Collaborative Agreements Research Articles

An umbrella review of pharmacist prescribing: stakeholders’ views and impact on patient outcomes

Abstract Introduction There is great geographical diversity in the degree of prescribing rights pharmacists have. In some countries such as the United Kingdom (UK), pharmacists have unrestricted prescribing rights following appropriate training; in other countries, pharmacists cannot legally prescribe. The impact of pharmacist prescribing (PP) has been studied in various qualitative and quantitative research studies, but this evidence has not been synthesised to support the development of PP internationally. Aim The aim of this umbrella review was to describe the international PP models, establish the impact of PP on patient outcomes and describe key stakeholders’ views of PP, by synthesising all the available systematic reviews (SRs). Methods Six databases (Embase, CINAHL, MEDLINE, Web of Science, Cochrane Library and PsycINFO) were searched, from January 2003 to June 2023, for key terms such as ‘pharmacist’, ‘prescribing’, ‘prescription’ and ‘systematic review’, ‘meta-analysis’, ‘meta-synthesis’. Systematic reviews that examined PP for any clinical condition, for patients of any age and in any healthcare setting were eligible for inclusion. SRs examining pharmacists’ interventions other than PP were excluded as were articles not published in English. Two researchers independently screened titles, abstracts and full texts for eligibility; discrepancies were resolved by discussion with a third reviewer. A data extraction tool was developed, piloted and refined prior to data extraction based on guidance from PRIOR[1] and the Joanna Briggs Institute (JBI).[2] Extracted information included: SR characteristics; inclusion and exclusion criteria; description of prescribing models, setting, clinical conditions, clinical and health service utilisation outcomes and key stakeholders’ views of PP. Data have been synthesised narratively due to the heterogeneity of included studies. Results A total of 6439 titles were retrieved from searches, with 917 duplicates removed. Following abstracts and full text screening (5522 and 129 respectively), 39 systematic reviews (8 qualitative; 19 quantitative and 12 mixed-methods) were included. The description of PP models varied within and between the SRs and demonstrated implementation of different PP models globally. Collaborative practice agreement with a physician, dependant prescribing by protocol and/or formularies were common in Canada and the United States, while supplementary prescribing and independent prescribing models were described in the UK. Prescribing activity was evident in all care settings and for a wide range of clinical conditions. SRs reporting on targeted clinical conditions, noted that patients of pharmacist prescribers had similar blood pressure control and depressive symptoms, better cholesterol and blood glucose control and reduced pain intensity when compared with patients of medical prescribers. SRs also suggests that pharmacist prescribers make fewer errors than non-pharmacists. Key stakeholders noted largely positive views towards PP, with a reduction in physician workload, an improvement in pharmacist job satisfaction, better utilisation of pharmacist knowledge and skills noted. Concerns over pharmacists’ diagnostic abilities, legal accountability for errors and appropriate implementation of PP models were noted. Conclusion A variety of PP models exist internationally. Careful examination of each model should be undertaken prior to adoption and implementation in countries where PP is currently not permitted.

Clinical Telepharmacy: Addressing Care Gaps in Diabetes Management for an Underserved Urban Population Using a Collaborative Care Model.

Introduction: Optimal chronic care management is limited by low health care access and health literacy among underserved populations. We introduced clinical pharmacy services to enhance our patient-centered home model, which serves mostly Medicare/Medicaid-insured patients. Primary care providers (PCP) refer patients with uncontrolled diabetes to the pharmacist for chronic disease management between PCP appointments to bring A1c to goal under a collaborative agreement. This workflow existed before the COVID-19 pandemic and was primarily in-person visits. Our model transitioned to telehealth, where pharmacy services continued via audio/video visits to avoid disruption in care. Methods: A collaborative scope of practice within care guidelines was developed with PCPs. Established patients with uncontrolled diabetes were referred to the clinical pharmacist. The workflow remained consistent through January 1, 2019 to January 31, 2020 (pre-COVID), and April 1, 2020 to October 31, 2021 (post-COVID). February and March 2020 were excluded due to changing operational processes at the pandemic onset. The pharmacist independently saw patients for medication-related interventions and ordered associated labs within the scope of practice. The program was retrospectively evaluated via process metrics (visit volume and intervention types) and clinical outcome (A1c reduction). Results: A total of 105 patients were referred for diabetes management during the study period. These were in-person pre-COVID (95%) and shifted to entirely audio/video (100%) post-COVID. Impact of pharmacy services was sustained through the change in care model: an A1c reduction of more than 0.5% was observed in 65% (n = 20) and 69% (n = 49) of patients managed by the pharmacist, pre- and post-COVID, respectively. Pharmacy visit volumes were 86 versus 308, respectively. Conclusion: Pharmacy referral and visit volumes increased over the pandemic, made possible via telehealth. The goal attainment rate observed pre-COVID was amplified even with the growth in services over time. Clinical pharmacy services delivered through audio/video telehealth visits may be equally effective compared to face-to-face services.

Improving Mobile Ad hoc Networks through an investigation of AODV, DSR, and MP-OLSR Routing Protocols


 Mobile Ad Hoc Networks (MANETs) pose a dynamically organized wireless network, posing a challenge to establishing quality of service (QoS) due to limitations in bandwidth and the ever-changing network topology. These networks are created by assembling nodes systematically, lacking a central infrastructure, and dynamically linking devices such as mobile phones and tablets. Nodes employ diverse methods for service delivery, all while giving priority to network performance. The effectiveness of protocols is crucial in determining the most efficient paths between source and destination nodes, ensuring the timely delivery of messages. Collaborative agreements with MANETs improve accessibility, allow for partial packet delivery and manage network load, ultimately minimizing delays and contributing to exceptional carrier performance. This article conducts a comparative analysis of simulation parameters for AODV, DSR, and MP-OLSR protocols to explore QoS limitations associated with different routing protocols. The study primarily focuses on evaluating various quality metrics for service improvement, assessing protocol performance. Simulation results underscore the DSR protocol's 80% superior throughput compared to AODV and MP-OLSR. However, in terms of delay and packet delivery ratio, the hybrid protocol outperforms both AODV and DSR protocols. These findings provide a distinct perspective for testing the compliance services of MANETs.

Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series

OBJECTIVE Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and ­patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy. METHODS In a prospective case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period. RESULTS Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a ­median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital ­readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate. CONCLUSIONS Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers.

Real-world overall survival and characteristics of patients with ER-zero and ER-low HER2-negative breast cancer treated as triple-negative breast cancer: a Swedish population-based cohort study

Estrogen receptor-low (ER-low) HER2-negative breast cancer has similar pathological and molecular characteristics as triple-negative breast cancer (TNBC), and it is questionable whether it should be considered a separate entity. When the international guidelines lowered the cutoff for ER positivity to ≥1% in 2010, the ≥10% threshold was kept in Sweden. ER-low breast cancer (ER 1-9%) is thus in Sweden treated as TNBC. We aimed to describe patient and tumor characteristics, treatment patterns and overall survival in a Swedish population-based cohort of patients with ER-zero and ER-low HER2-negative breast cancer treated as TNBC. All TNBC cases diagnosed in Sweden 2008-2020 were included in a population-based cohort study. Patient, tumor and treatment characteristics were analyzed by ER-status (ER 0% vs 1-9%), and associations between subgroups compared using χ2 test. Survival endpoint was overall survival (OS), and Kaplan-Meier curves were estimated. Cox proportional hazards models were used to estimate adjusted hazard ratios comparing ER-low to ER-zero. Of the 5655 tumors, 90.1% had an ER expression of 0%, while 9.9% were ER-low. ER-low tumors were grade III in 69.4% (80.8% in ER-zero tumors, p-value=0.001), with a median Ki67 of 60% (63% in ER-zero tumors, p-value=0.005). There were no significant differences in given chemotherapy (p=0.546). A pathological complete response (pCR) was achieved in 28.1% of ER-low tumors (25.1% in ER-zero tumors). In the unadjusted analysis of OS, women with ER-low disease had a borderline but not significantly better OS than those with ER-zero disease (HR 0.84 (95% CI 0.71-1.00), p=0.052). ER-status 1-9% vs 0% was not associated with OS in the multivariable analysis (HR 1.11 (0.90-1.36)). Distant disease-free survival did not differ by ER-status 0% vs 1-9% (HR 0.97 for ER-zero vs ER-low (0.62-1.53), p=0.905). After preoperative treatment, the impact of pCR for OS did not significantly differ between ER-zero or ER-low disease. ER-low HER2-negative breast cancer has characteristics and prognosis similar to TNBC, when treated in the same way. Therefore, it seems reasonable to use a ≥10% threshold for ER positivity. This would provide patients with ER-low tumors the same treatment opportunities as patients with TNBC, within studies and within clinical routine. This work was financially supported by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, in accordance with terms and conditions of a Master Collaboration Agreement between the company and Karolinska Institutet.

F1000Research collaboration with the Research on Research Registry & Hub

F1000Research is proud to announce the new collaborative agreement between the Research on Research, Policy & Culture Gateway and the online repository for research on research (RoR) activity, the Research on Research Registry & Hub. This collaboration aims to connect scholars and organisations in the growing RoR discipline (the study of research practices also referred to as ‘meta-research’ or ‘science of science’), facilitating knowledge exchange and research transparency through project registration and open publication of outputs.

Status and challenges of university-industry linkage in the Tigray Regional State of Ethiopia

University-Industry Linkage (UIL) is the interaction of academic or research universities and industries of different sectors for complementary benefits. This paper presents the results of a study conducted to understand the present status and challenges of UIL in the Regional State of Tigray, Ethiopia. Using convergent parallel mixed research design, the study addressed two research questions: (1) what is the status of UIL in the Regional State of Tigray, Ethiopia? (2) what are the UIL challenges facing universities and industries in the Regional State of Tigray, Ethiopia? Respondents were recruited from two universities and eight industries of different business areas including service, manufacturing, finance and energy. A survey questionnaire and interview protocols were developed by adapting items used in previous studies and distributed to a sample size of 1350. The findings show that there are occasional collaborations between the universities and industries in the Region mostly focusing on internship and training. Although communications and meetings are conducted between the universities and industries to create UIL opportunities in Tigray, signed collaboration agreements remain mostly on the shelf mainly due to lack of due attention and commitment from both sides in taking the step forward. Therefore, awareness creation measures and sound policy framework and guidelines should be in place for effective and practical collaborations to exist and get realized.

Regional emergency networks: how organizations shape technological collaborations under extreme conditions

ABSTRACT The aim of this research is to undertake explorative research and present propositions that would identify the drivers of regional emergency networks, i.e. regional technological collaborative agreements under extreme conditions. Based on previous studies on emergency management, we empirically evaluate how 49 organizations built 53 technological cooperative agreements within the context of COVID-19. We consider individual, dyadic and whole network level variables to build on theory about how these emergency networks are created. We propose that emergency networks are developed under embedded relationships, with physically proximate partners that are also indirectly connected. Secondly, we establish that emergency networks are characterized by heterarchical leadership with lower density connections between many different partners. Finally, we deliberate on the role of partner diversity in developing emergency networks, establishing alternative propositions based on the similarity in innovative capacity and institutional character of the partners.

Preface

It is a great honor and pleasure to present the proceeding of the 11th International Seminar on Ocean and Coastal Engineering, Environmental and Natural Disaster Management (ISOCEEN) and the agreement of collaboration between Institut Teknologi Sepuluh Nopember and Thuyloi University Vietnam. The signing of Memorandum of Understanding represents a commitment to strengthen academic ties, research collaborations, and cultural exchanges between Institut Teknologi Sepuluh Nopember and Thuyloi University Vietnam.Started by the second vice-chancellor of Institut Teknologi Sepuluh Nopember, Ir. Mas Agus Mardyanto, M.E., Ph.D., the event brings the theme Development of Ocean Science and Technology for Sustainable Blue Economy. Our coastal, ocean, and offshore activities and products must adopt more innovative thoughts and efforts to ensure that we achieve sustainable development goals. Through this seminar, engineers and scientists whose activities are related to research and solving problems in the coastal, marine, maritime, hydrodynamics, oil, and gas are expected to develop science and technology in Coastal, Ocean, and Offshore Engineering in an integrated manner. Different perspectives are addressed by keynote speakers:• Prof. Dr.Eng. Hitoshi Tanaka from Tohoku University, Japan,• Ir. Suharyanto, M.Sc., Director of Marine Spatial Planning – KKP• Prof. Dr. Eng. Nguyen Trung Viet, Thuyloi University, VietnamWith contributions from over 100 participants and over 35 accepted papers, the seminar was successfully conducted in Swissbel Hotel Manyar, Surabaya, Indonesia, on September 27th, 2023. Selected papers presented in ISOCEEN 2023 will be published in The IOP Conference Series: Earth and Environmental Science (ESS) indexed in SCOPUS.On behalf of the organizing committee of ISOCEEN 2023, I would like to warmly thank all the authors who, with their presentations, generously contributed to the lively exchange of scientific information that is so vital to the endurance of scientific conferences of this kind. Special thanks to all committees for their efforts in preparing the manuscripts and managing the sessions, respectively. Also, all lecturers within ITS, Contributing Authors, Seminar delegates, experts, scholars, and all students participate in ISOCEEN 2023.Best regards,Prof. Suntoyo, S.T, M.Eng., Ph.D.ChairmanList of Editors, Committee are available in this pdf.

Methodology for Good Machine Learning with Multi-Omics Data.

In 2020, Novartis Pharmaceuticals Corporation and the U.S. Food and Drug Administration (FDA) started a 4-year scientific collaboration to approach complex new data modalities and advanced analytics. The scientific question was to find novel radio-genomics-based prognostic and predictive factors for HR+/HER- metastatic breast cancer under a Research Collaboration Agreement. This collaboration has been providing valuable insights to help successfully implement future scientific projects, particularly using artificial intelligence and machine learning. This tutorial aims to provide tangible guidelines for a multi-omics project that includes multidisciplinary expert teams, spanning across different institutions. We cover key ideas, such as "maintaining effective communication" and "following good data science practices," followed by the four steps of exploratory projects, namely (1) plan, (2) design, (3) develop, and (4) disseminate. We break each step into smaller concepts with strategies for implementation and provide illustrations from our collaboration to further give the readers actionable guidance.

Creating Collaboration: How Social Movement Organizations Shape Digital Activism to Promote Broader Social Change

Social movement organizations (SMOs) have increasingly embraced digital activism, using social media and networking tools to advocate for a cause, to mobilize globally distributed consumers and pressure businesses to change their practices. Past research primarily focuses on how SMOs have used viral social media posts to prompt businesses to take immediate action on an issue. This article proposes a shift in the discourse to explore how SMOs’ digital activism can promote broader social change through collaborative agreements rather than merely demanding narrow concessions or compliance. We examine the online campaigns of a large international SMO and show how the campaigns influenced three global businesses to alter their environmental practices and industry standards. We find that the SMO used contrasting combinations of content positioning and social networking strategies to mobilize consumers, ultimately achieving collaboration agreements by influencing businesses’ risk perceptions and the potential strategic gains from collaboration with the SMO. The comparative analysis yields insights into how SMOs may vary their digital activism strategies depending on consumers’ loyalty to a business and its offerings, including its products and services. We develop a theoretical perspective that explains why and how consumer loyalty can shape SMOs’ selection of digital activism strategies and the process of achieving collaboration agreements. The findings also advance the literature on digital activism strategies by introducing the notion of ambivalent content positioning and emphasizing the significance of social networking for risk management and sustaining SMOs’ digital activism.

The COVID-19 Vaccines Evaluation Program: Implementation, Management, and Experiences, 2021-2023.

In 2021, China's domestically produced coronavirus disease 2019 (COVID-19) vaccines received approval from regulatory bodies and were administered worldwide. Due to a low number of infections within China during that period, it became imperative to evaluate the vaccines' real-world effectiveness through international studies. To facilitate this, China CDC launched the COVID-19 Vaccines Evaluation Program (COVEP). This program formed research collaboration agreements with health institutes across five World Health Organization regions, addressing key questions about vaccine performance through ten cooperative agreements. The findings from COVEP projects reinforced confidence, both domestically and globally, in the effectiveness of the vaccines produced in China. Moreover, the outcomes observed internationally were frequently mirrored by later studies conducted within China. COVEP thus pioneered a novel approach for fostering cross-national research collaborations, addressing significant public health issues and exemplifying a framework for international cooperation. This approach is in line with the strategic objectives and other development efforts of China CDC's national disease control and prevention initiatives.

Coordination and optimization decision of assembly building supply chain under supply disruption risk

Assembly buildings, in the context of the low-carbon transformation of the construction industry, achieve superior outcomes in terms of carbon emission reduction, enhancement of building uniformity, and optimization of resource utilization as compared to traditional buildings. However, the supply chain for assembly building is marked by a significant susceptibility to risk and a need for timely fulfillment of requirements. This paper examines the risk of disruption and capacity limitations in the assembly building supply chain resulting from supply disruptions. It establishes a three-tier supply chain for assembly buildings, including primary component suppliers, backup suppliers, assembly manufacturers, and retailers. The study compares the optimal decision-making and coordination strategies of the supply chain members under centralized, decentralized, and joint agreements. The supply chain dual-source procurement decision coordination model is constructed by incorporating capacity constraints and analyzing the effects of supply disruption probability, repurchase coefficient, revenue sharing coefficient, cost, and other parameters on the expected profits of the supply chain members using arithmetic simulation. Research has indicated that when the likelihood of a disturbance occurring rises, the anticipated financial gain for the main provider decreases, while the predicted financial gain for the secondary supplier increases. The implementation of a collaborative agreement between the assembly maker and the parts backup provider would result in much greater anticipated profits compared to the decentralized decision-making approach. The impact of the revenue sharing coefficient on the predicted earnings of retailers and assembly manufacturers is more significant compared to the repurchase coefficient. The selection bias between NA and NB techniques under capacity constraints mostly arises from the assertiveness of the wholesale asking prices of inexpensive component suppliers, leading assembly manufacturers to increasingly prefer the NA option. This paper's research successfully achieves the contractual coordination of the assembly building supply chain, enhances the resilience of the assembly building supply chain, and promotes the long-term sustainable development of the assembly building supply chain.

"Community strengthening through citizen monitoring of water quality: A systematic review".

Citizen participation in decision-making is a fundamental democratic pillar of democracy. However, the degree of citizen involvement and recognition by governmental institutions may be conditioned by the level of competence and knowledge demonstrated. Therefore, carrying out collective projects can contribute to strengthening citizen engagement in water management issues. Nonetheless, there is limited knowledge about the various types of citizen engagement and the practices that have facilitated greater inclusion in decision-making regarding water resources. This study aims to identify and analyze practices that strengthen water community organizations through citizen monitoring-based involvement. A systematic literature review was conducted using the PRISMA method. The research was guided by the following questions: What are the differences in the level of citizen involvement and the degree of transformation facilitated by citizen monitoring of water quality (CMWQ) between the global North and South? What practices strengthen community organizations in decision-making based on CMWQ? Moreover, what challenges do community water organization structures community water organization structures face when based on CMWQ? A total of 161 publications were identified for the analysis of critical themes. After applying the eligibility criteria, 33 documents were selected for content analysis. The reviewed monitoring exercises indicate that the highest level of citizen organization achieved by participants is commonly recognized as "Water Committees". One practice that strengthens these committees is the generation of collaboration agreements among different types of allies, based on a shared objective. However, in the Global South and at the institutional level, there is still resistance to water quality data generated by citizen monitors, especially in regions with large-scale open-pit mining projects. To sustain the efforts of community figures, monitoring programs with public funding need to be established, and public policies supporting these initiatives at the institutional level must be implemented.

Community-Based Ecotourism Development Planning in Bukit Lawang Plantation Village, Bahorok District, Langkat Regency

This study explores the development of community-based ecotourism in Perkebunan Bukit Lawang village, Langkat Regency. Emphasizing active community involvement in decision-making, the research highlights its effectiveness in ensuring both positive economic impacts and environmental sustainability. Local residents manage tourism-related income independently, fostering a self-sustaining model without imposing burdens on the government. Community engagement extends to roles as vendors and cleanliness officers, creating new employment opportunities and cultivating a welcoming atmosphere for visitors. The success of Perkebunan Bukit Lawang's ecotourism is evident through multifaceted economic benefits, including direct, indirect, and sustainable impacts. Active community participation enhances the destination's image, portraying a locally friendly and open attitude, contributing to a comfortable atmosphere for tourists. The study underscores the importance of preserving the unique local culture and character. Initiatives such as supporting traditional institutions, facilitating and supporting community needs, respecting diverse activities, allowing creative space for locals, and implementing cultural preservation programs are crucial for maintaining the area's distinctiveness.While highlighting strengths such as pristine natural conditions and a strategic location, challenges persist, including inadequate visitor awareness of environmental cleanliness and ambiguous regulatory frameworks. Lack of clear regulations results in overlapping responsibilities, requiring collaborative agreements to define sustainable tourism responsibilities. In conclusion, active community participation is crucial for successful community-based ecotourism. Strengthening synergies, empowering communities, raising environmental awareness among tourists, and continuous cultural preservation efforts are vital for sustainable development, transforming Perkebunan Bukit Lawang into an environmentally sustainable tourist destination, empowering the local community sustainably.

Cross-domain collaboration. Lessons learned from three different communities in the Netherlands

Introduction: Primary care in the Netherlands faces major challenges. Health problems are becoming more complex and care is preferably provided in one's own environment. Application of the concept of Positive Health reveals that non-medical care is sometimes the better option. The aim is for people to be self-reliant, if required in collaboration with informal caregivers or applicable citizen initiatives. We call it collaborative self-reliance. These challenges require reorganization towards a health care system in which citizens, health- and welfare professionals and policy makers collaborate. However, the development of such collaboration is context specific and challenging.
 Aim and Methods: We applied participative action research to identify success factors and barriers to develop cross-domain collaborations in care and support networks, including healthcare and welfare professionals and citizens. Three different communities in the south-east part of the Netherlands were included, a small rural village, a medium sized village and a multicultural city district. Researchers joined the three communities to closely follow the developments and provide support from September 2021 to November 2022. Data were collected through document analysis, observation and interviews. Our approach was informed by community development theory. Interviews were thematically analysed using the qualitative analysis software Atlas.ti.
 Results: Preliminary results revealed several important points of attention. As regards their collaboration, networks should formulate an ambition but also concrete objectives. Because the energy is in the action, the group must prevent it from becoming a discussion group only without taking concrete action to achieve its objectives. Nevertheless, regular meetings are necessary for continuation towards the objectives of the network. For the change process, next to a driving force, a liaison is important to facilitate cross domain collaboration. Knowledge and skills in change management improves the efficiency of the process. Furthermore, it is important to consider the ecological level that the network intends or needs to influence to reach your goal. To involve citizens, a sense of community is a prerequisite. In general, successful networks are not discouraged by not achieving a goal, they reflect and persevere. Final results will be presented during the conference.
 Conclusion: The development of care- and support-networks is a complex and lengthy process in which various barriers need to be overcome. Consequently, it requires commitment and perseverance of all participants. A driving force and liaison are important to keep the process going. Making sound collaboration agreements is valuable for sustainable collaboration.
 Implications: It is recommended to be aware of the socio-ecological level on which the network operates. Networks need to identify concrete objectives and invest in commitment of stakeholders to facilitate sustainable collaboration. It is relevant to identify quick wins at the start in order to conserve the energy and commitment of the group.

Expanding expedited partner therapy and HIV prophylaxis in the emergency department.

Sexually transmitted infections (STIs) continue to have a disproportionate impact on individuals belonging to sexual, gender, and racial minorities. Across the nation, many emergency medicine pharmacists (EMPs) possess the skills and knowledge to expand the provision of expedited partner therapy (EPT) for STIs and provide HIV prophylaxis within existing practice frameworks. This report serves as a call to action for expanded provision of EPT and HIV prophylaxis by EMPs and highlights current barriers and solutions to increase pharmacist involvement in these practice areas. Emergency medicine pharmacy practice continues to expand to allow for limited prescribing authority through collaborative practice agreements (CPAs). In recent years, CPA restrictions have been changed to facilitate treatment of more patients with less bureaucracy. This report addresses the unique challenges and opportunities for expanding EPT and HIV pre- and postexposure prophylaxis provision by pharmacists in emergency departments (EDs). Furthermore, current strategies and treatments for EPT, such as patient-delivered partner therapy and HIV prophylaxis, are discussed. Pharmacist involvement in STI treatment and HIV prevention is a key strategy to increase access to high-risk populations with high ED utilization and help close current gaps in care. Expanding EMP provision of EPT and HIV prophylaxis may be beneficial to reducing the incidence of STIs and HIV infection in the community. CPAs offer a feasible solution to increase pharmacist involvement in the provision of these treatments. Legislative efforts to expand pharmacist scope of practice can also contribute to increasing access to EPT and HIV prophylaxis. With these efforts, EMPs can play an essential role in the fight against STIs and HIV.

Impact of childhood 13-valent pneumococcal conjugate vaccine introduction on adult pneumonia hospitalisations in Mongolia: a time series analysis

IntroductionFew studies have assessed the potential indirect effects of childhood pneumococcal conjugate vaccine (PCV) programs on the adult pneumonia burden in resource-limited settings. We evaluated the impact of childhood PCV13 immunisation on adult all-cause pneumonia following a phased program introduction from 2016. MethodsWe conducted a time-series analysis to assess changes in pneumonia hospitalisation incidence at four district hospitals in Mongolia. Adults (≥18 years) that met the clinical case definition for all-cause pneumonia were enrolled. A negative binomial mixed-effects model was used to assess the impact of PCV13 introduction on monthly counts of pneumonia admissions from January 2015—February 2022. We also performed a restricted analysis excluding the COVID-19 pandemic period. All models were stratified by age and assessed separately. Additional analyses assessed the robustness of our findings. FindingsThe average annual incidence of all-cause pneumonia hospitalisation was highest in adults 65+ years (62·81 per 10,000 population) and declined with decreasing age. After adjusting for the COVID-19 pandemic period, we found that rates of pneumonia hospitalisation remained largely unchanged over time. We did not observe a reduction in pneumonia hospitalisations in any age group. Results from restricted and sensitivity analyses were comparable to the primary results, finding limited evidence of a reduced pneumonia burden. InterpretationWe did not find evidence of indirect protection against all-cause pneumonia in adults following childhood PCV13 introduction. Direct pneumococcal vaccination and other interventions should be considered to reduce burden of pneumonia among older adults. FundingPfizer clinical research collaboration agreement (contract number: WI236621).

Aspek Hukum Dan Perjanjian Kerjasama Pemerintah Dan Swasta Dalam Proyek Infrastruktur

This research aims to investigate the legal aspects involved in the collaborative agreements between the government and the private sector in infrastructure projects. Infrastructure projects play a crucial role in a country's development, and collaboration between the public and private sectors is often the primary foundation for realizing it. Legal analysis includes an in-depth study of regulations and laws governing these partnership agreements. Legal factors such as responsibilities, risk-sharing, and the rights and obligations of both parties are the primary focus. Furthermore, the research also considers contractual aspects within these agreements by assessing their structure, provisions, and dispute resolution mechanisms. By analyzing the legal role in the relationship between the government and the private sector in the context of infrastructure projects, this research is expected to provide a deeper understanding of the dynamics and challenges faced in implementing such collaborations. The implications of the research findings are expected to contribute to the development of more effective and reliable regulations to support the sustainability of infrastructure projects in the future.

Abstract B074: Discovery of MK-1084, a low dose selective clinical stage KRAS G12C inhibitor

Abstract KRAS mutations are the predominant oncogenic drivers in multiple indications including non-small cell lung carcinoma (NSCLC), colorectal carcinoma (CRC) and pancreatic ductal adenocarcinoma (PDAC). KRAS has long been considered a challenging target due to the perceived lack of druggable binding pockets and high flexibility of the protein. However, recent progress in discovering and developing covalent inhibitors against the GDP-loaded form of G12C mutant KRAS has provided a strategy for targeting mutant-specific KRAS as the cysteine residue in the switch II pocket offers a handle for covalent modification. With encouraging efficacy data observed with KRAS G12C-GDP covalent inhibitors in the clinic, attention has shifted to increasing response rate and durability of response. Achieving these goals will likely require combination therapies with different mechanisms of action such as PD-1 or EGFR inhibitors, or other inhibitors within the MAPK pathway (e.g. MEKi, SHP2i). Excellent tolerability of a KRAS G12C inhibitor in such combination settings will be a pre-requisite to success of this strategy. In 2019, Merck & Co., Inc., entered into a research collaboration and license agreement with Taiho Pharmaceutical Co, Ltd. and Astex Pharmaceuticals (UK), to research, develop and commercialize small molecule modulators of mutant KRAS oncogenes, including MK-1084, an inhibitor of G12C-GDP which was advanced under the collaboration. MK-1084 is a highly potent and specific KRAS G12C-GDP macrocyclic inhibitor that was discovered from a structure-guided lead optimization effort. It exhibits a favorable preclinical potency, PK, PK/PD, efficacy, off-target and tolerability profile and has QD oral dosing potential with a projected clinical dose that compares favorably to approved competitors. The significantly lower dose projection along with superior off-target profile puts MK-1084 in a position to differentiate in the clinic regarding dose/pill burden, potential for drug-drug interactions (DDIs) and/or risks associated with drug induced liver injury (DILI) in a combination setting. MK-1084 is currently being evaluated in the clinic for solid tumors as a monotherapy and in combination with pembrolizumab. We will describe the research efforts that led to the discovery of MK-1084, its pre-clinical profile, and disclose its structure. Citation Format: Matthew L Maddess, David L Sloman, Xiaoshen Ma, Anandan Palani, Alexander Stoeck, Aaron C Sather, Nicolas Solban, Ruchia Duggal, Jeanine Ballard, Erik V Munsell, Lin-Chi Chen, Yongxin Han, Richard Miller, Symon Gathiaka, Christopher Brynczka, Hongming Li, Ruojing Yang, Christopher Brynczka, Phil Day. Discovery of MK-1084, a low dose selective clinical stage KRAS G12C inhibitor [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr B074.