriers to buprenorphine initiation allows for better resource allocation. Clinicians would likely further benefit from additional education regarding medications for opioid use disorder (MOUD), available resources, and follow-up statistics.

Promoting healthy food access initiatives in urban areas of the USA: Strategies to address food insecurity and improve nutritional health

This concept paper proposes initiatives to promote healthy food access in urban areas of the USA, addressing food insecurity and improving nutritional health. By implementing strategies such as community gardens, farmers' markets, and incentives for grocery stores, this paper aims to create sustainable solutions to improve food access and health outcomes in urban communities. Access to healthy food is a critical determinant of health, yet many urban areas in the USA face challenges related to food insecurity and limited access to nutritious foods. This concept paper explores strategies to promote healthy food access initiatives in urban areas of the USA, with a focus on addressing food insecurity and improving nutritional health. The paper discusses the current state of food insecurity and its impact on health outcomes in urban areas, highlighting the need for targeted interventions to improve access to healthy foods. It then examines various strategies that have been successful in promoting healthy food access, including community gardens, farmers' markets, and mobile food markets. Key components of successful healthy food access initiatives, such as community engagement, policy advocacy, and partnerships with local organizations, are discussed. The paper also explores the role of technology, such as online grocery delivery services, in improving access to healthy foods in urban areas. Through a comprehensive analysis, this concept paper aims to provide insights into effective strategies for promoting healthy food access in urban areas of the USA. By implementing these strategies, policymakers, healthcare providers, and community organizations can work together to address food insecurity and improve nutritional health in urban communities. Keywords: Healthy Food, Insecurity, USA.