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Following the passage of a tropical cyclone (TC) the changes in temperature, salinity, nutrient concentration, water clarity, pigments and phytoplankton taxa were assessed at 42 stations from eight sites ranging from the open ocean, through the coastal zone and into estuaries. The impacts of the TC were estimated relative to the long-term average (LTA) conditions as well as before and after the TC. Over all sites the most consistent environmental impacts associated with TCs were an average 41% increase in turbidity, a 13% decline in salinity and a 2% decline in temperature relative to the LTA. In the open ocean, the nutrient concentrations, cyanobacteria and picoeukaryote abundances increased at depths between 100 and 150 m for up to 3 months following a TC. While at the riverine end of coastal estuaries, the predominate short-term response was a strong decline in salinity and phytoplankton suggesting these impacts were initially dominated by advection. The more intermediate coastal water-bodies generally experienced declines in salinity, significant reductions in water clarity, plus significant increases in nutrient concentrations and phytoplankton abundance. These intermediate waters typically developed dinoflagellate, diatom or cryptophyte blooms that elevated phytoplankton biomass for 1–3 months following a TC.

Patient-reported outcomes (PROs), such as symptoms, functioning, and other health-related quality-of-life concepts are gaining a more prominent role in the benefit–risk assessment of cancer therapies. However, varying ways of analysing, presenting, and interpreting PRO data could lead to erroneous and inconsistent decisions on the part of stakeholders, adversely affecting patient care and outcomes. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints in Cancer Clinical Trials-Innovative Medicines Initiative (SISAQOL-IMI) Consortium builds on the existing SISAQOL work to establish recommendations on design, analysis, presentation, and interpretation for PRO data in cancer clinical trials, with an expanded set of topics, including more in-depth recommendations for randomised controlled trials and single-arm studies, and for defining clinically meaningful change. This Policy Review presents international stakeholder views on the need for SISAQOL-IMI, the agreed on and prioritised set of PRO objectives, and a roadmap to ensure that international consensus recommendations are achieved.

Research suggests that acculturation is associated with increased alcohol consumption among Latinxs. The purpose of this narrative review is to contribute to this literature by examining the association between acculturation and alcohol use within current theoretical and etiological frameworks on cultural norms, acculturative stress, and acculturative gaps. This review also compares the utility of these explanatory frameworks for guiding future research. Two databases (PubMed and PsycInfo) were used to identify peer-reviewed studies pertaining to the associations between acculturation and alcohol use among Latinxs. Studies that examined drinking norms, acculturative stress, acculturation gaps, and drinking behavior in Latinxs were included. The types of study approaches and designs included quantitative, qualitative, cross-sectional, cohort, and longitudinal studies published between January 2000 and December 2021. Quality assessment and data synthesis were conducted by two reviewers. A total of 65 articles reporting empirical studies were included in the final review. Eighteen studies did not utilize a specific framework, but generally supported that acculturation is associated with increased alcohol consumption and alcohol related consequences among Latinxs. Additionally, sixteen studies examined cultural norms, twenty-two examined acculturative stress, while only nine utilized a gap discrepancy framework. Studies examining drinking norms appeared to largely explain changes in drinking behavior among Latinas, while studies examining acculturative stress seemed to be better equipped to explain changes in drinking behavior among Latino men. Meanwhile, the Gap Discrepancy Model articulates the gap between old and new cultural influences and can be conceptualized as an additional dimension of acculturative stress.

Multiple species of the genus Dinophysis produce diarrhetic shellfish toxins (okadaic acid and Dinophysis toxins, OA/DTXs analogs) and/or pectenotoxins (PTXs). Only since 2008 have DSP events (illnesses and/or shellfish harvesting closures) become recognized as a threat to human health in the United States. This study characterized 20 strains representing five species of Dinophysis spp. isolated from three US coastal regions that have experienced DSP events: the Northeast/Mid-Atlantic, the Gulf of Mexico, and the Pacific Northwest. Using a combination of morphometric and DNA-based evidence, seven Northeast/Mid-Atlantic isolates and four Pacific Northwest isolates were classified as D. acuminata, a total of four isolates from two coasts were classified as D. norvegica, two isolates from the Pacific Northwest coast were identified as D. fortii, and three isolates from the Gulf of Mexico were identified as D. ovum and D. caudata. Toxin profiles of D. acuminata and D. norvegica varied by their geographical origin within the United States. Cross-regional comparison of toxin profiles was not possible with the other three species; however, within each region, distinct species-conserved profiles for isolates of D. fortii, D. ovum, and D. caudata were observed. Historical and recent data from various State and Tribal monitoring programs were compiled and compared, including maximum recorded cell abundances of Dinophysis spp., maximum concentrations of OA/DTXs recorded in commercial shellfish species, and durations of harvesting closures, to provide perspective regarding potential for DSP impacts to regional public health and shellfish industry.

After observing the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols for gynecological surgery patients, an interdisciplinary team initiated a quality improvement project with an ERAS protocol to minimize opioid use of patients undergoing elective cesarean birth. Secondary outcomes during the three-month project included decreasing the patient's length of stay and inpatient care costs. We used the Lean Six Sigma methodology and measured aggregated patient outcomes of opioid use, length of hospital stay, and total cost. In addition, we incorporated the ERAS protocol into the electronic health record. Results showed a reduction use of morphine milligram equivalents of opioids, a slight decrease in length of hospital stay, and no change in the inpatient costs. The team recognized that implementation of an ERAS protocol is a best practice to reduce opioid use in patients undergoing a cesarean birth and decided to permanently include it in patient care processes.

Tropical cyclones impose tremendous impacts on microplankton communities. When Hurricane Harvey struck Texas in August 2017, delivering record rainfall, the resulting historically large freshwater plume provided an opportunity to identify how the coastal microplankton community responded to such a drastic shift in hydrography. Two cruises were conducted along the Texas coast one week apart to assess the impact of the low-salinity plume moving downcoast. The spatial–temporal variability and recovery of the microplankton community was compared with microplankton community changes during and after 13 other tropical storm/cyclone events observed during the decade-long record from the Texas Observatory for Algal Succession Timeseries (TOAST). Results revealed an unprecedented ciliate-dominated community developed in the weeks following Hurricane Harvey. TOAST data revealed diatoms dominated during upwelling and water column mixing. Moderate downwelling conditions favored dinoflagellates while strong downwelling and reduced salinity following Hurricane Harvey resulted in a ciliate-dominated community. The unexpectedly large biomass of ciliates and low diatom biomass observed during the response cruise indicated that the microplankton community had not yet recovered. Intensification of future hurricanes may produce brief blooms of diatoms, while dinoflagellates or ciliates dominate following high freshwater discharge. These drastic shifts in microplankton communities pose important implications for biogeochemical cycling, trophic interactions and commercial fisheries.

Ectopic pregnancy (EP) is defined as the implantation of an embryo outside of the uterus and is a leading cause of first trimester maternal mortality and morbidity. This article discusses a possible role for epithelial to mesenchymal transition in the pathogenesis of EP, given the notable similarity of protein expression between the two processes.

Continuous monitoring and early warning together represent an important mitigation strategy for harmful algal blooms (HAB). The coast of Texas experiences periodic blooms of three HAB dinoflagellates: Karenia brevis, Dinophysis ovum, and Prorocentrum texanum. A plankton image data set acquired by an Imaging FlowCytobot over a decade of operation was used to train and evaluate two new automated image classifiers. A 112 class, random forest classifier (RF_112) and a 112 class, convolutional neural network classifier (CNN_112) were developed and compared with an existing, 54 class, random forest classifier (RF_54) already in use as an early warning notification system. Both 112 class classifiers exhibited improved performance over the RF_54 classifier when tested on three different HAB species with the CNN_112 classifier producing fewer false positives and false negatives in most of the cases tested. For K. brevis and P. texanum, the current threshold of 2 cells.mL-1 was identified as the best threshold to minimize the number of false positives and false negatives. For D. ovum, a threshold of 1 cell.mL-1 was found to produce the best results with regard to the number of false positives/negatives. A lower threshold will result in earlier notification of an increase in cell concentration and will provide state health managers with increased lead time to prepare for an impending HAB.

Nurses have a long history of practice in public health. More recently basic population health knowledge and skills are being required across all nursing practice settings. To prepare nurses for this practice nursing education has long included public or community health nursing (PHN) content and skills as part of prelicensure education at the baccalaureate level and above. However, little work has been done to document student competency in these areas. Competency-based education is a process whereby students are held accountable for the mastery of knowledge and skills deemed critical for an area of study. The AACN Public/Population Health Workgroup addressed the challenge of measuring baccalaureate student nursing competencies in population health by developing an unfolding case study, with embedded questions assessing selected competencies. Lacking established population health competencies in nursing curriculum at the time of this work but wanting to assess students' basic competencies across the care continuum, the Workgroup selected relevant competencies from the Council of Public Health Nursing Organizations (formerly called the Quad Council) Competencies for Public Health Nurses. Utilizing these selected competencies, the Workgroup devised the unfolding case study and piloted it with 275 baccalaureate nursing education programs across the country. The findings from the Pilot demonstrated nursing student competency achievement and how this achievement changed as students progressed through the curriculum. The authors report implications and recommendations for competency measurement in population health based on the results of the pilot.

Due to the increasing prevalence of Dinophysis spp. and their toxins on every US coast in recent years, the need to identify and monitor for problematic Dinophysis populations has become apparent. Here, we present morphological analyses, using light and scanning electron microscopy, and rDNA sequence analysis, using a ~2-kb sequence of ribosomal ITS1, 5.8S, ITS2, and LSU DNA, of Dinophysis collected in mid-Atlantic estuarine and coastal waters from Virginia to New Jersey to better characterize local populations. In addition, we analyzed for diarrhetic shellfish poisoning (DSP) toxins in water and shellfish samples collected during blooms using liquid-chromatography tandem mass spectrometry and an in vitro protein phosphatase inhibition assay and compared this data to a toxin profile generated from a mid-Atlantic Dinophysis culture. Three distinct morphospecies were documented in mid-Atlantic surface waters: D. acuminata, D. norvegica, and a "small Dinophysis sp." that was morphologically distinct based on multivariate analysis of morphometric data but was genetically consistent with D. acuminata. While mid-Atlantic D. acuminata could not be distinguished from the other species in the D. acuminata-complex (D. ovum from the Gulf of Mexico and D. sacculus from the western Mediterranean Sea) using the molecular markers chosen, it could be distinguished based on morphometrics. Okadaic acid, dinophysistoxin 1, and pectenotoxin 2 were found in filtered water and shellfish samples during Dinophysis blooms in the mid-Atlantic region, as well as in a locally isolated D. acuminata culture. However, DSP toxins exceeded regulatory guidance concentrations only a few times during the study period and only in noncommercial shellfish samples.

Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (4 years or presentation at age12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.

The current study examined experienced weight stigma (EWS), internalized weight bias (IWB), and maladaptive eating patterns (ME) among sexual minority (SM) and heterosexual individuals.The sample consisted of cisgender heterosexual and SM men and women. Participants were drawn from introductory psychology classes and a variety of supplemental recruitment methods (Facebook, Instagram, MTURK, etc.).SM individuals reported higher levels of EWS, IWB, and maladaptive eating patterns than heterosexual individuals. Heterosexual men reported the lowest levels of EWS, IWB, and ME compared to all other groups. Additionally, there was a significant association between greater EWS and IWB and greater ME. Gender identity and sexual orientation impacted the strength of the relationship between IWB and ME and, to a lesser extent, EWS and ME.This investigation contributes to knowledge of the impact of gender identity and sexual orientation on EWS and IWB, and demonstrates that IWB and EWS are significant concerns for the SM community, especially in relation to ME.Level IV, cross-sectional study.

Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients' symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item's importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs. ispartof: BMJ OPEN vol:11 issue:6 ispartof: location:England status: published

Importance Extenuating circumstances can trigger unplanned changes to randomized trials and introduce methodological, ethical, feasibility, and analytical challenges that can potentially compromise the validity of findings. Numerous randomized trials have required changes in response to the COVID-19 pandemic, but guidance for reporting such modifications is incomplete. Objective As a joint extension for the CONSORT and SPIRIT reporting guidelines, CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstances) aims to improve reporting of trial protocols and completed trials that undergo important modifications in response to extenuating circumstances. Evidence A panel of 37 international trial investigators, patient representatives, methodologists and statisticians, ethicists, funders, regulators, and journal editors convened to develop the guideline. The panel developed CONSERVE following an accelerated, iterative process between June 2020 and February 2021 involving (1) a rapid literature review of multiple databases (OVID Medline, OVID EMBASE, and EBSCO CINAHL) and gray literature sources from 2003 to March 2021; (2) consensus-based panelist meetings using a modified Delphi process and surveys; and (3) a global survey of trial stakeholders. Findings The rapid review yielded 41 673 citations, of which 38 titles were relevant, including emerging guidance from regulatory and funding agencies for managing the effects of the COVID-19 pandemic on trials. However, no generalizable guidance for all circumstances in which trials and trial protocols might face unanticipated modifications were identified. The CONSERVE panel used these findings to develop a consensus reporting guidelines following 4 rounds of meetings and surveys. Responses were received from 198 professionals from 34 countries, of whom 90% (n = 178) indicated that they understood the concept definitions and 85.4% (n = 169) indicated that they understood and could use the implementation tool. Feedback from survey respondents was used to finalize the guideline and confirm that the guideline’s core concepts were applicable and had utility for the trial community. CONSERVE incorporates an implementation tool and checklists tailored to trial reports and trial protocols for which extenuating circumstances have resulted in important modifications to the intended study procedures. The checklists include 4 sections capturing extenuating circumstances, important modifications, responsible parties, and interim data analyses. Conclusions and Relevance CONSERVE offers an extension to CONSORT and SPIRIT that could improve the transparency, quality, and completeness of reporting important modifications to trials in extenuating circumstances such as COVID-19.

Recent estimates of the economic cost for a family of four, who do not fall below the official poverty measure (U. S. Department of Health and Human Services TU.S. Disparities amongst racial and ethnic groups exist when those reporting 1 >. chronic diseases exceed the respective U.S. population. Additionally, certain pre-existing conditions in adults, such as cancer, chronic kidney disease, chronic obstructive pulmonary disease, Down syndrome, cardiovascular disease, immunocompromised state (organ transplant), obesity, severe obesity, Sickle cell disease, smoking, and type 2 diabetes mellitus increase the risk for severe illness (requiring hospitalization) from COVID-19 fCDC. 2021af Multiple chronic diseases are associated with poor health outcomes (Sambamoorthi. [...]of Medicaid expansion (АСА), access to care has increased for low-income people and people of color.

AIM Assessment of functional abilities is an essential component in the diagnosis of neurodevelopmental disorders in young children. Functional abilities, assessed using the Pediatric Evaluation of Disability Inventory-Computer Adapted Test (PEDI-CAT), are used to determine eligibility for early intervention funded under the National Disability Insurance Scheme in Australia (NDIS). This study aims to compare the use of the PEDI-CAT with the Vineland-3, a comprehensive parent interview for the determination of support needs, diagnosis, and eligibility for funding. METHOD Seventy-five preschool aged children referred for formal diagnosis were assessed with the Vineland-3, and subscale scores reviewed for clinical judgement. These children were also assessed on the PEDI-CAT speedy version and the results on the two tests compared. RESULTS The PEDI-CAT was less sensitive than the Vineland-3 to the functional difficulties being experienced in this population of preschool aged children. The Vineland-3 had floor effects on some scales and deficits masked by skills in other areas in the same domain, but standard subscale scores allowed skills and areas needing support to be defined. Overall 25% of children clinically in need of support were not identified on the Pedi-cat compared to only 4% using Vineland Domain scores and 3% using Vineland-3 subscale scores. The PEDI-CAT also identified significantly lower levels of support required with only 32% of children found to need very substantial support compared to 40% of children on the Vineland Domain scores, and 59% using subscale scores. CONCLUSION Based on the results of this study, the Vineland-3 comprehensive interview interpreted using subscale scores as well as domain scores is more sensitive than the PEDI-CAT in identifying young children in need of support as well as the areas and degree of support required.

Importance Patient-reported outcomes (PROs) can inform healthcare decisions, regulatory decisions, and healthcare policy, and also can be used for audit/benchmarking and to monitor symptoms and provide timely care tailored to individual needs. However, several ethical issues have been raised in relation to PRO use. Objective To develop an international, consensus-based, PRO-specific ethical guidelines for clinical research.Evidence ReviewThe PRO ethics guidelines were developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network’s guideline development framework. This included a systematic review of the ethical implications of PROs in clinical research. The databases MEDLINE (Ovid), EMBASE, AMED and CINAHL were searched from inception until May 2020. The keywords ‘patient reported outcome*’ and ‘ethic*’ were used to search the databases. Two reviewers independently conducted title and abstract screening before full-text screening to determine eligibility. The review was supplemented by the SPIRIT-PRO Extension recommendations for trial protocol. Subsequently, a two-round international Delphi process (n=96 participants; May and August 2021) and a consensus meeting (n=25 international participants; October 2021) were held. Prior to voting, consensus meeting participants were provided with a summary of the Delphi process results and information on whether the items aligned with existing ethical guidance.Findings Twenty-three items were considered in the first round of the Delphi process: six relevant candidate items from the systematic review and seventeen additional items drawn from the SPIRIT-PRO Extension. Ninety-six international participants voted on the relevant importance of each item for inclusion in ethical guidelines and twelve additional items were recommended for inclusion in round 2 of the Delphi (35 items in total). Fourteen items were recommended for inclusion at the consensus meeting (n=25 participants). The final wording of the PRO ethical guidelines was agreed by consensus meeting participants with input from six additional individuals. Included items focused on PRO-specific ethical issues relating to research rationale, objectives, eligibility requirements, PRO concepts/domains, PRO assessment schedules, sample size, PRO data monitoring, barriers to PRO completion, participant acceptability and burden, administration of PRO questionnaires for participants who are unable to self-report PRO data, input on PRO strategy by patient partners or members of the public, avoiding missing data and dissemination plans. Conclusions and Relevance The PRO ethics guidelines provide recommendations for ethical issues that should be addressed in PRO clinical research. Addressing ethical issues of PRO clinical research has the potential to ensure high-quality PRO data while minimising participant risk, burden and harm and protecting participant and researcher welfare.

Continuous monitoring and early warning together represent an important mitigation strategy for harmful algal blooms (HAB). The coast of Texas experiences periodic blooms of three HAB dinoflagellates: Karenia brevis, Dinophysis ovum, and Prorocentrum texanum. A plankton image data set acquired by an Imaging FlowCytobot over a decade of operation was used to train and evaluate two new automated image classifiers. A 112 class, random forest classifier (RF_112) and a 112 class, convolutional neural network classifier (CNN_112) were developed and compared with an existing, 54 class, random forest classifier (RF_54) already in use as an early warning notification system. Both 112 class classifiers exhibited improved performance over the RF_54 classifier when tested on three different HAB species with the CNN_112 classifier producing fewer false positives and false negatives in most of the cases tested. For K. brevis and P. texanum, the current threshold of 2 cells

1–2% of pregnancies are ectopic, the majority implanting in the Fallopian tube. A single, systemic dose of methotrexate, a DNA-synthesis (S phase) inhibitor, has been used since 1991 for outpatient treatment of women with stable EP. However, methotrexate has limited clinical and cost effectiveness, restricting its use to 25–30% of these women. There is an unmet need for better medical treatment for EP. Colony stimulating factor-1 (CSF-1) promotes placentation and creates a pro-inflammatory environment that is fundamental for the maintenance of a normal pregnancy. We hypothesised that CSF-1 is also involved in the placentation and maintenance of an EP. Herein, we demonstrate the immunolocalisation of the CSF-1 receptor (CSF-1R) as well as its ligand (CSF-1) in immortalised first trimester trophoblast cells. We show that a specific CSF-1R kinase inhibitor, GW2580, abolishes CSF-1 induced trophoblast cell proliferation and migration and can be cytotoxic. We then demonstrate the expression of CSF-1R and CSF-1 in the cytotrophoblast and syncytiotrophoblast within ectopic implantation sites from women with EP. Our data suggests that CSF-1 is involved in the survival and proliferation of trophoblast cells in EP. This suggests that pharmacological disruption of CSF-1/CSF-1R signaling axis could be the basis of a new therapeutic for EP.

The aim of this review was to examine whether there is a link between psychopathy and self-harm. A systematic search identified 14 papers which examine this link. A quality appraisal checklist was used to evaluate the quality of each study. The application of the quality appraisal checklist showed that the majority of the studies had good internal validity; however, there were some biases that affected the external validity of some studies. The results indicated that there may be a positive association between total psychopathy score and self-harm; however some studies with smaller sample sizes and low rates of self-harm failed to show this association. The results of most of the studies showed a positive association between Factor 2 of the Psychopathy Checklist (PCL-R; Hare, 2003) and self-harm. No link was found between Factor 1 and self-harm. The results did not show consistent evidence for a link between any of the four facets and self-harm. Although this review indicates a link between Factor 2 and self-harm, and a possible link between total psychopathy score and self-harm, the small number of studies in this area means that the research is not robust enough to provide strong evidence for these associations.

This thesis is submitted in partial fulfilment of the requirements for the degree of Doctorate of Forensic Clinical Psychology at the University of Birmingham. The thesis consists of two volumes. Volume 1 This volume consists of three chapters. The first chapter is a literature review examining whether there is a link between psychopathy and self-harm. The second chapter is a quantitative study investigating whether scores on the HCR-20 and FAM risk assessment tools predict frequency of self-harm in females within a secure psychiatric hospital. The third chapter comprises a public domain briefing document which provides a plain language summary of the literature review and empirical paper. Volume 2 This volume consists of five Forensic Clinical Practice Reports (FCPRs). The first details the case of a 63-year-old man with depression and paranoid schizophrenia, formulated from both cognitive and psychodynamic perspectives. The second is a service evaluation examining whether scores on the HCR-20 and HoNOS decrease over time for patients detained within a secure psychiatric hospital, and whether individuals’ scores on these measures reflect the level of security in which they reside. The third FCPR documents the case of a 34-year-old man experiencing offence-related anxiety, shame and depression. The fourth FCPR is a single-case experimental design investigating the effectiveness of a trauma-focussed cognitive-behavioural intervention for offence-related PTSD. The fifth FCPR is an abstract of an oral case presentation of a 14-year-old girl experiencing school anxiety. Pseudonyms have been used throughout to ensure anonymity.

The purpose of Carbon Capture and Storage (CCS) is to reduce emissions of greenhouse gases to the atmosphere as a climate change mitigation activity. However, given the relatively high costs currently associated with CCS, coupling CCS with Enhanced Oil Recovery (EOR) could provide a critical financial incentive to facilitate development of CCS projects in the near term. One issue is that projects to enhance oil production are primarily implemented to increase oil production with (tertiary recovery methods and any long term storage of CO2 is considered a potential ancillary benefit. When projects are designed as CCS from the start, there is typically a site evaluation process to review the storage formation according to best practice criteria for CCS. In EOR, the formation where CO2 would be stored is predetermined by the existing oil bearing reservoir, raising potential questions about monitoring, long-term CO2 storage liabilities, potential, leakage, permanence and other issues that must be addressed in CCS projects but may fall outside the boundaries of a typical EOR project. Finally, although this paper is premised on historical and current experiences with enhanced oil recovery projects, similar considerations could also be given to enhanced recovery of natural gas. There are no specific technological barriers or challenges in transitioning and converting a pure CO2-EOR operation into a CO2 storage operation but there are a number of legal, regulatory and economic differences which must be addressed if an EOR project is to serve as a CCS project. Lack of experience or unresolved issues related to EOR becoming CCS could create barriers unless the issues are fully understood and managed to the satisfaction of regulators. Understanding best practice and the policy and regulatory frameworks affecting CCS from EOR is an important driver for ensuring that CO2-EOR projects are developed in a manner which will enable the carbon stored to be recognised as a mitigation activity under local legislation/carbon market schemes and in national GHG inventories which support monitoring progress under the COP21 Paris Agreement. The paper provides an overview of the key issues in the USA, Canada, EU, Australia, and Brazil and provides recommendations for what companies need to do should they wish to transition from EOR to CCS for existing or future operations.