Financial Costs Research Articles

Testicular Germ Cell Tumors: A Review.

Testicular cancer is the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year. Between 90% and 95% of testicular cancers are germ cell tumors (GCTs). The mean age at diagnosis for testicular cancer is 33 years. GCTs are categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation. Risk factors include cryptorchidism, family history of testicular cancer, gonadal dysgenesis, infertility, cannabis use, and genetic conditions such as Klinefelter syndrome. The most common presenting symptom of testicular cancer is a painless testicular mass. History, physical examination, scrotal ultrasound, laboratory assessment of GCT-associated serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase), and prompt referral to a urologist are indicated when testicular cancer is suspected. Early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important to optimize outcomes. At diagnosis, GCT is stage I (localized to the testicle) in 70% to 75% of patients, stage II (metastatic only to the retroperitoneal lymph nodes) in 20%, and stage III (widely metastatic) in 10%. Treatment of GCTs is guided by histology, clinical staging, and risk classification, with 5-year survival rates of 99%, 92%, and 85% for those diagnosed at stages I, II, and III, respectively. Optimal treatment often involves a multidisciplinary team at high-volume, experienced medical centers and may include surveillance (serum tumor markers [α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase] and imaging of the chest, abdomen, and pelvis), surgery (retroperitoneal lymph node dissection), chemotherapy, and/or radiation. Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy such as cardiovascular disease, secondary malignancies, and potential psychosocial effects such as anxiety, depression, and social isolation. Testicular cancer is the most common solid malignancy in young men in the US, and 90% to 95% are GCTs. Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively. Prompt diagnosis and treatment are important to optimize outcomes, and treatment decisions should balance oncologic control with survivorship concerns to minimize long-term adverse effects of treatment.

Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access).

Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015. Our aim was to determine the key challenges for MT implementation and access worldwide. We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country. We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program. Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.

The Impact of Digital Transformation on Corporate Green Technology Innovation

Green technology innovation is an important approach to addressing environmental pollution and achieving high-quality development. In the context of the booming digital economy, whether and how corporate digital transformation can promote green technology innovation is a significant theoretical issue that urgently needs to be addressed. We use data from China’s A-share listed companies from 2011 to 2020 to explore the impact of digital transformation on corporate green technology innovation, based on the construction of measurement indicators for digital transformation through textual analysis methods. It is found that digital transformation can significantly promote corporate green technology innovation, and this conclusion is still valid after a series of robustness and endogeneity tests. Mechanism testing shows that reducing financing cost and enhancing collaborative research are the two effective pathways for digital transformation to promote green technology innovation. Further analysis also reveals that for state-owned enterprises, non-foreign-invested enterprises, high environmental responsibility enterprises, and non-heavy-polluting enterprises, digital transformation plays a more significant role in promoting green technology innovation. Our research findings are conducive to promoting the integrated development of digital transformation and green economy, and provide theoretical reference for the formulation and implementation of digital transformation policies.

Fluid intake, fiber consumption, and physical activity related to constipation among elderly, which one is more important? A cross-sectional study in Iran

Background: Chronic constipation is a common, self-reported, and symptom-based disorder which can significantly influence an individual’s health-related quality of life and imposes several financial costs. Aims: The present study aimed to evaluate the effect of water consumption, fiber intake, and physical activity (PA) on constipation, and which one is more critical by considering the mediating effect of BMI. Subjects and Methods: This cross-sectional study involved 400 older adults in 2019 referring to the comprehensive health service centers in Karaj, the capital of Alborz province. The data were collected using the questionnaires of demographic and anthropometric characteristics, PASE (Physical activity for elderly), fluid intake, FFQ (Food Frequency questionnaire), Wexner constipation, and Persian lifestyle questionnaire analyzed using SPSS and LISREL software. Results: Based on the final fitted model, PA is the most critical constipation-related factor compared to the fluid intake and fiber consumption. In addition, fiber consumption is the second crucial factor affecting constipation, and there is a negative association between constipation and fiber intake. Conclusion: As price is one of the barriers to fiber consumption among the elderly, the recommendation to do physical activity such as walking to solve constipation is efficient and inexpensive for individuals with different socio-economic status. Keywords: Physical activity, Wexner constipation, fiber consumption, elderly, Iran.

An Empirical Analysis of the Effect of Multiple Credit Ratings on Reducing Asset Securitization Financing Costs

This paper delves into the correlation between multiple credit ratings and the financing costs associated with asset securitization, utilizing data spanning from 2012 to 2022 pertaining to credit, corporate asset-backed securities, and asset-backed notes. The research reveals that incorporating multiple credit ratings, as opposed to relying solely on a single rating, favorably impacts the accessibility of more favorable financing costs. Furthermore, the employment of both the "issuer pays" and "investor pays" rating models, as compared to utilizing just the "issuer pays" model, proves to be more effective in mitigating the financing costs of asset securitization products.

Nature Posters Enhance Subjective but not Objective Cleanness in Public Housing: Evidence from a Field Experiment

Littering has negative effects on the environment and is seen as a sign of social disorder. A previous field experiment in public housing buildings showed that implicit posters using eyes and nature posters were more effective in reducing litter than explicit posters using norms and financial costs. The aim of the present field experiment was to test the effects of the nature poster against a control group. We assessed “objective” (based on ratings of photos) and “subjective” cleanness (based on residents’ reports) and explored the role of connectedness to nature. Results from 182 waste disposal areas and 739 residents show that nature posters did not enhance objective cleanness, but did enhance subjective cleanness after one month. This effect was partly accounted for by feelings of connectedness to nature in residents. Also, objective ratings indicated greater cleanness compared to subjective cleanness ratings. We conclude that nature posters had little impact on objective cleanness but enhanced subjective experiences of cleanness, which can be an important driving force for feelings of social order and comfort.

Abstract TP120: Hospital Finance Optimization Through AI-based Stroke Care Coordination Platform

Introduction: AI-based Stroke Care Coordination Platforms (AI-SCCP) have been shown to improve patient transfer decisions and provide access to the highest quality standards of care for all patients. Since strokes happen everywhere and anytime, we examine the economic benefits of implementing AI-SCCPs for two different hospital types: CSC - a comprehensive 24/7 stroke program inclusive of endovascular surgical care and PSC - “Acute Stroke Ready” facilities with radiological imaging and thrombolytic medication treatment capacities but no endovascular surgical care and patients/families. Methods: Using 2021 Medicare MS-DRG payment averages, we calculate the AI-SCCP's PSC break-even point, its effects on CSC finances, and the reduced transfers' economic benefits for the patient and family. Results: Avoided transfers enable the PSC to continue caring for the patient locally, increasing patient volume and resulting in increases in total contribution margin and net revenues beyond the costs of the AI-SCCP. While these retained patients decrease the CSC patient transfer volume, the CSCs will still provide care to all PSC patients needing surgical interventions and patients with MS-DRGs 61-66 who arrive at their locations via initial presentation in their emergency departments. Only 1.7% of all non-surgical stroke discharges were from PCS rural/small-town community hospitals (15% of all US hospitals), illustrating that there is room to avoid more futile transfers. Futile transfers have financial costs for family members, such as hotels, transportation, meals, and lost wages during the patient’s care and increased negative impacts on the patient’s health. Futile transfers increase the episode of care costs to the healthcare system through added ambulance transfers and physician and facility bills, adding out-of-pocket patient costs without adding health outcomes or value. Conclusions: AI-SCCPs offer financial benefits to the PSC and CSC by ensuring patients are at the facility, which provides the best possible benefits for them, a triple “win” for the PCS, CSC, and patients/families. For financially strained PCSs, the retained revenue is critical. Using AI-SCCPs ensures that local hospital/emergency departments can provide timely, expert stroke care for patients and their families in situ. In cases of necessary transfer, the receiving CSC team is prepared and ready to treat these patients, saving valuable time and brain immediately.

Financial Cost of Treating Polytrauma in a Public Tertiary Hospital in the South-Eastern Democratic Republic of Congo: A Case Series Study

Financial Cost of Treating Polytrauma in a Public Tertiary Hospital in the South-Eastern Democratic Republic of Congo: A Case Series Study

Digital transformation and debt financing cost: A threefold risk perspective

Digital transformation and debt financing cost: A threefold risk perspective

Impacts of patent pledge financing on corporate investment: Evidence from a quasi-natural experiment in China

Patent pledge financing (PPF), emerging as the unification of knowledge capital and financial resources, not only enhances the value of firms' intellectual property but also offers new insights into addressing corporate financing challenges. However, the impact of PPF on corporate investment remains unclear. This study utilizes data from Chinese A-share listed companies to assess how the implementation of PPF pilot policies influences corporate investment through the construction of a difference-in-differences model. We reveal that the PPF pilot policies have significantly stimulated corporate investment by lowering debt financing costs and concurrently expanding investment opportunities. Subsequent analyses suggest that the impact of PPF pilot policies on corporate investment is more pronounced for companies facing higher financing constraints, possessing greater patent value, and operating in regions with lower levels of financial development. This research provides empirical support for the notion that financial innovation mitigates corporate financing challenges and fosters economic growth.

Unraveling the effect of resource use, environmental innovation and financing access in developed and emerging economies

Purpose The purpose of this study is to investigate the effects of resource use and environmental innovation on firms’ financial costs. Design/methodology/approach The sample consists of 2,588 firm-year observations from 647 companies collected from Thomson Reuters over a five-year period (year 2014 to year 2018). The authors analyze the data using panel-corrected standard errors, which corrects heteroskedasticity issues and contemporaneous error in the data. Further, the authors adopt cluster analysis based on the year and industry. The authors also adopt the generalized method of moments and two-stage least squares regression to check for endogeneity issues and validate the findings. Findings The findings generally indicate that resource use is negatively associated with firms’ cost of capital. Firms’ engagement with operational activities improves savings in the usage of resources, but environmental innovation is found to be positively associated with the cost of capital. This may be attributable to higher capital investment, stringent risk assessment and third-party assurance associated with firms’ environmental innovation. Research limitations/implications The findings urge regulators, practitioners and stakeholders to engage in more dialogues to reduce the costs associated with environmental sustainability innovation. This may be in the form of new technologies, energy-saving products, waste recycling and green innovations. Government intervention via greater infrastructure, tax incentives and regulatory reform may support the growth of innovation in emerging market economies. Practical implications Efforts are needed to encourage a dynamic, innovative and entrepreneurial mindset among the people living in emerging countries. Also, government regulatory reform is imperative in encouraging innovations in the environmental, social and governance ecosystem. Social implications The effect on society would be in the form of a new product innovation that creates better living standards and environments for the communities. Originality/value To the best of the authors’ knowledge, this is one of the few studies that focuses on the impact of firms’ resource use and environmental innovativeness and its implications on business financial costs in both emerging and developed markets.

The Temporal and Financial Costs of Trauma Activation Wait Times.

Level 1 Trauma Centers alert hospital staff in advance of a trauma patient's arrival to allow time for trauma team assembly and preparedness. Excess staff wait times may result in reduced trauma center productivity and efficiency. The objective of this study was to explore the wait time expended by various hospital staff in anticipation of trauma patient arrivals and calculate cost and adequacy of preparation time. This prospective observational study recorded a sample of wait times for trauma team staff members at an urban Level 1 Trauma Center for 12months. We observed 288 trauma activations in total. We constructed a dataset of notification alerts, patient arrival times, staff arrival, and wait times, along with a qualitative staff assessment of time to prepare for the trauma patient's arrival. We applied detailed salary data to quantify the financial cost of Trauma Center staff wait time. When staff waited for a trauma patient's arrival, average wait times ranged from 4.27 to 10.67 minutes. This cost $139791.65 during calendar year 2023 at our hospital. Staff had enough time to arrive at trauma incidents 99.1% of the time. In 4.2% of cases (n = 12), staff had no advance notification of an incoming trauma patient. We find that a longer duration between the issuance of alerts and the actual arrival of trauma patients represents a direct financial cost attributable to lost productivity in addition to indirect and cascading effects on operational efficiency and patient care.

SOCIO-ECONOMIC AND ENVIRONMENTAL IMPACTS OF ADOPTING GREEN BUILDING TECHNIQUES IN FEDERAL CAPITAL CITY, ABUJA NIGERIA

This study employed a Descriptive-Survey Research Design with a mixed-method approach, combining both quantitative and qualitative data collection techniques to assess the socio-economic and environmental impacts of adopting green building techniques in Abuja, Nigeria. Data were collected from primary sources through structured surveys, semi-structured interviews, field observations, and secondary sources, including literature reviews. A multi-stage sampling method was used to select key stakeholders, such as developers, architects, government officials, and property owners. The Krejcie and Morgan sample size determination table was applied to ensure statistical validity. The quantitative data focused on financial metrics, cost analysis, and perceptions of stakeholders regarding green buildings. The qualitative data provided insights into construction practices through interviews and observations. Statistical techniques, including AMOS (Structural Equation Modeling), were applied to analyze key sustainability indicators, economic viability, and policy frameworks. Results indicated that the adoption of green building techniques offers substantial socio-economic benefits. The economic viability of green buildings was highlighted by reduced operational costs, energy savings, and water conservation strategies. The environmental benefits included significant reductions in carbon emissions, improved air quality, and waste reduction. However, challenges such as high initial costs, limited technical expertise, weak policy enforcement, and a lack of awareness among stakeholders were identified as barriers to widespread adoption. The findings suggest that green building practices can contribute to Abuja’s urban sustainability goals, but further improvements in policy, training, and public awareness are necessary to maximize these benefits. Statistical results, such as a Chi-squared/degree of freedom ratio (ChiSq/df) of 2.331, a Goodness of Fit Index (GFI) of 0.916, and Root Mean Square Error of Approximation (RMSEA) of 0.066, supported the model’s adequacy. Furthermore, the overall Cronbach's alpha coefficient for the reliability test was 0.956, indicating high internal consistency.

What will introducing and delivering new maternal vaccines cost in Ghana and Mozambique? A prospective analysis.

The maternal vaccine landscape is expanding, including the anticipated global rollout of the now approved respiratory syncytial virus maternal vaccine. Integrating maternal immunization (MI) into health systems in low-and middle-income countries (LMICs) will require adaptation to existing immunization delivery platforms and have cost implications. In this study, we project the cost of maternal vaccine introduction and delivery in Ghana and Mozambique to help inform introduction decisions and ensure financial sustainability of future MI interventions. We used an activity-based prospective cost projection approach to estimate MI introduction and delivery costs for a five-year period from a health system perspective. Country stakeholders informed the strategies for MI delivery. Interviews with key immunization and maternal health program representatives informed on the anticipated health system adaptation requirements, activities, and resource needs taken into account in the cost projections. Supplementary data from a sample of sub-national health administrative units, vaccine stores, and health facilities also informed the costing analysis. Financial and economic costs are estimated and presented in 2023 USD units. New maternal vaccines in both countries are anticipated to be delivered leveraging the existing maternal tetanus vaccine delivery practices. The non-vaccine cost of delivering one dose of maternal vaccine was estimated at $3.42 (financial) and $4.12 (economic) in Ghana, and $1.84 (financial) and $2.21 (economic) in Mozambique. Health worker training, communication and social mobilization, and program planning and coordination constitute the main cost drivers. Cost differences between countries are partly driven by the anticipated baseline coverage and baseline health system capacity gaps. Very few studies exist on the costs of delivering maternal vaccine in LMICs. This study begins to fill this gap. These MI cost projections are comparable to other new vaccine introduction costs in similar settings, providing insights for local and global stakeholders seeking to understand costs of MI delivery.

CLASSIFICATION OF GREEN BUILDING TECHNIQUES APPLICABLE TO THE FEDERAL CAPITAL CITY, ABUJA NIGERIA

This study applied a Descriptive-Survey Research Design with a mixed-method approach to assess the socio-economic and environmental impacts of green building techniques in Abuja, Nigeria. Data were gathered from primary and secondary sources, including structured surveys, semi-structured interviews, field observations, and literature reviews. A multi-stage sampling method identified key stakeholders such as developers, architects, government officials, and property owners, using the Krejcie and Morgan sample size determination table for statistical accuracy. Quantitative data centered on financial metrics, cost analysis, and stakeholders' perceptions, while qualitative data provided insights through interviews and direct observations. Data analysis incorporated statistical methods, AMOS (Structural Equation Modeling), comparative analysis, and content analysis to evaluate sustainability indicators, economic viability, and policy frameworks. The study classified green building techniques in Abuja, focusing on five categories: Energy-Saving and Energy Utilization (ESEU), Water-Saving and Water Utilization (WSWU), Material-Saving and Material Utilization (MSMU), Indoor Environmental Quality (IEQ), and Site Planning and Land Surveying (SPLS). The findings highlighted the varying performance of 19 techniques in the ESEU category, with Off-Grid Systems (OSG) achieving an average performance of 37.8% and Traditional Grid Systems (TTSG) achieving higher performance levels in most techniques. In the WSWU category, several techniques like WSWU-2, WSWU-3, and WSWU-4 exhibited high performance, with a 100% adoption in TTSG. In the MSMU category, techniques like MSMU-9 and MSMU-10 achieved near-perfect performance in both OSG and TTSG, while others, such as MSMU-13, showed limited adoption. The IEQ category displayed a continuous variation in performance, with significant improvements in TTSG for techniques like IEQ-7 and IEQ-14, which recorded increases of 23.0% and 19.3%, respectively. Finally, in the SPLS category, the performance of techniques such as SPLS-17 and SPLS-26 was exemplary, with full implementation observed. The statistical analysis, including comparisons between OSG and TTSG systems, demonstrated that green building practices could significantly enhance energy efficiency, water conservation, and material utilization. However, challenges such as the limited adoption of renewable materials, inconsistent implementation of water-saving technologies, and inadequate policy frameworks were identified. The findings underline the need for policy improvements, capacity building, and greater public awareness to accelerate the widespread adoption of green building techniques in Abuja. The study’s statistical findings were supported by a Cronbach's alpha of 0.943, indicating high reliability in the research instruments.

The effect of delayed-release antibiotics on the rate of postoperative wound infection for implanted neuromodulatory devices.

Implanted neuromodulatory devices are important for the surgical management of pain, epilepsy, movement disorders, and spasticity. These devices are surgically implanted, but many must be periodically explanted and replaced as batteries deplete or devices fail. Replacement surgery risks further infections that require device explantation, incur large financial costs, and reduce patient quality of life. To reduce infection rates, a single surgeon began using vancomycin-impregnated absorbable calcium sulfate delayed-response beads with neuromodulatory device and intrathecal pump primary implantations and replacements. The infection rates when using vancomycin-impregnated beads were compared with previously published rates from the same surgeon. Patients were identified who underwent primary placement or replacement of an implanted neuromodulatory control device (pumps, generators, and stimulators) with vancomycin-impregnated absorbable calcium sulfate beads between 2019 and 2022. Control data were obtained from patients who underwent surgery prior to the start of using antibiotic beads (2016-2019). Postoperative infection status as well as de-identified demographic and clinical data were extracted from electronic health records. Patients were stratified by use of antibiotic beads, device type, and whether they had an infection within 1 year requiring explantation. Statistical comparisons were made using independent t-tests, Fisher's exact test, and the chi-square test, with α set at 0.05. Effect size was calculated using Cohen's h statistic. A total of 665 surgeries were included for 611 patients who received antibiotic beads with device implantation, compared to 393 surgeries for 379 patients without antibiotic beads. The postoperative wound infection rate was 1.5% (n = 10 patients) versus 3.6% (n = 14 patients) for antibiotic beads versus controls (p = 0.03). When stratified by device type, a significant reduction in infection rate was found only with deep brain stimulation (DBS) generators (3.4% for controls vs 0.2% for beads, p = 0.002), which corresponds to a small to medium effect size (h = 0.27). The use of vancomycin-impregnated absorbable calcium sulfate beads was associated with a reduced rate of postoperative infection rates with implantable devices, and specifically for DBS primary implantation and replacement surgeries.

The Cost of Political Action Committee Funding: Evidence on Political Action Committee Funding Refusal Across Candidate Race and Gender

The Cost of Political Action Committee Funding: Evidence on Political Action Committee Funding Refusal Across Candidate Race and Gender

Public digitalization and enterprise innovation in China’s high-tech listed companies

ABSTRACT The digital economy is deeply embedded in enterprise production and operational processes, promoting the improvement of enterprise innovation. We established a theoretical model to verify the positive relationship between public digitalization and enterprise innovation. Moreover, we considered China’s high-tech listed companies from 2011 to 2019 as a sample to test the research hypothesis. Based on a fixed effects model, we found that public digitalization significantly promotes enterprise innovation input (such as R&D input or R&D personnel), output (represented by patent applications), and efficiency (compared by input and output). By heterogeneity analysis, we find that government digital support is not significant in promoting enterprise innovation. And the promotion effect of public digitalization on enterprise innovation is less evident in the sample of non-high-tech listed companies. An intermediary mechanism test also indicated that public digitalization significantly decreases financing, labour, cooperation, and transaction costs and promotes enterprise innovation. This study clarifies the innovation cost-saving effect of public digitalization in promoting enterprise innovation, which supplements relevant theories. In practice, this study reminds policymakers to pay attention to the creation of a public digital environment.

P-505. Integrating PrEP Services into a Gynecology Clinic in Alabama: A Qualitative Analysis of Key Determinants

Abstract Background In the Southeastern United States, Black women are disproportionately diagnosed with HIV compared to White women. Client-centered approaches are needed to increase uptake of HIV prevention tools, including pre-exposure prophylaxis (PrEP). Gynecology (GYN) clinics are uniquely positioned to provide PrEP for women and Black women prefer receiving PrEP from GYN providers, but PrEP delivery in GYN settings has been limited. Thus, we evaluated barriers and facilitators to PrEP provision in GYN clinics. Methods From 08/2022-04/2023, we conducted dyadic focus groups and in-depth interviews with providers (i.e., physicians, nurses, and medical assistants) and clients accessing care at a university-affiliated GYN clinic in Alabama where clients face high STI burden. Interview guides grounded in the Information-Motivation-Behavioral Skills Model explored barriers to PrEP service delivery. Inductive qualitative analysis identified emergent themes from transcripts. Results 10 providers and 21 clients (100% Black, 100% female, median age 32 (range 19-44), 90.5% insured (67% with Medicaid)) were interviewed. Emergent themes included: (1) Sexual health – including STI/HIV prevention – as part of routine women’s healthcare. Providers preferred a risk-based approach to sexual healthcare while clients preferred a sex-positive approach. (2) Incorporation of PrEP services into women’s healthcare. Both clients and providers supported that PrEP is important for women’s health. Providers felt PrEP discussions should be limited to specific visits whereas clients desired regular discussions of PrEP. (3) Multi-level barriers for PrEP service delivery in GYN clinics. Barriers included limited client and provider PrEP knowledge, inadequate clinic resources, financial costs, and STI/HIV stigma. Conclusion Incorporating PrEP services into GYN clinics could increase PrEP uptake amongst Black women. Effective multi-level interventions should focus on increasing client and provider PrEP knowledge, integrating sexual health history assessment into routine care, mitigating STI/HIV stigma, and addressing structural barriers. Disclosures Latesha Elopre, MD, Merck: Grant/Research Support

Costs of Family Building for Physicians and Medical Students

This survey study examines the financial costs incurred by physicians and medical students in building their families.