Recent Changes Research Articles

Late-Holocene stability and recent changes in small mammal communities in north-central Andean forests of Patagonia

Past and current climatic and environmental changes have contributed to configure actual species distributions and abundances. Knowing their evolution over time allows discrimination between natural and anthropogenic causes in current composition of faunal communities. We evaluate the changes in small mammal assemblages from the north-central Patagonian Andean forests since the Late-Holocene to recent times and their relationship with the environmental modifications driven by human activities. A bone sequence from Población Anticura archaeological site (lower Manso river valley, Río Negro province, Argentina) was studied, which encompasses a time span from the early Late-Holocene (3350 ± 100–2270 ±80 years BP) to final Late-Holocene (1420 ± 70–530 ±50 years BP) and Historical times (480 ± 70–280 ±40 years BP). The species composition indicates that forest environment established in the area from at least the Late-Holocene (dominance of Loxodontomys micropus, with subordinate frequencies of Abrothrix olivacea, A. hirta, Geoxus valdivianus, Irenomys tarsalis, and Paynomys macronyx), with patches of (or near to) open environments (presence of Reithrodon auritus and cavids). It is remarkable the presence of cavids, which increased their abundance in the sequence towards Historical times but disappeared nowadays. The low frequencies (<10%) of the rodent Oligoryzomys longicaudatus along the entire sequence is also relevant, since this rodent is the reservoir of the Andes strain of the Hantavirus (ANDV), which causes pulmonary syndrome. This mouse dominates the small mammal assemblages from forests and ecotonal shrublands of northwestern Patagonia (abundances exceed 50% in owl pellets recently collected from the study area). Current configuration of forest and ecotonal assemblages, particularly the high abundance of O. longicaudatus, should be mainly linked to anthropogenic causes, including the introduction of cattle, land clearing, and the advance of introduced plant species such as the sweet briar ( Rosa eglanteria). Particularly, this exotic shrub offers shelter and additional food for O. longicaudatus, turning their shrublands into spaces of high epidemiological risk.

Are Renal Tumor Diagnostics Becoming Too Advanced for Many Pathology Laboratories?

The recent influx of novel renal neoplasms, particularly molecularly-defined renal carcinomas, has introduced new challenges in the daily practice of most pathology laboratories. These tumors are uncommon, they do not always have well-established morphologic features, and the expression profile of most common biomarkers is not well understood. Moreover, the diagnosis of molecularly-defined renal carcinomas requires the documentation of the disease-defining molecular alteration, with molecular studies or surrogate immunohistochemical markers. Unfortunately, most pathology laboratories lack molecular laboratories, or it is not cost-effective to maintain assays of the specific biomarkers in these unusual tumors. Pathologists should have updated knowledge about the recent changes in renal neoplasms and be aware of these limitations.

Deployment of Digital Devices in Prisons in New South Wales in Australia: Exploring the Benefits, Challenges, and Opportunities for Incarcerated Women

Women in prison experience a double digital divide, due to gendered discrimination and carceral isolation. We focus on a recent policy change in New South Wales (NSW), Australia, whereby digital devices were provided to incarcerated people. This policy change is considered in light of women’s trauma histories and the importance of community and family connection. We respond to themes presented at the United Nations’ Sixty-Seventh Session on the Commission of the Status of Women, specifically achieving equality and empowerment for all women and girls in the digital age. Incarcerated women must be prioritized when addressing the gendered digital divide.

The barn owl as an accumulator of bone remains in central western Argentina: multi-taxa neo-taphonomic approach and implications for Holocene contexts

Barn owls are the most widely distributed group of owls in the world and are among the most common accumulators of small vertebrate remains at archeological and paleontological sites. Despite its importance as a bone remains accumulator and predictor of paleoenvironmental conditions due to its generalist habits, the vertebrate prey of this raptor has been scarcely studied from an ecological community perspective, especially considering the diverse range of prey it captures. Archeological, paleontological, and taphonomic studies typically reveal taxon-specific patterns, focusing primarily on small rodents. In order to overcome this problem, we studied an assemblage of vertebrate bones from barn owl pellets in the central Monte Desert of Argentina. Our analysis included the full range of prey taxa, including rodents, marsupials, birds, and reptiles, addressed from both an ecological and neo-taphonomic perspective. We compare the taxonomic and taphonomic findings with those from regional small vertebrate records obtained from various sampling types over the past 50 years to explore recent environmental changes within the Anthropocene. The assemblage of small vertebrate prey presented here comprises five species of cricetids, one species from the Caviidae family, and at least one ctenomyid rodent species. Additionally, the assemblage includes one species of didelphid marsupial, one reptile species, and at least six passeriform bird species that belong to separate families. The overall taphonomic trends are consistent with the typical barn owl pattern. However, our analysis identified a larger percentage of postcranial elements exhibiting signs of digestion compared to pellet-derived vertebrate bone assemblages previously documented. Furthermore, it is important to note that a significant proportion of avian bone fragments exhibit distinct signs of digestion.

Development of Cultural and Faith Tourism in SCO and Turkic States: Uzbekistan's Potential and the Exemplary Turkish Case

This article treats Turkish tourism sector's recent changes, focusing on its increasing relationships with the Shanghai Cooperation Organization (SCO) countries and Turkic states. The paper examines about Turkiye's efforts to expand its tourism partnerships beyond its traditional European allies and emphasizes its cooperation with SCO member countries such as Russia, Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. Furthermore, it underlines Turkey's efforts to revive the ancient Silk Road—particularly through the "Middle Corridor" plan—in an effort to increase Turkic states' cultural, economic, and tourist collaboration. Cultural and religious tourism in the Turkic states is highlighted, with a particular emphasis on Turkiye and Uzbekistan. The paper concludes with practical proposals to further develop of cultural and faith tourism, i.e. effective promotional campaigns, cheap flights, and visa-free travel. Generally, the article provides a thorough overview of Turkiye's ever expanding tourism sector as well as its strategic efforts to promote significant cooperation within the SCO region.

Zooarchaeological perspectives in the framework of the Anthropocene: Contributions to ecological, environmental and conservation studies from South America

This special volume considers major recent changes in southern South American animal communities. Eleven papers consider megafauna, pinnipeds, marine mammals, small terrestrial mammals and birds and are grouped under four sub-headings: (1) Isotopic insights into guanaco populations; (2) Historical sources and marine ecosystem change; (3) Changes in small mammal communities and human impacts; and (4) megafaunal extinction, domestication, avifauna and recent interactions with humans. Although some of these contributions include changes that occurred earlier in the Holocene, many highlight a current decrease in the taxonomic diversity of communities and ecosystems in different environments, which are likely to have been caused by modern human activities. The Anthropocene concept is seen as providing a useful framework for understanding and mitigation of such adverse human impacts.

COMPETITIVENESS ASSESSMENT WITH THE IMPLEMENTATION OF AN ENERGY CAPACITY MARKET IN BRAZIL

Purpose: This article investigates issues related to the need to implement a capacity market in the Brazilian electricity sector to add security to the system and increase market competitiveness to benefit its energy consumers, as well as attract investments to the supply segments of this industry. Theoretical Framework: This research focuses on the Market Design Theory and the transition to the capacity market, detailing its principles and relevance in the current context. Through it, we seek to understand the mechanisms that shape the contemporary market. Design/Methodology/Approach: This research adopts an applied research approach. It is structured as a case study, where Brazil is analyzed in the context of implementing a capacity market. Techniques such as interviews, and documentary research were used to collect data. Findings: The study delves into the intricacies of establishing a capacity market in a competitive environment. The central findings encompass distinctions between the separation of backing and energy versus the capacity market; the blueprint of the auction and regulation of contracting; shaping the long-term market perspective; and the methodology for deducing the capacity market demand. Research, Practical & Social Implications: This article contributes to the literature by surveying cases on capacity market development in developed countries. Furthermore, as a practical contribution, it details the benefit of implementing a capacity market in the Brazilian case. Originality/Value: This research provides innovative solutions for Brazil, drawing from global benchmarks and tailoring them to Brazil's unique challenges and recent legal changes.

Language shift in time of war: the abandonment of Russian in Ukraine

ABSTRACT The article demonstrates an impressive shift from Russian to Ukrainian in war-time Ukraine. I rely on nationwide survey data from before and after February 2022 to analyze the scale and structure of the recent change in patterns of language use. I demonstrate not only an impressive shift across the practices but also a larger scale of change in public communication than in private use. Next, I examine responses to a small online survey and focus group discussions in different parts of Ukraine for detailed accounts of different categories of people’s patterns of language use in various practices and explanations of the reasons for change – or continuity – in those patterns. I demonstrate a new phenomenon of the predominant reliance on Ukrainian at work and in other public communication by many people who used to speak predominantly Russian and still keep it as the main language of family use.

Start-ups in the Brazilian Innovation Ecosystem

The article analyses the dynamics of start-up growth in Brazil highlighting the role of government, companies, venture capital and the innovation system in start-up policy. The most significant recent change in the Brazilian start-up ecosystem was the rise of growth-oriented entrepreneurship and start-ups. The 2021 Brazilian Legal Framework of Start-ups and Innovative Entrepreneurship is a milestone as it establishes mechanisms for the acquisition of products/services by the government provided by start-ups.

Temporal changes in pre-existing health conditions five years prior to pregnancy in British Columbia, Canada, 2000-2019.

Pre-existing health conditions increase the risk of obstetric complications during pregnancy and birth. However, the prevalence and recent changes in the frequency of pre-existing health conditions in the childbearing population remain unknown. To estimate the temporal changes in the prevalence of pre-existing health conditions among pregnant women in British Columbia, Canada. We carried out a population-based cross-sectional study of 825,203 deliveries in BC between 2000 and 2019 and examined 17 categories of physical and psychiatric health conditions recorded within 5 years before childbirth. We also undertook age-period-cohort analyses to evaluate temporal changes in pre-existing health conditions. The prevalence of any pre-existing health condition was 26.2% (n = 216,214) with overall trends remaining stable during the study period. Between 2000 and 2019, the prevalence rates of anxiety (5.6%-9.6%), bipolar (1.6%-3.4%), psychosis (0.7%-0.8%), and eating disorders (0.2%-0.3%) increased. The prevalence of hypertension increased sharply from 0.06% in 2000 to 0.3% in 2019. Diabetes mellitus and stroke rates increased, as did the prevalence of systemic lupus, multiple sclerosis, and chronic kidney disease. Advanced maternal age was strongly associated with both psychiatric and circulatory/metabolic conditions. A strong birth cohort effect was evident, with rates of psychiatric conditions increasing among women born after 1985. In British Columbia, Canada, 1 in 4 mothers had a pre-existing health condition 5 years prior to pregnancy. These findings underscore the need for multi-disciplinary care for women with pre-existing health conditions to improve maternal, foetal, and infant health.

Soil CO2 emission and stable isotopes (δ13C, δ18O) of CO2 and calcites reveal the fluid origin and thermal energy in the supercritical geothermal system of Krafla, Iceland

The Krafla geothermal system is located within a volcanic center that periodically erupts basaltic lavas, and has recently attracted an economic interest due to supercritical fluids forming near a shallow magma intrusion (∼ 2 km depth). Here, we discuss new soil CO2 flux and stable isotope data of the CO2 efflux (δ13C) and hydrothermal calcites (δ13C, δ18O) of drill cuttings to estimate both the current magmatic outgassing from soils and the thermal flows in the geothermal system. Soil CO2 emission is controlled by tectonics, following the NNE-SSW fissure swarm direction and a WSW-ENE trend, and accounts for ∼62.5 t d−1. While the δ18O of the H2O in equilibrium with deep calcites is predominantly meteoric, both the δ13C of the soil CO2 efflux and of the fluids from which calcite precipitated have a clear magmatic origin, overlapping the δ13C estimated for the Icelandic mantle (−2.5 ± 1.1 ‰). Estimates based on the soil CO2 emission from the southern part of the system show that these fluxes might be sustained by the ascent and depressurization of supercritical fluids with a thermal energy of ∼800 MW. Such significant amount of energy might reach 1.5 GW if supercritical conditions extended below the whole investigated area. Finally, we report an increase in the soil CO2 emission of about 3 times with respect to 14 years ago, likely due to recent changes in the fluid extracted for power production or magmatic activity. Pairing the soil CO2 emission with stable isotopes of the efflux and calcite samples has important implications for both volcano monitoring and geothermal exploration, as it can help us to track magmatic fluid upflows and the associated thermal energy.

The political economy of populists in power, between policy and polity: Evidence from the Israeli case

This paper explores the connection between the current wave of populism, economic policies and governance practices. We first review the different ways in which populist political economy has been conceptualised, focusing on the relationship between populism and neoliberalism in terms of both policy and polity. We then briefly discuss right-wing populist governments’ recent economic policies and institutional changes. We argue that, while representing a continuation of neoliberalism in some areas, right-wing populism may, when in power, undermine neoliberal economic policies and institutional power by subverting governance norms and reintroducing the state as a major actor in the economy. To demonstrate and support our argument, we analyse the Israeli case, in which the right-wing populist leader Benjamin Netanyahu led three governmental coalitions between 2009 and 2019. We focus on the Israeli government’s response to the cost-of-living crisis and the housing crisis. We show that the populist Israeli government went beyond clientelism and welfare chauvinism and moved towards a more redistributive and expansionist economic agenda. To finance and legislate this agenda, it used unorthodox, short-term governance practices to bypass or overcome institutional limitations.

Teaching and Safety-Net Hospital Penalization in the Hospital-Acquired Condition Reduction Program

The Hospital-Acquired Condition Reduction Program (HACRP) evaluates acute care hospitals on the occurrence of patient safety events and health care-associated infections. Since its implementation, several studies have raised concerns about the overpenalization of teaching and safety-net hospitals, and although several changes in the program's methodology have been applied in the last few years, whether these changes reversed the overpenalization of teaching and safety-net hospitals is unknown. To determine hospital characteristics associated with HACRP penalization and penalization reversal. This retrospective cross-sectional study assessed data from 3117 acute care hospitals participating in the HACRP. The HACRP penalization and hospital characteristics were obtained from Hospital Compare (2020 and 2021), the Inpatient Prospective Payment System impact file (2020), and the American Hospital Association annual survey (2018). Hospital characteristics, including safety-net status and teaching intensity (no teaching and very minor, minor, major, and very major teaching levels). The primary outcome was HACRP penalization (ie, hospitals that fell within the worst quartile of the program's performance). Multivariable models initially included all covariates, and then backward stepwise variable selection was used. Of 3117 hospitals that participated in HACRP in 2020, 779 (25.0%) were safety-net hospitals and 1090 (35.0%) were teaching institutions. In total, 771 hospitals (24.7%) were penalized. The HACRP penalization was associated with safety-net status (odds ratio [OR], 1.41 [95% CI, 1.16-1.71]) and very major teaching intensity (OR, 1.94 [95% CI, 1.15-3.28]). In addition, non-federal government hospitals were more likely to be penalized than for-profit hospitals (OR, 1.62 [95% CI, 1.23-2.14]), as were level I trauma centers (OR, 2.05 [95% CI, 1.43-2.96]) and hospitals located in the New England region (OR, 1.65 [95% CI, 1.12-2.43]). Safety-net hospitals with major teaching levels were twice as likely to be penalized as non-safety-net nonteaching hospitals (OR, 2.15 [95% CI, 1.14-4.03]). Furthermore, safety-net hospitals penalized in 2020 were less likely (OR, 0.64 [95% CI, 0.43-0.96]) to revert their HACRP penalization status in 2021. Findings from this cross-sectional study indicated that teaching and safety-net hospital status continued to be associated with overpenalization in the HACRP despite recent changes in its methodology. Most of these hospitals were also less likely to revert their penalization status. A reevaluation of the program methodology is needed to avoid depleting resources of hospitals caring for underserved populations.

Feeding Practices in Infants with Hematochezia and Necrotizing Enterocolitis on Acute Care Cardiology Units.

Infants with congenital heart disease (CHD) are at risk for developing both benign hematochezia and necrotizing enterocolitis (NEC). Despite these risks there are very few studies that investigate modifiable risk factors such as feeding practices. It remains unclear what feeding practices should be avoided due to higher incidence of CHD-NEC. We aim to assess the feeding practices across three high volume tertiary centers to establish a relationship between various feeding practices and development of NEC. A multicenter retrospective review of feeding practices at the time of documented hematochezia event that occurred between 1/2019 and 1/2021 in infants with CHD who were less than 6months of age. NEC was defined as Bells Stage 2 or greater. Age, weight, ventricular morphology, primary diagnoses, feeding route, feed change, and formula type were evaluated. 176 hematochezia events occurred in 121 patients, 72% of these events were considered benign hematochezia with the remaining 28% being true NEC. Single ventricle (SV) physiology (p < 0.05), younger age, < 45days of life, (p < 0.001), and feeding route were statistically associated with true NEC (p < 0.01). Formula type and recent change in feed administration were not associated with NEC. The caloric density of feeds at the time of hematochezia was nearing significance. The majority of hematochezia events are benign in nature, however, there should be heightened awareness in patients who are SV, younger in age, and those who are post-pylorically fed. There may be some risk in using higher caloric density feeds (> 24kcal/oz), however, additional research is needed to fully establish this relationship.

Rethinking the Holocene temperature conundrum

Recent scholarship argues for more research to resolve the ‘Holocene temperature conundrum’, an apparent discrepancy between decreasing proxy-reconstructed and increasing model-simulated long-term temperature trends during the late Holocene. Here, we argue that the observed proxy-model offset likely results from inappropriate comparisons of different seasonal and spatial signals in the reconstructed and simulated palaeo-data. Since proxy archives have been used to reconstruct global annual mean temperatures, they have been compared against model simulations of the same seasonal and spatial domains. However, we suggest that most of the proxy-based large-scale reconstructions are biased towards Northern Hemisphere summer temperatures, and as such model comparisons have predominantly focused on the wrong target data. Further to advancing our understanding of long-term temperature trends, we recommend prioritising the refinement of proxy networks and climate reconstructions to preserve the full spectrum of naturally forced, interannual to multi-millennial variations needed to contextualise recent anthropogenic changes against past Holocene ranges.

Investigating Multidecadal Trends in Ice Cover and Subsurface Temperatures in the Laurentian Great Lakes Using a Coupled Hydrodynamic–Ice Model

Abstract While changing lake surface conditions have received significant research scrutiny, changes in subsurface conditions, including stratification and heat content, remain largely unexplored. In this work, we highlight changes in thermal structure, stratification dynamics, and ice characteristics in the Laurentian Great Lakes (Lakes Superior, Huron, Michigan, Erie, and Ontario) as simulated between 1979 and 2021. Three-dimensional lake hydrodynamics and ice cover were modeled using the Finite Volume Community Ocean Model (FVCOM) coupled with the Los Alamos sea ice model (CICE). Analysis revealed significant increases in surface (0.4°–0.6°C decade−1) and subsurface (0.1°–0.4°C decade−1) temperatures as well as dramatic losses in ice cover (1%–8% decade−1) and ice volume (0–3 km3 decade−1) over the last 40 years. Estimated surface heating rates were strongest during the summer and fall, while subsurface warming was most rapid during the nearly isothermal winter and spring. Intensified (decreased) summer (winter) stratification led to shifts in lake turnover dynamics, with delayed fall turnover dates (2–6 days decade−1) and earlier spring overturn dates (2–9 days decade−1). Modeled surface temperatures (LST), bottom temperatures (LBT), and annual averaged ice cover (AAIC) were used to estimate low-frequency climate signals, which were highly correlated with the Atlantic multidecadal oscillation. Warming trends fit to residual climate signals (LST: 0.1°C decade−1; LBT: 0.03°C decade−1; AAIC: −1% decade−1), calculated by removing low-frequency variability from the raw climate signal, were lower than those fit to associated low-frequency components, suggesting that recent climate change in the Great Lakes may be strongly influenced by natural multidecadal climate variability.

Update on the Selection Criteria of Plastic Surgery Residents: A Survey of Program Directors and Associate Program Directors.

Plastic and reconstructive surgery (PRS) is recognized as a highly competitive specialty. Since the first assessment of resident selection criteria in 2007, PRS residency programs have adopted holistic review processes and adapted to changes such as a decline in medical schools participating in the Alpha Omega Alpha Honor Medical Society as well as the recent transition to pass/fail grading for the United States Medical Licensing Examination (USMLE) step 1 examination (Schultz et al. Plast Reconstr Surg Glob Open . 2020;8:e2892; Tadisina et al. Plast Reconstr Surg . 2017;139:330e-331e). This study was devised to evaluate current PRS residency criteria in light of these changes. An anonymous, 12-item, electronic survey was generated and distributed using Alchemer. An email was sent to 171 program directors (PDs) and associate program directors (APDs) of PRS residency programs. Survey questions were developed to collect data regarding respondent demographics and their desired criteria when assessing residency applicants. Complete responses were collected and analyzed with summary statistics and multivariate logistic regression using RStudio (version 1.3.109). In total, 44 (25.7% response rate) of the 171 PDs and APDs completed the survey. Of the 16 programs (36.4%) with a USMLE cutoff score, 7 (43.8%) reported a range of 230 to 239 and 6 (37.5%) reported a range of 240 to 249. Without a score for step 1, the majority (48.8%) of respondents believe that step 2 scores will replace step 1 scores in terms of assessment criteria, and the content of recommendation letters was selected as the criterion with the greatest increase in weight (66.7%). In addition, 27.3% of programs require a step 2 score at the time of interview. The top 3 academic criteria in order of decreasing importance were the content of recommendation letters, clinical grades, and letter writers, whereas the top 3 nonacademic criteria were subinternship performance, maturity, and interview performance. Plastic and reconstructive surgery remains a highly competitive specialty for residency applicants. Our findings suggest that Alpha Omega Alpha membership remains diminished in importance, whereas USMLE cutoff scores have increased. With recent changes in the step 1 grading system, PDs and APDs will rely more heavily on step 2 scores and the content of recommendation letters.

Epidemiological shifts in bronchiolitis patterns and impact of the COVID-19: A two-season comparative study.

Bronchiolitis is a common lower respiratory tract infection (LRTI) affecting infants and young children. Respiratory syncytial virus (RSV) has historically been the primary causative agent, but other viruses also contribute to the LRTI epidemiology. Recent changes in epidemiology and clinical patterns due to the coronavirus disease 2019 (COVID-19) pandemic have raised concerns. This study aims to analyze the impact of the pandemic on bronchiolitis epidemiology and severity. Two consecutive bronchiolitis seasons (October 2021 to March 2022 and October 2022 to March 2023) were compared. Data on viral agents, hospitalization duration, clinical severity, and respiratory support requirements were collected from pediatric patients at San Marco Hospital, University of Catania. In the 2021-2022 season, RSV was the predominant virus (40%), followed by other viruses, with mild clinical outcomes. In the 2022-2023 season, RSV remained prevalent (58.7%), but other viruses, including rhinovirus (RV) and influenza, showed a significant increase (p < .05) in bronchiolitis cases and severity. Notably, RSV-related bronchiolitis did not exhibit greater severity compared to non-RSV cases in the 2022-2023 season, contrary to the previous year. The COVID-19 pandemic appears to have shifted the epidemiological landscape of bronchiolitis, with a peak incidence in November instead of January/February. Non-RSV viruses (RV, influenza A and B, as well as metapneumovirus) have gained prominence, possibly due to viral competition and reduced pandemic-related restrictions. Traditionally, RSV has been the primary pathogen responsible for most bronchiolitis cases. Nonetheless, the findings of this study indicate a shifting landscape in bronchiolitis etiology, with RSV gradually diminishing in its role. Contrary to the previous year, RSV-related bronchiolitis did not exhibit greater severity compared to non-RSV cases in the 2022-2023 season.

A72 THE ENDOSCOPIC YIELD OF PRIORITIZED INDICATIONS USING A PROVINCIAL-WIDE COLONOSCOPY REFERRAL FORM

Abstract Background The widespread use of a standardized and validated province-wide colonoscopy referral form (PCRF), regrouping mutually exclusive indications into suggested priority wait time categories, has allowed for a more comprehensive assessment of routine colonoscopy practice Aims To validate the Quebec PCRF by better characterizing endoscopic finding yields according to specific clinical indications. Methods This retrospective cohort study includes consecutive adult patients with available data from the PCRF from two tertiary hospitals. The primary outcome was the diagnostic rates of colorectal cancer (CRC). Secondary outcomes assessed incidences of clinically significant lesions (CSL) on endoscopy and confirmed at pathology. These are CRC, advanced adenomas, sessile serrated polyps, polyps ≥ 5mm, colitis, colonic strictures, and miscellaneous other findings excluding hemorrhoids and diverticulosis. Descriptive and inferential statistics, and multivariable regression predictive modeling are reported. Results Overall, 14,657 patients (mean age 59.2 ± 14.0 years, 50.9% female) were included from September 2018 to August 2022. The most frequent indications for colonoscopy were polyp surveillance (IN13, 20.8%), recent change in bowel habits (IN7, 11.9%), a positive fecal immunochemical test (IN5, 8.3%), a family history of CRC or polyps (first-degree relative) (IN8, 6.4%), and suspected active inflammatory bowel disease (IBD) (IN3, 5.8%). Overall, 40.6% had CSL, including CRCs in 0.8%. CRCs were found more frequently for IN2 (19.7% vs 2.0%, pampersand:003C0.01), IN5 (29.9% vs 8.2%, pampersand:003C0.01), and an unexplained documented iron deficiency anemia (IN6) (11.8% vs 5.2%, pampersand:003C0.01). CSLs were more frequent for IN3 (1.6% vs 5.8%, p=0.04), IN7 (4.7% vs 12.0%, p=0.01), IN8 (0.8% vs 6.5%, p=0.01), IN13 (7.1% vs 20.9%, pampersand:003C0.01), IBD surveillance (IN15, 0.0% vs 4.0%, p=0.02), and surveillance for a significant family history (IN21, 0.0% vs 3.7%, p=0.02). On multivariable analysis, CRC was significantly associated with IN2 OR=31.8 (4.86; 208.7), IN5 OR=19.2 (3.86; 95.7), and IN6 OR=15.7 (2.37; 78.0) - (all are high priority PCRF referrals with a suggested shorter wait time than for most other indications). CSLs were significantly associated with age (OR=1.03 (1.02; 1.03)), IN2 (OR=2.32 (1.35; 3.99)), IN5 (OR=2.37 (1.74; 3.22)), and IN13 (OR= 1.66 (1.36; 2.02)). Conclusions This large cohort study confirms the validity of indications and corresponding prioritization of wait times of a PCRF. Funding Agencies CPAC and MSSS

Effect of Changing Estimated Glomerular Filtration Rate Formula on Sugammadex Use and Pulmonary Complications for African American and non-African American Patients.

Sugammadex is associated with fewer postoperative pulmonary complications than is neostigmine reversal of neuromuscular blockade. However, the Food and Drug Administration-approved package insert states that its use is "not recommended" in severe renal impairment, separately defined as creatinine clearance <30 mL/min. Recently, the formula for estimating glomerular filtration rate (GFR) was updated to remove the race variable. Compared to the prior formula, the new consensus equation lowers the estimated GFR for African American patients and raises it for everyone else. We sought to determine how this change could differently impact the use of sugammadex, and thus the rate of pulmonary complications, for both African American and non-African American patients. We used Monte Carlo simulation models to estimate the difference in pulmonary complications that would be suffered by patients when the change in creatine clearance calculated from the estimated GFR (using the old race-based and new race-neutral Chronic Kidney Disease Epidemiology Collaboration formulas) crossed the 30 mL/min threshold, which would require a change in sugammadex or neostigmine use. We found that 0.22% (95% confidence interval 0.14%-0.36%) of African American patients' creatinine clearance would drop from above to below 30 mL/min making sugammadex not recommended and 0.19% (0.16%-0.22%) of non-African American patients would have creatinine clearance increase to >30 mL/min making sugammadex now recommended. Based on our model, we estimate that African American patients would suffer (count [95% confidence interval]) 3 [0.4-6] more pulmonary complications per 100,000 African American patients who received rocuronium or vecuronium through the change from sugammadex to neostigmine reversal to comply with labeling recommendations. Conversely, the same change in formulas would reduce the number of non-African American patients suffering pulmonary complications by 3 [2-4] per 100,000. The recent change in GFR formulas may potentially be associated with an increase in postoperative pulmonary complications in African American patients and a decrease in postoperative pulmonary complications in non-African American patients through GFR-driven changes in sugammadex use.