Network Members Research Articles

Impact of firm’s supply chain network position on digital transformation: evidence from China

Purpose Given the complexity and increasing interdependence of supply chain networks, a broader perspective beyond a simple binary relationship is needed to analyse the impact of supply chain networks on firms. Based on social network theory, this study aims to explore the relationship between firms’ network position in the supply chain network and digital transformation, as well as the moderating effects of structural holes and network partners’ digitalisation. Design/methodology/approach This study analyses a sample of Chinese A-share companies listed on the Shanghai and Shenzhen Stock Exchanges for the period 2011–2020 using regression analysis to test hypothesised relationships. Findings A firm’s centrality in the supply chain network is positively related to its digital transformation, and that the firm’s structural holes and the level of network partners’ digitalisation can both strengthen the positive influence of network centrality on digital transformation. Moreover, the heterogeneity analysis reveals that the positive effect of firms’ network centrality on digital transformation is more pronounced in non-SOEs and upstream firms. Practical implications In the pursuit of digital transformation, firms should recognise the significance of their position in the supply chain network and enhance their capability for information and resource acquisition by proactively strengthening their business cooperation with other network members. Moreover, firms should emphasise the value of open networks and their partners in supply chain networks. Originality/value This study applies social network theory to investigate the role of a firm’s external supply chain network in its digital transformation, clarifying the context and boundaries in which a firm’s position in the supply chain network influences digital transformation. The results extend the research and theoretical perspective on digital transformation and the consequences of supply chain networks.

Decompensated Liver Cirrhosis Research Network (UK-CLIF): Building consensus for hepatology trials in the UK

Liver disease is a major, and increasing, cause of death in the UK. The UK Chronic Liver Failure network (UK-CLIF) was developed as a multi-stakeholder network with the aim to advance cirrhosis research, with emphasis on geographical areas of high disease prevalence or limited research activity. The process involved network development through dissemination and snowball sampling techniques, with monitoring of network development and connections between participants, developed over two online meetings. Network membership included representatives from patients, carers, clinicians, researchers, R&D professionals, industry representatives, and the third sector. Subsequently, two facilitated in-person workshops were conducted with network participants. World Café methodology and participant dot voting was used to develop areas of priority and consensus in: (i) research infrastructure for cirrhosis clinical trials, (ii) clinical factors affecting research delivery, and (iii) research priorities for future trials. Thematic analysis demonstrated that the need for patient-centric trial materials, a lack of resource for clinicians to participate in research, and variability in the standard of inpatient care for cirrhosis, were barriers for cirrhosis clinical trials. Future activities for UK-CLIF include participation in a process of quality standard setting for inpatient care for cirrhosis, and coordination of a James Lind Alliance Priority Setting Partnership to develop research questions for liver cirrhosis.

Factors for Consideration by Pediatric Rheumatologists When Scoring the Physician Global Assessment of Disease Activity in Juvenile Idiopathic Arthritis: First Step Toward an Internal Consensus.

The physician global assessment of disease activity (PhGA) is a tool used nearly ubiquitously by pediatric rheumatologists for the assessment of patient disease activity status. However, this tool lacks standardization in its scoring. This survey aimed to identify score influencing factors, along with inclusion or exclusion of extra-articular manifestations and imaging, when scoring the PhGA in juvenile idiopathic arthritis (JIA). Electronic surveys were sent to Paediatric Rheumatology International Trials Organisation and Pediatric Rheumatology Care and Outcomes Improvement Network members who completed a previous survey on scoring of the PhGA. Respondents were asked to rank their top seven factors for inclusion in the PhGA for nonsystemic JIA (nsJIA) and systemic JIA (sJIA), along with ranking extra-articular manifestations and imaging for inclusion. Frequency and percentage of rank and Likert responses were analyzed, and geographic regions as well as level of experience were compared using the chi-square test and Fisher's test. A total of 276 respondents from 54 countries and six continents participated. For nsJIA, factors selected by >50% included number of swollen joints, active uveitis, duration of morning stiffness, and number of tender joints. For sJIA, factors selected by >50% were presence and duration of fever, laboratory tests, number of swollen joints, serositis, rash, hepatomegaly, lung disease, and lymphadenopathy. Agreement on the inclusion of extra-articular factors, such as uveitis, macrophage activation syndrome, and sJIA-associated lung disease, had >70% moderate or strong agreement for inclusion, whereas psoriasis had only 50.5% agreement for inclusion and imaging had 64.7% agreement for inclusion. Variations in rank between different geographic regions or level of experience were minor. This survey identifies factors that pediatric rheumatology providers find important for PhGA scoring of disease activity, documents varying agreement on inclusion of extra-articular manifestations of disease, and lays the framework for further consensus work.

Network determinants of relationship influence on HIV prevention decision-making among people in the social networks of women who have experienced incarceration in the US.

Many cisgender women in the US who have experienced incarceration are at substantial risk for HIV acquisition after they return to the community. Various network interventions have been leveraged for HIV prevention in this population. The objective of this study was to identify network and relationship determinants of influence on HIV prevention decisions, including PrEP. We conducted interviews with a network mapping exercise with participants recruited from the social and sexual networks of women who had experienced incarceration. Participants enumerated important individuals in their lives from the past six months and provided demographic and relationship data as well as whether each relationship influenced their HIV prevention decisions. We abstracted network data from the interview transcripts and described the data set using descriptive statistics and network density graphs. To measure associations between characteristics at each level and whether a relationship was considered influential regarding PrEP decision-making, we use multiple logistic regression with random intercepts for each respondent. We interviewed 32 participants, average age 33.5 years (SD = 8.98), majority female (n = 28, 87.5%), white (n = 23, 71.8%), heterosexual/straight (n = 25, 78.1%), and with a personal history of incarceration (n = 29, 90%). They reported 253 relationships (119 family, 116 friend, 18 sexual relationships). Most adult network members had used drugs or alcohol (n = 182, 80.9%), and of those, 30.8% had used them with the participant (n = 53). The mean network size was 7 (SD = 4) and network density was 52.2%. In the full model, significant positive predictors of an influential relationship included participant non-heterosexual identity (OR 27.8), older average age in the network (OR 3.9 per standard deviation), and being a current or prior sexual partner (OR 10.1). Significant negative predictors included relationships with individuals who use or had used drugs (OR 0.28), longer average relationship duration in the network (OR 0.09) and being in a network with at least one sexual partner (OR 0.2). There are significant positive and negative determinants of relationship influence related to PrEP at individual-, dyad-, relationship-, and network-levels. These support using nuanced network approaches to behavior change that respect and leverage the diversity of relationships that comprise the social networks of women who have experienced incarceration.

Improving implementation of health interventions among ECEC organisations: a social network analysis

Abstract The environment wherein a child grows up determines many health and life outcomes of the child. The early childhood education and care (ECEC) is an important setting for children which offers possibilities for health promotion activities. A learning network with professionals from ECEC organisations in South-Limburg, the Netherlands is established, aimed at sharing health promotion ‘best practices’. This study examined the network structure of the learning network and of ECEC locations regarding health topics such as nutrition, physical activity and sun protection. A mixed-methods design was adopted. An online-questionnaire was used to examine the relationships of the members of the learning network (N = 6) and ECEC locations (N = 59) between these organisations and with organisations related to the health topics. Data was analysed and visualised using a social network analysis (SNA) in UCINET. Thereafter, semi-structured interviews were held with the members of the learning network (N = 6), to discuss the network structure and possible improvements of the network. The SNA showed a weak network structure for the learning network and ECEC locations. Connections were mostly related to organisations in the field of nutrition and physical activity. This implied that health interventions related to sun protection and green environments were not implemented to the same extent as nutrition and physical activity. The interviews provided insight into the underlying reasons for (the lack of) certain connections. Overall, the members were satisfied with the quality and quantity of their current collaborations. The SNA and interviews indicated that the collaboration between ECEC organisations and organisations related to other health topics like green environment or sun protection could be improved. Therefore, it is recommended that ECEC organisations should engage in collaborations with organisations in these domains.

2.L. Round table: Monitoring health reforms to inform policy innovation: the Health Systems and Policies Monitor

Abstract Background The European Observatory on Health Systems and Policies’ (Observatory) Health Systems and Policy Monitor (HSPM) network convenes an international group of around 50 national health systems researchers from over 40 institutions across 31 high-income countries, including all EU countries, Canada, Israel, the UK and the US. In advance of the HSPM annual meeting, experts share the current year’s “top-three” health reforms in their countries via a standardized survey, soliciting details on content and general implementation processes. Reforms are iteratively organized into to 2 of 11 clusters, derived from the WHO health system building blocks. Experts then discuss background, status and content of national reforms in the year’s main clusters and initiate cross-country collaborations. A repository of over 650 reforms since 2018 has been created and is available online, showcasing reform patterns in HSPM countries. The collected data have informed studies on reform trends in HSPM countries from 2018-2019 and between 2020-2022, with work ongoing. Data are also consulted by researchers and policymakers wishing to learn about and from reforms in other countries. This workshop specifically aims to: • Inform participants about the methodologies used by the HSPM network to track reforms • Highlight common trends in major health reforms across countries since 2018 • Discuss national health reforms and the value of understanding and tracking these across countries • Identify research gaps in reform monitoring relevant to policy makers • Discuss how the health system research community can generate more relevant and actionable evidence Added-value The comparative analysis of reform trends provides insights into how systems operate and the types of reforms more likely to be implemented. The sharing of these insights also serves as a source of inspiration, allowing countries to learn from each other’s successes and failures and adopt proven best practices. This is relevant for policymakers and researchers striving to support health systems strengthening. Therefore, the workshop will support knowledge exchange between researchers and policymakers by (1) informing researchers and policymakers about similar ongoing reforms in other countries and (2) identifying areas where researchers can contribute to country reform agendas, and (3) stimulating interest in cross-country collaborative research on similar and topical reforms in different countries. Format This is a roundtable workshop chaired and moderated by the Observatory. An overview of reform trends and patterns since 2018 will set the scene, followed by an interactive discussion with policymakers and HSPM network members to (1) delve into trend dynamics and implications for health policy and research and (2) identify major (missing) research areas relevant to policymakers. In addition, we will leverage the geographic scope and expertise of the audience to reflect on the value of monitoring reforms. Key messages • Cross-country exchange of information on reform trends and implementation patterns can inspire future reforms and help policymakers identify promising policy approaches abroad. • Knowledge exchange between researchers and policymakers helps to determine evidence gaps and to generate relevant and actionable evidence that can drive policy innovation. Speakers/Panelists Reinhard Busse Berlin University of Technology, Berlin, Germany Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Iwona Kowalska-Bobko Jagiellonian University Medical College, Institute of Public Health, Cracow, Poland Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg Vesna-Kestrin Petric Ministry of Health, Ljubljana, Slovenia

Expansion and Exploration of the Superdiffuser Model With Agent-Based Modeling

The superdiffuser model predicts that the diffusion of a new behavior can be accelerated if superdiffusers (people who are connectors, persuaders, and mavens) are recruited to promote the behavior. We propose an expanded model where the importance of these traits varies by network structure and other network member characteristics. We assessed the plausibility of these proposed moderators using a simulation of an agent-based model in which each moderator was varied along with the superdiffuser traits of those initially seeded with the behavior. Analysis of the results of those simulations showed support for many, but not all, of the predictions as well as several surprising results that are suggestive for future empirical research.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes. Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates. Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 ( n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified ( n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded ( n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%–50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes. Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume. Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

Contrasting topologies of synchronous and asynchronous functional brain networks

ABSTRACT We generated asynchronous functional networks (aFNs) using a novel method called optimal causation entropy and compared aFN topology with the correlation-based synchronous functional networks (sFNs), which are commonly used in network neuroscience studies. Functional magnetic resonance imaging (fMRI) time series from 212 participants of the National Consortium on Alcohol and Neurodevelopment in Adolescence study were used to generate aFNs and sFNs. As a demonstration of how aFNs and sFNs can be used in tandem, we used multivariate mixed effects models to determine whether age interacted with node efficiency to influence connection probabilities in the two networks. After adjusting for differences in network density, aFNs had higher global efficiency but lower local efficiency than the sFNs. In the aFNs, nodes with the highest outgoing global efficiency tended to be in the brainstem and orbitofrontal cortex. aFN nodes with the highest incoming global efficiency tended to be members of the default mode network in sFNs. Age interacted with node global efficiency in aFNs and node local efficiency in sFNs to influence connection probability. We conclude that the sFN and aFN both offer information about functional brain connectivity, which the other type of network does not.

The evolution of transnational municipal knowledge networks

AbstractThe recent growth of transnational municipal networks requires a better understanding of their evolution. For some actors, this growth has resulted in arbitrary or top‐down decisions on network membership followed by low commitment and inefficient use of time and financial resources. By reinterpreting secondary data through an evolutionary approach, this paper argues that the overall systemic nature of the networks is shaped not only by their institutional settings and the composition of actors but also by a set of specific qualities (coherence, boundedness and unified function) that may change over time. Based on the network perspective and system approach, the paper advances our understanding of transnational knowledge networks and the maximising of their effectiveness. Using exemplars, it suggests a conceptual framework for the evolution of transnational municipal knowledge networks.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (>300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

6667 IGF1 Induces The Expression of CYR61 In Metastatic Prostate Cancer

Abstract Disclosure: G.L. Ortiz Hernández: None. M. Walker: None. L. Woods-Burnham: None. R.A. Kittles: None. C.A. Casiano: None. S.L. Neuhausen: None. The cysteine-rich angiogenic inducer 61 (CYR61) is a member of the cellular communication network (CCN) protein family that can be induced by growth factors. CYR61-specific functions are dependent on cellular context. In prostate cancer (PCa), CYR61 contributes to cell growth and survival through its interactions with extracellular ligands, such as integrins avb3 and a6b4, in the extracellular matrix space. CYR61 contains an insulin-like growth factor-binding protein domain suggesting that it may interact with insulin-like growth factor-I (IGF1). High serum levels of IGF1 are directly linked to PCa development and recently have been studied as a predictor of metastatic disease. Given the important roles that IGF1 and CYR61 play in PCa and their potential interaction, it is critical to investigate their molecular interplay. The correlation between PCa aggressiveness and circulating levels of CYR61 and IGF1 is poorly studied. Our goal was to assess the contribution of the interaction of CYR61-IGF1 to PCa cell proliferation. Their combined role may explain a proportion of aggressive PCa. This study was designed to characterize the role of IGF1-induced expression of CYR61 in metastatic PCa cellular models and to determine if this interaction contributes to aggressive tumor properties (e.g., proliferation, migration, tumorsphere formation). Using immunoblotting, we demonstrated that CYR61 is upregulated in the metastatic cell line PC3. Furthermore, optimized knockdown of CYR61 using siRNA significantly reduced PC3 cell proliferation, viability, and prostasphere formation. To examine the underlying mechanisms associated with IGF1 signaling, we assessed the activation of either the PI3/Akt and MAPK pathways in PC3 cells with CYR61 silencing. CYR61 siRNA-mediated knockdown decreased activation of the PI3/Akt pathway but did not affect the MAPK pathway. In addition, we found that IGF1 induces protein expression of CYR61 in a time-dependent manner, validated by both immunoblotting and confocal microscopy. PC3 cell lines are androgen receptor negative (AR-) and glucocorticoid receptor positive (GR+), which is characteristic of aggressive, advanced metastatic castration-resistant prostate cancer (mCRPC). Currently, we are conducting the same experiments in LNCaP cells, which are AR+/GR-, to determine if the CYR61-IGF1 interplay also occurs in PCa cells capable of AR signaling. In conclusion, we found that CYR61 expression is induced by IGF1 and its inhibition decreased the capacity of metastatic PCa cells to proliferate. Our results suggest that CYR61 inhibition may have the potential for treating metastatic PCa. Presentation: 6/1/2024

6667 IGF1 Induces the Expression of CYR61 in Metastatic Prostate Cancer

Abstract Disclosure: G.L. Ortiz Hernández: None. M. Walker: None. L. Woods-Burnham: None. R.A. Kittles: None. C.A. Casiano: None. S.L. Neuhausen: None. The cysteine-rich angiogenic inducer 61 (CYR61) is a member of the cellular communication network (CCN) protein family that can be induced by growth factors. CYR61-specific functions are dependent on cellular context. In prostate cancer (PCa), CYR61 contributes to cell growth and survival through its interactions with extracellular ligands, such as integrins avb3 and a6b4, in the extracellular matrix space. CYR61 contains an insulin-like growth factor-binding protein domain suggesting that it may interact with insulin-like growth factor-I (IGF1). High serum levels of IGF1 are directly linked to PCa development and recently have been studied as a predictor of metastatic disease. Given the important roles that IGF1 and CYR61 play in PCa and their potential interaction, it is critical to investigate their molecular interplay. The correlation between PCa aggressiveness and circulating levels of CYR61 and IGF1 is poorly studied. Our goal was to assess the contribution of the interaction of CYR61-IGF1 to PCa cell proliferation. Their combined role may explain a proportion of aggressive PCa. This study was designed to characterize the role of IGF1-induced expression of CYR61 in metastatic PCa cellular models and to determine if this interaction contributes to aggressive tumor properties (e.g., proliferation, migration, tumorsphere formation). Using immunoblotting, we demonstrated that CYR61 is upregulated in the metastatic cell line PC3. Furthermore, optimized knockdown of CYR61 using siRNA significantly reduced PC3 cell proliferation, viability, and prostasphere formation. To examine the underlying mechanisms associated with IGF1 signaling, we assessed the activation of either the PI3/Akt and MAPK pathways in PC3 cells with CYR61 silencing. CYR61 siRNA-mediated knockdown decreased activation of the PI3/Akt pathway but did not affect the MAPK pathway. In addition, we found that IGF1 induces protein expression of CYR61 in a time-dependent manner, validated by both immunoblotting and confocal microscopy. PC3 cell lines are androgen receptor negative (AR-) and glucocorticoid receptor positive (GR+), which is characteristic of aggressive, advanced metastatic castration-resistant prostate cancer (mCRPC). Currently, we are conducting the same experiments in LNCaP cells, which are AR+/GR-, to determine if the CYR61-IGF1 interplay also occurs in PCa cells capable of AR signaling. In conclusion, we found that CYR61 expression is induced by IGF1 and its inhibition decreased the capacity of metastatic PCa cells to proliferate. Our results suggest that CYR61 inhibition may have the potential for treating metastatic PCa. Presentation: 6/1/2024

Examining Local Government’s Web-Based Climate Risk Transparency in Florida

The article draws from institutional and social vulnerability theories and examines the determinants of climate risk transparency by local governments. Using data from Florida cities, the study investigates the impact of membership in climate networks and local socioeconomic and sociodemographic factors on web-based climate risk transparency. The findings support the view that membership in climate compact organizations, such as the International Council of Local Environmental Initiatives (ICLEI) and Southeast Florida Regional Climate Compact (SEFRCC), serve as institutional factors that lead to climate risk disclosures and contribute to improved adaptive governance and transparency. It also shows that college education, which likely enhances individuals’ ability to search for, interpret, and use information regarding climate risk, contributes to the decision to disclose information. Lastly, it reveals that bigger cities are more likely to disclose climate risk to mitigate these threats because disasters in large urban centers affect businesses and commuters and cause more significant damage than in smaller towns.

Development of a tool to assess financial advocacy service delivery.

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5%

Discrimination and the Proliferation of Stressors: A Social Network Analysis

This study offers one of the few investigations into the role of discrimination in the stress proliferation process. Using a community-based sample of adults and actor-partner interdepended models, our findings reveal an intra-personal spillover effect, wherein individuals experiencing direct discrimination also report heightened secondary stressors across various life domains (i.e., general life, romantic partnerships, employment, social and recreational activities, and the health of family/friends). We further demonstrate an inter-personal crossover effect, indicating that individuals whose close network members experience high levels of discrimination reported an increased number of secondary everyday stressors across various life domains. Notably, the stress proliferation stemming from vicarious discrimination is primarily confined to intimate partner ties and does not extend to kinship or non-family ties. This study extends the stress process research by advancing our understanding of discrimination's pivotal role in stress proliferation and illuminates the potential ripple effects of discriminatory experiences across social networks.

Confidants and Caregivers: Network Multiplexity and Subjective Well-Being of Older Adults.

Older adults rely on personal networks for different types of support. Given shifts in family composition in later adulthood, more work is needed to map network members who can provide multiple aspects of support and the implications for older adults. We explore the phenomenon of having the same network members as both a confidant and a caregiver (multiplexity) and its implications for the well-being of older adults. Using the 2011 National Health and Aging Trends Study (NHATS), we describe the prevalence of having someone as both a confidant and a caregiver (henceforth "multiplex helper") for older adults and examine its association with subjective well-being. We also investigate the differences by having whom as multiplex helpers. About three-quarters (76%) of older adults with at least one confidant and one caregiver have at least one multiplex helper. Partnered older adults are more likely to have any multiplex helpers than unpartnered counterparts and usually nominate their partner as a multiplex helper, whereas the unpartnered are more likely to rely on their children to serve multiple roles, especially for widowed older adults. Having a multiplex helper is associated with better subjective well-being. Network multiplexity is prevalent and positively associated with the subjective well-being of older adults who have at least one confidant and one caregiver, above and beyond having any confidants or caregivers separately. The baseline patterns established in this study lay the groundwork for future research to further explore support dynamics in older adults' networks.

Survival of Infants Born at 22 to 25 Weeks' Gestation Receiving Care in the NICU: 2020-2022.

To provide contemporary data on infants inborn at 22 to 25 weeks' gestation and receiving care at level 3 and 4 neonatal intensive care units in the United States. Vermont Oxford Network members submitted data on infants born at 22 to 25 weeks' gestation at a hospital with a level 3 or 4 NICU from 2020 to 2022. The primary outcome was survival to hospital discharge. Secondary outcomes included survival without severe complications, length of stay, and technology dependence. Overall, 22 953 infants at 636 US hospitals were included. Postnatal life support increased from 68.0% at 22 weeks to 99.8% at 25 weeks. The proportion of infants born at 22 weeks receiving postnatal life support increased from 61.6% in 2020 to 73.7% in 2022. For all infants, survival ranged from 24.9% at 22 weeks to 82.0% at 25 weeks. Among infants receiving postnatal life support, survival ranged from 35.4% at 22 weeks to 82.0% at 25 weeks. Survival without severe complications ranged from 6.3% at 22 weeks to 43.2% at 25 weeks. Median length of stay ranged from 160 days at 22 weeks to 110 days at 25 weeks. Among survivors, infants born at 22 weeks had higher rates of technology dependence at discharge home than infants born at later gestational ages. Survival ranged from 24.9% at 22 weeks to 82.1% at 25 weeks, with low proportions of infants surviving without complications, prolonged lengths of hospital stay, and frequent technology dependence at all gestational ages.

Molecular Characteristics and Expression Patterns of Carotenoid Cleavage Oxygenase Family Genes in Rice (Oryza sativa L.)

Carotenoid cleavage oxygenases (CCOs) cleave carotenoid molecules to produce bioactive products that influence the synthesis of hormones such as abscisic acid (ABA) and strigolactones (SL), which regulate plant growth, development, and stress adaptation. Here, to explore the molecular characteristics of all members of the OsCCO family in rice, fourteen OsCCO family genes were identified in the genome-wide study. The results revealed that the OsCCO family included one OsNCED and four OsCCD subfamilies. The OsCCO family was phylogenetically close to members of the maize ZmCCO family and the Sorghum SbCCO family. A collinearity relationship was observed between OsNCED3 and OsNCED5 in rice, as well as OsCCD7 and OsNCED5 between rice and Arabidopsis, Sorghum, and maize. OsCCD4a and OsCCD7 were the key members in the protein interaction network of the OsCCO family, which was involved in the catabolic processes of carotenoids and terpenoid compounds. miRNAs targeting OsCCO family members were mostly involved in the abiotic stress response, and RNA-seq data further confirmed the molecular properties of OsCCO family genes in response to abiotic stress and hormone induction. qRT-PCR analysis showed the differential expression patterns of OsCCO members across various rice organs. Notably, OsCCD1 showed relatively high expression levels in all organs except for ripening seeds and endosperm. OsNCED2a, OsNCED3, OsCCD1, OsCCD4a, OsCCD7, OsCCD8a, and OsCCD8e were potentially involved in plant growth and differentiation. Meanwhile, OsNCED2a, OsNCED2b, OsNCED5, OsCCD8b, and OsCCD8d were associated with reproductive organ development, flowering, and seed formation. OsNCED3, OsCCD4b, OsCCD4c, OsCCD8b, and OsCCD8c were related to assimilate transport and seed maturation. These findings provide a theoretical basis for further functional analysis of the OsCCO family.

An international film dosimetry intercomparison to establish a multi-center audit framework.

In 2021, a Technical Meeting was hosted by the International Atomic Energy Agency (IAEA) where it was recommended that a standardized method for assessing the accuracy of film dose calculations should be established. To design an audit that evaluates the accuracy of film dosimetry processes. To propose a framework for identifying out-of-tolerance results and to perform an international pilot study to test the audit design. Six members of an international Dosimetry Audit Network (DAN) developed an audit for radiochromic film dosimetry. A single host center provided the materials to each participating DAN member to conduct the audits. Materials included: (1) a set of two irradiated audit films (10 Sq: 10cm × 10cm, 15 Sq: 15cm × 15cm), (2) a reference calibration film set, and (3) a blank sheet of film. The participants were blinded to the dose and tasked with producing dose maps using their standard film dosimetry process. Average Region-Of-Interest (ROI: 2cm × 2cm) dose was measured from the dose maps and compared to the known dose. In the audit, all participants used their local scanning and software protocols. Film calibration was performed in two distinct ways: (1) using a calibration film set which was provided by the host center and (2) using a calibration film set which was locally irradiated. Several variations of the audit were also performed to examine how scanning and software processing can affect film dosimetry results. In the first variation of the audit (VariantA), a set of film scans was processed using five different software solutions. In the second variation of the audit (VariantB), all films were scanned on the same scanner and processed using two in-house software solutions. Taking one film scan from each participant, the standard deviations (1σ) (SD) in the dose returned from the host calibration and returned from the local calibration were±7.2% and±6.5% respectively, with variations from -12.4% to 12.9% of the known dose. The larger dose variations in the data set were attributed to the corrections applied for variations in scanner brightness during processing and incorrectly assigned calibration doses. When the raw image data set was processed by an expert user of each software solution (VariantA) the SDs were±2.7% and±3.7% for in-house and vendor-based software, respectively. When the films were scanned on a single scanner and processed with the two in-house software solutions (VariantB) the results had a SD of±2.3%. An audit has been designed and tested for radiotherapy film dosimetry at an international level. A framework for diagnosing issues within a film dosimetry process has been proposed that could be used to audit centers that use film as a dosimeter. Incorporating quality assurance throughout the film process is important in obtaining accurate and consistent film dosimetry. A better understanding of vendor-based software systems is necessary for users to process accurate and consistent film dosimetry.