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Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n=70) used the DRUID(®) mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n=39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (β=−0.935, SE=0.204, p

Background While the available SARS-CoV2 vaccines are up to 94% effective at preventing COVID-19-related death or invasive mechanical ventilation, only 76% of the United States population aged ≥18 years have received a primary series and 49% have received a booster. Vaccine administration has been complicated by changing schedule recommendations, packaging in multi-dose vials, and federal reporting requirements that may have limited the locations offering vaccines. We therefore implemented a pharmacy-based initiative to provide SARS-CoV2 vaccination to patients admitted to an academic health center, in order to encourage vaccination when patients had presented for other care. Methods A pharmacy committee developed a protocol for administering the three authorized SARS-CoV2 vaccines to interested inpatients while minimizing vaccine waste, monitoring for safety events, and providing next dose education. Associated training included multidisciplinary education on requirements related to vaccine Emergency Use Authorization (EUA) status. While developing the protocol, the vaccine committee utilized a temporary procedure to administer vaccines once weekly through review by antimicrobial stewardship pharmacists during August 2021. The protocol went live in September 2021 for inpatient and emergency department sites, with subsequent tracking of the number of doses ordered (stratified by vaccine type and dose number) and number administered. Results From August 3 2021 to March 25 2022, a total of 389 vaccine orders were placed with 302 doses (78%) administered, including 126 Moderna (48 first, 20 second, 15 third, 42 booster, and 1 undesignated), 165 Pfizer/BioNTech (80 first, 24 second, 41 third, 14 booster, and 6 undesignated), and 11 Janssen COVID-19 vaccine doses. Only 18 vaccine orders were placed on patients in the ED, with 14 (78%) of those doses administered. Of the 87 vaccine orders not administered, 6 were placed but not given, and 81 were placed and then discontinued. Conclusion With multidisciplinary collaboration, SARS-CoV2 vaccination can be performed in inpatient and ED settings. However, orders should be monitored for protocol compliance and order discontinuation, as these may increase potential for waste. Disclosures All Authors: No reported disclosures.

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal. We invited experts from clinical practice, education, and simulation to form a national short life working group ( Diagram of the national short life working group A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme. The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery. 1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (

This chapter will consider normal development, functional adaptations at birth, and abnormal development. Liver and gallbladder anomalies are sometimes accompanied by abnormalities in other systems or seen as part of a fibrocystic syndrome/ciliopathy. In neonatal cholestasis, or liver failure, the liver may be biopsied. Biopsy rates in these settings vary between centers. Gene chip analysis can be performed on peripheral blood, for conditions with known genetic mutations, and biopsy is regarded by some as a “third-line” investigation in biliary atresia. Despite this, there will always be cases where biopsy is a key contributor to the multidisciplinary diagnosis of neonatal liver disease. An approach to the interpretation of patterns of liver disease, representing common diagnoses, in this age group, is presented in the settings of neonatal jaundice and liver failure. Trauma and iatrogenic causes of liver disease are considered. Intestinal failure-associated liver disease is an example of the pathologist’s role in the timing and appropriateness of transplantation, by staging liver disease and excluding additional diseases or systemic conditions. Examination of the explanted organ confirms disease processes, important in follow-up for potentially recurrent conditions. Finally, the fetal and neonatal liver can be the site of tumor formation. Salient features of these are described.