Wide Variation Research Articles

A Closer Look at Race, Ethnicity, and Gender Neutral Models

Abstract Litigation cases involving the expected earnings of minor children provide an ideal environment to examine the implications of public policies that attempt to mitigate racial, ethnic, and gender discrimination in the calculation of economic damages. This paper extends the existing literature on the implications of race, ethnicity, and gender neutral models by evaluating both educational attainment probabilities and estimated lifetime earnings within educational attainment categories. Recent related studies have focused on the educational attainment portion of the calculation only. We perform thousands of simulations of a child’s lifetime earnings using neutral estimations—a proxy for removing discrimination—and compare those estimates to ones in which race, ethnicity, and gender are taken into account. We find wide variation within racial and ethnic groups when earnings are incorporated into the analysis, consistent with prior research. Importantly, however, our findings pertain primarily to females, suggesting that interactions between gender and race and ethnicity are an added complexity. The practical implication of our findings is that neutral models can adversely impact individual members of protected groups. The results provide further guidance to policymakers who might be interested in the real-world outcomes associated with legislation that restricts how economists calculate economic damages.

Mental disorders during pregnancy and postpartum in Bangladesh: A narrative review.

Bangladesh has made significant progress in declining maternal mortality in recent decades. However, the available evidence on the various maternal mental disorders in the country has not been comprehensively and critically reviewed to date. This narrative review aimed to assess the mental disorders and associated factors during pregnancy and postpartum in Bangladesh. A thorough search was performed in PubMed, Scopus, Google, Google Scholar, and BanglaJOL with search terms at the end of January 2024 to identify the original articles published on psychiatric morbidities during pregnancy and postpartum. This review included 28 empirical studies published between 2007 and 2023 with a sample size ranging from 100 to 39,434. Two studies were published before 2010, 16 studies were published between 2011 and 2020, and 10 studies were published between 2021 and 2023. No countrywide study was noted, the Bangla Edinburgh Postnatal Depression Scale (EPDS-B) was used in 57% of studies, suicidal behavior was assessed in three studies, postpartum depression (PPD) was featured in 16 studies, and three qualitative studies were noted. The prevalence of PPD ranged from 9% to 51.7%. About 46% of mothers had positive scores for common mental disorders. The prevalence of mental disorders was 14.2%; among them mood disorders were present at 6.1% and psychoses were noted at 4.5%. There are wide variations in the prevalence of maternal mental disorders in Bangladesh from study to study; a lower prevalence was noted when diagnostic tools were used even though no nationwide study with confirmatory diagnostic tools was noted. Studies with nationwide distribution and diagnostic tools are warranted to understand the problem precisely.

Investigation of the beam quality and dose rate dependence of PAKAG polymer gel dosimeter in optical readout technique

This study aims to evaluate the optical response dependence of the PAKAG polymer gel dosimeter on photon energy and dose rate. The produced gel dosimeters were irradiated using a Varian CL 21EX medical linear accelerator with delivered doses of 0, 2, 4, 6, 8, and 10 Gy. To examine the response dependence on the delivered dose rate, dose rates of 50, 100, 200, and 350 cGy min−1 were investigated. Additionally, two incident beam qualities of 6 and 18 MV were examined to study the response dependence on the incident beam energy. The irradiated polymer gel dosimeters were readout using a UV–vis spectrophotometer in the 300 to 800 nm scan range. The results reveal that a wide variation in dose rate (50–350 cGy.min−1) influences the absorbance-dose response and the sensitivity of PAKAG gel. However, smaller variations did not show a significant effect on the response. Furthermore, the response changed insignificantly with beam quality for investigated energies. It was concluded that the optical reading response of the PAKAG polymer gel dosimeter is satisfactorily independent of external parameters, including dose rate and incident beam quality.

Comparison of in situ black-lipped oyster spat collection and larval dispersal modelling results in semi-closed pearl-farming lagoons of the Tuamotu Archipelago

Spat collection of the pearl oyster Pinctada margaritifera in atoll lagoons of French Polynesia is the fundamental sustain of black pearl farming. Spat collection has always yielded variable results in space and time, but obvious signs of steady decreases, even collapses, have emerged in several lagoons. Spat collection materializes the ecological connectivity pathways between wild spawning populations and the location of artificial larval settlement substrates. To assess if oyster larval dispersal modelling could capture such pathways, we compared four six-week long spat collector deployment periods with dispersal simulations in two different lagoons. Spat collectors displayed wide spatial and temporal variations. Numerical modelling and field experiments were generally not in agreement. Although both methods have limitations, they can still approximate each other. But the accuracy of model simulations cannot be ascertained with spat collection data only. Using a SWOT (Strength-Weakness-Opportunities-Threats) analysis, we emphasize the complementarity of both approaches for management decisions.

332. OUTCOMES OF SALVAGE SURGERY FOR ESOPHAGEAL CARCINOMA: A NATIONWIDE COHORT STUDY

Abstract Background Compared to a standard resection, salvage esophagectomy is a more complex procedure and associated with increased postoperative morbidity and mortality. This study aimed to investigate short-term outcomes of salvage surgery for esophageal carcinoma and the influence of hospital volume and baseline characteristics on outcomes. Methods All patients undergoing esophagectomy for esophageal cancer registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) between 2012-2022 in the Netherlands were included. Patients were classified as salvage or non-salvage by registering surgeons. The definition was: surgery after definitive chemoradiotherapy. Postoperative mortality (30-day/-in-hospital) and morbidity were compared between salvage and non-salvage patients using multilevel logistic regression analyses. Hospital variation in the use of salvage esophagectomy was investigated using funnel plots. The influence of annual hospital volume (<40->40) and annual salvage volume (<6->6) on outcomes of salvage patients were investigated. Using backward elimination, relevant baseline characteristics influencing outcomes after salvage surgery were identified. Results Between 2012-2022, 7,749 patients underwent esophagectomy, of whom 251 (3%) underwent salvage resection, varying from 0%-8% of esophagectomies between centers. Salvage surgery was associated with an increased risk of 30-day/in-hospital mortality (11% vs. 3%; OR:3.65; 95%CI:2.38-5.61) and severe complications (43% vs. 28%; OR:1.81; 95%CI:1.40-2.34). Salvage patients treated in high-volume esophagectomy centers (>40) had a decreased risk of 30-day/in-hospital mortality compared to low-volume centers (9% vs. 19%; OR:0.42; 95%CI:0.18-0.99), with no relation found between annual salvage volume and outcome. Certain baseline characteristics, foremost men, elderly (>75 years) and squamous cell carcinomas, were associated with worse short-term outcomes of salvage surgery. Conclusion Salvage surgery for esophageal carcinoma is infrequently but increasingly performed in the Netherlands, with wide hospital variation in its use. Salvage surgery is associated with worse short-term outcomes when compared with non-salvage esophagectomy. Outcomes after salvage surgery were favorable in high-volume esophagectomy centers, suggesting a volume-outcome relationship for salvage surgery.

Rapid pyrolysis technique for determination of kinetic parameters of ammonium perchlorate decomposition

A laser pyrolyser setup is developed to achieve isothermal conditions using a heating rate of up to ~105 ºC.s-1 for rapid pyrolysis of a sample. It provides mechanistic information about the decomposition behavior of the sample during combustion, typically in the condensed phase. Typically, chemical kinetics data for condensed phase reactions during combustion is not derived from ab initio techniques, but rather by fitting the variation of linear burning rate with pressure with appropriate kinetic parameters. This leads to a wide variation of chemical kinetic parameters governing the decomposition of the same solid propellant ingredient, such as the commonly used oxidizer, ammonium perchlorate (AP). Therefore, a newly developed laser pyrolyser along with Fourier transform infrared (FTIR) spectroscopy was used to study the rapid pyrolysis of AP at 1bar. The concentration profiles of the evolved gases were used to develop the global reaction mechanism. The global reaction mechanism that emerged is: NH4ClO4→1.09H2O+0.06HNO3+0.56NO2+0.18N2O+0.5Cl2+0.71O2+0.88H2 with pre-exponential factor (A) = 6.6×107s-1 and activation energy (Ea) = 108kJ.mol-1. Kinetic parameters of the same AP sample from thermogravimetric analysis are A = 5.6 ×105s-1, and Ea = 100kJ.mol-1. This suggests that kinetic parameters obtained from slow heating experiments predict a reaction rate significantly lower than that observed under high heating rates. Therefore, the raw data generated from rapid pyrolysis would be useful as an input to solid propellant combustion models improving their predictive capability.

737. ETHNIC, GENDER AND TUMOR-SPECIFIC ASSESSMENT OF BODY COMPOSITION IS CRITICAL FOR CLINICAL RELEVANCE IN PATIENTS UNDERGOING THERAPY FOR ESOPHAGEAL

Abstract Background Growing evidence has supported a role for body composition in predicting survival in patients undergoing esophagectomy. A contemporary meta-analysis of published data (n=44 studies) conducted for this study confirmed an association between reduced muscle mass at diagnosis and worse overall survival (HR 1.72, 95%CI 1.49-1.97). Variation in methods of assessing and defining parameters of body composition remain however an important barrier to the wider adoption in routine clinical practice. This is particularly pertinent in esophageal cancer due to known sex, biological and geographical difference in tumor subtypes. This study seeks to define baseline variation in body composition parameters and to report their association with 90-day and overall survival in a large international cohort of patients undergoing esophagectomy for cancer. Methods Patients who underwent esophagectomy in fourteen high-volume centers between January 2007 to December 2019 were eligible for inclusion. Survival data were included up until June 2022. Skeletal muscle, visceral and subcutaneous adipose tissues within CT images, acquired at the time of diagnosis, were analyzed in accordance with a standardized protocol. Results 1716 patients were recruited to this study from three global regions: North America (n=386;22.5%), Europe (n=940;54.8%) and Asia (n=390;22.7%). Patients were predominantly male (79.5%) and adenocarcinoma was the most common histological subtype (66.6%). Wide variation of skeletal muscle (17.1-83.5cm2), visceral adiposity (0.2-170.1cm2) and subcutaneous adiposity (0.2-216.8cm2) was observed at presentation. Characteristics significantly associated with levels of muscle and adiposity were global region, sex, age, and histological subtype (P<0.001) (Figure 1). Compared to adenocarcinoma, squamous cell carcinoma was associated with significantly lower levels of muscle and adiposity, a finding that was independent of global region, sex, and age using a multivariable linear regression model (p<.0001). Median follow-up was 71.3 (95%CI 69.1-73.5) months with a median overall survival of 60.9 (95%CI 53.0-68.9) months. Reduced skeletal muscle and an excess of total adiposity at the time of diagnosis was associated with worse 90-day mortality and long-term survival. An interactive online survival prediction tool was developed to provide personalized survival estimates based on relevant predictors including skeletal muscle, total adiposity at diagnosis and other tumor and patient specific variables. Conclusions This is the first and largest study to adopt standardized methods to define international variation in parameters of body composition in esophageal cancer patients. Findings corroborate the potential role of body composition as a method of prognostication in esophageal cancer and presents a on-line tool for convenient integration into clinical practice.

Nutritional, safety, and starch properties of flour from selected sweet cassava (Manihot esculenta Crantz) varieties grown in Nakuru County Kenya

Cassava plays a critical role in food security, particularly in sub-Saharan Africa due to its drought-resistant nature, high-yielding potential, and multipurpose application. This study analyzed ten cassava varieties recently introduced in Nakuru County, Kenya for their proximate composition, mineral content, anti-nutritional factors, and starch digestibility. The results showed significant variations in these factors among the varieties. The main component of cassava flour was total digestible starch, accounting for approximately 84.86 %, with low levels of crude fat and protein. Cassava flour showed low calcium, iron, and zinc levels, and a wide variation in phytates, potentially reducing their bioavailability. All the flour from the ten cassava varieties met safety limits for cyanide levels <10 mg/kg, with the Selele variety having the lowest cyanide. The starch analysis showed higher levels of Slowly Digestible Starch (41.1–53.0 %) and lower levels of Rapidly Digestible Starch (29.5–36.0 %). Cassava flour also showed significant levels of resistant starch ranging between 4.56 % and 7.23 %, supporting its beneficial impact on human health. The study provides valuable insights for cassava breeders to develop targeted nutritional qualities and empowers consumers to make informed choices.

Outcomes of Patients With Traumatic Brain Injury Transferred to Trauma Centers

Wide variations exist in traumatic brain injury (TBI) management strategies and transfer guidelines across the country. To assess the outcomes of patients with TBI transferred to the American College of Surgeons (ACS) level I (LI) or level II (LII) trauma centers (TCs) on a nationwide scale. In this secondary analysis of the ACS Trauma Quality Improvement Program database (2017 to 2020), adult patients with isolated TBI (nonhead abbreviated injury scale = 0) with intracranial hemorrhage (ICH) who were transferred to LI/LII TCs we re included. Data were analyzed from January 1, 2017, through December 31, 2020. Outcomes were rates of head computed tomography scans, neurosurgical interventions (cerebral monitors, craniotomy/craniectomy), hospital length of stay, and mortality. Descriptive statistics and hierarchical mixed-model regression analyses were performed. Of 117 651 patients with TBI with ICH managed at LI/LII TCs 53 108; (45.1%; 95% CI, 44.8%-45.4%) transferred from other centers were identified. The mean (SD) age was 61 (22) years and 30 692 were male (58%). The median (IQR) Glasgow Coma Scale score on arrival was 15 (14-15); 5272 patients had a Glasgow Coma Scale score of 8 or less on arrival at the receiving trauma center (10%). A total of 30 973 patients underwent head CT scans (58%) and 2144 underwent repeat head CT scans at the receiving TC (4%). There were 2124 patients who received cerebral monitors (4%), 6862 underwent craniotomy/craniectomy (13%), and 7487 received mechanical ventilation (14%). The median (IQR) hospital length of stay was 2 (1-5) days and the mortality rate was 6.5%. There were 9005 patients (17%) who were discharged within 24 hours and 19 421 (37%) who were discharged within 48 hours of admission without undergoing any neurosurgical intervention. Wide variations between and within trauma centers in terms of outcomes were observed in mixed-model analysis. In this study, nearly half of the patients with TBI managed at LI/LII TCs were transferred from lower-level hospitals. Over one-third of these transferred patients were discharged within 48 hours without any interventions. These findings indicate the need for systemwide guidelines to improve health care resource use and guide triage of patients with TBI.

Role of periodic oscillating flow modulators on mixed convection in a long horizontal channel

Present study explores mixed convection characteristics in a long horizontal channel subjected to multiple periodically distributed flow modulators. The flow modulators are represented by oscillating blades placed along a centerline of the channel whose lower and upper walls are kept at constant high and low temperatures respectively. In replicating the blade oscillation, moving mesh approach has been adopted within Arbitrary Lagrangian–Eulerian (ALE) framework for a representative periodical unit. The corresponding non-dimensional governing mass, momentum and energy conservation equations have been solved through Galerkin finite element solver for a wide variations of modulator's dynamic condition (oscillating frequency and maximum angular displacement) for different fluids represented by Prandtl number. Heat transfer performance of the system has been demonstrated in terms of spatially-averaged transient as well as time-averaged Nusselt number while qualitative analysis of fluid flow and thermal field has been presented as streamline and isotherm plots. Present study indicates that the time averaged Nusselt number undergoes significant variation with blade oscillating frequency and maximum angular displacement depending on both the Prandtl number and Reynolds Number. Power spectrum analysis obtained through Fast Fourier Transformation (FFT) of the imposed blade frequency and induced thermal frequency reveals different correlation depending on the blade frequency. Blade friction power requirement has been found to increase at higher blade frequency as well as maximum angular displacement. However, contrary to power consumption, increase in frequency does not result in a significant rise in heat transfer. Consequently, specific heat transfer decreases at higher blade oscillating frequency and maximum angular displacement.

Influence of aloe-vera powder addition on microstructure and mechanical properties of wire + arc additively manufactured ER70S-6 steel

ER70S-6 steel Wire Arc Additive Manufactured deposit was fabricated using Gas Tungsten Arc Welding (GTAW) under two conditions: without and with aloe-vera powder. Aloe-vera is added at the interlayer during deposition. The effect on microstructure evolution, hardness and tensile properties due to addition of aloe-vera were investigated. Without aloe-vera deposits recorded non-uniform microstructure from lower to upper zone, resulting in wide variation in hardness. On the other hand, presence of aloe-vera minimized the microstructural inhomogeneities. The presence of aloe-vera also suppressed the formation of bainite phase and stabilize the hardness throughout the deposit. The tensile strength of the aloe-vera added deposit also increases compared to without powder particle deposit.

Maize genotypes with favourable dgat1–2 and fatb alleles possess stable high kernel oil and better fatty acid health and nutritive indices

Diverse uses of maize oil attracted various stakeholders, including food, feed, and bioenergy, highlighting the increased demand for sustainable production. Here, 48 diverse sub-tropical maize genotypes varying for dgat1–2 and fatb genes governing oil attributes, were evaluated in three diverse locations to assess trends of oil content, fatty acid (FA) profile, the effect of environment on oil attributes, the impact of different gene combinations and determine FA health and nutritional properties. The genotypes revealed wide variation in oil content (OC: 3.4–6.8 %) and FA compositional traits, namely palmitic (PA, 11.3–24.1 %), oleic (OA, 21.5–42.7 %), linoleic (LA, 36.6–61.7 %), and linolenic (ALA, 0.7–2.3 %) acids. Double-mutants with both favourable alleles (dd/ff) exhibited 51.6 % higher oil, 33.2 % higher OA, and 30.2 % reduced PA compared to wild-types (d+d+/f+f+) across locations. These double-mutants had lower saturated FA (12.2 %), and higher unsaturated FA (87.0 %), indicating reduced susceptibility to autooxidation, with lower atherogenicity (0.14), thrombogenicity (0.27) and peroxidisability (48.15), higher cholesterolemic index (7.16), optimum oxidability (5.27) and higher nutritive-value-index (3.35) compared to d+d+/f+f+, making them promising for significant health and nutritional benefits. Locally adapted stable novel double-mutants with high-oil and better FA properties identified here can expedite the maize breeding programs, meeting production demands and addressing long-standing challenges for breeders.

A significant correlation between ABA-induced seed-germination delay and salt tolerance of seedling in Brassica napus

ABSTRACT Under abiotic stresses, such as salt stress, abscisic acid (ABA) production is induced and enhances stress tolerance. ABA is also an important plant hormone that regulates vital biological responses, including seed gemination delay. However, the interplay between stress conditions and biological responses is not well understood. Previously, we reported a wide salt tolerance variation among Brassica napus varieties. This range of salt tolerance makes B. napus ideal for exploring the relationship between salt tolerance and ABA-induced seed germination delay. First, we investigated the ABA-induced seed-germination delay of 22 B. napus varieties, each with different salt tolerances. We observed that highly salt-tolerant varieties exhibited significant seed-germination delays when exposed to increasing ABA concentrations. Additionally, among the varieties, exogenous ABA induced a range of different germination delays, suggesting a significant correlation between germination delay and salt tolerance at the seedling stage. Expression analysis, with and without ABA treatment, for several genes involved in the ABA signalling pathway and downstream was also performed at seed germination. The results suggest the potential involvement of ABI5 and SOS1 in both germination regulation and salt tolerance.

Effect of intensive seasonal pumping and recharge on sulfur biogeochemistry in groundwater of agricultural riparian zones

Physico-chemical characteristics of groundwater are often impacted by agricultural practices such as land use, fertilizer types, and groundwater pumping. This study aimed to identify contaminant sources and redox processes controlling the hydrogeochemistry of groundwater in riparian zones influenced by intensive agricultural activities, focusing on sulfur species. Groundwater samples were collected bimonthly from March 2014 to March 2015 from groundwater wells in two zones in South Korea with different agricultural systems. The water isotopic compositions of the groundwater indicated that all groundwater originated from the same meteoric water. Groundwater samples affected by periodic groundwater pumping exhibited wide variations in Mn2+ (47.8 ± 18.2 μM) and Fe2+ (123 ± 61.0 μM) and elevated SO42−, while NO3− was below the detection limit. Groundwater chemistry was affected by fertilizer and manure, and denitrification. The oxidation of reduced sulfur compounds by oxygen and nitrate did not fully account for the elevated SO42− concentrations and isotopic composition of sulfate (δ34S and δ18O) in the investigated aquifers. Therefore, we postulate that water level change due to periodic groundwater pumping and recharge enabled oxidants (MnO2 and Fe3+) to also contribute to oxidation of reduced sulfur. Additionally, fertilizers with distinct δ34S values and bacterial sulfate reduction (BSR) affected groundwater chemistry and its sulfur species, including δ34SSO4 and δ18OSO4. Removal of sulfate from the aquifer during pumping limited BSR. Consequently, the agricultural practices may further increase sulfate concentrations in the groundwater. This environmental impact should be thoroughly managed because high sulfate concentrations in drinking water cause ingestion problems in humans.

Rapid assessment of acetophenone using an anti-interfering triple-emission Ln3+-functionalized HOF@MOF sensor

The development of high-performance sensors for rapidly detecting acetylacetone (AP) in water samples is necessary because its release into the environment can result in many vital problems for human health and environment. Herein, we first designed a hybrid by integrating HOF with ZIF-8 through a sequential growth strategy. By separately introducing blue-emitting SiQDs and green- and red-emitting Tb3+ and Eu3+ into ZIF-8 and HOF, the resultant ZIF-8@SiQDs@HOF@Eu3+@Tb3+ comprised three emission peaks at 484, 545 and 620 nm, all of which could be employed as switch-off responsive peaks to low concentrations of AP with a detection limit of 0.79 ppm. However, in environments with high concentrations of AP, a turn-on signal at 484 nm was observed. Thereupon, the ratiometric fluorescence intensity of the ternary emission varied within different concentration ranges, accompanied by the fluorescence color evolution from red to salmon to plum to purple to final blue. Moreover, a portable sensing film was fabricated for rapid warning, sensitive and visual determination of AP in complicated environments. Therefore, this triple-emission sensor with wide color variations and strong anti-interference advantages could promote further research to improve the selectivity, sensitivity and inherent self-correction of multimodal fluorescence detection and the ease of sensing operation.

Mind the gap—What is the appropriate time interval between sequential dentine stimuli to elicit a dentine hypersensitivity pain response in clinical studies?

ObjectivesTo determine the time interval required for a tooth diagnosed with DH to recover from a stimulus (cold air-blast/tactile) and respond with a similar elicited pain response to a repeat stimulus. MethodsA single-centre, non-randomised, clinical study in healthy adult volunteers. Eligible participants with ≥1 tooth with either a qualifying Schiff score ≥2 following cold air-blast or tactile Yeaple score of ≤20 g were allocated to tactile or air-blast group. Following primary stimulation, the designated tooth was restimulated 10, 5, 2 min and immediately after initial pain cessation. Pain was recorded with participant VAS and investigator Schiff for air-blast. Results40 participants completed the study per group. There was a significant difference in VAS scores for tactile 4 delay intervals (p < 0.001) but not air-blast stimulus, and a significant difference in mean change in VAS score from immediate to two-minute delay between stimuli (8.0 tactile vs 0.8 air-blast, p = 0.011). VAS scores in response to either stimulus showed very wide variation between participants, but changes over delay intervals within participants were relatively slight. There was a significant progressive decrease in mean Schiff score with shortening delay intervals from 10 min (2.38) to stimulation immediately after pain cessation (2.15), p = 0.018. ConclusionsThe findings suggest healthy teeth recover after DH stimulation more quickly following an air-blast than tactile stimulus, with around 2 min allowing recovery from both. Many factors including habituation and pain measurement subjectivity need to be considered. It would be prudent for future studies to use of ≥3 min delays. Clinical significanceNo clinical study has attempted to determine the appropriate interval between successive stimuli in DH patients. The results will impact directly on the conduct of DH trials. These findings suggest the interval could be reduced to around 2-min, but the current standard of 5-min is sufficiently long to give valid results.

Learning Networks: How Family Medicine Departments Are Meeting the Requirement.

In 2023, the Accreditation Council for Graduate Medical Education added participation within a "learning collaborative" or "learning network" (LN)as a requirement for family medicine residencies. The structure and scope of what makes an acceptable LN was only vaguely defined. The purpose of this study was to learn how many family medicine residencies associated with departments already belong to LNs, the purpose and funding of these existing LNs, and barriers to entering LNs. An online survey was sent to family medicine department chairs through a Council of Academic Family Medicine Educational Research Alliance omnibus study from August to September 2023. Survey questions explored the purpose, structure, and funding of LNs that associated residency programs already belonged to as well as the chairs' beliefs and knowledge about LNs. Of the 227 chairs, 119 completed the survey (50.2%). About 53% reported that their department was part of an LN, with more than one-third belonging for 5 years or less; 47% had a low understanding of what an LN is; and 71% had little to no concern that collaborating in an LN would negatively affect residency recruitment. The purpose of most LNs was a mix of research, education, and clinical activities. Faculty's lack of knowledge about LNs and lack of time were the top barriers identified to joining an LN. Funding was varied, and departmental funding was positively associated with administrative control of the LN. About half of the residency programs associated with family medicine departments already belong to LNs. Wide variation among existing LNs may lead to significantly disparate outcomes for residents and residencies as they navigate this new requirement.

Understanding the Perspectives of Key Stakeholders Toward Medicare's Home Health Value-Based Purchasing (HHVBP) in the US

ObjectivesThis study examines the perspectives of key stakeholders in home health toward Medicare's Home Health Value Based Purchasing (HHVBP) program, piloted among home health agencies (HHAs) in 9 states from 2016 to 2021, and based on initial performance, was expanded to the remaining 41 (nonpilot) states in January 2023. DesignWe conducted semistructured interviews wherein we inquired participants’ views toward and experiences with HHVBP. We used convenience and purposive sampling to obtain diversity in HHA size, geography, and quality. Setting and ParticipantsWe conducted interviews from July 2022 to May 2023 with HHA leaders, staff, and clinicians, advocacy and trade organization leaders, and policy experts from pilot and nonpilot states. MethodsWe used thematic analysis to develop a codebook that included framework-derived, a priori, and inductive codes. We identified key themes and subthemes accordingly. ResultsForty-seven stakeholders representing 25 unique organizations participated: 22 (47%) from pilot states and 25 (53%) from nonpilot states; of these, 24 (51%) were HHA leaders, 13 (28%) were organizational leaders, and 10 (21%) were clinicians; 26 (55%) were centered in the Northeast, 9 (19%) in the West, 7 (15%) had a national presence, and 5 (11%) were centered across the South. Four key themes emerged. There were (1) wide variations in awareness, understanding, and attitudes toward HHVBP regardless of pilot status or stakeholder type; (2) concerns about aspects of HHVBP, including consequences for HHAs and patients; (3) a range of strategies used by HHAs to address HHVBP; (4) other concurrent issues that HHAs were navigating alongside HHVBP. Conclusions and ImplicationsDespite HHVBP's national implementation, awareness of and attitudes toward HHVBP varied across stakeholders from pilot and nonpilot states, as did efforts to address it. Although some viewed the policy favorably, others were concerned it could negatively impact HHAs and patients. Understanding the experiences of stakeholders is vital for illuminating the intended and unintended consequences of HHVBP policy.

2300 A survey on the underlying knowledge of doctors’ in conducting polypharmacy review and medication optimisation in older adults.

Abstract Introduction Polypharmacy is common among older adults and could result in adverse outcomes if not reviewed and optimised regularly (Davies et al, 2020). The aim of this survey is to assess and report on the variation in doctors’ understanding of medication reviews at Maidstone and Tunbridge Wells hospitals (MTW). Method A short, anonymised, online questionnaire was circulated to all current doctors at MTW via email and WhatsApp groups. Results 38 doctors of different grades (Foundation Year One-Consultant) from a variety of medical and surgical specialties responded. Of these, 41% could correctly define appropriate polypharmacy, but only 6% could define problematic polypharmacy. Most respondents (59.5%) had not received any training on structured medication reviews (SMR). 51.4% were not aware of any tools used in medication optimisation. 43% said they ‘always carry out’ medication reviews in clinical practice and 8.3% said that they never do. Less than half (38%) felt confident in completing SMR. The main barriers to routine implementation of SMR identified by the respondents were: lack of confidence (27%), time pressures (26%), senior clinicians not giving importance to SMR (16%), 3% felt it was not the doctor’s responsibility. Most respondents (91.7%) said that they would benefit from further training in SMR. Conclusions The results show that there is a wide variation in the respondents’ understanding and practice of medication reviews. Also, that there is a clear and well- founded demand for training. Once training has been formulated and delivered a follow up survey of those attending should be used to help gauge its effectiveness. The small sample size is a limitation of this study affecting its generalisability as is the fact that it was a self-selected group completing the survey.

Gender diversity in the National Joint Registry.

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration. Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001). Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons.