Close Gaps Research Articles

Active Versus Passive Learning in Large-Group Sessions in Medical School: A Randomized Cross-Over Trial Investigating Effects on Learning and the Feeling of Learning

Abstract Purpose The evidence base for active learning in medical education is based largely on trials with suspect internal validity. We empirically compared the learning and feeling of learning of participants when in large-group interactive sessions and passive lectures using a rigorous trial capable of providing an unambiguous assessment of effect. Further, we evaluated if there was a differential effect based on prior achievement. Materials and Method We conducted a two-day randomized cross-over trial with 146 s-year medical students. Passive learning involved lecture-based case presentation with minimal interaction; in the large-group interactive session, students worked in teams on the same cases. Participants completed a test of learning and a feeling of learning survey. Effects were estimated using linear mixed-effects models. Results Participants in the large-group interactive session scored 0.27 standard deviations higher on the test of learning (p = 0.010) than when in the passive lecture. Learners in the lower 50% of prior achievement benefited most from active learning. The feeling of learning was 0.56 standard deviations higher in the large-group interactive session (p < 0.001). Conclusions Transformation of passive lectures to interactive learning sessions is feasible, has the potential to close achievement gaps by benefiting the lowest achieving learners the most, and provides students a greater sense of learning than passive lectures.

The molecular dialogue between Zymoseptoria tritici and wheat.

Zymoseptoria tritici is a highly damaging pathogen that causes high wheat yield losses in temperate climates. Z. tritici emerged during the domestication of wheat in the Fertile Crescent and has been extensively used as a model system for population genetic and genomic studies. New genetic tools and resources have provided a better understanding of the molecular components involved in the wheat-Z. tritici interaction, highlighted by the cloning of three wheat resistance genes and four Z. tritici avirulence genes. Despite the considerable progress made in the last few years, the mechanisms that mediate Z. tritici colonization remain largely unknown. In this review, we summarize the latest advances in understanding the molecular components mediating wheat-Z. tritici interactions and we discuss future research lines to close current knowledge gaps.

Developing and Evaluating SEE-Diabetes: A Patient-Centered Educational Decision Support System for Diabetes Car.

This feasibility study evaluated the effectiveness of Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered educational tool designed to promote shared decision-making of diabetes management in older adults. We aimed to assess SEE-Diabetes's ability to facilitate patient engagement and collaborative goal setting, as measured by the Observational Patient Involvement (OPTION) scale and Shared Decision-Making Questionnaire (SDM-Q-Doc). We hypothesized that these instruments would effectively differentiate between healthcare providers who actively leveraged SEE-Diabetes to guide patient-centric conversations and set goals compared to those who did not. SEE-Diabetes, developed through a 4-year user-centered design process, was employed in simulated clinical encounters at the University of Missouri Health Care. We conducted an analysis of 12 clinical encounters using video recordings. This analysis involved three simulated patients and four providers, two internals and two externals, utilizing a mixed-methods approach. We assessed the decision-making process using SEE-Diabetes by SDM-Q-Doc, OPTION scale, and conversation analysis. The average scores for the SDM-Q-Doc and the OPTION scale, out of a possible 100, were 52.6 and 75.9, respectively. Our findings revealed that active provider engagement with SEE-Diabetes during patient interactions served as an effective medium to facilitate shared decision-making and to set patient-centered goals. Providers who actively utilized SEE-Diabetes to guide conversations, ask open-ended questions, and incorporate patient input into goal setting demonstrated significantly higher OPTION and SDM-Q-Doc scores compared to those who used the tool less frequently or primarily for documentation purposes. Providers expressed positive feedback, highlighting its conciseness, patient-centricity, and optimism about integrating SEE-Diabetes into their future practices. SEE-Diabetes showed considerable promise in improving interactions between patients and providers, presenting an innovative approach to diabetes management for older adults. This tool has the potential to not only close communication gaps but also enable patients to take a more active role in their healthcare decisions.

Mapping research on integrating artificial intelligence into physics learning

The problem and the aim of the study. The incorporation of AI in physics education promises to create a more personalized, streamlined, and efficient learning environment that caters to the varied needs of both students and educators. This study aims to provide insights into the evolving research landscape, identify key contributors and emerging trends, and help close gaps in current knowledge. This research is a descriptive analysis using bibliometrics with primary source database used is Scopus. Research methods. This research is a descriptive analysis using bibliometrics with primary source database used is Scopus. The primary source database used is Scopus. There are four main stages of bibliometrics research: developing a study strategy, acquiring evidence, analyzing the data, and summarizing and displaying data, including articles from the field's creation to the end of 2022. The first query produced 1,883 suitable publications for study, including articles from the field's creation to the end of 2022. Results. The result reveals that AI in physics education is a globally connected field with remarkable growth, diverse contributions, and international collaborations. The United States of America dominates in the corresponding authors' countries category. It is known that more than 200 documents are produced. Instead, 18 other countries obtained a total production of 10 to 100 documents. The research paper on AI in physics education distribution from 2013 to 2022 is tends to increase from 2013 to 2018 and fall into a start at 2022. Furthermore, these articles become crucial for future study, resulting in high citations and an influence on the growth of AI in physics education. The most relevant papers are presented in the order of publication journal Quartile 1 (Q1) with CiteScore 1.00-7.20 as of December 2023. Based on the reviewed paper, these studies make significant contributions to education, particularly in physics and the integration of AI. Prior studies demonstrate AI's beneficial effects on physics education, providing helpful information to help educators and policymakers overcome implementation obstacles. In conclusion, the field has grown significantly, which is indicative of growing interest as well as academic activity. The continual rise in research papers, particularly the notable increase from 2019 to 2022, indicates growing attention and relevance. Further research is urged to examine innovative teaching strategies, focus on student-centered approaches, examine actual-life classroom applications, identify new areas of interest, promote interdisciplinary collaboration, and monitor shifting trends. By ensuring that AI is in step with recent advancements and addressing fresh problems in this rapidly evolving field, these recommendations are meant to assist academics in furthering the development and enhancement of AI in physics education.

Stroke Prevention and Treatment for Youth with Sickle Cell Anemia: Current Practice and Challenges and Promises for the Future.

Sickle cell anemia (SCA) is an autosomal recessive inherited hemoglobinopathy that results in a high risk of stroke. SCA primarily affects an underserved minority population of children who are frequently not receiving effective, multi-disciplinary, preventative care. This article reviews primary and secondary stroke prevention and treatment for children with SCA for the general adult and pediatric neurologist, who may play an important role in providing critical neurologic evaluation and care to these children. Primary stroke prevention is efficacious at reducing ischemic stroke risk, but it is not consistently implemented into clinical practice in the United States, resulting in these children remaining at high risk. Acute symptomatic stroke management requires neurology involvement and emergent transfusion to limit ischemia. Furthermore, while chronic transfusion therapy is a proven secondary preventative modality for those with prior symptomatic or silent cerebral infarcts, it carries significant burden. Newer therapies (e.g., stem cell therapies and voxelotor) deserve further study as they may hold promise in reducing stroke risk and treatment burden. Effective primary and secondary stroke prevention and treatment remain a challenge. Informing and engaging neurology providers to recognize and provide critical neurologic evaluation and treatment has potential to close care gaps.

Unlocking the potential of digital therapeutics: The need for consistent and granular inclusion in drug compendia for managed care.

The field of digital therapeutics (DTx), software programs that prevent, manage, and treat medical conditions, continues to grow. DTx offers new treatment options and has the potential to close gaps in care caused by unmet patient needs, provider shortages, or socioeconomic or geographical disparities. However, the field of DTx has not seen steady adoption owing to barriers, particularly related to coverage, payer acceptance of the category, provider use, and integration within existing health care delivery tools. One challenge for payers to effectively evaluate and cover DTx products is ensuring that consistent data elements are listed for these products in traditional drug compendia databases. Managed care organizations will need similar information about DTx product features as are available for traditional medications to inform coverage and reimbursement decisions. The Academy of Managed Care Pharmacy DTx Advisory Group developed and distributed a request for information to the 5 top drug compendia companies to assess how compendia products incorporate DTx and prescription DTx. This article summarizes how DTx are listed within different compendia products and offers insights on future data needs to adequately inform payers. As the DTx sector grows and consumer demand rises, compendia listing services will need to evolve to accommodate these new therapies and treatment modalities and facilitate patient access and efficient claims processing. Recommendations for how compendia companies can support managed care in these efforts are outlined.

Patient experiences of cancer genetic testing by non-genetics providers in the surgical setting.

As indications for hereditary cancer genetic testing (GT) for patients with breast cancer (BC) expand, breast surgery teams offer GT to newly diagnosed patients to inform surgical plans. There is, however, limited data on the experiences of patients undergoing cancer GT by non-genetic providers. This study used in-depth interviews with 21 women recently diagnosed with BC at a large academic health system to capture their experiences. Post-positivist codebook thematic analysis was used to identify major themes from the interviews. Participants reported an overall positive experience of this GT process, stating that they prefer GT at an existing appointment shortly after their diagnosis, even though they described the conversation as brief. Many participants indicated thinking about or desiring GT before the offer was made. Interestingly, most participants did not see surgical decision-making as the main reason for GT and were instead motivated by concern for relatives and to have complete information. Interview data indicated areas for improvement in patient-provider communication, and most participants agreed that additional reference information on GT in the form of written or video materials would be helpful. Offering GT at an initial breast surgery appointment is acceptable and desired by patients with a new BC diagnosis and should be considered as a way to increase access to GT for these patients. However, additional information for patients is needed to close gaps in communication and provide a trustworthy reference following a busy medical appointment.

Nursing care to patients who have the home as the preferred place of death: a scoping review

BackgroundThe existing literature on nursing care for patients who choose home as their preferred place of death is scattered and lacks a coherent overview. This scoping review aimed to explore and categorize the available evidence on how nurses provide care for patients preferring to die at home.MethodsStudies that included nurses and were focused on nursing care for patients who choose the home as their preferred place of death were included in the review. The scoping review considered studies with quantitative, qualitative, or mixed method designs; systematic reviews; and meta-analyses. No time restrictions were added. Key information sources were Medline, CINAHL (EBSCO), Scopus (Elsevier) and Google Scholar. Systematic reviews were searched for in the Cochrane Database of Systematic Reviews. Unpublished studies and grey literature were searched for in ProQuest Dissertations and Theses. The reference list of the studies included was searched.ResultsA total of 13 studies were deemed eligible for inclusion in the review, of which (n = 11) were qualitative and (n = 2) were both qualitative and quantitative. The studies were published between 2008 and 2023 and were conducted in the United Kingdom (n = 5), Norway (n = 4), Australia, Sweden, Canada and Japan. The studies included in this review highlighted issues of competence, resource limitations, flexibility as a coping mechanism, as well as collaboration and family caregivers.ConclusionsThis review identified significant challenges in delivering nursing care for patients who prefer to die at home, including staff shortages, resource limitations, and educational deficiencies. Despite these barriers, nurses showed a strong commitment to patient care, highlighting the need for increased support and collaboration with family caregivers to improve home-based end-of-life care.Implications for researchTo improve care for patients who wish to die at home, it is crucial to address staff shortages and enhance nurse training to close knowledge gaps and ensure consistent, high-quality care. Healthcare systems must also allocate adequate resources to ensure that nurses have the necessary tools to deliver safe and effective care in home settings. Strengthening interdisciplinary collaboration will further enhance patient outcomes by supporting both nurses and family caregivers in end-of-life care.

Measles outbreak under the Leaning Tower of Pisa in Italy

Abstract Background Measles cases in Italy (58,9 mln population) were 8 in 2021, 15 in 2022 and 43 in 2023. Between January and April 2024 there were 213 cases in Italy, with higher incidence in children. Pisa Local Public Health Department (201073 population) experienced a measles outbreak in the same period. Methods Cases were classified according to Decision (EU) 2018/945. A bidirectional tracing (backward and forward) was conducted to identify transmission chain and contacts of cases. Immunization status was checked on Regional Vaccination Registry. Results 33 suspected measles cases were notified in Pisa between 21st January and 17th April 2024: 16 by General Practitioners and 17 by Hospital Emergency Room. Additionally, 1 undiagnosed case was found during the epidemiological investigation. 2 notifications were withdrawn by General Practitioner because of lack of the diagnostic criteria. Laboratory analysis confirmed 24 cases. Last confirmed case occurred on 23rd February, while not confirmed cases occurred mostly in the last part of the period (6 in a row from 3rd March to 17th April), suggesting an infodemic effect. Women were more affected than men (17 vs. 7). Except for 2 babies (9 months and 1 year old age), the outbreak affected young adults with a mean age of 40 yo. Hospitalization rate was 37,5%. The first 5 unrelated cases occurred between 19th and 21st January. A second wave involved 13 people, 12 of them were related to a single case. Transmission occurred in Emergency Room (7), in a mall (1) and in the neighborhood (4). A third wave involved 4 cases (family contacts). 2 cases were imported from Sicily and Spain. All cases were unvaccinated, 2 were migrants. Around 950 contacts were traced. Conclusions In Pisa, high vaccination coverage of children < 2years of age (≥95%) protected school population and cases to spread, but there are pockets of unvaccinated adults which could allow measles circulation. Key messages • An effective public health response is required to contrast increasing measles cases in EU/EE countries. • As recommended by ECDC, public health services need to close immunity gaps, addressing catch-up actions towards adults and vulnerable groups as migrants.

Assessing the adequacy and sustainability of the Northern Territory health workforce with respect to burden of disease and injury, 2009-2021: an analysis of administrative data.

To assess the adequacy of the Northern Territory health workforce with respect to population size and burden of disease, overall and by selected health specialties; to assess its sustainability by investigating changes in workforce numbers. Analysis of Australian Health Practitioner Regulation Agency (AHPRA) health workforce data (2013-2021) and burden of disease data (disability-adjusted life-years, DALYs) drawn from national and NT burden of disease studies (and projected for 2019-2021). NT and Australian health workforces, 2009-2021. Adequacy of the NT health workforce, assessed as the ratio of the mean annual numbers of NT health workers per 1000 population or health workers per 1000 DALYs (2009-2013 and 2014-2018) to those of the Australian workforce (2013 and 2018); sustainability of the NT health workforce, defined as the number of health workers per 1000 population or per 1000 DALYs increasing between 2013 and 2021. The number of health workers per 1000 population was slightly higher in the NT than for Australia in both time periods (2009-2013 v 2013: 23.30 v 21.79 per 1000 population, 6.9% larger; 2014-2018 v 2018: 25.79 v 23.47 per 1000 population, 9.9% larger); however, it was smaller with respect to burden of disease (2009-2013 v 2013: 82.6 v 107.4 health workers per 1000 DALYs, 23.1% fewer; 2014-2018 v 2018: 91.5 v 117.1 per 1000 DALYs, 21.8% fewer). In particular, 464 more nurses and midwives (11.4% more than the mean for 2013-2021), 196 more physiotherapists (115%), 189 more psychologists (102%), 152 more pharmacists (79%), and 144 more dentists (106%) are needed in the NT to match the corresponding numbers of health workers by disease burden for Australia as a whole. The number of Aboriginal health practitioners per 100 000 DALYs fell during the study period. Health worker population density alone does not reliably assess health workforce needs; burden of disease information is important for workforce planning that meets population health needs. The NT health workforce needs to be increased by about 28% to reflect the population burden of disease and injury. Shortages in the NT health workforce must be eliminated to close health gaps between Indigenous and non-Indigenous Australians.

Biosynthesis of pH-Responsive Mesoporous Silica Nanoparticles from Cucumber Peels for Targeting 3D Lung Tumor Spheroids.

Lung adenocarcinoma is considered to be one of the primary causes of cancer-related deaths globally. Conventional treatments, such as chemotherapy and radiation therapy taken together, have not significantly lowered mortality rates. Repositioning of authorized anticancer medications supported by nanotechnology has therefore emerged as an effective strategy to close such gaps. In this context, mesoporous silica nanoparticles (MSNs) were biosynthesized from cucumber peels and were loaded with doxorubicin, a common anticancer drug to form doxorubicin-bound mesoporous silica nanoparticles (DMSNs). The study addresses a sustainable method for turning waste materials into MSNs, which can be used to create multifunctional nanosystems. The therapeutic module (DMSNs) was designed specifically to target 2D monolayer cells and 3D tumor spheroids of lung adenocarcinoma cancer. The DMSNs demonstrated notable antiproliferative activity and effective intracellular localization in addition to being biocompatible and innately fluorescent. Subsequent investigations revealed significant antibacterial activity against Staphylococcal infection, which is primarily prevalent in lung cancer patients. Thus, the developed MSNs held promising potential for anticancer drug delivery systems and have antibacterial potential to treat bacterial infections in patients with lung cancer. Furthermore, the cucumber peel-mediated synthesis of MSNs could also aid in the management of food waste and promote the adoption of the waste-to-health paradigm for sustainable solutions.

Potassium limits productivity in intensive cereal cropping systems in Southeast Asia.

Potassium (K) has received little attention as a potential yield-limiting factor in cropping systems. Here we investigated the K status in intensive cereal cropping systems in Indonesia, which are representative of many other Southeast Asian countries. Our analysis included nutrient input-output balance, leaf nutrient status, long- and short-term fertilizer trials, and farmer surveys. We revealed that soil K levels alone are insufficient to meet plant requirements, and current fertilizer applications are inadequate to prevent K deficiencies and large negative annual soil K balances in farmer fields (average -62 kgK ha-1). On-farm fertilizer trials indicated that nearly 80% of rice crops and 70% of maize crops achieved higher yields with the application of K fertilizer. Addressing K limitations will require an enhanced capacity to predict crop responses to K fertilizer, together with long-term, flexible fertilizer and crop residue management strategies. Furthermore, similar K limitations have probably emerged in other regions globally due to intensive cropping with insufficient K replenishment, which must be addressed to close yield gaps on existing farmland.

Assessment of equine intestinal epithelial junctional complexes and barrier permeability using a monolayer culture system.

Gastrointestinal disease is a leading cause of death in mature horses. A lack of in vitro modeling has impeded the development of novel therapeutics. The objectives of this study were to develop and further characterize a small intestinal monolayer cell culture derived from equine jejunum including establishing normal measurements of intestinal permeability and restitution. Three-dimensional enteroids, derived from postmortem sampling of equine jejunum, were utilized to develop confluent epithelial monolayers. The presence of differentiated intestinal epithelial cell types and tight junctions were confirmed using histology, reverse transcription PCR (RT-PCR), RNAscope, protein immunofluorescence and transmission electron microscopy. Transepithelial resistance (TER) and macromolecule flux were assessed as measurements of paracellular and transcellular permeability. Scratch assays were utilized to model and assess intestinal restitution. Monolayer cell cultures reached 100% confluency by ~5-7 days. Equine jejunum monolayers were confirmed as epithelial in origin, with identification of differentiated intestinal epithelial cell types and evidence of tight junction proteins. Function of the intestinal barrier was supported by acquisition of physiologically normal TER values (179.9 ± 33.7 ohms*cm2) and limited macromolecule flux (22 ± 8.8% at 60 min). Additionally, following a scratch wound, epithelial cell monolayers migrated to close gap defects within 24 h. In conclusion, this study describes the development of a novel intestinal epithelial monolayer cell culture for equine jejunum, and provides evidence of intestinal epithelial cell differentiation, formation of physiologically relevant barrier function and use as a model of intestinal restitution to test potential therapeutics for equine colic.

Limited RSV Vaccine Administration: A Case for Redesigning the Preventive Care Model

In this commentary, the authors describe existing barriers to vaccination access linked to the restriction of pharmacists’ prescribing authority, rationalize the need for more innovative care models to enhance the role of the pharmacist, and outline the framework required for health care redesign to enable nonphysicians to close gaps in preventive care. Regulatory and legal issues challenge care redesign at scale. To illustrate this scalability issue and its downstream impact on public health, real-world data from a large national pharmacy chain in the United States, CVS Pharmacy, were leveraged to examine the influence of state-by-state immunization policies on respiratory syncytial virus vaccination administration during the national rollout for adults. As a result of these policies, preventive care (e.g., vaccination administration) was limited in a vulnerable population.

Terra Preta production from Ghanaian and Zambian soils using domestic wastes

Quests for productive soils to close yield gaps call for innovative strategies. This study tested an off-site formation of the Amazonian Terra Preta (TP) in a potential modern analogon under coastal savannah climatic conditions of Ghana. Four Ghanaian and two Zambian soils; two types of biochar (i.e., rice husk biochar and charcoal residues); domestic wastes (i.e., kitchen leftovers, animal manures, human urine, and kitchen ash) were mixed with the soils wetted to 100% water holding capacity, and incubated under aerobic conditions for nine months. Indicators of the TP include total carbon (C), pH, base saturation, basic cations, and plant-available P, which were measured using standard methods of soil analysis. The TP formation enhanced soil pH by 0.02 to 2.9, ranging from pH 7.2 to 8.2, with charcoal residues having the highest effect on pH. The modern TP was characterized by relatively high total C, pH, K, Ca, Mg, Na, base saturation, and plant-available P. These properties reflect unique interactions between the chars, wastes, and soils, suggesting the potential for on-site TP formation. It calls for further studies, commitment, and perseverance in their formation in the future.

Anti-HBs Seroprevalence in Blood Donors from Tyrol, Austria.

Background/Objectives: Antibodies against the hepatitis B surface antigen (anti-HBs) are a marker of immunity against hepatitis B virus (HBV) infections. There is uncertainty about the anti-HBs seroprevalence in the general population of Austria. Methods: We conducted a cross-sectional analysis in blood donors from the Federal State of Tyrol in Austria (August-September 2023) to estimate anti-HBs seroprevalence and median antibody levels. Results: We enrolled 3935 blood donors (median age 47.6 years [25th-75th percentile: 33.3-56.6]; 40.7% female), who were hepatitis B surface antigen negative and had no detectable HBV-DNA. Overall seroprevalence was 51.4% (95% CI: 49.8-52.9%). Anti-HBs seropositivity decreased with higher age (p < 0.001), with 70.3% (66.1-74.3%) being seropositive among participants < 25 years of age and 30.2% (24.2-36.9%) in those aged ≥ 65 years. More females than males were seropositive (54.3% [51.8-56.7%] vs. 49.4% [47.4-51.4%]; p = 0.003). Seroprevalence was significantly higher in urban than in rural areas in participants aged 40 to <55 (p = 0.045) and ≥55 years (p = 0.001). Among 2022 seropositive participants, the overall median anti-HBs antibody level was 539.3 IU/L (25th-75th percentile: 116.3-5417.0). Furthermore, 5% of the participants had an anti-HBs antibody level between 10 and <20 IU/L, 18% between 20 and <100 IU/L, and 77% ≥100 IU/L. Conclusions: Anti-HBs seroprevalence in blood donors from Tyrol, Austria, was 51.4% between August and September 2023 and differed across age, sex, and residence area. Catch-up vaccination programs, especially targeting the elderly living in rural areas, are needed to close HBV immunity gaps.

Interactions of Polychlorinated Biphenyls and Their Metabolites with the Brain and Liver Transcriptome of Female Mice.

Exposure to polychlorinated biphenyls (PCBs) is linked to neurotoxic effects. This study aims to close knowledge gaps regarding the specific modes of action of PCBs in female C57BL/6J mice (>6 weeks) orally exposed for 7 weeks to a human-relevant PCB mixture (MARBLES mix) at 0, 0.1, 1, and 6 mg/kg body weight/day. PCB and hydroxylated PCB (OH-PCBs) levels were quantified in the brain, liver, and serum; RNA sequencing was performed in the striatum, prefrontal cortex, and liver, and metabolomic analyses were performed in the striatum. Profiles of PCBs but not their hydroxylated metabolites were similar in all tissues. In the prefrontal cortex, PCB exposure activated the oxidative phosphorylation respiration pathways, while suppressing the axon guidance pathway. PCB exposure significantly changed the expression of genes associated with neurodevelopmental and neurodegenerative diseases in the striatum, impacting pathways like growth hormone synthesis and dendrite development. PCBs did not affect the striatal metabolome. In contrast to the liver, which showed activation of metabolic processes following PCB exposure and the induction of cytochrome P450 enzymes, the expression of xenobiotic processing genes was not altered by PCB exposure in either brain region. Network analysis revealed complex interactions between individual PCBs (e.g., PCB28 [2,4,4'-trichlorobiphenyl]) and their hydroxylated metabolites and specific differentially expressed genes (DEGs), underscoring the need to characterize the association between specific PCBs and DEGs. These findings enhance the understanding of PCB neurotoxic mechanisms and their potential implications for human health.

A Cross-Sectional Analysis of ALS/ BLS Care in Low Acuity 9-1-1 Response by Geography and Insurance Status Utilizing the 2019 NEMSIS Dataset

Purpose. The objective of this study was to examine the relationship between patient acuity and level of EMS care adjusting for rurality and insurance. Methods. Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. EMS responses (n = 4,375,568) were analyzed comparing patient acuity and CMS Service level, Advanced Life Support (ALS) vs Basic Life Support (BLS), to assess for associations in acuity and CMS Service level using logistic regression. Results. Overall, there was a decreased odds of advanced life service use at low acuity EMS responses (OR=0.443, 95% CI=0.440-0.445). Sub analysis exploring the interaction between CMS Service Level, Rurality demonstrates an overall trend of decreasing odds of low acuity EMS responses among rural areas and BLS care (OR=0.492, 95% CI=0.486,0.498) and ALS care (OR=0.198, 95% CI=0.197,0.200). When analyzing trends among public vs all other insurance and rural vs urban settings, there were decreases in low acuity ALS care in the rural setting; ALS and Pub Insurance (OR 0.447, 0.444-0.450, p&lt;0.001), ALS and Rural (OR 0.198, CI 0.197-0.914, p&lt;0.001) among low acuity responses. The results indicate that acuity and service level vary according to insurance and rurality. In the low acuity call type, we see decreased odds of ALS use compared BLS use in those with public insurances compared to other insurance. There is also a geographic component to these results where the use of Advance Life Support services declined with decreases in urbanicity. Discussion. These results potentially highlight that rural areas utilize less emergency medical response resources in low acuity responses. As such, EMS programs like community paramedicine, could be potentially effective interventions to close gaps in access to care for rural residents.

Critical needs to close monitoring gaps in pan-tropical wetland CH4 emissions

Abstract Global wetlands are the largest and most uncertain natural source of atmospheric methane (CH4). The FLUXNET-CH4 synthesis initiative has established a global network of flux tower infrastructure, offering valuable data products and fostering a dedicated community for the measurement and analysis of methane flux data. Existing studies using the FLUXNET-CH4 Community Product v1.0 have provided invaluable insights into the drivers of ecosystem-to-regional spatial patterns and daily-to-decadal temporal dynamics in temperate, boreal, and Arctic climate regions. However, as the wetland CH4 monitoring network grows, there is a critical knowledge gap about where new monitoring infrastructure ought to be located to improve understanding of the global wetland CH4 budget. Here we address this gap with a spatial representativeness analysis at existing and hypothetical observation sites, using 16 process-based wetland biogeochemistry models and machine learning. We find that, in addition to eddy covariance monitoring sites, existing chamber sites are important complements, especially over high latitudes and the tropics. Furthermore, expanding the current monitoring network for wetland CH4 emissions should prioritize, first, tropical and second, sub-tropical semi-arid wetland regions. Considering those new hypothetical wetland sites from tropical and semi-arid climate zones could significantly improve global estimates of wetland CH4 emissions and reduce bias by 79% (from 76 to 16 TgCH4 y−1), compared with using solely existing monitoring networks. Our study thus demonstrates an approach for long-term strategic expansion of flux observations.

5099 Capturing the Patient Voice for Diabetes Eye Exams

Abstract Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None. Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area. Presentation: 6/1/2024