Search

Objective: Management of tympanic membrane perforations is varied. This study aimed to better understand current practice patterns in myringoplasty and type 1 tympanoplasty. Methods: An electronic questionnaire was distributed to American Academy of Otolaryngology – Head and Neck Surgery members. Practice patterns were compared in terms of fellowship training, practice length, practice setting, paediatric case frequency and total cases per year. Results: Of the 321 respondents, most were comprehensive otolaryngologists (60.4 per cent), in private practice (60.8 per cent), with a primarily adult practice (59.8 per cent). Fellowship training was the factor most associated with significant variations in management, including pre-operative antibiotic usage (p = 0.019), contraindications (p < 0.001), approach to traumatic perforations (p < 0.001), use of local anaesthesia (p < 0.001), graft material (p < 0.001), tympanoplasty technique (p = 0.003), endoscopic assistance (p < 0.001) and timing of post-operative audiology evaluation (p = 0.003). Conclusion: Subspecialty training appears to be the main variable associated with significant differences in peri-operative decision-making for surgical repair of tympanic membrane perforations. [ABSTRACT FROM AUTHOR]

The Gharb aquifer plays a critical role as a source of drinking water and irrigation in Morocco. However, rapid economic growth and increased use of chemical fertilizers have led to groundwater pollution and land degradation. To address this issue, a vulnerability assessment was conducted using the Susceptibility Index (SI) method. Five parameters including depth to groundwater, effective recharge, slope, soil type, and land use/land cover were considered to evaluate groundwater vulnerability. The vulnerability assessment revealed index values ranging from 31 to 160. The study area was categorized into three zones of relative vulnerability (low, moderate, and high). Spatial analysis demonstrated significant spatial heterogeneity, with moderate vulnerability observed in areas characterized by shallow groundwater and composed primarily of sandstones in the northwest and southwest regions. In the entire study area, the low, medium, and high vulnerability zones covered 3%, 70%, and 26% (101 km2, 2725 km2, and 986 km2), respectively. Furthermore, Tritium isotope analysis and nitrate content were selected and applied as pollution markers to confirm and validate the obtained vulnerability map. The Tritium (3H) content in groundwater reveals a correlation with an R2 value of 0.86 with the degree of vulnerability, while the nitrate concentration in the aquifer’s groundwater showed a correlation with an R2 value of 0.55.

The combined use of PolSAR and hyperspectral data can improve the classification accuracy. This paper proposes a new classification approach for combining use of PolSAR and hyperspectral image data sets. At the first step, polarization signature is generated from coherency matrix of PolSAR image data. In the second step, in order to improve spatial resolution, the Hyperion image was pan-sharped with the ALI Pan image. In the third step, the Random Forest (RF) classifier is used for classifying PolSAR and hyperspectral data sets in five different classes including: Water (Wa), urban area (Ur), vegetation (Vg), road (Ro), and soil (So). Then, in order to fuse the output of RF for incorporated two data sets, simple majority voting (MV) and weighted majority voting (WMV) methods are used. Three UAVSAR, Hyperion and ALI images that acquired on April 2015 was chosen for this study. The results showed the ability of the polarimetric data for classifying urban and vegetation, and hyperspectral images for water, soil and road classes. Also, the combination of two data sets by using of WMV method causes the improvements of the classification performance. [ABSTRACT FROM AUTHOR]

In recent years, forests in the north of the country have been attacked due to human interference. Increasing population and development of residential and agricultural areas have led to deforestation. Change detection is one of the most common methods for evaluating natural resources. The aim of this study is to monitor changes in forests of Golestan province in two period times from 1990 to 2019, using Landsat images. Accordingly, by incorporating those data sets land use maps are produced. Also, the SVM algorithm is used with six different classes including forest (F), urban area (U), agriculture (A), uncultivated land (UL), water (w) and bare soil (BS). The achieved overall accuracies are 85.48% and 89.86%. Then the map and matrix changes were obtained by post-classification comparison method. The results showed that the Golestan province's forests were reduced and converted to agricultural and urban land uses. [ABSTRACT FROM AUTHOR]

Uterine rent is one of the almost new topics in which the nature, validity and invalidity and its effects have been variously debated and different opinions have been expressed. In most studies and researches in this field, the nature of this obligation and the rules governing it have usually been considered as the criterion for the man and woman who have the sperm, but in this research, the main attention and emphasis is on the woman who undertakes this Commits and what is the necessity and justification on the basis of which he agrees to this action. Can the subject of the contract be the encroachment on a part of the human body? In this study, the correctness of citing the principle of immorality has been criticized and evaluated, and by examining one of the pre-Islamic marriages called "marriage of impeachment", it is concluded that the ownership of ablution, including the rights of God It has been given exclusively to the couple through marriage. Finally, due to the conflict of this contract with the general rules of contracts, including the subject of marriage and good morals, the rights of the child and the rules of non-mahram, the promise to annul it is strengthened.

Abstract Background Tudor domain-containing proteins (TDRDs) play a critical role in piRNA biogenesis and germ cell development. piRNAs, small regulatory RNAs, act by silencing of transposons during germline development and it has recently been shown in animal model studies that defects in TDRD genes can lead to sterility in males. Methods Here we evaluate gene and protein expression levels of four key TDRDs (TDRD1, TDRD5, TDRD9 and TDRD12) in testicular biopsy samples obtained from men with obstructive azoospermia (OA, n = 29), as controls, and various types of non-obstructive azoospermia containing hypospermatogenesis (HP, 28), maturation arrest (MA, n = 30), and Sertoli cell-only syndrome (SCOS, n = 32) as cases. One-way ANOVA test followed by Dunnett’s multiple comparison post-test was used to determine inter-group differences in TDRD gene expression among cases and controls. Results The results showed very low expression of TDRD genes in SCOS specimens. Also, the expression of TDRD1 and TDRD9 genes were lower in MA samples compared to OA samples. The expression of TDRD5 significantly reduced in SCOS, MA and HP specimens than the OA specimens. Indeed, TDRD12 exhibited a very low expression in HP specimens in comparison to OA specimens. All these results were confirmed by Western blot technique. Conclusion TDRDs could be very important in male infertility, which should be express in certain stages of spermatogenesis.

This paper treats the design, control and implementation of a non-isolated low voltage DC/DC converter with a high voltage ratio coupled a fuel cell stack and a DC bus which can be used in transport applications. The proposed converter consists of two cascade stages non-isolated DC/DC converters. The first stage is an interleaved boost converter and the second is a double dual-interleaving boost converter. The selection of each stage is based on the efficiency of the converter with a high output voltage, a small input current ripple, and an output voltage ripple. The control of the converters is ensured by a dual loop control that contains for the first step a voltage loop with a linear PI controller and a fast current loop using a non-linear sliding controller for both converters. After that, the voltage loop of the first stage is replaced by an energy loop based on a differential flatness control approach. The simulation of the proposed control is performed under Matlab-Simulink environment and validated by experimental results using small-scale test bench with dSPACE-1104 card. This paper presents and comments the introduced device and discusses the obtained results. [ABSTRACT FROM AUTHOR]

This paper proposes an experimental study of a control strategy for a voltage regulated DC hybrid power source employing photovoltaic (PV) panels as the main source, fuel cell (FC) emulator as the auxiliary power source and lead-acid batteries for the reason of storage and to ensure the right balance between the distributed generation system and the load. This approach is based on the DC link voltage regulation; wherever the energy generated is managed through this nonlinear approach based on the differential flatness property. In addition, the entire description of the state's trajectories can be obtained using this control technique, in which improvement of the dynamic response, stability and robustness of the proposed PV-FC hybrid system by decreasing the static error in the output regulated voltage all has been taken into account in this work. The experimental results show that the proposed control based on the flatness theory is able to manage well the power flow in a hybrid system with photovoltaic, fuel cell and lead-acid batteries. [ABSTRACT FROM AUTHOR]

Survival from Wilms tumour is excellent. Hence, better markers are required to restrict treatments causing late sequelae to those at highest risk of relapse. We investigated the prognostic significance of loss of heterozygosity (LOH) on 1p and 16q in 426 favourable histology Wilms tumours treated with either immediate nephrectomy (63%) or preoperative chemotherapy (37%). Four years RFS and OS were 84.6% and 92.0%, respectively. 10.3% tumours had LOH 1p, 14.6% LOH 16q, with 2.6% at both loci. In multivariate analysis, LOH 16q was associated with an increased risk of relapse (hazard ratio (HR) 2.69, 95%CI: 1.47-4.92) and death (HR 2.67, 95%CI: 1.17-6.06). LOH 1p showed no significant associations. These results were not influenced by treatment approach. LOH 16q is an adverse risk factor in favourable histology Wilms tumour, regardless of initial approach to therapy. Its relationship with histological risk groups defined after neo-adjuvant chemotherapy requires analysis in a larger series, and is the subject of the current SIOP WT 2001 trial. [ABSTRACT FROM AUTHOR]

Intravenous (IV) digoxin loading dose recommendations for rate control of atrial arrhythmias in critically ill patients are not well studied. When using digoxin in the setting of atrial fibrillation/atrial flutter (AF/AFL), a loading dose (LD) in either a fixed-dose regimen, weight-based dose, or pharmacokinetic-based calculation to target a serum digoxin concentration (SDC) of 0.8-1.5 ng/mL is recommended. The objective of this study was to assess the safety and effectiveness of digoxin LD used in critically ill patients for rate control of AF/AFL and to assess the SDC achieved. This single center retrospective cohort study included patients who received IV digoxin and had a SDC drawn. The primary endpoint was the median SDC achieved after a digoxin LD. Secondary outcomes included the frequency of SDCs ≥1.5 ng/mL and heart rate (HR) control. A total of 92 patients were included. The median total LD of digoxin for the entire cohort was 11mcg/kg (750 mcg). For 61% of the cohort, the LD was distributed over six-hour intervals. The median SDC after completion of the IV digoxin LD was 1.3 ng/mL (0.9, 1.7). The incidence of supratherapeutic SDC was 36% for the total cohort. A target HR < 110 beats per minute within 24 hours from digoxin LD was achieved in 60% of the cohort. In conclusion, a median total digoxin LD of 750 mcg in critically ill patients with AF/AFL, targeting a SDC < 1.5ng/mL may be considered for acute rate control, taking into account drug-drug interactions in the cardiac intensive care unit. Future studies are necessary to confirm our findings., Competing Interests: DISCLOSURE OF FUNDING AND CONFLICT OF INTEREST All authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The use of noninvasive respiratory support- namely high flow of oxygen delivered via nasal cannula (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV) - has been expanding in recent years. The physiologic mechanisms underlying each of these forms of support are generally well understood. In contrast, the effects on the sensorimotor mechanisms of swallowing movements, and of breathing and swallowing coordination ─ critical elements of airway protection and bolus clearance ─ remain unclear. The purpose of this systematic review is to assess the existing evidence about the impact of noninvasive respiratory support on swallowing mechanics, airway protection, and respiratory-swallowing patterns in adults., Methods: Six databases (PubMed, EMBASE, Web of Science, Scopus, CINAHL and ProQuest Dissertations & Theses) were searched using predetermined terms. Inclusion criteria were: 1) adult humans 2) use of noninvasive respiratory support, and 3) assessment of swallowing., Results: We identified 8727 articles for screening; 15 met the inclusion criteria. Six studies assessed noninvasive respiratory support in healthy adults, and 9 assessed participants with heterogenous respiratory diagnoses including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), acute respiratory failure, and chronic respiratory failure due to neuromuscular disease. Risk of bias was assessed using a modified NIH Quality Assessment Tool. In healthy adults, results demonstrated mixed effects of HFNC and CPAP on measures of swallowing function, airway protection, and respiratory swallowing patterns. Negative effects on respiratory-swallowing patterns were reported with NIV. In adults with heterogeneous respiratory diagnoses, six studies reported that HFNC, CPAP, or nasal NIV improved measures of swallowing and respiratory-swallowing patterns. HFNC has mixed effects on swallowing measures in ICU patients. NIV increased atypical respiratory-swallowing patterns in patients with stable COPD., Conclusions: Due to small sample sizes and the wide variation in study designs, the impact of noninvasive respiratory support on swallowing, airway protection, and respiratory-swallowing patterns cannot be confidently assessed based on the current evidence. Future studies using standardized, validated, and reproducible methods to assess the impact of noninvasive respiratory support on swallowing physiology and airway protection are warranted., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Aims: Tumour rupture (TR) signifies stage III disease and requires treatment intensification, which includes radiotherapy. We studied the associations between radiological, surgical and pathology TR in children with Wilms tumour (WT) in a United Kingdom multicentre clinical study., Patients and Methods: The IMPORT (Improving Population Outcomes for Renal Tumours of Childhood) study registered 712 patients between 2012 and 2021. Children with TR on central radiology review (CRR) at diagnosis and/or indication of preoperative TR on surgical forms were included. Correlation between radiology/surgery/pathology findings was made., Results: Total 141 patients had TR identified (69 on CRR, 43 on surgical form and 29 on both), and 124/141 had images available for CRR, and 98/124 had features suggestive of TR on diagnostic CRR (63 magnetic resonance imaging/35 computed tomography). TR was limited to the renal fossa in 47/98 (48%) and intraperitoneal in 51/98 (52%). Three of 98(3%) had upfront surgery, and 87/95 (92%) had TR confirmed on post-chemotherapy preoperative scans. Among 80/98 (82%) cases with TR on CRR and available surgical forms, TR was not confirmed on surgery or pathology in 38/80, giving a false-positive rate of 48%. Preoperative TR was indicated on 72 surgical forms, with images available for CRR in 55. Twenty-six of 55 (47%) were false-negative for TR on CRR and of those 10/26 (38%) had TR confirmed on pathology., Conclusions: Radiology alone should not be used to define TR, as it does not accurately correlate with surgical or pathology findings, and therefore cannot be relied upon for definitive staging and treatment. A multidisciplinary team should take the decision regarding the final abdominal stage and treatment using a multimodality approach considering clinical, radiological, surgical and pathological findings., (© 2024 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

WT1 encodes a podocyte transcription factor whose variants can cause an untreatable glomerular disease in early childhood. Although WT1 regulates many podocyte genes, it is poorly understood which of them are initiators in disease and how they subsequently influence other cell-types in the glomerulus. We hypothesised that this could be resolved using single-cell RNA sequencing (scRNA-seq) and ligand-receptor analysis to profile glomerular cell-cell communication during the early stages of disease in mice harbouring an orthologous human mutation in WT1 (Wt1 R394W/+ ). Podocytes were the most dysregulated cell-type in the early stages of Wt1 R394W/+ disease, with disrupted angiogenic signalling between podocytes and the endothelium, including the significant downregulation of transcripts for the vascular factors Vegfa and Nrp1. These signalling changes preceded glomerular endothelial cell loss in advancing disease, a feature also observed in biopsy samples from human WT1 glomerulopathies. Addition of conditioned medium from murine Wt1 R394W/+ primary podocytes to wild-type glomerular endothelial cells resulted in impaired endothelial looping and reduced vascular complexity. Despite the loss of key angiogenic molecules in Wt1 R394W/+ podocytes, the pro-vascular molecule adrenomedullin was upregulated in Wt1 R394W/+ podocytes and plasma and its further administration was able to rescue the impaired looping observed when glomerular endothelium was exposed to Wt1 R394W/+ podocyte medium. In comparative analyses, adrenomedullin upregulation was part of a common injury signature across multiple murine and human glomerular disease datasets, whilst other gene changes were unique to WT1 disease. Collectively, our study describes a novel role for altered angiogenic signalling in the initiation of WT1 glomerulopathy. We also identify adrenomedullin as a proangiogenic factor, which despite being upregulated in early injury, offers an insufficient protective response due to the wider milieu of dampened vascular signalling that results in endothelial cell loss in later disease. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland., (© 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.)

Introduction: The use of push-dose vasopressors to treat anesthesia-induced hypotension is a common evidence-based practice among anesthesiologists. In more recent years, the use of push-dose vasopressors has transitioned to the emergency department (ED) and critical care setting. There is debate on the best choice of a push-dose vasopressor, with push-dose epinephrine or phenylephrine being more commonly used. This scoping review evaluated publications regarding the clinical use of push-dose norepinephrine., Methods: We queried research studies in both PubMed and Google Scholar on the use of push-dose norepinephrine in human subjects, with numerous randomized controlled trials that compare norepinephrine to other vasopressors including phenylephrine, ephedrine, and epinephrine., Results: A large majority of the studies were performed in the setting of spinal anesthesia prior to cesarean section, while several involved the administration of general anesthesia, with limited-to-no literature in the emergency and critical care setting. Of the 27 studies that we included in the review, 17 were randomized controlled trials. These studies demonstrated that norepinephrine was safe and effective., Conclusion: Prior research has demonstrated the superiority of norepinephrine as a pressor of choice for various shock states. In this review, the safety and efficacy of push-dose norepinephrine is demonstrated, and favorable hemodynamic markers are shown in comparison to other agents. In addition, there are some safety and efficiency benefits to using push-dose norepinephrine from an administration standpoint, as well as clinically in decreased need for repeat doses. Further high-quality studies in the emergency and critical care realm would be beneficial to confirm these findings., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Background: The announcement of a cancer diagnosis represents a real turning point, significantly and pessimistically changing the patient's vision of his future. The task of the healthcare professional in communicating bad news is complex. It requires careful use of words, establishing a relationship of trust, a patient approach, and encouraging the person affected by cancer to express their emotions. This is a sociological study of a series of cancer patient cases designed to reveal the different perceptions and experiences of cancer patients with regard to the announcement of the diagnosis of cancer by healthcare professionals., Materials and Methods: This descriptive qualitative study was done in 2022. The participants were selected from cancer patients cases treated in the Fès-Meknès Region. Participants in this study were 35 patients selected using a purposeful sampling method. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used to analyze the data using Atlas.ti software., Result: A double suffering has been observed among cancer patients with regard to the announcement of their cancer diagnosis. In addition to the intensification of negative feelings and distress at the time of the announcement, dissatisfaction has been observed with the way in which the cancer diagnosis is communicated. The announcement does not address the holistic needs of the cancer patient, particularly with respect to health literacy. This finding is justified by limitations in relation to the basic training of the medical and nursing cops with regard to the announcement of the diagnosis., Conclusion: This event represents a critical moment, requiring a multidisciplinary approach and involving various professionals involved in cancer management. Health professionals need to develop the skills necessary to accurately but smoothly announce a cancer diagnosis in order to maintain hope regardless of prognosis. Thus, an indispensable aspect to take into account in diagnostic communication is the cancer patient's level of literacy., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Purpose: Tongue manometry (i.e., tongue pressure measurement) is a commonly used assessment for patients with suspected oral-motor involvement in swallowing disorders. Availability of lingual manometry has changed in recent years, with the introduction of the Tongueometer device being a more affordable tongue manometry system. The purpose of this study was to test concurrent (criterion) validity of the Tongueometer compared to the current standard reference device, the Iowa Oral Performance Instrument (IOPI)., Method: Adults without dysphagia were recruited for participation in this study. Standard lingual measurements (swallowing-related pressures, maximum isometric pressure [MIP], and maximum isometric endurance) were recorded, with the bulb anteriorly placed, with both devices, in a randomized order. The Bland-Altman method was used to determine concurrent (criterion) validity of these measurements compared to the clinical standard IOPI device. A recently available suggested corrective value by Curtis et al. (2023) was also applied, with comparisons made between devices both with and without the Curtis correction., Results: The final sample included 70 adult participants aged 20-89 years ( M age = 52.3 years). Measures with the Tongueometer device were significantly lower when compared with the same measures taken using the IOPI ( p < .01) for all measures including MIP, endurance, and swallow pressures. The correction suggested by Curtis and colleagues did not ameliorate these differences., Conclusions: The Tongueometer lingual measurements were consistently lower compared to the IOPI. Clinical use of values taken with the Tongueometer device should be compared to normative data published for each specific device. Available features of each device (e.g., display, bulb texture, technology/application) should be considered when selecting which device to use with an individual patient.

Objective: To assess the association between aspartate aminotransferase (AST) to platelet count ratio index (APRI score), during the first and third trimesters of pregnancy and the development of intrahepatic cholestasis in pregnancy (ICP)., Methods: Case-control study was conducted. The study included patients diagnosed with ICP by elevated bile acids (n = 118) and a control group of women with symptoms such as elevated liver enzymes or pruritus with normal level of bile acids (n = 127) who attended a large tertiary teaching medical center between the years 2014 and 2021. The groups were compared in terms of obstetrical characteristics, perinatal outcomes, first- and third-trimester laboratory tests, and APRI scores during the first and third trimester. A receiver operating characteristic (ROC) analysis was performed to determine the APRI score cutoff value that could predict ICP., Results: The third-trimester APRI scores of patients with ICP were significantly higher than those of the control group (P < 0.001). The ROC analysis revealed that the cutoff value for the APRI score was 0.42 with 65.3% sensitivity and 73.2% specificity., Conclusion: Our results suggest that the third-trimester APRI score is positively associated with ICP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Systematic review of the literature., Objective: The goal of this study is to review and summarize current literature on local flap reconstruction of external auditory canal (EAC) defects., Methods: PubMed and Ovid databases were queried utilizing search term combinations of "external auditory canal," "defects," "flaps," "local," and "reconstruction." References in included articles were subject for review and inclusion. Articles published between 2013 and 2023 were included in the study., Results: A total of 108 articles were screened after duplicates were excluded. Of the 108 articles, 3 were not written or translated to English, 10 were not accessible for review on either database, and 71 were not applicable to our subject of interest. The remaining 24 articles were included in the systematic review. Due to the primary descriptive nature of the surgical techniques and variability of data collection, a formal meta-analysis was not possible., Conclusions: The EAC defect creates a difficult reconstructive dilemma. The armamentarium for repairing these defects can range from healing by secondary intention to free tissue transfer, however, local flap reconstruction proves to be a reliable and versatile option. This article reviews current local flap techniques for EAC defects and compares their advantages and disadvantages. Further, the authors provide a treatment algorithm and indications for choosing each flap in external auditory canal reconstruction., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The modern study of Wilms tumour was prompted nearly 50 years ago, when Alfred Knudson proposed the 'two-hit' model of tumour development. Since then, the efforts of researchers worldwide have substantially expanded our knowledge of Wilms tumour biology, including major advances in genetics - from cloning the first Wilms tumour gene to high-throughput studies that have revealed the genetic landscape of this tumour. These discoveries improve understanding of the embryonal origin of Wilms tumour, familial occurrences and associated syndromic conditions. Many efforts have been made to find and clinically apply prognostic biomarkers to Wilms tumour, for which outcomes are generally favourable, but treatment of some affected individuals remains challenging. Challenges are also posed by the intratumoural heterogeneity of biomarkers. Furthermore, preclinical models of Wilms tumour, from cell lines to organoid cultures, have evolved. Despite these many achievements, much still remains to be discovered: further molecular understanding of relapse in Wilms tumour and of the multiple origins of bilateral Wilms tumour are two examples of areas under active investigation. International collaboration, especially when large tumour series are required to obtain robust data, will help to answer some of the remaining unresolved questions., (© 2023. Springer Nature Limited.)

Objective: To understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications., Methods: We created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7., Results: The completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals' attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS., Conclusions: This deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment., (© 2023. The Author(s).)