Implementation Of Action Plan Research Articles

S10-3 Research on policy audits for promoting physical activity at the local level in Japan

Abstract Purpose Increasing levels of health-enhancing physical activity (HEPA) requires a comprehensive policy framework across all political levels. At the local level, Japan has a two-tier system of government: prefectures and municipalities. We developed specific tools to identify the strengths and weaknesses of the implementation of national HEPA policies by the different local governments. Methods We started by developing and testing the Local Policy Audit Tool (L-PAT) in all 47 Japanese prefectures (Takeda et al. 2019). It comprises 11 items based on WHO’s HEPA Policy Audit Tool (PAT), covering key policy actions such as: the presence of a local action plan; its implementation; and cross-sectoral cooperation. The L-PAT was sent to key government departments (e.g. health, sports, urban planning and transport) in all prefectures. As a second step, we assessed the development and implementation of local action plans for HEPA promotion in municipalities using the City PAT (C-PAT), which employs six questions based on the HEPA PAT. We surveyed a random selection of 272 out of Japan’s 1,700+ municipalities, stratified by administrative division and population. Results The results of the L-PAT indicate that health and sports are the most active departments in promoting HEPA policy at prefecture level. Some prefectures also reported HEPA actions by the urban planning and transport sectors, although these sectors are not covered by the national policy. A major result of the C-PAT survey was that the scale and contents of projects implemented differed depending on the size of the municipality. Both tools revealed that local governments have a low awareness of the “Japanese physical activity guidelines for health promotion 2013” in their policy planning and implementation. Conclusions In 2023, both the Japanese physical activity guidelines and the government's most comprehensive health policy, “Healthy Japan 21”, will undergo major revisions. The next step after the L-PAT and C-PAT would be to revise the content of the C-PAT questionnaire to increase its usefulness; that is, a policy audit tool for continuously monitoring local HEPA policies will be created on this occasion, aimed at supporting future national planning processes for HEPA promotion.

Analysis of production loss trough quality management tolls - Case study in am electric energy meter production industry

In the modern world, organizations need to be constantly looking for ways to improve their production processes. One way to achieve this goal is through the use of basic quality tools, which are widely used by organizations. In this work we used the check sheet, the Pareto chart, cause and effect diagram, 5W2H and FPY. This work aims to minimize the high rate of production loss in the Exat test in the production lines of a company located in the State of Amazonas that operates in the electronic sector. After the analysis it was concluded that the high failure rate in Exat is linked to high numbering / misalignment / bad contact, identifying the causes of failure and then was built and implemented action plan that decreased the rate by 34.36% compared to previous year implementation of action plan.

EU OPEN STRATEGIC AUTONOMY POLICY AS A TRIGGER OF INDUSTRIAL DEVELOPMENT AND A CHALLENGE FOR REGULATORY COOPERATION

The purpose of the article is to study the instruments of the policy of strategic autonomy of the European Union with an emphasis on projects of common European interest, and to assess its impact on the development of the industrial potential of member countries in the context of intensified economic competition in the international arena, accompanied by the erosion of regulatory cooperation. EU strategic autonomy aims to reduce the productivity gap between the EU and the US in all sectors of the economy. Strategic autonomy, among other things, is aimed at updating the EU’s comprehensive industrial strategy, which will help counteract trends of deindustrialization, expand access to venture capital, and accelerate the formation of a truly single capacious market of EU member states. Strategic autonomy will affect the prospects for building a sustainable, climate-neutral and cost-effective system that contributes to the growth of citizens’ well-being. It has been established that the new approach to industrial policy is closely related to the policy of strategic autonomy of the EU; a whole range of measures is aimed at increasing the effectiveness of industrial policy: the adoption of an Action Plan for the proper implementation and compliance with the rules of the single market; review of EU competition rules; development of an Action Plan for the protection of intellectual property, which involves ensuring the technological sovereignty of the EU; combating the theft of intellectual property, improving legislation in the field of public procurement, taking into account environmental requirements. The New Industrial Policy identifies the key factors in the EU’s industrial transformation and aims to achieve a threefold objective: maintaining global industrial competitiveness and a level playing field both in the domestic market and at the global level; turning Europe into a climate-neutral part of the world by 2050; achieving digital leadership in the world. In essence, we are talking about a new quality of economic growth, a new environmental model. The strategy is aimed at increasing the strategic autonomy of the EU in a period of increasing global competition and provides for reducing dependence on external supplies of critical raw materials, developing key technologies strategically important for the industrial future of Europe. The EU’s strategic autonomy policy restricts trade and competition in several ways: through the implementation of quantitative restrictions (quotas; import bans; bans on foreign investment); through price controls, subsidies and standards that apply equally to domestic and foreign suppliers; by establishing new digital policy rules (new restrictions on data regulation; data exchange obligations; taxes on digital services; regulation of digital services markets). Choosing unbalanced policy priorities can lead to reduced investment efficiency, slower competition, slower innovation, and worsening productivity and technology gaps between the EU and the US. The regulatory potential of strategic autonomy to promote market distortions is usually justified by the benefits of safety for society, ethical and environmental considerations, welfare effects for consumers and increased competitiveness of producers, however, it is predicted that it will inevitably produce losses that will be incurred by economic entities. manufacturing practices, review of value chains and supply chains, and due to legal uncertainty associated with how regulation is developed and applied. This inevitably indicates the risks of increased regulatory competition on an international scale.

Quality in neonatal mortality audits: Results of pilot study from district of Dhule, Maharashtra.

As per WHO guidelines, it is important to have quality among mortality audit documents to improve outcome in health services. To assess quality of facility-based neonatal mortality audits implementation. Mixed-method descriptive analysis was conducted. Totally, 96 death review documents were reviewed. The 25 healthcare workers were interviewed in depth. Observation analysis done for audit meetings using WHO modified checklist for quality in audit toolkit. The observation of audit meetings highlighted that almost half of the members were not communicated regarding vision of audit and framework of audit and review meetings. In quantitative analysis, it was found that secondary care hospitals were not having accuracy and consistency in audit documentation. The quality of neonatal death audit was poor due to challenges faced by the hospitals in creating an enabling atmosphere, which can be overcome by sharing the vision of audit with the whole staff of the hospital. A standard operating procedure for audit committee to be adopted to implement action plans. Commitment, investment, and intentional leadership from everyone, including all healthcare workers, can make these ambitious goals attainable.

Spatiotemporal dynamics, traceability analysis, and exposure risks of antibiotic resistance genes in PM2.5 in Handan, China.

Fine particulate matter (PM2.5) seriously affects environmental air quality and human health, and antibiotic resistance genes (ARGs) in PM2.5 posed a great challenge to clinical medicine. The year of 2013-2017 was an important 5-year period for the implementation of Air Pollution Prevention and Control Action Plan (APPCAP) in China. Here, we took Handan, a PM2.5 polluted city in northern China, as the research object and analyzed ARGs in PM2.5 in winter (January) from 2013 to 2017. The results showed that the abundance of ARGs was the highest in 2013 (3.7 × 10-2 copies/16S rRNA), and ARGs were positively correlated with air quality index (AQI) (r = 0.328, P < 0.05) and PM2.5 concentration (r = 0.377, P = 0.020 < 0.05) in the 5-year period. The ARGs carried by PM2.5 in four functional regions of sewage treatment plant, steel works, university, and park showed that sul1 and qepA had higher abundance in each functional region, and the total ARG abundance in sewage treatment plant (1.3 × 10-1 copies/16S rRNA) was the highest, while lowest in park (2.0 × 10-3 copies/16S rRNA). Potential source contribution function (PSCF) and concentration-weighted trajectory (CWT) model were used to trace the pollutants at the sampling points, which indicated that the surrounding cities contributed more than quarter to the sampling points. Therefore, regional transportation reduces the spatial distribution difference of ARGs in PM2.5. The exposure dose of ARGs in different functional regions illustrated that the total inhaled dose of ARGs in sewage treatment plant (1.7 × 105 copies/d) was the highest, while lowest in park (3.2 × 104 copies/d). This study is of great significance for assessing the distribution and sources of ARGs under the clean air initiative in China.

Local Governance Support Tools for Disaster Risk Reduction and Climate Adaptation Strategies: The EU Contribution in the Case Study of the Municipality of Naples

Today’s global context poses ongoing challenges that can be addressed by implementing a systemic and strategic approach directed toward climate-resilient cities. During times of energy and digital transition, managing climate risks involves analysing sector-specific impacts and fostering a shared commitment at the national and international levels; in this sense, European programs promote the dissemination of good practices and implementation of projects and tools to improve the resilience of communities to climate challenges. This paper examines the Naples municipality as a case study within the SEACAP 4 SDG capitalization project in the implementation of innovative governance support tools for hazard and climate adaptation, mitigation, and energy rehabilitation to enhance local governance, planning, and design strategies towards a sustainable and low-emission future. Within the creation of a living lab, tools were selected as part of the project, and training sessions were held targeting key stakeholders. The training aimed to form and inform key players about the tools’ potential, leading to their incorporation into the municipality’s strategic action plan for future implementation. This case study has a high repeatability and stands as a starting point for the implementation of this approach in numerous other local municipalities.

Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa.

Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders. Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure. The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation. The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders' level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.

Riau Regional Government Collaboration in the Implementation of the P4GN National Action Plan

Indonesia is currently facing quite serious challenges in terms of the abuse of narcotics and illegal drugs. In general, narcotics and psychotropic substances can be used as medicinal ingredients in the medical field and in the development of science. The effects of this dependence can result in death. Not only that, other aspects such as moral and social are also affected by narcotics abuse. One of the biggest problems in Riau is the high circulation of drugs coming from abroad. The high distribution of drugs is influenced by various factors, in this case, geographical and demographic conditions in Riau. Based on the identification of drug-handling problems in Riau Province that have been explained, this paper has the objectives of, among others, analyzing efforts to implement P4GN, especially in the context of tackling drug trafficking and abuse in Riau Province; and analyze efforts to implement P4GN in Riau from a national security perspective. This research approach is qualitative with a descriptive research design. The research location is in Riau Province with the determination of informants using a purposive sampling technique. Collaborative governance focuses on the voluntary aspects of collaborative practice. From the voluntary aspect is expected that every actor involved can work optimally to achieve goals in the effort to implement P4GN in Riau Province. Communities, especially in Riau and throughout Indonesia in general, to correctly understand the concept of national security in a comprehensive manner.

Improved biomass burning pollution in Beijing from 2011 to 2018

The prohibition of open straw burning and clean energy transitions, implemented in the last 10 years, resulted in remarkable reductions in ambient biomass burning pollution in Beijing. Here, we present the reduction of biomass burning molecular tracer (i.e., levoglucosan) concentrations using year-long filter sample results collected in Beijing respectively during 2010–2011 and 2017–2018. The annual mean concentrations (95% CI) of levoglucosan during 2010–2011 and 2017–2018 were 0.34 (0.29–0.38) μg m−3 and 0.11 (0.09–0.13) μg m−3, respectively, with a 67% decrease. Compared to 2011, the two traditional open biomass burning episodes in early summer and during the fall post-harvest season disappeared in 2018. Meanwhile, the intensity and duration of biomass burning episodes during the heating season in 2017–2018 was much weaker and shorter than that in 2010–2011. Our results indicate that the implemented clean air action plans were effective in reducing open biomass burning, but the control of biofuel combustion activities during the heating season remains a major challenge in China.

A Review of TVET Quality Assurance Practice in Uganda

The movement towards internationalisation of education and training practices to facilitate the global flow of labour, technology, trade, and industry; has brought to the forefront the discussions of national TVET strategies, the issues of credibility of qualifications in regard to national economic growth and graduates’ mobility nationally and internationally in search of employment opportunities. This pressure to internationalise TVET systems and qualifications has mainstreamed the development and implementation of national and regional frameworks for quality assurance through which the comparability of standards and qualifications can be achieved. Document analysis research methodology has been used to review and analyse existing regulatory frameworks on quality assurance of education and training in Uganda so as to establish: 1) Existing quality TVET assurance governance entities, 2) Regulatory frameworks that guide TVET quality assurance, and 3) Progress on future opportunities for quality assurance. The findings showed that: numerous loopholes exist in the quality assurance processes of the education sector as a whole; the TVET sub-sector in Uganda is still being guided by the BTVET Act of 2008 lacks a regulatory structure to oversee quality assurance throughout the entire TVET sub-sector in the country; lack of a policy implementation action plan for the TVET Policy; governance of TVET quality assurance in the country is scattered among many government departments and agencies; and existing quality assurance guiding frameworks never encompassed investment and financing of TVET. The paper recommends that the Government of Uganda prioritises the: establishment of the TVET council as envisaged in the TVET Policy, the development and operationalisation of the TVET qualifications framework and TVET qualifications registry system, and the development of a TVET policy implementation Action Plan.

Carbendazim residue in plant-based foods in China: Consecutive surveys from 2011 to 2020

Carbendazim, a widely used fungicide in China, has been found to have reproductive toxicity and mutagenic effects. However, information on the spatial-temporal variations of carbendazim residues in food in China is limited. Here, we investigated the presence of carbendazim in China's plant-based foods from 2011 to 2020, evaluated the spatial-temporal characteristics, and assessed the associated exposure risks in the Chinese diet. The results revealed a high detection frequency of carbendazim in fruits (26.4%) and high concentrations in vegetables (∼110 mg kg−1), indicating widespread misuse of the fungicide. The acute risks of consuming certain vegetables and cereals exceeded the recommended limits by up to 12 and 5 times, respectively. Although there has been a decline in carbendazim residue levels in food since the implementation of the Chinese government's action plan for zero growth of pesticide use in 2015, some provinces still exhibited high levels of carbendazim in multiple food categories, which were positively correlated with annual pesticide application. We highlight that carbendazim contamination reflects the broader issue of pesticide use in China. It emphasizes the need for committed and targeted national policies to reduce carbendazim residues in food and suggests that such measures could also regulate the use of other pesticides, given that pesticide abuse in China is not limited to specific types. We call for the re-evaluation of maximum residue limits of carbendazim, particularly in highly consumed foods such as cereals.

Meningkatkan Kompetensi Pedagogik Guru Di Sekolah Dasar Melalui Pengawasan Yang Dilakukan Oleh Kepala Sekolah.

ABSTRACT&#x0D; The purpose of this research is to clarify how school administrators supervise teachers to improve pedagogical skills in the classroom. This study focuses on two issues: (1) how to improve school education by involving the community, and (2) the biggest challenges in content management and teacher development. Data mining and constructive methods were used in this investigation. The results showed that effective methods for managing principals and training teachers consisted of: (1) routine classroom practices, (2) supervision by administrators and educators, (3) floating procedures for describing class visits, and (4) evaluation of leadership activities with the intention of discussing and sharing ideas to improve teaching in the classroom. However, there are also constraints on the capacity of principals to supervise school administrators, including (1) Management issues, such as control of school administrators, teacher anxiety, and educators' lack of understanding of supervision; and (2) The decisions made by the school administration, such as the implementation of action plans, curriculum, teaching resources, teaching strategies, and teaching methods used by teachers in the teaching staff. Due to their busy schedule outside of school hours and the lack of support and incentives for teachers, especially in terms of preparing them for monitoring, the follow-up of school administrators was inadequate. Principals, teacher pedagogic competence, and monitoring are the keywords.&#x0D; Keywords: supervision, school principals, and teacher pedagogic competence

Pemberian Mitigasi dan Pemberdayaan ODHA di Aceh melalui Kelompok Dukungan Sebaya (KDS) Seudara

This service aims to provide psychological support to Key population friends and People with HIV/AIDS (ODHA) through Peer Support Groups/Social Welfare Institutions in North Aceh. Method: carried out by direct observation and interviews with North Aceh KDS/LKS with the stages namely preparation, assessment, alternative program planning, action plan formalization, implementation, and evaluation. Results: Every North Aceh KDS/LKS administrator can act as a facilitator in motivating fellow ODHA that they need psychological support for their current health condition (with HIV status). The Implementation Phase of Activities The participation of ODHA friends who are involved in the North Aceh KDS/LKS board is expected to be able to carry out program activities that can provide support to fellow ODHA friends. The collaboration between North Aceh KDS/LKS administrators, ODHA friends, and health service facilities has been going well. namely: Assistance and Outreach to Key Populations and ODHA, Facilitating Access to Health Services, Health Talks (BBS), Social Services, ODHA Home Visits, and World AIDS Day (HAS).

Treatment of Seizure Clusters in Epilepsy: A Narrative Review on Rescue Therapies.

Epilepsy is a common neurological disorder in the United States, affecting approximately 1.2% of the population. Some people with epilepsy may experience seizure clusters, which are acute repetitive seizures that differ from the person's usual seizure pattern. Seizure clusters are unpredictable, are emotionally burdensome to patients and caregivers (including care partners), and require prompt treatment to prevent progression to serious outcomes, including status epilepticus and associated morbidity (e.g., lacerations, fractures due to falls) and mortality. Rescue medications for community use can be administered to terminate a seizure cluster, and benzodiazepines are the cornerstone of rescue treatment. Despite the effectiveness of benzodiazepines and the importance of a rapid treatment approach, as many as 80% of adult patients do not use rescue medication to treat seizure clusters. This narrative review provides an update on rescue medications used for treatment of seizure clusters, with an emphasis on clinical development and study programs for diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. Results from long-term clinical trials have shown that treatments for seizure clusters are effective. Intranasal benzodiazepines provide ease of use and patient and caregiver satisfaction in pediatric and adult patients. Adverse events attributed to acute rescue treatments have been characterized as mild to moderate, and no reports of respiratory depression have been attributed to treatment in long-term safety studies. The implementation of an acute seizure action plan to facilitate optimal use of rescue medications provides an opportunity for improved management of seizure clusters, allowing those affected to resume normal daily activities more quickly.

La mise en œuvre du plan d’actions de la Valette au Mali : Initiatives de dissuasion migratoire et de « réinsertion » des migrants de retour pour quel résultat ?

La mise en œuvre du plan d’actions de la Valette au Mali : Initiatives de dissuasion migratoire et de « réinsertion » des migrants de retour pour quel résultat ?

Evaluating root causes contributing to real-world disparities in ovarian cancer care: Insights from an implementation science initiative utilizing tethered patient-provider surveys and chart reviews.

e18665 Background: Quality ovarian cancer care is significantly impeded by racial disparities in treatment and survival outcomes for black women with ovarian cancer. In this implementation science (IS) initiative, we evaluated root causes for disparities in care among patients with ovarian cancer at 3 diverse health systems and implemented focused action plans to facilitate improved care quality and promote health equity. Methods: Between 11/2020 and 3/2021, we surveyed oncology team members (n = 53) and ovarian cancer patients (N = 41), and performed randomized and retrospective baseline chart audits (N = 100) at 3 health systems to assess current practices, challenges/barriers, and areas for improvement in equitable care of ovarian cancer patients. Providers then participated in audit/feedback (AF) educational sessions and developed and implemented action plans to address identified gaps. Follow-up chart audits measured practice change following the educational initiative. Results: Significant differences were found between Black and non-Black patients in chart documentation patterns and self-reported survey responses. For example, Black patients were significantly less likely to have chart-documented practices of biomarker testing (BRCA testing 47% of Black patients, and 70% on non-Black patients), assessments for treatment-related adverse events and supportive care (40% vs 70%), fertility counseling (4% vs 17%) and shared decision-making (57% vs. 81%). Patient survey and data suggest racial/cultural differences in the emphasis placed on different treatment decision-making factors, as well as differences in the time/extent to which treatment risks and benefits are discussed with patients. Oncology team members participating in AF sessions developed action plans to improve equitable ovarian cancer care, including increasing education and patient counseling, increasing use of patient navigators, and improving documentation. After implementing action plans, follow-up chart audits showed improvement in the provision of patient education, shared decision-making, biomarker testing, and supportive care for both Black and non-Black patients with ovarian cancer. Conclusions: These findings reveal important factors contributing to racial disparities in ovarian cancer outcomes. The identified gaps may inform future IS initiatives and represent key opportunities for improvement in equitable ovarian cancer patient care. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, GlaxoSmithKline, and Merck &amp; Co. Inc., who had no role in the study design, execution, analysis, or reporting.

An Analysis of Socioeconomic Determinants of the Black-White Disparity in Food Insecurity Rates in the US.

Previous research has not fully explored socioeconomic factors that influence the Black-White food insecurity disparities at the state and county levels in the United States. The goal of this study was to identify socioeconomic determinants associated with the Black-White food insecurity gap in the US at the state and county levels with rigorous quantitative investigation. The 2019 Map the Meal Gap dataset and multivariate regression analyses were used to identify factors associated with the prevalence of the Black-White disparity in food insecurity rates. Unemployment rate and median income gaps were found to be the strongest predictors of the Black-White disparity in food insecurity and the Black food insecurity rates in both state- and county-level models. Specifically, a 1% increase in Black unemployment rate compared with White unemployment rate was associated with a 0.918% and 0.232% increase in the Black-White disparity in food insecurity on average at the state and county levels, respectively. This study highlights the potential root causes of food insecurity and significant socioeconomic determinants associated with the Black-White food insecurity gap at the state and county levels in the US. Policymakers and program creators should implement action plans to address the income disparities and reduce unemployment rates among Blacks to eradicate this gap and ensure equity in food access between Blacks and Whites.

Advancing TNBC care in the community oncology practice: Insights from a quality improvement initiative.

e18762 Background: New and emerging treatments for metastatic triple negative breast cancer (mTNBC) are improving outcomes for patients. However, given the fast pace of innovation, staying informed about the latest clinical trial data, guideline recommendations, and adverse event management, is challenging, particularly in community-based settings. To improve the care of mTNBC patients, we conducted a quality improvement (QI) initiative across 10 community-based oncology practices. Methods: Between 9/7/2021 and 2/11/2022, we surveyed multidisciplinary oncology team members (N = 121) at 10 community oncology clinics to assess current practices, challenges/barriers, and areas for improvement in mTNBC care. Providers then participated in audit/feedback (AF) educational sessions (N = 150) where they (a) assessed system-specific practice gaps identified via the provider surveys, (b) prioritized areas for improvement, and (c) developed action plans for addressing root causes of the identified gaps. Results: Providers reported the top challenge in caring for patients with mTNBC as sequencing treatment options across multiple lines of therapy (33%). Providers participating in the AF sessions identified impact on overall survival (55%), molecular test results (49%), and impact on patient quality of life (44%) as their primary considerations when differentiating among new and emerging targeted therapies for mTNBC. Additionally, clinicians reported having the most difficulty managing gastrointestinal distress (31%), cardiotoxicity (31%), and endocrinopathies (31%) associated with novel therapies. Providers believed improved collaboration across interprofessional teams (32%) and increased patient education for aspects of supportive care (28%) would improve care for mTNBC patients. To address the identified gaps at each location, teams developed action plans to improve coordinated mTNBC care, provide patient-centered supportive care, increase testing for targeted therapies, improve symptom and adverse event management, and create standardized order sets. Conclusions: Through this QI initiative, clinical teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into mTNBC care to optimize patient outcomes. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from Gilead Sciences, Inc., who had no role in the study design, execution, analysis, or reporting.

Quality care of patients with HR+/HER2- breast cancer: Insights from an implementation science program.

e18756 Background: Oral oncolytics have transformed the treatment landscape of HR+/HER2- breast cancer, shifting the responsibility for medication adherence and side effect management to patients. To optimize patient outcomes, collaborative patient-provider education on treatment expectations, adverse event management, and shared decision-making is imperative. Methods: From 11/2021 to 2/2022, HR+/HER2- breast cancer patients (N = 55) and health care professionals (HCPs) (N = 69) who treat breast cancer from 5 community practices were surveyed on attitudes, values, and challenges related to treatment, adherence, and adverse event management on oral therapies. HCPs (N = 59) participated in audit-feedback (AF) sessions to reflect on their own practice and develop action plans to improve care, which were implemented in subsequent collaborative patient-provider learning sessions. Informed by survey findings and insights from patient focus groups a, a point-of-care oral oncolytic toolkit was disseminated to support patients and providers in effective communication, treatment adherence, and side effect management. Results: In surveys, HCPs and patients reported side effects of medication as the top challenge impacting treatment adherence, with fatigue (33%), nausea/vomiting (28%), and hair loss (28%) the most challenging side effects. Notably, 46% of HCPs reported inadequate time to discuss patient goals, preferences and concerns as the biggest barrier for shared decision-making, and 15% of patients reported their doctor does not always ask about goals, preferences, and concerns. Reflection on survey and focus group insights in AF sessions enabled providers to develop and implement action plans including the provision of patient education resources on medication adherence and side effect recognition and management, scheduling adequate follow-up appointments to ensure side effect management and medication compliance, and engaging in shared decision-making. In patient-provider collaborative sessions, patients demonstrated substantial knowledge gains in how to communicate, recognize, and manage side effects associated with treatment, and providers committed to continuing patient education. Conclusions: Through a combination of a patient and provider survey study, patient focus groups, HCP AF sessions, and collaborative patient-provider learning sessions, action plans and education resources were developed and implemented to support the provision of effective treatment management for HR+/HER2- breast cancer. The methods and findings of this study represent key opportunities for improvement in caring for patients with HR+/HER2- breast cancer. Study Sponsor Statement: This activity is supported by educational grants from Lilly and Novartis Pharmaceuticals Corporation, who had no role in the study design, execution, analysis, or reporting.

Comparative study of deterministic and probabilistic assessments of microbial risk associated with combined sewer overflows upstream of drinking water intakes

Combined sewer overflows (CSOs) are a source of microbial contamination of drinking water intakes located downstream from their discharge. To safeguard the quality of the source water, it is essential to evaluate the risk levels associated with these municipal structures. This study compares two risk assessment approaches to test their applicability for assessing the risk of CSOs to drinking water intakes in a highly urbanized watershed. The first approach was based on a deterministic equation that combines the characteristics of an overflow structure allowing the risk to be rated as very low, low, medium, high, or very high. The second probabilistic risk assessment approach yielded findings that are probabilistically distributed across the five levels of risk. This approach was developed by constructing a novel Bayesian network to probabilistically link the different factors defining the exposure of water intakes to the hazards of CSOs. The comparison between the results of these two approaches highlighted the importance of simultaneously considering many scenarios for assessing the risk of contamination of source waters. It was possible to use the Bayesian network rather than the deterministic equation, which only supports one scenario at a time. It was also shown that the deterministic approach often overestimated risk levels for CSO outfalls close to the water intake. This occurred because the assessment process emphasized the distance factor between the discharge point and the water intake, while neglecting other crucial characteristics of the overflow, such as duration and frequency. In particular, the deterministic approach tended to underestimate risk for CSOs associated with low overflow frequencies as it did not support scenarios of overflow duration, unlike the probabilistic approach. The validation and sensitivity analysis of the Bayesian model revealed that the population residing in the CSO's drainage basin, along with the frequency and duration of the overflows, exerted the greatest influence on the resulting risk levels. These factors outweighed other variables utilized in the risk assessment, including vulnerability of the drinking water intake, the type of overflow recorder, pipe diameter, and variables defining the exposure of the water intake to the discharge. In the context of implementing action plans, the Bayesian network is estimated as a cost-effective technique as it prioritized overflow structures needing special attention in a highly urbanized watershed, where the same CSOs were deterministically rated as having the same risk level. The results also demonstrated the effectiveness of the Bayesian model in addressing data gaps faced by water managers and stakeholders. The Bayesian model proved capable of assessing risks with uncertainties for CSOs, even with limited input data available. These findings can assist managers in identifying problematic structures by considering various scenarios, unlike the deterministic approach, which left almost half (n = 42) of the study site's overflow structures unassessed due to data limitations.