Open Routing Research Articles

EVALUATING SINO-US INTERESTS IN THE INDO-PACIFIC REGION: A NEO-FUNCTIONALIST PERSPECTIVE

This article explores the evolving power dynamics between the US and China in the Indo-Pacific region, focusing on how rivalry between these actors can be reduced to foster greater cooperation and regional integration. ASEAN's role in promoting stability and institutional cooperation is examined as a key factor in shaping the region's security. The paper discusses whether diplomatic and economic cooperation, despite rising Sino-American tensions, can contribute to the development of regional institutional cooperation mechanisms. Using a functionalist/neo-functionalist framework, it analyzes how the conflict-cooperation dichotomy between the US, China, and their interactions with ASEAN and other regional actors impacts the Indo-Pacific security structure. The study argues, consistent with neo-functionalist postulates, that mutual cooperation, including ASEAN’s diplomatic efforts, is crucial for enhancing regional integration and stability. Addressing the security dilemma requires strategic cooperation that considers all actors' concerns, such as open trade routes and energy security. The paper concludes that a new Cold War-like scenario between Washington and Beijing, where both vie for regional hegemony, is unlikely in the Indo-Pacific’s multipolar context. Instead, ASEAN plays a vital role in fostering regional stability through institutional mechanisms, making institutional cooperation a viable model for reducing tensions and creating stability in the region.

Trade-off optimization of a location-routing problem involving open routes and flexible fleet: a case study in Guadalajara, Mexico

Trade-off optimization of a location-routing problem involving open routes and flexible fleet: a case study in Guadalajara, Mexico

Evolution of biofuels: Unraveling diverse applications and emerging horizons

The comprehensive review presents multi-faceted biofuel applications in various sectors and prospects, highlighting state-of-the-art technologies and potential changes in triglyceride-based biofuels. From the first-generation biofuel produced from food crops to the fourth generation of engineered microbes, there is an improvement in technologies and sustainability. Transesterification synthesis of biodiesel with different chemical catalysts and biocatalysts shows continuous efforts toward making the process more efficient and economically viable; emerging technologies like hydrodeoxygenation and pyrolysis open new routes for optimized biofuel production with less environmental impact. With a focus on biodiesel, bioethanol, biobutanol, and biohydrogen, this paper deals with their contributions to energy generation in a sustainable manner and environmental stewardship. AI and machine learning in the production of biofuels could provide new revolutions in efficiency and sustainability directly from feedstock selection to product recovery. Bioethanol is effectively used in gasoline blends with several advantages, reducing carbon dioxide emissions. Biobutanol is a good transport fuel alternative, with high energy content, easily used with the existing infrastructure. Biological processes yield Biohydrogen and may have bright prospects for producing clean energy, specifically in the case of bioelectrochemical systems. Prospects hinge on addressing the challenges, promoting research and development, and fostering collaboration and investment in biofuel innovation. This review underscores the importance of continued efforts to advance biofuel technologies, recognizing their pivotal role in achieving a sustainable energy future while addressing global energy and environmental challenges.

Equation of state and universal solid phase of one-dimensional dipolar fluids

Macroscopic and structural properties of one-dimensional (1D) dipolar fluids are investigated theoretically. The equation of state is fully explored by means of analytical limiting laws, integral equations and corroborating Monte Carlo simulations. An interesting mapping with the Tonks gas (i.e. hard rods) is established at strong coupling. Crucially, we report a novel solid phase characterized by auniversal algebraic decayof the pair distribution function whose range extends with increasing coupling. This discovery provides a clarified view in 1D systems and open new routes to explore theoretically as well as experimentally.

Structural basis of the mechanism and inhibition of a human ceramide synthase.

Ceramides are bioactive sphingolipids crucial for regulating cellular metabolism. Ceramides and dihydroceramides are synthesized by six ceramide synthase (CerS) enzymes, each with specificity for different acyl-CoA substrates. Ceramide with a 16-carbon acyl chain (C16 ceramide) has been implicated in obesity, insulin resistance and liver disease and the C16 ceramide-synthesizing CerS6 is regarded as an attractive drug target for obesity-associated disease. Despite their importance, the molecular mechanism underlying ceramide synthesis by CerS enzymes remains poorly understood. Here we report cryo-electron microscopy structures of human CerS6, capturing covalent intermediate and product-bound states. These structures, along with biochemical characterization, reveal that CerS catalysis proceeds through a ping-pong reaction mechanism involving a covalent acyl-enzyme intermediate. Notably, the product-bound structure was obtained upon reaction with the mycotoxin fumonisin B1, yielding insights into its inhibition of CerS. These results provide a framework for understanding CerS function, selectivity and inhibition and open routes for future drug discovery.

Healthcare professionals’ preferences for the specialist pharmacy service medicines advice clinical enquiry service: a discrete choice experiment

Abstract Introduction The Specialist Pharmacy Service Medicines Advice (SPS-MA) service answers enquiries from primary care professionals in England. The preferences of service users for the way this service is provided (e.g. opening hours, speed and route of reply, amount of detail in answer etc.) are unknown. Such information would be useful to ensure the service meets the needs of users as well as possible within the constraints of available resources. Aim To determine healthcare professionals’ preferences for the Specialist Pharmacy Service Medicines Advice clinical enquiry service using a discrete choice experiment (DCE). Methods International Society for Pharmacoeconomics and Outcomes Research good research practices were used to conduct a DCE1. Previous literature2, documentary analysis of SPS-MA policies, and interviews with four SPS-MA enquirers and three SPS-MA service providers/managers identified seven key attributes of the clinical enquiry service. Each attribute could be defined using one of 2-3 descriptions (‘levels’). A D-efficient experimental design generated 20 pairs of potential clinical enquiry service variants, each described by one level linked to each of the seven attributes. These 20 pairs were blocked into two online surveys (10 pairs per survey), which asked participants to choose which service from each pair they would prefer to contact. The 1669 SPS-MA clinical enquiry contacts with a recorded email in the year to November 2023 were randomised to receive an email invitation to complete one of the survey variants. Preferences for each attribute level were estimated using conditional logit regression. Using the HRA decision tool, this project was not considered research by the NHS. It was given a favourable opinion by the University of Bath ethics review process on 27th November 2023 (reference 1153-2222). Results 236 participants completed a survey (52% GP pharmacists, 26% other pharmacists, 22% other professional; median 15 years’ experience). Weekend opening and opening hours did not significantly affect preferences (p≥0.226). All other attributes did significantly affect preferences (p≤0.015). An answer within one hour or two days was most valued (preference weightings (95%CI) relative to five days: 0.89 (0.76-1.03) and 0.58 (0.45-0.72), respectively). Communication by email was highly valued (preference weighting: 0.62 (0.47-0.77) relative to telephone only). The availability of a website of frequently asked questions was also valued (preference weighting: 0.48 (0.31-0.64) relative to no website). Answering the telephone within 20 seconds and a detailed response were valued, but to a lesser degree. Sub-group analysis found that participants qualified for <15 years valued email communication and detailed responses more strongly than other participants (p≤0.035). Discussion / Conclusion Where clinically appropriate, the SPS-MA clinical enquiry service should prioritise speed of reply, communication by email and a website of frequently asked questions. Longer opening hours are not required. This is the first study to use of a DCE to investigate professional enquirers’ preferences for a medicines information/advice service. This allowed analysis of the strength of preferences and how they were traded off. Due to the small number of non-pharmacist enquirers to the SPS-MA service, it was not possible to investigate how professional background influences preferences.

Dual-assessment of resilience and recovery strategies of road networks under rainstorm-induced waterlogging disasters

The dynamic resilience of road networks, threatened by rainstorm-induced waterlogging disasters, is crucial for recovering and reconstructing urban functions. We established a dynamic event impact mechanism by dividing the process of this disaster impact on the road network into four stages. To ensure that we can accurately evaluate the resilience of the road network during this disaster, we constructed a dual-resilience model based on performance and topology with two angles. On this basis, we compare four different recovery strategies including the average recovery strategy, key recovery strategy, two recovery strategies stacked, and opening low-altitude routes. The results show that resilience recovery is better in the short term by choosing to open low-altitude routes, and in the long term by choosing an average recovery strategy. In addition, the average recovery strategy and the essential recovery strategy are implemented best during the rainstorm occurrence stage.

Incidence, Management, and Outcomes of Pediatric Infectious Aneurysms.

Infectious intracranial aneurysms (IIAs) are rare cerebrovascular complications of infective endocarditis (IE) accounting approximatively for 0.5% to 6.5% of all aneurysms. In children, mycotic aneurysms secondary to IE are uncommon. This is a retrospective study of patients treated for pediatric IIA secondary to IE at our institution with an emphasis on presentation, etiologies, nuances in management, and outcomes. One hundred fifty-one patients were treated for IE secondary to congenital or acquired heart disease, of which 13 patients (8.6%) presented with intracranial hemorrhage. IIA occurred in 5 patients (2.6%) with IE. IIA accounted for 15% of intracranial aneurysms treated during the study period. Pediatric patients with ruptured IIAs have a high rate of rerupture, and early surgical intervention should be considered through an open or endovascular route when available.

Integration of PZT thick films on additively manufactured substrates for vibrational energy harvesting applications

This work aims to integrate screen-printed thick film (50–100 µm) Pb(Zr,Ti)O3 (PZT) on additively manufactured stainless steel substrates for vibration energy harvesting. The manufacturing technologies advanced by this research opens new horizons for energy harvesting applications as it standardizes the development and manufacturing processes, thereby making vibration energy harvesters more feasible. Since the parts are built layer-by-layer, the thickness of the different layers of the substrate can be controlled. The substrates under study were manufactured using SLM (Selective Laser Melting) additive manufacturing technology from Stainless Steel 17-4 PH powder. Simple cantilever harvesters are chosen as an initial target to focus on the optimization of the screen-printing process. The sample is 15.6 mm long, 4.1 mm wide, and 0.35 mm thick cantilever beam with a 50 µm thick PZT screen-printed layer sandwiched between two gold electrodes. A dielectric layer printed on the stainless steel substrate was introduced to promote adhesion. Clamping 6.1 mm of the beam length, its resonant frequency was measured experimentally at ∼2 kHz. The maximum output power was 37 nW under a resonant base acceleration with an amplitude of 2.94 m/s2 and a load resistance of 90 kΩ. A good fit was found between the experiment and a Finite Element Model with a difference of 12%. Thermal stress analysis was carried out to study the impact of the difference of Coefficient of Thermal Expansion on the bending of the harvester and the adhesion between the layers. The result shows the importance of matching the Coefficient of Thermal Expansion of the substrate with that of the PZT layer to avoid delamination between the layers and to improve adhesion. These initial results open routes for optimized designs of printed piezoelectric energy harvesters.

New Model for an Open Vehicle Routing Problem to Optimize the Blood Sample Collection Process within a Network of Clinical Laboratories

Clinical laboratories play a key role in delivering health care services, as the results of clinical tests affect 70% of medical decisions. Therefore, to provide high-quality services, smaller laboratories often send some of their samples to a well-equipped central laboratory. This study aims to minimize total transportation costs in collecting blood samples from geographically dispersed locations. Given the perishable nature of blood samples, the collection process must be completed within 2 h. Since these laboratories do not own a vehicle fleet, a third-party logistics (TPL) service provider is used in the collection process. We define this problem as a heterogenous fleet open vehicle routing problem with dynamic hub location (HFOVRP-HL). The main contribution of our work is developing a novel open vehicle routing problem (OVRP) model in which sequences of open routes and their intersections, creating dynamic and virtual hub nodes, are allowed. A mixed-integer programming (MIP) formulation is presented and solved using the CPLEX solver in GAMS, and the optimal solution is obtained. Computational results demonstrate that HFOVRP-HL outperforms classical HFOVRP, generalized HFOVRP with decoupling points (HFOVRP-DP), and HFOVRP with fixed hubs. Sensitivity analysis on key parameters confirms the model’s validity and superiority, offering substantial reductions in transportation costs. This research provides valuable insights for optimizing blood sample logistics in clinical laboratory networks.

Update on Sodium Glucose Cotransporter Type 2 Inhibitors Use in Kidney Transplant Patients

Sodium glucose cotransporter type 2 inhibitors are a new class of drugs that act on the cardiovascular system, kidneys and metabolism in a multiple ways. Indeed, even though their principal action involves the transport of sodium and glucose in the convoluted distal tubule, they have multiple actions, such as antifibrotic and endothelial protective effects. Their principal mechanism consists of the loss of sodium and glucose. Therefore, they affect blood pressure and glucose metabolism. Their first use was in the diabetic general population; later, some studies documented their activity in the nondiabetic general population and in heart failure in chronic kidney disease patients. Only in recent years have several small studies documented the efficacy of these drugs in diabetic and nondiabetic kidney transplant patients; relatively large studies are rare, very recent, and open new routes for the development of these drugs.

Microbial green synthesis of luminescent terbium sulfide nanoparticles using E. Coli: a rare earth element detoxification mechanism

BackgroundRare-earth sulfide nanoparticles (NPs) could harness the optical and magnetic features of rare-earth ions for applications in nanotechnology. However, reports of their synthesis are scarce and typically require high temperatures and long synthesis times.ResultsHere we present a biosynthesis of terbium sulfide (TbS) NPs using microorganisms, identifying conditions that allow Escherichia coli to extracellularly produce TbS NPs in aqueous media at 37 °C by controlling cellular sulfur metabolism to produce a high concentration of sulfide ions. Electron microscopy revealed ultrasmall spherical NPs with a mean diameter of 4.1 ± 1.3 nm. Electron diffraction indicated a high degree of crystallinity, while elemental mapping confirmed colocalization of terbium and sulfur. The NPs exhibit characteristic absorbance and luminescence of terbium, with downshifting quantum yield (QY) reaching 28.3% and an emission lifetime of ~ 2 ms.ConclusionsThis high QY and long emission lifetime is unusual in a neat rare-earth compound; it is typically associated with rare-earth ions doped into another crystalline lattice to avoid non-radiative cross relaxation. This suggests a reduced role of nonradiative processes in these terbium-based NPs. This is, to our knowledge, the first report revealing the advantage of biosynthesis over chemical synthesis for Rare Earth Element (REE) based NPs, opening routes to new REE-based nanocrystals.

The Ship is Laden with Rice and Salt: A Comparison of Two Sailing Models on an Early 17th Century Trade Route Between Java and Sumatra

Archaeological and historical sailing modeling has become an increasingly productive field of study in the twenty-first century. The research has largely concentrated on methodological development, yet comparisons between models have so far been lacking. In this paper we juxtapose two directed sailing models, Digital Navigator and qtVlm, on a route from East Java to South Sumatra. In the early seventeenth century, the former was a major producer and exporter of rice and salt, while especially Jambi, Indonesia, on the island of Sumatra, had become dependent on imports due to cash-cropping of black pepper. Our simulation results show the optimal sailing season on this route falls between May and September, and that La Niña events somewhat affect the length of this time window. During favorable winds both models produce quite similar routes. In adverse winds there is more variation between the models and the temporal frequency of wind data has more marked effects on routing. The models’ sailing durations match fairly well to the one measured from the Selden Map of China, but the simulated optimized routes tend to take more direct open sea routes than the coast-hugging route on the map. This implies that other factors such as ease of navigation played a more significant role in route selection than mere efficiency. Furthermore, a comparison to the production schedules of rice and salt in the Gresik region shows that products from the same summer’s harvests would have been available for export to Sumatra.

The Cognitive Architecture of Infant Attachment.

Meta-analytic evidence indicates that the quality of the attachment relationship that infants establish with their primary caregiver has enduring significance for socioemotional and cognitive outcomes. However, the mechanisms by which early attachment experiences contribute to subsequent development remain underspecified. According to attachment theory, early attachment experiences become embodied in the form of cognitive-affective representations, referred to as internal working models (IWMs), that guide future behavior. Little is known, however, about the cognitive architecture of IWMs in infancy. In this article, we discuss significant advances made in the field of infant cognitive development and propose that leveraging insights from this research has the potential to fundamentally shape our understanding of the cognitive architecture of attachment representations in infancy. We also propose that the integration of attachment research into cognitive research can shed light on the role of early experiences, individual differences, and stability and change in infant cognition, as well as open new routes of investigation in cognitive studies, which will further our understanding of human knowledge. We provide recommendations for future research throughout the article and conclude by using our collaborative research as an example.

Supermarket-chain grocery delivery optimization through crowdshipping

Acknowledging the rising significance of online sales, the grocery business has embraced the challenge of fulfilling the consequently growing consumer expectations for the last-mile delivery efficiency. This paper investigates the grocery delivery optimisation for the supermarket chain based on the crowdshipping mechanism, which can be one of the viable strategies for establishing prompt and affordable delivery service for customers. Considering the deterministic optimisation setting, this study presents a characteristic routing model with crowdsourced couriers named supermarket-chain grocery delivery crowdshipping problem (SCGDCP), which is a variant of the pickup-and-delivery problem, and develops a corresponding mixed integer linear programming (MILP) model. The SCGDCP involves distinctive problem features including individual depots for couriers, multi-trip open routing, and dual time windows of courier operating and order arrival, which pose the computational challenge in problem solving. A bespoke solution procedure based on adaptive variable neighbourhood search (AVNS) strategy is thus designed for tackling the practical-size SCGDCP. The conducted numerical experiments demonstrate the computational efficiency of the proposed MILP model for the small-size instances with no more than 30 grocery orders and the superiority of the developed AVNS procedure for the Grubhub sampling test instances with up to 200 orders.

Analysis of Cytotoxic Granules and Constitutively Produced Extracellular Vesicles from Large Granular Lymphocytic Leukemia Cell Lines.

Large granular lymphocyte leukemias (LGLLs) are rare lymphoproliferative malignancies caused by clonal expansion of granular lymphocytes. T-cell LGLL and natural killer (NK) cell LGLL are defined based on their cellular origin. Their clinical manifestation and pathophysiology vary depending on the subtype and include, e.g., neutropenia, anemia, recurrent infections, and autoimmunity. A limited number of available patient-derived cell lines are considered valuable tools to study the biology of these malignancies. They differ in the expression of lineage-specific surface markers, but generally contain cytotoxic effector molecules in characteristic granules. We investigated the presence and release of lysosome-associated effector proteins in patient-derived LGLL cell lines by flow and imaging cytometry, by Western blotting and by bottom-up proteomics profiling. The tested cell lines did not express FasL (CD178), but did express CD26/DPP4+. Intracellularly, we detected major differences in the abundance and subcellular distribution of granzymes, perforin, and granulysin. Similar differences were seen in enriched lysosome-related effector vesicles (LREVs). The proteomics profiling of enriched EVs from an NK-LGLL line (NKL) and a T-LGLL line (MOTN-1), confirmed individual profiles of effector molecules. Our analyses underscore the individual distribution of effector proteins but also open new routes to define the role of intra- and extracellular granules in the disease manifestation or pathology of LGLLs.

Analysis between open and laparoscopic appendectomy. A comparative study of the procedure in Brazil and worldwide

Introduction: The appendix is an organ in the human body that serves as a reservoir for natural bacteria in the gastrointestinal tract and also has an immunological function that is not so well understood. The acute inflammatory process that can occur in this organ is called acute appendicitis and is the most common surgical emergency worldwide. Objectives: To carry out a literature review on the analysis between open and laparoscopic appendectomy, and to compare how this surgery is performed in Brazil and worldwide. Material and Methods: The methodology used was a literature review. The research was carried out through an electronic search of scientific articles published on the Scielo (Scientific Electronic Library Online) and Lilacs (Latin American Health Sciences Literature) and Pubmed websites. The health terminologies consulted in the Health Sciences Descriptors (DeCS/BIREME) were used to analyze open and laparoscopic appendectomy. Discussion: Appendectomy has largely replaced open surgery as the treatment of choice for diseases of the appendix, especially acute inflammation, as it has effective results and some advantages. Video appendectomy did not gain absolute acceptance as quickly as cholecystectomy, for example, and it is only in the last 10 years that this type of minimally invasive approach has excelled the open approach worldwide. Conclusion: According to the literature, laparoscopy has recently become the most prevalent way of performing appendectomy. Despite this trend, the majority of appendectomies were performed by the open route. This can be explained by logistical, financial or medical team preparation issues. Some studies have shown that the rate of complications after surgery in the laparoscopic group was significantly lower than in the open appendectomy group.

Aiming for zero: Success of the hysterectomy surgical site infection prevention bundle.

The Center for Disease Control's National Healthcare Safety Network (NHSN) reported increased Standardized Infection Ratios (SIRs) for hysterectomy at a large community hospital. To promote a surgical site infection (SSI) prevention bundle implemented to reduce hysterectomy-associated SSI. A multidisciplinary Workgroup implemented the Hysterectomy SSI Prevention Bundle in 2020 to enforce standardization of perioperative techniques. This study included all benign hysterectomies pre-implementation (n = 857) and post-implementation (n = 772). Per NHSN categorization guidelines, "abdominal hysterectomy" includes both open and laparoscopic routes. "Inpatient surgery" is date of discharge different from date of surgery; "outpatient surgery" is same date of discharge. "SSI" includes superficial, deep, and organ/space; "complex SSI" includes deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. After implementation of the SSI bundle, SIRs for hysterectomy were reduced to <1.0, indicating infection prevention. Reductions in SIR were significant for outpatient abdominal hysterectomy (0.868 [p = .007]), inpatient vaginal hysterectomy (0 [p < .001]), inpatient complex abdominal hysterectomy (0 [p = .040]), and inpatient complex vaginal hysterectomy (0 [p < .001]). Differences between groups were significant for increased laparoscopic and decreased vaginal hysterectomies (p < .001), increased outpatient surgeries (p < .001), and longer procedure duration (p < .001). Implementation of an SSI prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.

Travelling Thomas: Slave Trade and Missionary Travel in the Acts of Thomas

The Acts of Thomas is a long, rich, and fascinating narrative about the Apostle Thomas who was forced to travel to India as a missionary. When Thomas hesitates to go, his master Jesus literally sells him as a slave to an Indian merchant. Like other Apocryphal Acts, the Acts of Thomas revolves around the apostolic figure battling both human and demonic adversaries. Celibacy is central, although familiar narrative elements from ancient romances and novels are also present. On his way, Thomas sings, prays, teaches, heals, converts, and baptizes. His travel follows open trade routes in the ancient world, by land and by sea. He participates in various social events like parties, weddings, and family celebrations. His own status as a foreign slave/apostle, with a strange religion, is negotiated and contested: Sometimes he is treated like a foreign slave, suffering violence and harassment. On other occasions, his exotic strangeness in language and religion gives him access to royal palaces and influential men and women. By examining the role played by slavery in initiating this travel, as well as various intersections of religion and gender in the overall narrative, this article explores the Acts of Thomas to draw a more nuanced picture of travel in the ancient world.

Aiming for Zero: Success of the Hysterectomy Surgical Site Infection Prevention Bundle

Background: The Center for Disease Control’s National Healthcare Safety Network (NHSN) reported an increased Standardized Infection Ratio (SIR) at a large community hospital, calculated by the number of observed infections over the number of predicted infections. In response to the increased SIR, a multidisciplinary Hysterectomy Surgical Site Infection (SSI) Prevention Workgroup was formed in 2019. Objective: To promote a surgical site infection prevention bundle that was implemented at a large community hospital to reduce hysterectomy associated surgical site infections. Study Design: The Workgroup implemented an evidence-based Hysterectomy SSI Prevention Bundle which enforced standardization of measures and techniques at: The pre-operative clinic appointment, the day of surgery, the intra-operative time prior to incision, the intra-operative time from incision to closure, and in the immediate post-operative recovery. The Hysterectomy SSI Prevention Bundle was implemented November 2, 2020. This study included all hysterectomies for benign pathologies from 10/1/2018 to 9/30/2020 [pre-implementation (n=811)] and 1/1/2021 to 9/30/2022 [post-implementation (n=772)]. Per NHSN data categorization guidelines, a designation of abdominal hysterectomy includes both open and laparoscopic routes. Inpatient surgery was defined as that with a date of discharge different from date of operation; outpatient surgery was defined as the one with the same date of discharge. SSIs included superficial, deep and organ/space, while complex SSIs included deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. Results: After implementation of the SSI bundle, SIR for hysterectomies was reduced to &lt; 1.0, indicating infection prevention. Outpatient abdominal hysterectomy SIR pre-implementation was 2.551 and post-implementation was 0.868 (p=0.007). The outpatient vaginal hysterectomy SIR pre-implementation was 0, and post-implementation remained 0 (p=0.364). Inpatient abdominal hysterectomy SIR pre-implementation was 1.554 and post-implementation was 0.443 (p=0.072). The inpatient vaginal hysterectomy SIR preimple-mentation was 1.064, and post-implementation was 0 (p &lt;0.001). The inpatient complex abdominal hysterectomy SIR pre-implementation was 1.757 and post-implementation was 0 (p=0.040). The inpatient complex vaginal hysterectomy SIR pre-implementation was 1.001, and post-implementation was 0 (p &lt;0.001). Differences between the pre- and post-implementation groups were significant for increased laparoscopic hysterectomies (p&lt;0.001), decreased vaginal hysterectomies (p&lt;0.001), increased number of same day discharges (p&lt;0.001), longer procedure duration (p&lt;0.001), and younger age (p=0.039). Conclusion: Implementation of an evidence-based surgical site infection prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.