Advisory Board Research Articles

The Knowledge Need of the College Students on Sexual Health and Their Attitude Towards Sexual Education

Objective: In this study it is aimed to determine the information needs of university students about sexual health and their attitudes towards sexual education. Methods: This study is a descriptive cross-sectional study from quantitative research methods. The research was carried out with the participation of 989 students between September 2021 and January 2022. The data were collected by the researchers using the personal information form, sexual health form, and Attitude towards Sex Education Scale, which were prepared online by the researchers through the Office 365 program. Results: It was determined that the mean age of the students participating in the study was 19.76±1.32 and 77.8% of them were female. It was found that the sociodemographic characteristics of the students, studying in the health department, the place of residence, the education and working status of their parents were found to have a statistically significant effect on their attitudes towards sexual education. Especially, 69.1% of the students wanted to have a sexual health counseling center in the university. It was determined that approximately one fourth of the students related to sexual health received training on this subject, and 58% stated that they wanted to receive training from the health personnel and 15.3% from the counseling center. It has been determined that students need family planning education. It was found statistically significant that students who had knowledge about family planning methods had higher attitudes towards sexual education. Conclusion: It can be suggested to establish advisory boards that students can benefit from in cooperation with universities and health institutions.

Between rhetoric and reality: effects of FIFA’s Human Rights Policy on its organisational structures and procedures

ABSTRACT In a ground-breaking development, The Fédération Internationale de Football Association (FIFA) responded to the global call for human rights protection within the sports world by adopting a Human Rights Policy. This policy represents a significant paradigm shift, redefining how sports organisations approach and advocate for equality, respect, and accountability in human rights. This article uses a single and explanatory qualitative case study approach to examine the effects of FIFA’s Human Rights Policy on the organisation. Data for this research were obtained through a documentary analysis of reports from FIFA’s Human Rights Advisory Board as well as eight semi-structured interviews with key stakeholders. The study sheds light on transformative changes across the administration of the organisation, its governance structures and decision-making procedures. By building on organisational change models, the study reveals a dual impact of FIFA’s Human Rights Policy. On the one hand, positive outcomes were identified, including significant organisational and administrative changes, increased resources, improvements in the FIFA World Cup bidding process and enhanced stakeholder engagement. On the other, challenges persist in fully integrating human rights throughout the organisation, particularly in leadership, governance structures, political decision-making, and remedy mechanisms.

Searching for Ways of Settling Land Conflicts by Peaceful Means in Cameroon: A Critical Analysis of the Peacemaking Role of the ‘Land Consultative Board’

The regulation of Land tenure systems is one of the main sources of conflicts in Africa and one of the continent’s most difficult realities to pin down. In its 1974 land reform, the Cameroonian legislature sought to strike a balance between traditional norms and modern instruments, between administrative, judicial and customary authorities, in order to establish an inclusive, democratic and peaceful system of land tenure. The establishment of the Land Consultative Board as the regulatory instrument the state planned to use in land matters was projected as the answer to this quest. While the original intention remains laudable - to enable the state, guarantor of the general interest to acquire a local instrument with the appropriate legitimacy and capable of ensuring the peaceful regulation of land tenure. It has to be said that, almost 50 years later, this ambition has not been achieved. The recurrence of land conflicts and the density of disputes reflect the inadequacy of the rules governing land tenure in Cameroon, depriving the board of any real regulatory authority. The central argument of this paper is that the legislator's ambition was not sincere because of the precedence of the administrative authority to the detriment of other actors. The choice of evaluating this working assumption through the theory of the instrumentation of public action is therefore essential. It makes it possible not only to determine the legislator's intention through textual and contextual analysis, but also to observe the interplay of actors around this regulatory instrument through an interdisciplinary approach. Between its structural inability to acquire real autonomy and the barely concealed desire to downgrade custom, its role has steadily diminished along with its influence, though without disappearing. It remains, however, the institutional relic where the philosophy of the “palaver tree,” supported by the practice of non-violence and democratic dialogue, can still survive, as well as the keystone of the entire land tenure system of the country. The analysis of the consultative Board’s peacemaking role through its instrumentation (or its instrumentalisation) opens up new perspectives for understanding the regulation of public action in our so-called Southern countries, especially for decision-makers, donors and any actor interested in the thorny issue of land tenure insecurity.

Minilateralism and effective multilateralism in the global nuclear order

ABSTRACT Following the 2023 report of the United Nations High-Level Advisory Board on Effective Multilateralism, this paper addresses the relationship between minilateralism and multilateralism in the global nuclear order. The paper theorizes minilateralism as a relational concept and fluid praxis, introducing a typology of inside and outside minilateralism. It then traces and analyzes these types of minilateralism within global nuclear weapons governance from 1970 to 2020. The paper finds that how states pursue minilateralism is conditional on how they perceive the effectiveness and legitimacy of wider membership multilateral institutions in nuclear governance. How complementary minilateralism is to effective multilateralism comes down to how minilateral groupings are positioned relative to multilateral institutions, how willing and able they are to integrate their activities in those institutions, and whether they, in turn, are considered legitimate. The paper concludes with recommendations for how minilateralism can complement effective multilateralism in global nuclear weapons governance and beyond.

Capitalizing on Implementation Science to Advance Antimicrobial Stewardship and Health Equity in Treating Pediatric UTI’s

Background: Pediatric urinary tract infections represent the most common pediatric infection with increasing gram-negative antibiotic resistance. Overutilization of antimicrobials including third generation cephalosporins are known drivers of this resistance. Antimicrobial stewardship (AS) efforts have recently shown that antibiotic selection may be influenced by patient race. Implementation science (IS) can provide frameworks and strategies to improve antimicrobial utilization and equity. Methods: This was a pre/post study of 2 geographically different children’s hospitals general pediatric floors assessing the impact of a set of implementation strategies developed to improve provider knowledge of best practice antimicrobials (based on local susceptibilities for treatment of UTI’s) and influence uptake of best practice prescribing. IS strategies included provider education, local clinical champion and opinion leader involvement, leadership involvement, local policy changes, and stakeholder co-design of decision support tools (a clinical pathway, a specific ITI antibiogram, and a dynamic order set). No education was provided regarding racial differences in prescribing habits. Outcomes were measured utilizing a portion of the RE-AIM Framework of assessing adoption of “Right” antibiotic, order set adoption, and equitable reach (racial differences in prescribing). Results: Hospital A and B had a first-generation cephalosporin prescription rate of 29.7% (n=441) and 20.6% (n-557) pre implementation and 44.6% (n=84) and 47.5% (n=118) post (p < 0 .001). Both hospitals also saw a significant reduction in third-generation cephalosporins. In Hospital A, APRN’s were more likely to prescribe a first generation cephalosporin (52.4%) than a DO (42.1%) or MD (26.4%) pre-implementation (p=0.004). In Hospital B, APRN’s were less likely to prescribe first generation cephalosporins (5.4%) than a DO (28.9%) or MD (19.4%) pre-implementation (p=0.004). No statistical significance was seen post implementation for antimicrobial selection by provider type for either hospital. Based on race, both hospitals had Black and Other patients receiving more first-generation cephalosporins while white patients were more likely to receive third-generation cephalosporins (p=0.033) pre implementation. No statistical significance was seen post implementation for antimicrobial selection based on race. No improvement was seen in order set utilization. Conclusion: With order set utilization not improving with implementation of new dynamic order set, other strategies such as education, clinical champion and opinion leader involvement, and provision of a local UTI antibiogram were likely contributors to the improvement in best antimicrobial for treatment of UTI’s. Further mixed method research is warranted to improve understanding of the relative performance of our strategies, especially the lack of provider adoption of the novel dynamic order set.Disclosure: Jessica Snowden: Advisory board - Pfizer

Breaking the Reflex: Impact in Hospital-Acquired Infection Incidence for Clostridioides difficile Infection

Background: Nucleic acid amplification tests (NAAT) do not distinguish between colonization and Clostridioides difficile (C.diff) associated diarrhea. On April 5th 2023 our laboratory introduced a new C. diff testing methodology. Previously, if a C. diff screen result was negative for toxin and positive for glutamate dehydrogenase (GDH), a second confirmatory test was conducted with NAAT. This confirmatory test was removed from our testing algorithm. NAAT testing may be ordered ad hoc when clinically relevant diarrhea persists, and alternative etiologies have been excluded. We wanted to evaluate the impact of change with testing methods. Method: Retrospective review of all inpatient hospital-acquired C.diff infections reported to NHSN database from Ascension Michigan Market which comprises 14 acute care hospitals from June 2019 to August 2023. Data for C diff was analyzed every quarter. The risk adjustments used to calculate the Standardized Infection Ratios (SIRs) for C. diff infections was set at 0.48 based on CDC mean SIR established for acute care hospitals in 2022. Results: A total of 14 acute care hospitals were included from which 866 C.diff cases were reported during this period. Overall, the SIR dropped from 0.59 from June-August 2019 to 0.32 reported from March-May 2023; 45.7 % decrease. The maximum reduction in SIR was seen post intervention at 0.21 from June-August 2023 which was 78.3% below the benchmark of 0.48. (Figure) Conclusions: Strategies to optimize current laboratory tests are critical to differentiate C. diff infection from colonization. The current strategy by changing the testing method led to substantial reduction in C-diff. Diagnostic stewardship studies should ideally include outcome measures targeted to post-intervention patients to determine clinical relevance and patient safety. Optimizing test utilization remains a critical component of quality healthcare delivery. Future NHSN updated surveillance definition will require incorporating clinical decision-making into the metric; that is including a combination of any positive C-diff test plus initiation of antibiotic therapy for C-diff.Disclosure: Reese Cosimi: Advisory Board - Abbvie

Preface

PROCEEDINGS The 2nd International Conference on Geological Engineering and Geosciences ICGoES 2022 Multidisciplinary Approach in Geological Engineering 21-22 September 2022 Geological Engineering Department, Faculty of Engineering, Universitas Gadjah Mada Yogyakarta, Indonesia Geological Engineering Department Universitas Gadjah Mada Jl. Grafika No 2, Mlati, Sleman Yogyakarta, 55281 INDONESIA List of Remark - Dean of Faculty of Engineering UGM, From The Conference Chair, Editors, Advisory Board, Scientific Committee, Keynote Speaker, Special Lecture and Book Launching and Organizing Committee are available in this Pdf.

Veränderungen in der Bereitstellung und Inanspruchnahme der Gesundheitsversorgung in deutschen Hausarztpraxen während der COVID-19-Pandemie – eine Befragung von Patient*innen in drei Bundesländern

IntroductionDuring the COVID-19 pandemic general practitioners (GP) practice teams were temporally confronted with major challenges which were accompanied by changes in practice organization and service provision. So far, little has been known about the views of patients who visited the GP practice for other than COVID-related reasons with regard to provision and use of GP services, the adjustments in the practice and the work of the practice team members. MethodsThe patient survey is a sub-study of the mixed-methods study VeCo-Praxis (GP healthcare for patients not suffering from COVID during the Corona pandemic) of the research practice network RESPoNsE (Research Practice Network East), which was conducted in the federal states of Berlin, Brandenburg and Thuringia. The questionnaire-based survey was carried out among patients who visited their GP practice in November 2022. The topics covered in the survey were developed by two focus groups consisting of 13 members of the RESPoNsE patient advisory board. The questionnaire was developed and piloted in a participatory approach with the RESPoNsE Patient Advisory Board. The results were analyzed descriptively using SPSS and discussed with the advisory board. Results1,405 questionnaires from 37 practices were analyzed. 97% of respondents felt that the treatment they received at their GP practice during the COVID-19 pandemic was good. For the vast majority, appointments and acute consultations, prescriptions, laboratory tests, discussions of diagnostic results, routine follow-up check-ups and health checks were available to a sufficient extent. From the patients’ perspective, the practices have successfully adapted to the challenges caused by COVID-19. Overall, the patients’ trust in and their appreciation of the work of the practice staff have increased since the pandemic. Patients stated that GP practices should continue hygiene procedures, such as wearing a mask or keeping physical distance, in the future. DiscussionDespite multiple reports of a significant decline in both provision and utilization of standard care in GP practices during the pandemic, our survey showed that the majority of patients felt that they received adequate GP care and were highly satisfied. The results should be interpreted against the background of possible selection bias. ConclusionIn this survey, GP patients were predominantly appreciative of GP care during the COVID-19 pandemic. The patients’ assessment of the provision and use of GP services during the pandemic complements the corresponding perspective of GPs and medical practice assistants.

Preface

Abstract The 3rd International Conference on Geological Engineering and Geosciences ICGoES 2023 Innovating the Future: Navigating the Intersection of Geology and Technology 21-22 September 2023 Hybrid Conference Yogyakarta, Indonesia Geological Engineering Department Universitas Gadjah Mada Jl. Grafika No 2, Mlati, Sleman Yogyakarta, 55281 INDONESIA © Geological Engineering Department Universitas Gadjah Mada 2023 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without written permission of the copyright holder (the publisher), except in the case of brief quotations embodied in reviews and certain other non-commercial uses permitted by copyright law. The publisher, authors, contributors, and endorsers of this publication each excludes liability for loss suffered by any person resulting in any way from the use of, or reliance on this publication. Foreword Dr. Agung Setianto Assoc. Prof. Head of Geological Engineering Department Universitas Gadjah Mada Yogyakarta, Indonesia It is an honour for the Geological Engineering Department of Universitas Gadjah Mada to hold the 3rd International Conference on Geological Engineering and Geosciences (ICGoES 2023), an annual conference program sponsored by our department. This is the 3rd year we hold this international conference, which was originally started in 2014 as a national level geology festival and seminar for Indonesian academics and students. The chosen theme for this year’s event, “Innovating the Future: Navigating the Intersection of Geology and Technology,” encapsulates the dynamic synergy between two realms undergoing rapid evolution. Within the sphere of geology and geosciences, technological advancements have ushered in a new era of understanding and exploration. These innovations offer powerful tools and novel methodologies that enable scientists to delve deeper into the complexities of our ever-changing planet, particularly in response to the pressing challenges posed by the climate crisis. The fusion of geology and technology not only expands our knowledge but also enhances our ability to adapt and respond effectively to environmental shifts. Yet, amidst the strides forward, there exist inherent challenges. The unprecedented accessibility to technology brings with it a set of hurdles, demanding careful navigation and thoughtful consideration. As we venture into this intersection, we must remain vigilant, recognizing both the opportunities and obstacles that accompany this transformative journey. I hope the success of this event will strengthen future collaboration between our university with universities and research institutes in Indonesia and from all over the world. Once again, we thank you for your contribution to and participation in ICGoES 2023 and I hope you had a great time and wonderful experience. List of conference chair, Editors, Scientific Committee & Reviewers, Advisory Board and Organizing Committee are available in this Pdf.

Conflict of Interest Disclosure in Oncology: Preliminary Insights From the Global ONCOTRUST-1 Cross-Sectional Study.

Conflicts of interest (COIs) between oncologists and industry might considerably influence how the presentation of the research results is delivered, ultimately affecting clinical decisions and policy-making. Although there are many regulations on reporting COI in high-income countries (HICs), little is known about their reporting in low- and middle-income countries (LMICs). Oncology Transparency Under Scrutiny and Tracking (ONCOTRUST-1) is a pilot global survey to explore the knowledge and perceptions of oncologists regarding COI. We designed an online 27-question-based survey in the English language to explore the perceptions and knowledge of oncologists regarding COI, with an emphasis on LMICs. Descriptive statistics and the Consensus-Based Checklist for Reporting of Survey Studies guidelines were used to report the findings. ONCOTRUST-1 surveyed 200 oncologists, 70.9% of them practicing in LMICs. Median age of the respondents was 36 (range, 26-84) years; 47.5% of them were women. Of the respondents, 40.5% reported weekly visits by pharmaceutical representatives to their institutions. Regarding oncologists' perceptions of COI that require disclosure, direct financial benefits, such as honoraria, ranked highest (58.5%), followed by gifts from pharmaceutical representatives (50%) and travel grants for attending conferences (44.5%). By contrast, personal or institutional research funding, sample drugs, consulting or advisory board, expert testimony, and food and beverage funded by pharmaceutical industry were less frequently considered as COI. Moreover, only 24% of surveyed oncologists could correctly categorize all situations representing a COI. These findings underscore the importance of clear guidelines, education, and transparency in reporting COI in oncology. This hypothesis-generating pilot survey provided the rationale for ONCOTRUST-2 study, which will compare perceptions of COI among oncologists in LMICs and HICs.

UTI Symptomatology and Antibiotic Prescribing among US Veterans Seen in Outpatient Clinics

Background: Infectious Diseases Society of America guidelines recommend antibiotic prescribing for urinary tract infections (UTIs) when there is a positive culture and signs and symptoms of infection. Despite these guidelines, prescribing for asymptomatic bacteriuria remains prevalent. We conducted a chart review of UTI outpatient encounters to determine the prevalence of antibiotic prescribing as well as patient and provider factors associated with inappropriate prescribing for UTIs. Methods: Patients who were seen at any Department of Veterans Affairs (VA) outpatient clinic with a positive urine culture from 1/1/2019-12/31/2022 were evaluated for inclusion. Exclusion criteria were pregnancy, neutropenia, neurogenic bladder, spinal cord injury/disorder, chronic kidney disease stage III and above, and those undergoing urologic surgical procedures within 7 days. Inappropriate prescribing was defined as an antibiotic prescription given for UTI treatment when no signs or symptoms of infection were recorded during the patient encounter. Chi-square, Fisher’s exact and t-tests were used to evaluate the association between patient and provider characteristics and antibiotic prescribing. Results: Among 341 visits, most patients were male (70%), White (40%), older (mean age of 65.8 ± 15.9 years) and treated at an urban facility (57%). Antibiotics were prescribed for 67% (229/341) of visits. Of the 229 antibiotic courses prescribed, 119 (52%) were appropriate; issued to patients with > = 1 sign or symptom consistent with a urinary tract infection. The most common symptom recorded was dysuria, followed by frequency, urgency, and hematuria (Figure 1). The remaining 110 (48%) antibiotic prescriptions were inappropriate; given to patients without documented UTI-related signs or symptoms. The proportion of inappropriate prescribing was higher among advanced practice practitioners (39/56; 69%) compared to physicians (68/113; 60%; P < 0 .0001). Prescribing of an antibiotic did not differ by gender (p-value=0.3779), race (p-value=0.3972), age (p-value=0.7461) or urban versus rural geography (p-value=0.3647). Discussion: In outpatient clinics, nearly half of antibiotics prescribed to patients with a positive urine culture occurred in the absence of documented of signs or symptoms of a UTI. These results suggest that interventions to improve antibiotic use for UTI-related concerns in the outpatient setting should address UTI-related signs and symptoms as well as asymptomatic bacteriuria. Advanced practice practitioners were more likely to prescribe without documentation of relevant signs or symptoms than physicians. Improving meaningful documentation about the presence or absence of signs and symptoms of a UTI may help reduce inappropriate antibiotic prescriptions in the outpatient setting.Disclosure: Robin Jump: Research support to my institution from Merck and Pfizer; Advisory boards for Pfizer

Contributing Factors to Central Line-associated Bloodstream Infections and Catheter-associated Urinary Tract Infections

Background: Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are key healthcare-associated infection (HAI) quality metrics. In this qualitative analysis, we aimed to identify common issues contributing to CLABSIs and CAUTIs occurring during the COVID-19 pandemic. Methods: In an academic healthcare network in Atlanta, GA, four hospitals perform real-time, apparent cause analyses (ACAs) for all CLABSIs and CAUTIs. Contributing factors are entered as free text into an electronic database. We analyzed data from 8/2020–8/2022. We first performed a qualitative open card sort of all reported contributing factors to CLABSI and created a novel framework based on mutually defined critical tasks (e.g., line insertion) and cross-cutting issues (e.g., communication breakdown). Contributing factors could describe ≥1 critical task and/or ≥1 cross-cutting issue. After establishing interrater reliability, a multidisciplinary group applied this framework to classify each contributing factor. For CAUTI, we used the same set of cross-cutting issues but identified new critical tasks via open card sorting. We then used the framework to classify each CAUTI contributing factor. We used descriptive statistics to identify frequent critical tasks and cross-cutting issues. Results: We reviewed 350 CLABSI ACAs with 602 contributing factors and 240 CAUTI ACAs with 405 contributing factors (Figure 1). Our classification framework comprised 11 cross-cutting issues and 9 critical tasks for CLABSI and 7 critical tasks for CAUTI (Figure 2). CLABSI: The critical tasks most often reported were bathing (19%), central line dressing maintenance (15%), and assessing central line indication (8%; Figure 3). Within these tasks, the most frequent issues described for bathing were the task not being performed (20%) and unclear documentation (18%); for dressing maintenance, the task was not performed (15%), not documented (15%), or poorly performed due to lack of competency (15%); and for assessing line indication, there was frequent communication breakdown (33%). CAUTI: The critical tasks most often reported were urinary catheter care (26%) and assessing the indication for urinary catheter (22%; Figure 4). Within these tasks, urinary catheter care was frequently not documented (38%) or not performed (16%); assessing urinary catheter necessity was often not documented (29%) or involved breakdown of communication (19%). Conclusion: We created a novel framework to evaluate common causes of HAIs in an academic healthcare network. This framework can be used to identify and track gaps over time and to develop quality improvement initiatives targeting key tasks and associated factors, such as communication difficulties when assessing device indications.Disclosure: Colleen Kraft: Consultant - REbiotix/Ferring; Scientific Advisory Board - Seres, LLC

A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan.

Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study. From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13-19 or 20-29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non-governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding. We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations. Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex health and social challenges facing communities today.

Antimicrobial Use in Veterans Affairs Community Living Centers, 2015 - 2019

Background: Optimizing antimicrobial use (AU) among post-acute and long-term care (PALTC) residents is fundamental to reducing the morbidity and mortality associated with multidrug-resistant organism (MDROs), as well as unintended social consequences related to infection prevention. Data on AU in PALTC settings remains limited. The U.S. Department of Veteran Affairs (VA) provides PALTC to over 23,000 residents at 134 community living centers (CLCs) across the United States annually. Here, we describe AU in VA CLCs, assessing both class and length of therapy. Methods: Monthly AU between January 1, 2015 and December 31, 2019 was extracted from the VA Corporate Data Warehouse across 134 VA CLCs. Antimicrobials and administration routes were based on the National Healthcare Safety Network AU Option protocol for hospitals. Rates of AU were measured as the days of therapy (DOT) per 1,000 resident-days. An antimicrobial course was defined as the same drug and route administered to the same resident with a gap of ≤ three days between administrations. Course duration was measured in days. AU Rates were measured as the days of therapy (DOT) per 1,000 resident-days. Results: The most common class of antimicrobial course administered during the study period was beta-lactam/beta-lactamase inhibitor combinations (15%) followed by fluroquinolones (14%), extended-spectrum cephalosporins (12%) and glycopeptides (11%; Figure 1). Neuraminidase inhibitors had the longest median (IQR) course duration (10 (IQR 8) days), followed by tetracyclines (8 (IQR 8) days), and then folate pathway inhibitors, nitrofurans and 1st/2nd generation cephalosporins (7 (IQR 7) days). Overall, 60% of antimicrobial courses were administered orally, with fluroquinolones the most frequently administered orally (20%). From 2015 – 2019, the annual rate of total antimicrobial use across VA CLCs decreased slightly from 213.6 to 202.5 DOT/1,000 resident-days. During the 5-year study period, fluroquinolone use decreased from 27.47 to 13.36 DOTs/1,000 resident-days. First and 2nd generation cephalosporin use remained relatively stable, but 3rd or greater generation cephalosporin use increased from 14.70 to 19.21 DOTs/1,000 resident-days (Figure 2). Conclusion: The marked decrease in the use of fluoroquinolones at VA CLCs from 2015-2019 is similar to patterns observed for VA hospitals and for non-VA PALTC facilities. The overall use of antibacterial agents at VA CLCs decreased slightly during the study period, but other broad-spectrum agents such as 3rd or greater generation cephalosporins increased over the same period. The strategies used to decrease fluroquinolone use may have application for other antibiotic classes, both in VA and non-VA PALTC settings.Disclosure: Robin Jump: Research support to my institution from Merck and Pfizer; Advisory boards for Pfizer

Dilation Outcomes for Transgender and Nonbinary Patients Following Gender-Affirming Vaginoplasty in a US County Safety-Net System

Purpose: The study purpose was to report neovaginal dilation outcomes and identify factors associated with pain, dilation discontinuation, and sexual function for transgender individuals who underwent gender-affirming vaginoplasty. Methods: A retrospective cohort study design was employed of transgender patients 18 years or older undergoing full-depth vaginoplasty and pelvic floor physical therapy (PFPT) between May 2018 and April 2021 at a safety-net hospital through medical record review and an online survey developed with a patient advisory board. Exclusion criterion was minimal-depth vaginoplasty or loss to follow-up. Results: In total, 137 patients included underwent full-depth vaginoplasty (46.7% survey response rate) 796.2 days (mean) postoperatively. Patients received 4.3 PFPT visits, with the last visit 12.4 weeks postoperatively (mean). Ninety patients (64.3%) achieved the 2 widest dilators, and 68 patients dilated to a depth of 5.5 inches or more (49.6%). The mean progression time between dilators was 5 weeks. Twenty-nine patients (21.2%) had pain preventing dilation, associated with minor or any surgical complication (OR = 5.7; 95% CI, 1.3-25.0) and posttraumatic stress disorder (P = .01), and had more PFPT visits for longer postoperatively than those without pain (P = .03). Nineteen respondents (32.2%) reported not dilating and were younger (P = .02), more likely to be lesbian, pansexual, or asexual (P = .01), and experienced depression (P = .01). Forty-four respondents (77.2%) were sexually active in the past 6 months, which was not associated with pain during dilation. However, respondents self-reporting dilation pain had greater dissatisfaction with their sex life (P = .02). Discussion: Patient dilation practices following vaginoplasty differ from protocols recommended by surgeons. Dilation goals should be adapted to individual patient characteristics and needs.

Partnering With Immigrant Patients and Families to Move Beyond Cultural Competence: A Role for Clinicians and Health Care Organizations

The delivery of culturally competent health care is recognized as critical to providing quality, equitable care for marginalized groups. This includes immigrant patients and families who experience significant barriers to health care and poor health outcomes. However, operationalization of cultural competence challenges health care delivery. Complementary concepts have also emerged such as cultural humility, cultural safety, and structural competence, recognizing the need for multi-level approaches involving patients, families, clinicians, health care organizations, the larger community, and policymakers. In this review, we define cultural competency and related frameworks and their applicability to immigrant patients and families. The evolution in terminology reflects an increasingly more comprehensive approach to understanding culture as multidimensional and shaped by social and structural factors. We then highlight strategies at each level, focusing on clinicians and organizations to leverage loci of control most directly within clinicians’ reach. Community-level strategies include community engagement (ie, vis-à-vis community health workers or community advisory boards) for clinical and research practice. Organization-level strategies include “immigrant-friendly,” or “immigration-informed” policies aimed at reducing immigration-related stressors, like limiting cooperation with immigration enforcement agencies or developing medical-legal partnerships to assist with patients’ legal needs. Lastly, policy-level strategies seek to change local and federal policies to address needs beyond health care (eg, education, housing, other social services), taking a “Health in All” policies approach that articulates health considerations into policymaking across sectors. Finally, we conclude with suggestions for future directions that center the experiences of immigrants, with the ultimate goal of sustainably meeting the complex needs of immigrant patients and families.

Reimagine an Accomplished Advisory Board

Reimagine an Accomplished Advisory Board

Examining the involvement of guardians of children with acute lymphoblastic leukemia in Tanzania as public contributors to inform the design and conduct of the GuardiansCan project: A mixed-methods study protocol.

Public contribution in research can lead to the design and conduct of more feasible and relevant research. However, our understanding of the acceptability and feasibility of public contribution and the evidence base regarding its impact in low- and middle-income countries (LMICs) is limited. In this study protocol, we describe a mixed-method examination of public contribution activities in the GuardiansCan project. The GuardiansCan project aims to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia (ALL) with the help of Mobile Health technology. We aim to: (1) involve guardians of children treated for ALL as Guardians Advisory Board (GAB) members in the managing and undertaking, analysis and interpretation, and dissemination phases of the GuardiansCan project; and (2) examine the acceptability, feasibility, and perceived impact of GAB members' contribution to the GuardiansCan project from the perspective of the GAB members and public contribution coordinators. We will recruit six to eight guardians of children treated for ALL to the GAB. We will hold workshops where GAB members contribute to all project phases. Using impact logs, we will record GAB workshop activities and the perceived impact of these activities. We will interview GAB members and public contribution coordinators 6 months after establishing the GAB, and at the end of each study within the project, to examine the acceptability, feasibility, and perceived impact of public contribution activities. We expect GAB contribution to increase project quality and relevance, and inform how to best embed public contribution in research in LMICs.

Homes Heat Health protocol: an observational cohort study measuring the effect of summer temperatures on sleep quality

IntroductionQuality sleep is essential to our health and well-being. Summertime temperatures in the bedrooms of homes in temperate climates are increasing, especially in city apartments. There is very little empirical...

John Costa’s 35 Years of Contributions to this Telecommunications Journal

John Costa has retired from this Journal’s Board of Editors, after 35 years of active contribution. From 1990 to 1992, he was Executive Editor (and Editor-in-Chief), producing eight issues of the Telecommunication Journal of Australia (TJA), the name of this Journal up until 2013. Just as significant were the many subsequent issues of the Journal for which he was Guest Editor, from 1994 onwards. TJA evolved first into the Australian Journal of Telecommunications and the Digital Economy (AJTDE: 2013–2018) and subsequently the more deliberately international Journal of Telecommunications and the Digital Economy (JTDE: 2019– ). As an ongoing and popular member of the Editorial Advisory Board, John was noted for his skill in commissioning new papers from distinguished overseas authors, as well as the impetus he gave the Journal in its coverage of new forms of satellite and terrestrial radio communications.