Additional Themes Research Articles

P-448. Contextual assessment and potential barriers and facilitators of a mobile health program to support treatment of tuberculosis and HIV in Kilimanjaro, Tanzania: opportunities for care integration

Abstract Background Despite increasing smartphone penetration globally, personalized mobile health (mHealth) care interventions remain largely untapped for people with tuberculosis (TB) in many settings. A smartphone platform adopted to support treatment of human immunodeficiency virus (HIV) in the US was adapted and piloted for HIV/TB care in a distinct urban population, with high usage and improved clinical outcomes. Systematic evaluation of potential contextual influences on mHealth implementation is needed to ensure appropriateness, feasibility, and acceptability of the intervention for HIV/TB care within Kilimanjaro.Table 1:Perspectives on existing HIV and TB care delivery experiences and integration of services Methods We conducted semi-structured in-depth interviews at Kilimanjaro Christian Medical Centre and Kibong’oto Hospital with patients (18 y/o+ with drug-susceptible/drug-resistant-TB, with/without HIV, > 1 month on treatment) and providers (e.g. physicians, nurses). Guides were designed using Bury’s Framework for Chronic Illness and the Consolidated Framework for Implementation Research (CFIR). Analysis was performed using a priori open coding/constant comparisons methodology. A preliminary codebook built deductively from frameworks was iterated with inductive codes based on emergent themes. Results To date, 12 patient and 12 provider interviews have been conducted; analysis is underway. Specific perspectives demonstrated opportunities for enhancement of HIV/TB care integration (Table 1). Preliminary analysis suggests feature phone access is more common among patients. Additional themes relate to perceptions of an external intervention source (CFIR domain: Intervention Characteristics), compatibility with current provider smartphone access/workload, existing directive nature of patient-provider relationships, and current level of system digitization at sites (workplace internet stability/data access) (Inner Setting). Conclusion Analysis to date reveals several prominent themes to consider for adaptation of the intervention: 1) daily life/experiences with TB/HIV 2) determinants of and 3) experiences with TB/HIV care 4) mobile phone ownership, usage 5) perceptions of the intervention within the context and to support 6) home urine testing for personalized dosing of TB medications. Disclosures Jacqueline Hodges, MD MPH, Gilead Sciences: Grant/Research Support

Factors contributing to non-compliance with active physiotherapy guidelines among chronic low back pain patients in India.

Physiotherapists exhibit different degrees of adherence to clinical guidelines for low back pain (LBP). The preferences and expectations of their patients significantly influence physiotherapists' adherence to these guidelines. Therefore, it is crucial to have a comprehensive analysis of the patients' perspectives, which can identify the factors that prevent the implementation of an active approach. We conducted semi-structured interviews with patients suffering from non-specific chronic LBP (CLBP). We transcribed the semi-structured interviews verbatim and conducted an inductive thematic analysis to uncover themes related to the participants' expectations and experiences of consultations with physiotherapists for CLBP. In total, we interviewed thirty-three individuals, with 14 women and 19 men (mean age 53 + 12 years). Our thematic analysis discovered six overarching themes that are relevant to patients' expectations and experiences. We identified several sub-themes under the "physiotherapist-related factors" and "patient-related factors" themes. Additional themes recognized were guideline-related factors, institution-related factors, healthcare-related factors, and health information. A significant number of participants expressed dissatisfaction with the short timeframe allocated by the physiotherapist. Multiple participants expressed dissatisfaction with their experience, particularly about the quality of explanations and the nature of the exercises provided. This emphasizes the importance of patient education, and physiotherapists should consider suggesting active interventions that the family, society, and culture can more easily accept. Accordingly, the formulation of future guidelines for nations like India should take into account these patient expectations and perspectives.

Educator-To-Student Sexual Harassment in UK and Irish Secondary Schools: A Qualitative Analysis

ABSTRACT The current study examines the way sexual harassment, a specific facet of educator sexual misconduct, is experienced by secondary school students. The qualitative component of an online survey was completed by participants aged 18+ who had attended secondary school in Ireland (n = 85) or the UK (n = 74), and who were recruited to participate via social media. Participants were asked to describe the incident of educator-student sexual harassment they experienced that had the greatest effect on them. Data were analyzed using a deductive approach to thematic analysis and coded into topic summary themes using Fitzgerald’s (1995) sexual harassment victimization measure and its respective sexual harassment categories. We also produced an additional theme—the context of sexual harassment. Collectively, these findings can inform educational policies and reporting processes for educator-student sexual harassment, to ultimately support the safety and well-being of all students.

Barriers to effective higher and degree-level apprenticeships: a systematic literature review and future research agenda

PurposeThe literature concerning higher- and degree-level apprenticeships (HDAs) in the post-levy era (2017–) is sparse and fragmented. Therefore, the purpose of this paper is to contribute to the international landscape of higher education work-based learning by identifying barriers to effective HDA programmes and outlining a future research agenda to address these.Design/methodology/approachThis study employs a systematic literature review methodology to explore barriers in HDAs. Adhering to PRISMA 2020 guidelines, the review follows a three-stage process to develop the sample. A meticulously designed search strategy uses targeted queries on the SCOPUS database, focusing on terms related to HDAs and their challenges. Inclusion criteria is set to papers from 2017 to 2024, covering book chapters and peer-reviewed journals in the English language. Articles were cross-checked with the Chartered Association of Business Schools (CABS) database, which refines the total to 68 papers. Data from these sources is then extracted and tabulated for qualitative content analysis.FindingsThe systematic literature review of 68 manuscripts finds challenges are faced by apprentices, employers and training providers alike. This includes, but is not limited to, ethnically correlated performance, stigma, careers advice, job design, mentoring practices and the incorporation of technology. Two additional themes of pedagogy/andragogy and policy emerge.Originality/valueBased on the analysis, the paper suggests an extensive portfolio of future research focused on collaborative practices. If addressed, this yields the power to influence future legislation and subsequent implementation.

‘It overwhelms the system’: examining EMS provision in a South Texas border community

ObjectiveExamine how the characteristics of border communities along the US southern land border impact Emergency Medical Services (EMS) personnel in these border communities.DesignUsing phenomenological approach, we conducted face-to-face, one-on-one interviews...

Financial toxicity among pediatric oncology families during therapy and early survivorship: a qualitative analysis.

Cancer treatment often results in adverse financial consequences-also termed financial toxicity. To build upon limited research in pediatric oncology, we conducted a qualitative study exploring families' lived experiences with financial toxicity and their perspectives on potential mitigation strategies. We conducted in-depth semi-structured interviews with a purposive sample of English- and Spanish-speaking family caregivers, 3-24months following diagnosis. We performed a thematic analysis focused on elucidating relationships between components/domains of financial toxicity, identifying mitigating and exacerbating factors, eliciting latent constructs for measurement, and querying caregivers' perspectives on interventions. We organized relationships between themes into a framework to compare with prior theoretically derived models. We interviewed 21 caregivers, diverse with respect to income, age, race and ethnicity, family structure/composition, and patient characteristics. We identified four themes relating to financial toxicity: increased spending on providing care to patients/siblings, reduced income due to challenges in maintaining employment, new or worsened material hardship, and heightened psychological distress regarding finances. We also identified an additional theme pertaining to response behaviors directed at managing financial toxicity, with helpful or harmful downstream effects. Factors that exacerbated or lessened financial toxicity included awareness of resources, geography, and community. Caregivers suggested potential mitigation strategies, including proactive education and resource provision. Pediatric patients and families can experience substantial financial impacts, which may differ from experiences of adults with cancer. These findings suggest a need for careful screening and measurement, as well as family-centered interventions and policies to reduce long-term consequences.

Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review.

Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs. We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework. We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use. Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs.

Alienation and/or anomie in pharmacists: a protocol for a narrative systematic review

IntroductionEpisodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people...

Patient-Reported Worst-Case Scenarios in Advanced Cancer: Presence, Contents, and Predictors.

Advancements in precision oncology have led to a growing community of adults with advanced cancer who live longer but face prognostic uncertainty, with corresponding fears of the future. Their worst future fears related to cancer remain understudied, hindering support efforts. This study aimed to characterize the presence, content, and predictors of imagined future worst-case scenarios related to cancer (WCS) among distressed adults with advanced cancer. Two hundred fifteen distressed adults with advanced solid tumor cancer (mixed type) responded to survey questions regarding the presence (Yes/No) of a WCS related to cancer and if yes, to briefly describe it. Mixed methods were used to assess WCS prevalence, thematic content, and sociodemographic, psychological, and medical predictors. Two thirds (66.5%) of advanced cancer survivors endorsed having a WCS. Content reflected four major themes of Death (52.2%), Suffering and Deterioration (47.1%), Cancer Progression and Future Uncertainty (28.7%), and Concern about Family (18.4%). WCS often contained more than one major theme, further distinguished by additional themes and sub-themes that revealed distinct fears. Higher anxiety and lower life meaning/peace predicted the presence of a WCS whereas sociodemographic characteristics, depression, time since diagnosis, and physical symptom burden did not. Younger age and living with children predicted a WCS focused on loved ones. WCS are prevalent and diverse in content among distressed adults with advanced cancer. Assessing WCS offers a quick and straightforward way to solicit advanced cancer survivors' most intense fears about the future with cancer, thereby facilitating patient-provider communication and support efforts.

‘We need to do more’: Preparing teachers for diverse classrooms in England

This research investigated teacher educators’ perspectives and practices related to preparing primary teachers for diverse classrooms in a 1-year initial teacher education (ITE) programme in an urban context in England. The research consisted of semi-structured interviews and document analysis within a complex inter-personal, social and policy context. A conceptual framework drawn from the literature was used to analyse the data in terms of teaching about, teaching to and teaching for diversity. An additional theme was uncovered on the role of autobiography in shaping teacher educators’ perspectives. Findings indicate that teacher educators employed six distinct practices related to preparing new teachers to teach in diverse classrooms, which were contextualised by national regulations and university-school partnerships. Key findings are that teacher educators themselves believed that ‘more should be done’ and that building dialogue around diversity within the teacher education community is a crucial step towards addressing inequities and diversity in ITE.

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes...

Male and Female Perceptions of Supervision During Strength Training.

A cross-sectional survey was distributed to 1322 members of a 1-on-1 personalized strength training studio. A total of 366 respondents (n = 134 male and n = 232 female), all aged over 20 years, reported considerable training experience, with 55% of the males and 42% of the females reporting 5+ years of experience. The data were analyzed and reported descriptively with differences >5% identified based on the use of a 5-point Likert scale, the sample size, and the nature of the observations. Disparities between the males and females were identified; the males reported higher perceptions of managing effort, technique, and programming without supervision compared to the females. Safety was noted as being more important to the females compared to the males. Qualitatively, additional themes were raised including an analogy of the personal relationship between the trainer and trainee being similar to that between medical professionals and patients. This was validated where the participants discussed their adaptations from supervised strength training for maintaining quality of life in aging and recovering from medical conditions and injury. The data are discussed in the context of a previous body of literature suggesting males falsely report higher levels of confidence in tasks compared to females, particularly in relation to effort, role models, and verbal encouragement. We posit that the greater confidence expressed by males at least partially explains the greater engagement in strength training practices by males compared to females, as well as explaining the higher level of participation in supervised strength training by females compared to males. This research proves beneficial for strength training practitioners in enhancing their understanding and expectations of clients, as well as hopefully proving insightful in engaging more people in strength training.

Dynamic Changes Toward Reflective Practice: Documented Shifts in Speech-Language Pathologists' Evaluation Practices.

This qualitative study explored the experiences of speech-language pathologists (SLPs) in professional learning communities (PLCs) during a year-long virtual professional development (PD) opportunity using an implementation science (IS) framework in an urban public school district for dynamic assessment (DA) training. The DA presented in the PD was modified based on ongoing discussions with key stakeholders in the district, so that it could be reasonably implemented in clinical practice while preserving the integrity of the DA's purpose. SLPs in an urban district were trained virtually using DA over the course of the school year. PD topics focused on decreasing bias and incorporating evidence-based practice into SLP approaches to speech-language evaluations. The SLPs underwent three training sessions and three separate PLC sessions. The SLPs were assigned a series of case studies to complement PLC sessions. An IS framework informed each step of the PD and PLCs to ensure applicability and integration of the content. Of the 366 SLPs working in the district, 209 consented and filled out two questionnaires and three exit slips to gather information on their experiences with the DAs and PLC models. SLPs reported new insights into their practice, including changes in assessment practices, awareness of bias in assessment practices, and increased confidence in working with families during the evaluation process. Two additional themes emerged: increased collaboration and enhanced group problem-solving skills when working with peers in PLC groups, and expanded proficiencies and heightened skills when applying DA practices to evaluations. The two challenges faced by SLPs included time constraints and confidence in the mastery of DA. This study offers an approach to shifting evaluation practices in large districts to incorporate more evidence-based approaches.

Centering racial health equity in systematic reviews paper 3: a systematic review of definitions for “racial health equity” and related terms within health-related articles

ObjectivesTo systematically evaluate definitions of “racial health equity” (RHE) and related terms within health-related academic literature. Study Design and SettingWe systematically evaluated definitions of RHE and related terms within health-related academic articles. Articles published in English were included, and no date restrictions were imposed. ResultsWe found 20 original articles containing relevant definitions out of 1816 retrieved articles, thirteen of which were published from 2020 to 2023. Themes used in the definitions varied; racism (n = 12) and quality of healthcare (n = 10) were the most common. Additional themes, including social hierarchy or marginalization, discrimination, justice, unmet social needs, and historical events were described within some definitions. Eleven of the included manuscripts defined race as a social construct. ConclusionThis study depicts RHE as an emerging concept with limited consensus on racism, quality of health, and social determinants of health as important underlying frameworks. To center equity efforts and actions under a workable and shared vision, we recommend continued discussions regarding underlying meanings of RHE concepts and propose establishing a definition that promotes unity across health fields and prevents ambiguity.

Pharmacists' Professional Satisfaction and Challenges: A Netnographic Analysis of Reddit and Facebook Discussions.

Pharmacists, essential healthcare providers, face significant challenges in professional satisfaction and well-being. This study investigates the factors influencing pharmacists' professional satisfaction, mainly focusing on workload, organizational support, job autonomy, work-life balance, and resilience against burnout. Data were collected from relevant online forums on Facebook and Reddit using a netnographic methodology. The data were anonymized and thematically coded to identify key themes from 23 conversation threads, primarily involving or concerning Romanian pharmacists. The analysis revealed several critical issues: widespread dissatisfaction with salaries, challenges in professional recognition, and the demanding nature of university education. Additional themes included economic and financial insights, global trends and technological impacts, personal experiences and satisfaction, professional growth and education, regulatory and market environment, and workplace dynamics. Findings indicate these factors significantly impact pharmacists' job satisfaction and overall well-being. The study concludes that addressing these issues through targeted interventions, such as policy reforms, educational updates, and enhanced organizational support, can improve the professional lives of pharmacists, thereby enhancing their contributions to healthcare outcomes.

"Death Is Not a Dirty Word:" A Qualitative Study of Emergency Clinician End-of-Life Communication.

Pediatric patients with life-limiting diagnoses frequently seek care in the pediatric emergency department (PED) during times of acute illness, or at end-of-life (EOL) . Although the population of patients with life-limiting diagnoses is heterogenous, clinician expertise in EOL communication is essential to providing family-centered care. In this study, we explored PED physician and nurse experiences with communication when eliciting EOL values, including factors specified to the PED environment, clinician perceptions of family supports and preferences, and clinicians' self-reflection of their skills and challenges in this sphere. We performed a prospective qualitative study using semistructured interviews of PED physicians and nurses recruited from a quaternary care center. Thematic content analysis was performed on the transcribed interviews to identify codes and, ultimately, themes. We interviewed 17 emergency department clinicians, including 10 physicians and 7 nurses. Thematic content analysis revealed 6 salient themes. The first theme related to contextual factors of the emergency department environment. Two additional themes related to patient and family characteristics, including unique patient and family factors and clinician interpretation of parental/family needs. Lastly, we found 3 clinician-focused themes including knowledge gaps in EOL communication, communication styles and priorities in EOL conversations with families, and coping with ethical challenges. PED clinicians report communication-related challenges to providing optimal care for families and patients with life-limiting diagnoses. Participants self-identified gaps in communication skills in this area. Future studies should focus on clinician educational interventions on the basis of this needs assessment and include family perspectives to develop best practice.

How Children Influence Weight-Related Behaviors of Women With Low Incomes: A Qualitative Study

Despite women with low incomes’ (WLIs) shared exposure to socioenvironmental risk factors for poor eating and physical activity (PA) behaviors, mothers are more likely than non-mothers to experience obesity. This qualitative study explored the experiences of 14 WLI, with and without children in the home, with engaging in weight-related behaviors. Four common themes were identified—elasticity of food budget, motivation, access to information, and access to PA opportunities; each had subthemes unique to mothers. There was an additional theme exclusive to mothers—time constraints. Results highlight how weight-related health behaviors of WLI are strongly related to the presence of children in the home and relationship status of the mother. The need to consider household composition when developing obesity-related interventions is essential to supporting WLI.

Healthcare professionals’ perspectives on the barriers and facilitators of integrated childhood obesity care

BackgroundBoth the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.MethodsIn this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.ResultsOverall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families’ situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.ConclusionsHealthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Religious influences on integration within U.S. refugee resettlement

ABSTRACT This study examines how religion influences integration among refugees resettling to Utah, in the western United States (U.S.). In-depth interviews were conducted with 88 refugees an average of 11 years post-resettlement. Qualitative analyses led to identification of key themes, including: 1) belief in a higher power guided integration and 2) religion influences services and relationships in Utah. Additional themes emerged regarding how religion informs integration over time, including: 3) religious conversion, 4) coping with racial exclusion, and 5) embracing religious pluralism. Findings have implications for incorporating attention to religious coping and religious freedom among displaced populations adapting to new environments.

Abstract B127: Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states

Abstract Background: Affordability challenges for gastrointestinal (GI) cancer care may be numerous and complex in socioeconomically disadvantages states of the southern US, like Alabama (AL) and Mississippi (MS). Given that a large share of the African American US population lives in the southern US, these challenges may be contributing to observed racial disparities in GI cancer. Methods: Semi-structured interviews were conducted with purposefully selected AL and MS GI cancer providers, other staff, and survivors. Interview guides were developed based on access to care conceptual frameworks to identify barriers and facilitators to surgical and overall cancer care along 5 domains: Availability, Accessibility, Affordability, Acceptability, and Accommodation. Transcripts were analyzed by 3 coauthors using an inductive thematic and content analysis qualitative approach with NVivo 12 Plus software. Intercoder agreement was reached at 91%. This analysis focuses on the Affordability domain. Results: Providers (N=27) were 11 surgeons, 4 medical and radiation oncologists, 1 primary care provider, 6 nurses, and 5 patient navigators, 22% practiced in rural areas, 78% in urban areas. Survivors (N=36) were 44-87 years of age, 42% female, 70% white, 30% African-American, 53% colorectal, 19% pancreatic, 28% esophageal cancer. Providers and survivors discussed affordability challenges at the patient and system level. Patient-level challenges were: 1) High cost burden besides payments to providers (e.g., transportation, ostomy bags, nutritional supplements, non-antineoplastic drugs, feeding tubes, deductibles), and 2) Spending priorities outside of health care (e.g., patients prioritizing what to spend limited incomes on, which bills to pay). System-level affordability barriers included: 1) Care impacted by insurance processes (e.g., delays due to preauthorization or hospital out-of-network, surgery scheduled around deductible), and 2) Logistical burdens to access resources to help patients afford care (e.g., applying for grants). Two additional themes emerged from the providers’ interviews only: 1) Added costs due to scarcity of quality medical services (e.g., cost of repeating imaging procedures that were of poor quality), and 2) Poverty making it unfeasible to deliver guideline-concordant care (e.g., providers unable to provide recommended radiation treatment if patients need to travel long distances and have no money for gas). One more theme emerged from the survivors’ interviews only related to the burden of a confusing billing system (e.g., repeat billing for the same doctor). Conclusions: Many affordability-related challenges exist for the care of GI patients from disadvantaged states of the Deep South, and impact survivors and providers’ decision making about treatment and other needs. Future research should quantify the extent of these challenges and determine how they contribute to observed racial disparities in GI cancer surgery and other treatment. Citation Format: Maria Pisu, Nataliya V. Ivankova, Jessica Morgan, Yu-Mei M. Schoenberger, Nathan C. English, Burkely P. Smith, Ivan I. Herbey, Courtney Williams, Bayley A. Jones, Wendelyn M. Oslock, Daniel I. Chu. Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B127.