Key Areas For Improvement Research Articles

Towards a 2025 National Ocean Literacy Strategy: Current Status and Future Needs in Primary Education

Globally, ocean health has become critically compromised due to compounding negative human impacts. Marine science education can play a key role in raising collective understanding of the vulnerability of marine environments and the importance of their protection, and this may best begin with integration of ocean literacy in schools. Previous research shows that K-12 students worldwide have a limited understanding of the ocean. This lack of familiarity with the ocean has been linked to the absence of topics related to marine science in most national school curricula. Teachers are the ultimate arbiters deciding whether and how to include these topics in their classes. However, the extent to which marine science may be currently being taught in formal education is still unknown. We used the Australian public school system as a case study to investigate the marine science teaching practices of primary school teachers (Foundation – Grade 6), through an online survey. Our results indicate that while teachers value the importance of ocean education from a young age, most of them rarely or only occasionally cover marine science topics in their lessons. Teachers cited increased levels of marine science knowledge and a greater availability of ocean-related educational resources linked to the school curriculum as key areas for improvement in ocean education practices. This study highlights the importance of formal marine science education in primary education, along with the need for professional development opportunities for teachers.

"No one size fits all" A Multi-Method Survey of Oncology Allied Health Professionals Experiences with Lesbian, Gay, Bisexual, Transgender/Queer Questioning Adolescent, and Young Adult Patients with Cancer and Reproductive and Sexual Health".

Objectives: To assess training needs for providers who care for adolescent and young adult (AYA) lesbian, gay, bisexual, transgender/queer questioning (LGBTQ) cancer patients, we conducted a mixed-method survey. During their cancer care experience, AYA cancer patients experience physical, psychosocial, and reproductive health challenges. In addition to these challenges, AYA LGBTQ individuals are a diverse and medically underserved population who experience unique challenges and disparities in medical care. Methods: Health care providers (n = 351) who participated in our reproductive health in cancer training program completed a survey with 28 quantitative items and 4 open-ended items assessing knowledge, confidence discussing reproductive health, and confidence in knowledge specific to reproductive needs and general health needs among AYA LGBTQ patients. Results: Confidence discussing and confidence in knowledge of reproductive and general health needs are lower regarding transgender and nonbinary patients. Nearly half of providers (45%) demonstrated low knowledge, while 38% and 17% demonstrated moderate and high knowledge, respectively. Open comments indicated providers desired more training around the needs of Trans and nonbinary patients, and creating welcoming environments. Conclusions: The majority of our participants demonstrate low or moderate knowledge regarding factors that can influence AYA LGBTQ patient care, suggesting that this is a key area for improvement. Furthermore, improving provider knowledge may subsequently improve confidence in general and reproductive needs of LGBTQ patients, resulting in improved patient-centered care. Improving provider knowledge and confidence may then ultimately help reduce disparities in cancer care among this patient population.

Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

BackgroundRheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia.MethodsData was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems.ResultsThe outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities.ConclusionThe prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the “Awareness Surveillance Advocacy Prevention” framework supported by relevant resolutions by the WHO.

The Effect of UV-C Irradiation on the Mechanical and Physiological Properties of Potato Tuber and Different Products

Amongst the surface treatment technologies to emerge in the last few decades, UV-C radiation surface treatment is widely used in food process industries for the purpose of shelf life elongation, bacterial inactivation, and stimulation. However, the short wave application is highly dose-dependent and induces different properties of the product during exposure. Mechanical properties of the agricultural products and their derivatives represent the key indicator of acceptability by the end-user. This paper surveys the recent findings of the influence of UV-C on the stress response and physiological change concerning the mechanical and textural properties of miscellaneous agricultural products with a specific focus on a potato tuber. This paper also reviewed the hormetic effect of UV-C triggered at a different classification of doses studied so far on the amount of phenolic content, antioxidants, and other chemicals responsible for the stimulation process. The combined technologies with UV-C for product quality improvement are also highlighted. The review work draws the current challenges as well as future perspectives. Moreover, a way forward in the key areas of improvement of UV-C treatment technologies is suggested that can induce a favorable stress, enabling the product to achieve self-defense mechanisms against wound, impact, and mechanical damage.

Individualized Out-of-Pocket Price Estimators for “Shoppable” Surgical Procedures: A Nationwide Cross-Sectional Study of US Hospitals

Price transparency for shoppable surgical services is a key requirement of several recent federal policies, yet the extent to which hospitals provide online OOP price estimators remains unknown. We reviewed a stratified random sample of 485 U.S. hospitals for the presence of a tool to allow patients to estimate individualized OOP expenses for healthcare services. We compared characteristics of hospitals that did and did not offer online price estimators and performed multivariable modeling to identify facility-level predictors of hospitals offering price estimator with and without surgical procedures. Nearly two-thirds (66.0%) of hospitals in the final sample (95% confidence interval 61.6%-70.1%) offered an online tool for estimating OOP healthcare expenses. Approximately 58.5% of hospitals included at least one shoppable surgical procedure while around 6.6% of hospitals included all 14 surgical procedures. The most common price reported was laparoscopic cholecystectomy (55.1%), and the least common was recurrent cataract removal (20.0%). Inclusion of surgical procedures varied by total annual surgical volume and health system membership. Only 26.9% of estimators explicitly included professional fees. Our findings highlight an ongoing progress in price transparency, as well as key areas for improvement in future policies to help patients make more financially informed decisions about their surgical care.

A Quality Improvement Project to Improve Experiences of Audio Quality for Remote Attendees of a Ward Round at a London Acute Adult Mixed Psychiatric Inpatient Ward

AimsWe sought to assess the degree, nature and impact of poor audio quality during ward rounds for individuals attending remotely using Microsoft Teams. We aimed to evaluate attendee experiences of audio quality against our expectation that due to the existing ward microphone system using a cardioid polar pickup pattern that attendees would have difficulty hearing all members of the multidisciplinary team, as well as the patient, gathered in the conference room. We also hypothesised that after switching to an omnidirectional sound recording system, we would observe an improvement in attendee satisfaction with audio quality during ward rounds.MethodsIndividuals who had remotely attended ward rounds at Lesney Ward, Oxleas NHS Trust between 01/11/21 and 01/01/22, mainly patient family members and community care co-ordinators, completed a digital feedback questionnaire regarding audio quality. There was no exclusion criteria. Data from Likert scale questions were analysed with descriptive statistical tests (mode and distribution of responses). As minimal demographic data were obtained, inferential statistical tests were not used. Qualitative data were analysed using thematic sorting based on prevalence of themes in the data.ResultsFeedback was provided by three family members, one ward team member and six members of the community mental health team prior to the intervention. Pre-intervention feedback indicated high levels of dissatisfaction with 6/10 respondents reporting they were “dissatisfied” and 1/10 “very dissatisfied”. Only 3/10 of attendees reported being able to hear and understand all individuals physically present in the room. In addition, respondents agreed that the audio quality was poor (modal response “bad”, 6/10), and that the sound quality impacted upon their experience of the ward round (modal response “yes, greatly”, 6/10).The three most common main issues reported by respondents were: people speaking too far from the microphone (7/10), voices sounding muffled (6/10), and too much background noise (4/10). Using their own words, respondents described how the ward round sound quality made them feel. Common themes identified through thematic sorting included: distress, difficulty in understanding information / management plan, ward round prolongation and inability to comprehend the patient or staff.ConclusionIn conclusion, we found that when using an in-built laptop microphone with unidirectional pick-up remote ward round attendee satisfaction was poor, though this improved with the introduction of an omnidirectional system. Key areas for improvement include assessment of optimal positioning for adequate audio pick-up, and the introduction of automatic transcription for individuals with hearing impairments.

Transitioning of the Northwest Learning Disability (NWLD) Academic Regional Teaching Forum (HEE-NW) to a Virtual Programme With Enhancement of Medical Education for Trainees, Trainers and MDT Professionals During the COVID-19 Pandemic- a Quality Improvement Project - QIP Project Lead &amp; Organiser -NWLD - Dr Syeda Hasan- Northwest HEE

AimsDespite the challenges posed by the pandemic, several resourceful initiatives were implemented, across the educational landscape. As the lead organiser of the academic forum the expectation was to develop a format for on-line monthly academic teachings with streamlining further innovative ideas of change to best effect. The key objective of this QIP,is to use virtual platform to establish an educational forum that is efficient, safe, reliable, easy to use and replicableMethods•A zoom based online forum was convened using QI framework to identify gaps in the programme along with new ideas of change.•The attendees experience new innovative practices within the programme format, in line with the original NWLD forum programme.•A ‘think-group’ consisting of the previous NWLD forum lead, ID training programme director and higher trainee facilitators proposed ideas towards a varied educational topic bank, in line with the ID curriculum•Qualitative feedback from the forum members collected at baseline and regular intervals.•As part of the implementation of these actions, conducted workshops evaluating the impact of COVID-19 on Educational, Psychological and Clinical landscapeResults•There were 18 virtual sessions,5 CPD hours per session, conducted monthly.•9 sessions in the first PDSA cycle from June 2020 - Feb 2021, and 9 sessions in the second PDSA from March 2021-November 2021.•Impact of COVID-19 workshops &amp; Complex case management workshops conducted in the first and second PDSA cycle as part of the monthly academic programme.•Participants for the academic regional teaching included Consultant Psychiatrist, higher trainees, Core trainees, Foundation doctor, specialty doctors, Medical Students and MDT professionals.•New members regionally, nationally and internationally became part of the academic programme both as attendees and as speakers along with the Chair of the ID Faculty.•The academic programme helped with educational and training needs. It helped in improving social participation for our members during COVID-19 pandemic.•Qualitative feedback has been collated and analysed. The feedback contains a wealth of comprehensive information that has been used to enhance the programme and training needs for the trainees and trainers.Conclusion•The program is well-received and led to knowledge, skill, and attitude improvements.•The depth analysis of the feedback has facilitated a targeted approach that has brought a meaningful improvement, in the quality of training and education.•Audience participation and engagement remains a key area for improvement.

Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic.

BackgroundHealthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor to the spread of the 2020 pandemic. Timely review of HCA cases is essential to identify learning to inform infection prevention and control (IPC) policies and organisational response.AimTo identify key areas for improvement through rapid investigation of HCA SARS-CoV-2 cases and to implement change.MethodsCases were identified based on date of first positive SARS-CoV-2 PCR sample in relation to date of hospital admission. Cases were reviewed using a structured gap analysis tool to identify key learning points. These were discussed in weekly multidisciplinary meetings to gain consensus on learning outcomes, level of harm incurred by the patient and required actions. Learning was then promptly fed back to individual teams and the organisation.FindingsOf the 489 SARS-CoV-2 cases admitted between 10th March and 23rd June 2020, 114 suspected HCA cases (23.3%) were reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were identified: individual patient vulnerability, communication, IPC implementation, policy issues and organisational response. Adaptations to policies based on these reviews were completed within the course of the initial phase of the pandemic.ConclusionThis approach enabled timely learning and implementation of control measures and policy development.

Global online interest in cervical cancer care in the time of COVID-19: An infodemiology study

IntroductionInternet search trends may gauge public awareness and interest in cancer and help identify key areas for improvement in public health interventions and awareness campaigns. During the COVID-19 pandemic, cervical cancer screening significantly decreased, and we hypothesized that this would be mirrored by a decreased online interest in cervical cancer care. MethodsUsing the Google Trends database, we analyzed 2018–2021 global search trends in the following topics: cervical cancer, human papillomavirus, HPV vaccine, Cervarix, Gardasil, Pap test, HPV test, and colposcopy. Search trends were reported in the unit search volume index (SVI), which correlated with country-specific socioeconomic and epidemiologic characteristics. ResultsWe found a sharp decline in global online search interest in cervical cancer following the declaration of the COVID-19 pandemic, after which interest gradually increased. During the pandemic, SVI for “cervical cancer” and “Pap test” significantly decreased, while SVI for “HPV vaccine” significantly increased. Higher online search interest in cervical cancer care was found in low- and middle-income countries, and countries in Latin America and the Caribbean, Asia, and Europe, reflecting their burden of disease and recent developments in cervical cancer control. ConclusionWhen the COVID-19 pandemic was declared, global online search interest in cervical cancer care decreased, reflective of the significant decline in cervical cancer screening rates during this time. Country-specific socioeconomic and epidemiologic characteristics correlated with online search interest in cervical cancer care. These global online search trends in cervical cancer may guide future public health interventions and awareness campaigns to eradicate this preventable disease worldwide.

Multidisciplinary Care and Prognosis in Patients With COPD and Interstitial Lung Disease Prescribed Long-Term Oxygen Therapy.

Home oxygen therapy is prescribed for patients with advanced lung disease based on the criteria established in landmark trials in subjects with COPD. In clinical practice, its use has been extrapolated to other diseases, including interstitial lung disease (ILD). Patients with COPD and ILD experience a high symptom burden and require access to specialized multidisciplinary care. We aimed to evaluate the health-related outcomes and supportive care needs of patients with COPD and ILD receiving home oxygen therapy. This was a retrospective cohort study using the oxygen database of a quaternary metropolitan teaching hospital. Patients with a diagnosis of COPD or ILD who were prescribed home oxygen therapy between January 2012-December 2018 were identified. Demographic information, results of physiologic testing, comorbidities, hospitalizations, and mortality data were collected. Three hundred and eighty-four subjects were included for analysis, of whom 56% were male. The median age was 75 y. The majority (59%) had a diagnosis of COPD. Long-term oxygen therapy (LTOT) was prescribed for 187 (48.7%), with no significant demographic differences between those with COPD or ILD. Another 187 were prescribed ambulatory oxygen alone, with 55 transitioning to LTOT during the study period. Most subjects (65.4%) were referred for pulmonary rehabilitation; however, palliative care referrals were generally low (22.9%). Referrals to other medical specialties and allied health were common (82%). Transplant-free survival after commencement of LTOT was poor, with 38% of subjects surviving at 5 y. The 5-y survival of subjects with ILD after commencing on LTOT was 10% compared to 52% for those with COPD. Multivariable Cox regression analyses showed that the only predictor of survival after commencing LTOT was the principal respiratory diagnosis. This study found that subjects prescribed LTOT had poor transplant-free survival after initiation, which was significantly worse for those with ILD compared to those with COPD. Despite their poor overall survival, worse than many cancers, only a minority were referred for palliative care input. Referrals to pulmonary rehabilitation were also suboptimal. This patient population had complex care needs requiring multidisciplinary management. Appropriate and early referrals to palliative care and improved care coordination for this complex group of patients are key areas for improvement in clinical practice.

Experiences of women who gave birth during the pandemic

The Care Quality Commission surveyed women who had gone through pregnancy and birth during the national lockdown in 2021. Dave Hancock looks at some positive results and key areas for improvement in maternity care

Investigating Interdependencies Between Key Features of Lessons Learned: An Integral Approach for Knowledge Sharing

While there is a clear consensus in the literature on the need to share lessons learned, it remains unclear how to properly do so. This paper addresses this point and offers insight into how best to incorporate tacitly held social preferences for developing knowledge-sharing strategies. A descriptive survey was conducted to analyse the knowledge sharing practices for lessons learned within the railway sector. Eight variables are investigated that are derived from the four LEAF features: learnability, embraceability, applicability, and findability. This study revealed that for learnability, storytelling and discussion with colleagues are preferred ways to share personal experiences. Trust and the creation of a learning culture emerged as key aspects of embraceability. With regard to applicability, a process-related knowledge-sharing focus for intraorganisational and a content-related focus for interorganisational knowledge domains are preferred. Better technological findability is identified as a key area of improvement. Finally, novel dependencies are established using the chi-square test between key LEAF features.

Validation of Psychometric Properties of the Nursing Work Index—Revised Scale in Portugal

The use of instruments designed to assess the nursing practice environment is crucial to improve the quality of nursing care, to anticipate problems and difficulties that may arise in organizations, and allow nurse managers to implement changes and improvements in key areas. In this study, we aimed to evaluate the psychometric properties of the Nursing Work Index—Revised Portuguese version (NWI-R-PT) scale. A quantitative, observational, descriptive, and cross-sectional study was conducted. Methods: The sample consisted of 767 nurses from 4 public Portuguese hospitals. Exploratory and confirmatory factor analysis techniques were used to test the distinct structural models. The scale’s accuracy was evaluated through internal consistency, using Cronbach’s alpha. Results: NWI-R-PT internal consistency was 0.91. The NWI-R-PT model with six factors, namely “Management Support,” “Professional Development,” “Fundamentals of Nursing,” “Nurse–Physician Relationship,” “Endowments,” and “Organization of Nursing Care,” was supported by exploratory and confirmatory factor analysis. The NWI-R-PT scale presents adequate goodness-of-fit indices concerning the final factorial model and the convergent validity. Conclusions: The NWI-R-PT scale has a competent and reliable structure. The scale’s validity is confirmed; therefore, it may be employed in all contexts in clinical practice, research, and nursing management. The NWI-R-PT is a useful and valid instrument to assess the nursing environment in hospitals, primary care, long-term care, and nursing homes. The scale has significance in improving the quality of nursing care and patient safety, the professional development of nurses, and organizational results.

Strategic human resource practices and new product development performance: the mediating role of intellectual capital

PurposeThe paper investigates the effects of strategic human resource practices on intellectual capital and new product development performance in knowledge-based firms.Design/methodology/approachA quantitative approach was adopted to conduct the present study. The respondents were sampled from knowledge-based firms in Iran. Overall, 120 managers in 60 knowledge-based firms were selected using convenience sampling. A confirmatory factor analysis was conducted to ascertain the validity and reliability of the observed items, and a structural equation model was employed for testing the proposed hypotheses.FindingsIn the studied firms, strategic human resource practices have a positive and significant effect on intellectual capital. Moreover, the findings of this study indicate that those firms that use their intellectual capital have a higher new product development performance.Research limitations/implicationsThe study focuses on knowledge-based firms in Iran, which limits the generalizability of the research results. Therefore, future studies should be carried out with samples from other settings and countries. Moreover, as the study was cross-sectional, the causal relationships could not be inferred directly.Practical implicationsWith regard to key areas of improvement identified in this study, knowledge-based firms should focus on increasing new product development performance by improving employees' training, involving them in their job-related decision-making process, empowering employees to innovate, developing intellectual capital and monitoring the customer's satisfaction level of new products.Originality/valueThe study extends the intellectual capital literature by linking strategic human resource practices to new product development performance in knowledge-based firms via intellectual capital as a mediator.

545 “After The Fire: Legacy of A College Dormitory Fire Twenty Years Later"

IntroductionIn January 2000 fire erupted at a local college. Panicked students, many who failed to attend school-sponsored fire drills or simply ignored alarms, found themselves scrambling to escape. Seven students were admitted to a burn center (BC) for critical burns, with 54 initially staged in the Medical Center Emergency Department. While this dormitory fire took place more than twenty years ago, its legacy is still being felt today.MethodsHistory shows that, with any tragedy, there are lessons to be learned to lessen the impact on property destruction, injury or death. Looking at the legacy of this fire, four key areas of improvement emerged: disaster preparedness, media relations, legislation and fire prevention.ResultsChanges to disaster preparedness include an expanded, more comprehensive response plan, revised triage and transfer protocols, BC staffing protocols, creation of a regional group of BCs, which eventually morphed into a Disaster Consortium, and a medical command center for regional disaster response. A series of articles resulted in a Pulitzer Prize-finalist book, documenting the journey of two of the survivors, with award-winning photographs displayed at a national museum. Redesigned fire safety programs emphasizing escape plans and the dangers of false alarms now targets high school and college students, an often overlooked group, and clinical education programs have expanded to include nursing’s role in disasters, reinforced with a functional exercise. Two survivors are motivational speakers, continuing to share their personal story on campuses across the United States. New legislation mandated sprinkler installation in dormitories nationwide, and a non-profit foundation was formed to improve burn care. The anniversary of this fire is commemorated annually on campus to serve as a powerful reminder for new generations of students.ConclusionsDespite this dormitory fire being ranked as the deadliest in state history, all these years later the legacy of this landmark event remains one of triumph and resilience, as its impact is still evident today. These lessons serve as the foundation for improved disaster response, locally, regionally and nationally.

Accuracy of germ cell tumor histological subtype and stage within the Canadian cancer registry.

411 Background: Cancer registries are the mainstay for Canadian population-based cancer statistics and research. Data is collected in provincial and territorial registries including the Nova Scotia Cancer Registry (NSCR). The goal of this study was to determine the accuracy of the NSCR data regarding the diagnosis, primary site, histological subtype, and stage of germ cell tumors (GCT) when compared to the individual pathology reports and staging investigations from the chart. Methods: This analysis included all NSCR patients diagnosed with GCT from 2006-2015. From the NSCR, the date and method of diagnosis, primary site, histology, and stage were recorded. This data was also extracted from each patient’s chart record. Any discrepancies between the two sources were reviewed and reasons behind the discrepancies were recorded. Results: 239 unique patients were identified in the NSCR during the specified time period. Ten were excluded as no chart records were available to confirm accuracy. 229 patients make up the study cohort. Using NSCR data 57.6% had seminoma, 34.5% nonseminoma (NSGCT), and 7.9% other. Discrepancies in pathology were noted in 29 patients (12.7%) for a number of reasons including no appropriate coding option in the NSCR, multiple tumors, biopsy only specimens with misinterpretation of tumor marker elevation, and true coding error. Using NSCR staging data (available in 185 cases) 71.9% had stage I, 12.4% stage II, 11.9% stage III, and 3.8% other. Discrepancies in stage were noted in 33 patients (17.9%) with NSCR data downstaging 10 patients (5.4%) and upstaging 19 patients (10.3%) predominantly due to miscoding patients as stage IS. The site of the primary GCT was discrepant in 12 patients (5.2%) due primarily to difficulty coding post chemotherapy orchiectomy specimens and burnt out primary testicular lesions. The date of diagnosis was accurate within 1 week for all patients except one which differed by several months. Conclusions: Canadian cancer registry data is population based and used for many purposes including policy decisions and research. The NSCR higher level data such as date of diagnosis and overall pathological diagnosis appears relatively accurate. However, there are inaccuracies in more detailed information like histological subtype and stage. This study raises awareness of these gaps. It also highlights key areas for improvement in educating registry personnel who interpret and enter data about the uniqueness of GCT pathology, staging and interpretation of tumor markers.

Potential growth in Turkey: Sources and trends

This paper estimates potential growth in Turkey using a production function estimation approach. Our approach aims to measure the inputs of production in the most detailed fashion that is possible and empirically addresses concepts of sustainable potential growth for Turkey. While developing measures of the sources of potential growth, we provide a thorough discussion of the estimated trends in labor force participation, capital growth by asset type, and total factor productivity since the mid-2000s. Our results suggest that the key driver of potential growth has increasingly been capital accumulation. The declining trend in the positive TFP growth stands out as the key area of improvement for potential growth.

Biosimilar development and review process in the BRICS-TM countries: Proposal for a standardized model to improve regulatory performance

ABSTRACT Objectives The current study is aimed at proposing a standardized regulatory model for biosimilar development and approval for adoption by BRICS-TM agencies, based on evaluation of regulatory guidelines and potential solutions to challenges. Methods An established validated questionnaire was used and the recommendations were collated. Propositions deemed critical for improving the regulatory pathway for biosimilar development were synthesized to design a new regulatory model. Results The key areas for improvement in BRICS-TM countries were: effective implementation of a step-wise approach; adoption of science-based regulatory evaluation for clinical efficacy studies and acceptance of analytical comparability studies in lieu of confirmatory clinical trials; a streamlined biosimilar development program for RBP sourcing; regulatory reliance for joint or shared review of the applications; and enhanced transparency and communication between the regulatory agencies and biosimilar developers. Based on these identified critical aspects, a simplified and standard regulatory model was developed to enable standardization of biosimilar guidelines across BRICS-TM countries for a common development program. Conclusions Effective implementation of the proposed standardized model for biosimilar development and approval processes across the BRICS-TM agencies will eliminate unwarranted studies, reduce the development costs, and enhance process efficiency thereby expediting patients’ access to new affordable biosimilar medicines. Plain language summary The studies presented in this article have identified key areas for improvement in biosimilar development and approval pathways in BRICS-TM countries, which have formed the basis for development of a model to standardize requirements for biosimilar development and the approval process, with a view to improve regulatory performance. Implementation of the proposed model by the BRICS-TM regulatory agencies with consideration of a stepwise approach and science-based evaluation of analytical data could reduce the duplication and unnecessary conduct of non-clinical studies, thereby reducing the development cost and review timelines. Data assessment based on reliance as considered in the proposed model would strengthen reliance networks and improve the process efficiency among the BRICS-TM regulatory agencies. Flexibility in regulatory requirements by the BRICS-TM agencies for the use of Reference Biologic Product (RBP) from other emerging economies and their interaction with the developers would enhance transparency and ease the challenges in sourcing RBP from different jurisdictions. This would further help in expediting a common biosimilar development process. Good Manufacturing Practice (GMP) inspection of the biosimilar manufacturing facilities by desktop audit or off-site audit and acceptance of GMP certifications from other reference agencies would improve the overall regulatory performance and reduce overall review timelines, leading to faster availability of biosimilar medicines for patient access.

Biofuels from microalgae biomass: A review of conversion processes and procedures

• Key areas for improvement in microalgae conversion include the nature of catalysts been utilized. Bio-based catalysts should be preferred due to high cost of synthetic catalysts. Methodical limitations such as high equipment cost for process scale-up can prevent research from advancing as it could. • Promising microalgae conversion processes which could be progressed are the use of bio-based solvents and supercritical fluids for biodiesel production, hydrothermal liquefaction for biogas production, microwave-induced pyrolysis for syngas production, and ultrasound/microwave enhanced extraction for bio-oil production. • For future developments, the use of the promising conversion techniques would probably gain the interest of more researchers than at present, considering the merits of same. In other words, more research is expected to evolve in coming years. Achieving the EU 2030 vision of a 15% minimum amount of biofuels utilized in the road transportation require more research on biofuel production from biomass feedstock. To this end, this review study examines the use of green, deep eutectic solvents and direct transesterification approaches for biomass conversion to biofuels. Next, biogas production from anaerobic co-digestion of microalgae biomass is presented. Lastly, the effect of operating conditions, as well as advantages and limitations of several biomass conversion techniques are outlined. Of note, this study presents promising microalgae conversion processes which could be progressed are the use of bio-based solvents and supercritical fluids for biodiesel production, hydrothermal liquefaction for biogas production, microwave-induced pyrolysis for syngas production, and ultrasound/microwave enhanced extraction for bio-oil production. These are based on the possibility of high yield and process economics. We have also enumerated knowledge gaps needed to propel future studies.

Abstract WMP27: Practice Makes Perfect. Does Obtaining Nihss Certification Assure Nurse Competence And Confidence?

Background: Competent, confident nurses are key to maintaining patient safety, promoting trust, and achieving good patient outcomes. As a Certified comprehensive stroke center, documentation of the National Institute of Health Stroke Scale (NIHSS) is required within 12 hours of admission. Nurses are required to complete an online course to be certified in the NIHSS. During rounds with neurology staff nurses, questions were raised about proficiently performing the NIHSS. The team wondered if an online certification of NIHSS assures competence and confidence performing the scale at bedside? Objective: To evaluate neurology staff nurse competence and confidence performing the NIHSS. Methods: From April 2021 to June 2021, neurology staff nurses on all shifts were randomly sampled to for an NIHSS spot check evaluation. Nurses rated their confidence, pre and post NIHSS spot check, utilizing a Likert scale from 1-5, 1=not confident, 2= somewhat confident, 3=neutral, 4=confident, 5=Very confident. The NIHSS was evaluated for competency utilizing two criteria; one point for performing the scale item correctly, and one point for scoring the item correctly, with a goal of 100% to achieve competency. Results: NIHSS spot checks significantly increased neurology staff nurses’ confidence and highlighted key areas of improvement for all participants. A total of 17 neurology staff nurses were randomly sampled from day and night shift. Average baseline confidence score was 3.8. Of those nurses, 64% increased their confidence level 1-point and 9% increased their confidence more than 1-point post evaluation. Ultimately, 100% of nurses were found to achieve competency on the NIHSS spot check. Conclusion: Neurology staff nurses were eager to be evaluated, expressing genuine interest in improving their practice. Spot checking nurses illuminated areas of improvement and provided much needed reassurance to nurses that were competent but not necessarily confident. A competent and confident nurse promotes safety and trust in their patients and assures good patient outcomes. This project demonstrated that NIHSS certification reflected competency and illustrated the value of periodically evaluating nurses 1:1 to provide re-education and promote confidence in practice.