Important Barriers Research Articles

Cross-device Portability of Machine Learning Models in Electromagnetic Side-Channel Analysis for Forensics

The possession of smart devices has ingrained itself into daily life. Therefore, smart devices, such as IoT and smartphones, are crucial sources of evidence in instances where criminal activity occurs. Due to the challenges in traditional digital forensic techniques involving smart devices, it has been recently proposed in the literature to leverage electromagnetic side-channel analysis (EM-SCA) for the purpose. This paper identifies and discusses an important barrier that exists in the application of EM-SCA for digital forensics that hinders its successful use, namely, the issue of cross-device portability of machine learning (ML) models that are used for EM-SCA. Firstly, the paper empirically evaluates the possibility of using trained ML models to extract forensic insights from EM radiation data of IoT devices. During this empirical study, the inability to reuse a trained ML model across different devices is identified. Secondly, the paper surveys the literature in search of related work that has studied the use of EM-SCA to gather information from smart devices. The purpose of the survey is to identify whether any existing work has been able to introduce potential approaches to enable cross-device portability of ML models in EM-SCA. The findings of this survey point to the fact that the identified problem still exists and requires further studies opening the door to future research.

Barriers to correct pronoun usage in healthcare settings

BackgroundUsing correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this.ObjectiveThis study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients’ correct pronouns.MethodsA 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients’ correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology.ResultsOf 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions.ConclusionThe study identifies important barriers to medical professionals correctly using TGNB patients’ pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns.

The Therapeutic Potential of Exosomes from Mesenchymal Stem Cells in Multiple Sclerosis.

Although treatment for multiple sclerosis (MS) has undergone a revolution in the last decades, at least two important barriers remain: alleviation of innate inflammation driving disease progression and promotion of remyelination and neural regeneration. Mesenchymal stem cells (MSCs) possess immunomodulatory properties and promote remyelination in murine MS models. The main therapeutic mechanism has, however, been attributed to their potent paracrine capacity, and not to in vivo tissue implantation. Studies have demonstrated that exosomes released as part of the cells' secretome effectively encapsulate the beneficial properties of MSCs. These membrane-enclosed nanoparticles contain a variety of proteins and nucleic acids and serve as mediators of intercellular communication. In vitro studies have demonstrated that exosomes from MSCs modulate activated microglia from an inflammatory to an anti-inflammatory phenotype and thereby dampen the innate inflammation. Rodent studies have also demonstrated potent immunomodulation and remyelination with improved outcomes following exosome administration. Thus, exosomes from MSCs may represent a potential cell-free treatment modality to prevent disease progression and promote remyelination in MS. In this narrative review, we summarize the current knowledge of exosomes from MSCs as a potential treatment for MS and discuss the remaining issues before successful translation into clinical trials.

Breast cancer immunotherapy: Realities and advances.

Breast cancer (BC) is the most common malignant tumor and the main cause of death in women worldwide. With increased knowledge regarding tumor escape mechanisms and advances in immunology, many new antitumor strategies such as nonspecific immunotherapies, monoclonal antibodies, anticancer vaccines, and oncolytic viruses, among others, make immunotherapy a promising approach for the treatment of BC. However, these approaches still require meticulous assessment and readjustment as resistance and modest response rates remain important barriers. In this article, we aim to summarize the most recent data available in BC immunotherapy to include the results of ongoing clinical trials and approved therapies used as monotherapies or in combination with conventional treatments.

The next event will be held with more quality: Identifying and prioritizing barriers to knowledge management in sports events

AbstractEffective knowledge management can help in better performance of projects such as sports events, and it can prevent the reinvention of systems, ideas, and also the repetition of errors. However, considering their temporary nature, projects face serious barriers in effective knowledge management. Therefore, the purpose of this research was to identify and prioritize the barriers of knowledge management in sports events. The statistical population included sports managers and also professors who were knowledgeable about the research subject. Barriers to knowledge management in sports events were identified in two steps. In the first step, the literature was reviewed, and then an interview was conducted with the samples, and in this way, three indicators and 19 sub‐indices were identified. Next, a questionnaire was designed. After collecting the questionnaires, the barriers were ranked through the process of pairwise comparisons in an analytic hierarchy process. The results showed that the most important barriers to knowledge management in the sports event are managerial barriers, with a relative weight of 0.521; barriers related to human resources, with a relative weight of 0.356; and infrastructural and support barriers, with a relative weight of 0.123. The results showed the importance of managerial barriers in the knowledge management of sports events, which shows the necessity of informing and training managers in this area.

Youths with extreme obesity: A high-risk group for pain and mental health impairments.

Youths with extreme obesity (Body mass index (BMI)>40) are at increased risk for physical and mental health impairments but this patient group has received little attention in research. This study aimed to analyze the pain experience and mental health impairments of youths with extreme obesity compared to those with mild and moderate obesity (BMI=30-39.9) by considering gender differences. Cross-sectional data of 431 youths (M=16.6; SD=2.3; 53.1% female) were analyzed. Of these, 159 (36.8%) youths were characterized by extreme obesity. Self-reported sociodemographic data, pain-related variables, depression, and health-related quality of life (HRQoL) were assessed with standardized questionnaires. Data were analyzed with univariate tests and logistic regression models. Youths with extreme obesity reported more pain in the last 4 weeks (p=.018), increased pain-related impairments in daily life (p=.009), more pain-related days of absence (p=.030), higher depression scores (p = .030), and reduced HRQoL (p=.005) compared to youths with mild and moderate obesity. In regression models, extreme obesity and pain in the last 4 weeks were associated when additionally including sex and age in the model (odds ratio 1.88; 95 % confidence interval 1.16 - 30.40, p=.010). In the subgroup of extreme obesity (n=159), women (n=83) reported more pain in the last 4 weeks (p=.001), higher depression scores (p<.001), and lower HRQoL (p<.001) compared to men (n=76). These findings underpin the need for standardized assessments of pain and mental health, especially in the treatment of female youths with extreme obesity. Upcoming studies may analyze reciprocal interactions since both aspects are important barriers for lifestyle changes and weight loss.

Financial Inclusion and Financial Education - An Effective Tool for Poverty Reduction (Georgia's example)

Poverty is one of the main challenges of the contemporary world. The Covid-19 pandemic has worsened the already slow pace of poverty reduction around the world. Some countries have managed to avoid the further growth of poverty, while others failed to overcome the problem. The troubles caused by the pandemic were also added to those caused by Russia-Ukraine war. If this trend continues, millions of people will still live in poverty in the future. The governments of almost all the countries, including Georgia, are actively taking various steps to reduce poverty, inter alia, largely by strengthening financial inclusion and financial education. Lack of financial inclusion is a challenge for low- and middle-income countries, which leaves millions without access to formal financial services. Another important barrier to overcoming poverty is the lack of financial education, one of the most important life skills for everyone. Without understanding basic financial concepts, it is quite difficult to make correct decision. Differences in financial education may affect wealth, inequality and poverty. The presented paper studies the impact of financial education and inclusion on poverty in Georgia based on the processing and analysis of secondary data, academic works, and reports of various international and local organizations.

Barriers and facilitators of retention in care after cervical cancer screening: patients’ and healthcare providers’ perspectives

BackgroundCervical cancer continues to threaten women’s health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings.MethodsA descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators.ResultsWe conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling.ConclusionsOur study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling.

Clinicians’ experience of barriers and facilitators to care delivery of an extracorporeal cardiopulmonary resuscitation service for out-of-hospital cardiac arrest: a qualitative survey

BackgroundOut-of-hospital cardiac arrest (OHCA) survival in the UK remains overall poor with fewer than 10% of patients surviving to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) is a developing therapy option that can improve survival in select patients if treatment begins within an hour. Clinicians' perspectives are a pivotal consideration to the development of effective systems for OHCA ECPR, but they have been infrequently explored. This study investigates clinicians' views on the barriers and facilitators to establishing effective systems to facilitate transport of OHCA patients for in-hospital ECPR.MethodsIn January 2023, Thames Valley Air Ambulance (TVAA) and Harefield Hospital developed an ECPR partnership pathway for conveyance of OHCA patients for in-hospital ECPR. The authors of this study conducted a survey of clinicians across both services looking to identify clear barriers and positive contributors to the effective implementation of the programme. The survey included questions about technical and non-technical barriers and facilitators, with free-text responses analysed thematically.ResultsResponses were received from 14 pre-hospital TVAA critical care and 9 in-hospital clinicians’ representative of various roles and experiences. Data analysis revealed 10 key themes and 19 subthemes. The interconnected themes, identified by pre-hospital TVAA critical care clinicians as important barriers or facilitators in this ECPR system included educational programmes; collectiveness in effort and culture; teamwork; inter-service communication; concurrent activity; and clarity of procedures. Themes from in-hospital clinicians’ responses were distilled into key considerations focusing on learning and marginal gains, standardising and simplifying protocols, training and simulation; and nurturing effective teams.ConclusionThis study identified several clear themes and subthemes from clinical experience that should be considered when developing and modelling an ECPR system for OHCA. These insights may inform future development of ECPR programmes for OHCA in other centres. Key recommendations identified include prioritising education and training (including regular simulations), standardising a ‘pitstop style’ handover process, establishing clear roles during the cannulation process and developing standardised protocols and selection criteria. This study also provides insight into the feasibility of using pre-hospital critical care teams for intra-arrest patient retrieval in the pre-hospital arena.

Needs, preferences, and patient participation for a randomized controlled trial on postneoadjuvant complete tumor response: A qualitative study of patients with esophageal cancer

PurposeFor patients with clinical complete response of non-metastatic esophageal cancer (EC) after neoadjuvant chemoradiotherapy (nCRT) or neoadjuvant chemotherapy (nCT), the two treatment options obligate postneoadjuvant surgery as the current standard treatment (surgery on principle) versus active surveillance with surgery as needed only in recurring loco-regional tumor as a possible future alternative or standard exist. Since these treatments are presumably equivalent in terms of overall survival, patient-centered information can encourage the discussion with the treating physician and can make it easier for patients to make trade-offs between the advantages and disadvantages of the treatment alternatives in a highly distressed situation.MethodsA qualitative prospective cross-sectional study was conducted to create patient-centered information material that is based on patients’ preferences, needs, and concerns regarding the two treatment options, and to investigate the potential participation in a consecutive randomized controlled trial (RCT). Therefore, EC patients (N = 11) were asked about their attitudes.ResultsConcerns about the surgery and possible postoperative impairments in quality of life were identified as most mentioned negative aspects of surgery on principle, and recurrence and progression fear and the concern that surgery cannot be avoided anyways as most named negative aspects of surgery as needed. In regard to the participation in an RCT, making a contribution to science and the hope that the novel therapy would be superior to the established one were relevant arguments to participate. On the other hand, the lack of a proactive selection of treatment was named an important barrier to participation in an RCT.ConclusionThe importance of adapting medical conversations to the patients’ lack of expertise and their exceptional cognitive and emotional situation is stressed. Results of this study can be used to improve patient-centered information and the recruitment of patients in RCTs in cancer.

Phytic acid-loaded polyvinyl alcohol hydrogel promotes wound healing of injured corneal epithelium through inhibiting ferroptosis

As the important barrier of intraocular tissue, cornea is easy to suffer various kinds of injuries. Among them, acute alkali burn is a thorny ophthalmic emergency event, which can lead to corneal persistent epithelial defects, ulcers, and even perforation. Ferroptosis, a mode of regulatory cell death, has been found to play a key role in the process of corneal alkali burn, of which lipid peroxidation and intracellular iron levels are considered to be the possible therapeutic targets. To seek new effective treatments, the study herein focused on the occurrence of oxidative stress and ferroptosis in corneal alkali burn, exploring the role of phytic acid (PA), a natural small molecule with both antioxidant and iron chelating capacity, in the repair of corneal epithelial injury. The in vivo therapeutic results showed that PA eyedrops treatment promoted the recovery of corneal morphology and function, and in vitro experiments proved that PA prompted the repair of oxidative stress induced-corneal epithelial injury through ferroptosis inhibition. In addition, better drug treatment effect could be achieved through hydrogel delivery and sustained release, and our in vivo experiments showed the superior therapeutic effects of PA delivered by PVA hydrogels with larger molecular weights on corneal injury. In summary, this study demonstrated the excellent effect of natural small molecule PA with antioxidant and high efficiency chelating ferrous ions on ferroptosis inhibition, and showed the outstanding application prospect of PVA/PA hydrogels in the treatment of corneal epithelial injury.

Spatial and Temporal Changes in Habitat Quality and Driving Forces in Typical Loess Hill and Gully Areas：A Case Study of the Zuli River Basin

Loess hills and gully areas are one of the important ecological barriers in China, and the study of the spatial and temporal changes of its habitat quality and its driving force is of great significance to guaranteeing the ecological security of China and safeguarding the national ecological rights and interests. Taking the Zuli River Basin as an example, the spatiotemporal distribution of the remote-sensing ecological index （RSEI） from 2000 to 2020 was systematically investigated using the Google Earth Engine platform and Landsat remote-sensing data. Combined with the coefficient of variation CV, the Theil-Sen Median slope estimation, the Mann-Kendall test of significance, and the Hurst index, the spatial and temporal changes of habitat quality in the study area were analyzed over a period of 20 years, and the effects of six major driving factors on the spatial distribution of RSEI were investigated using the geodetector method. The results of the study showed that： ① From 2000 to 2020, the value of the RSEI showed a downward and then upward trend, with an average annual increase of 0.084 5·（10 a）-1. ② During the 20-year period, the habitat quality improvement area accounted for 92.06%, of which the significant improvement area accounted for 28.49%, and the improvement area was mainly in Huining County, whereas the habitat degradation area only accounted for 7.82%. The trend of future ecological conditions showed that 74.98% of the areas would show a trend of continuous improvement or future improvement, but there would still be a potential risk of ecological degradation in 23.48% of the areas in the future. ③ Climate factors such as precipitation were the key factors affecting the habitat quality in the Zu Li River Basin； the interaction between factors had a higher explanatory power than that of any single factor on the habitat quality, among which the interaction between the precipitation factor and the elevation factor had the strongest explanatory power. The interaction between the terracing factor and the environmental factor significantly increased the explanatory power of the spatial variance, which indicated that terracing played an important role in improving habitat quality. The results of this study can provide a scientific basis for the management and sustainable development of the ecological environment in the loess hills and gullies.

Analysis of Spatial Distribution of Ecosystem Services and Driving Factors in Northeast China

Northeast China is an important ecological barrier in China, and an in-depth understanding of the spatial distribution in ecosystem services （ESs）, and the driving factors is crucial for realizing the subsequent management and protection of ESs. In the study, we quantitatively assessed the characteristics of spatial distribution in ESs in Northeastern China using the InVEST, RWEQ, and RUSLE models and identified the driving factors of ESs spatial distribution in conjunction with the geodetector based on meteorological data, remote sensing data, and socio-economic data. The results showed that the spatial distribution of ESs in Northeast China had obvious spatial heterogeneity. The high values of habitat quality （HQ）, carbon sequestration （CS） services, and soil conservation （SC） services were mainly distributed in the northern part of the four eastern leagues of the Inner Mongolia Autonomous Region, the northern part of Heilongjiang Province, and the eastern part of Northeast China, which were high in fraction vegetation cover, and low values were mainly found in southwestern and eastern Heilongjiang Province, western Jilin Province, and western Liaoning Province. The high values of the water yield （WY） service and wind prevention and sand fixation （WPSF） service were distributed in the east of the Inner Mongolia Autonomous Region and the east of Liaoning Province. The high values of WY services and WPSF services were distributed in the eastern part of Northeast China and the four eastern provinces of the Inner Mongolia Autonomous Region. According to the geodetector results, slope had the strongest explanatory power for the spatial distribution of SC services with a q-value of 0.31, land use/cover change had the strongest explanatory power for the spatial distribution of HQ and CS services with q-values of 0.64 and 0.52, respectively, and fraction vegetation coverage and annual precipitation had the strongest explanatory power for the spatial distribution of WPSF and WY services with q-values of 0.24 and 0.64, respectively, and there were interactions among all the driving factors. The spatial distribution of ESs in Northeast China was mainly influenced by natural factors. The results will provide a scientific basis for subsequent management and enhancement of ESs in Northeast China.

Gender and Race/Ethnicity dynamics in anesthesiology mentorship: results of a European survey

BackgroundMentorship is crucial to career advancement, medical education, and psychosocial support, especially for women and minorities. Although anesthesia mentoring programs have shown promise, there are no survey data regarding mentor-mentee relationship dynamics. This study aimed to explore the dynamics of the anesthesia mentor/mentee relationship.MethodsA open cross-sectional web-based survey was distributed by the European Society of Anesthesiology and Intensive Care and European Society of Regional Anesthesia to European anesthesiologists. Participation was anonymous and consent was obtained. The study evaluated responses relating to preferences, facilitators, and barriers to mentorship relationships along with sociodemographic information.ResultsIn total, 543 anesthesiologists responded to the survey, and 406 (111 mentees, 49 mentors, 193 both, 53 neither) responded to questions regarding mentorship. 184 anesthesiologists identified as woman and 22 as other genders (non-binary, transgender, gender-fluid, and self-described gender). Moreover, 250 anesthesiologists identified as white. Both mentors and mentees indicated that personal compatibility was the most important factor for successful mentorship. Barriers to mentorship included time consumption and perceived lack of interest from the mentor and mentee. Both mentors and mentees benefited from this relationship. The former reported feeling helpful, and the latter supported the development of clinical skills. The mentors indicated that their participation was important for protecting against burnout/exhaustion and impostor syndrome. Participants reported a preference for mentorship programs organized at the departmental level, offered at the start of the anesthesiology education curricula. Women were more likely to feel a ‘lack of interest’ in mentoring them as a barrier (OR = 2.49, P = 0.033). Gender was a barrier for mentors of other genders (OR = 23.9, P = 0.0027) and ethnicity (OR = 48.0, P = 0.0023). White mentees found gender (OR = 0.14, P = 0.021) and ethnicity (OR = 0.11, P = 0.048) to be less important barriers to successful mentorship relationship.ConclusionWhen possible, programs should prioritize matching mentors and mentees based on personal compatibility and experience in the mentee’s area of interest. Addressing the perceived lack of interest in mentoring is essential for promoting diversity, equality, and inclusion within anesthesiology, as well as and uplifting women and minorities.Trial registrationClinicaltrials.gov identifier: NCT05968339, First posted (01/08/2023).

Phylogeographic patterns match the floristic subdivisions: The diversification history of a widespread herb in subtropical China.

Subtropical China is dominated by evergreen broad-leaved forests (EBLFs) and is acknowledged as a critical region for its high floristic richness and endemism. Understanding of evolutionary mechanisms of such global biodiversity hotspots comes almost exclusively from long-lived tree species. Herbaceous plants represent critical biodiversity components in forests, however, the diversification history of understory herbs in subtropical EBLFs remain poorly understood. Here, we investigated the phylogeographic patterns and demographic history of Oreocharis auricula, a widespread perennial herb endemic to the EBLFs of subtropical China. Both cpDNA sequences and single-copy nuclear genes were used to investigate the genetic variation among 657 individuals from 68 populations. Evidences from molecular dating, demographic history construction, and species distribution modeling were also combined to infer the phylogeography and evolutionary history of O. auricula. Strong phylogeographic signals have been congruently observed using nuclear and plastid DNA markers, with the diversification patterns generally consistent with the recognized floristic subdivisions of subtropical China. Notably, we revealed an important phylogeographic barrier along the Nanling mountain range, which is also around a climatic transition at 24-26°N latitude in subtropical China, separating the south monsoon subtropical EBLFs from the mid-subtropical EBLFs. Demographic expansion and significant niche divergence were detected among the extant lineages, which may have diverged during the early Pleistocene. The inherent characteristics of understory herbs with limited dispersal and short generation time intensify the genetic divergence response of O. auricula to abiotic forces, contributing to the profound phylogeographic imprints of mountains and climate in such herbaceous flora. To further substantiate the generality of the identified patterns, it is paramount to extend phylogeographic investigations to other understory herbaceous taxa in subtropical China. These results have expanded our understanding of the diversification processes of subtropical forests in China.

Teaching critical thinking about health information and choices in secondary schools: human-centred design of digital resources.

Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Final resources include online lesson plans, teachers' guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Dietary Needs, Barriers, and Facilitators Among Patients on Hemodialysis and Their Caregivers: The GoodRENal Project in Spain

ObjectiveDietary restrictions are common in patients undergoing hemodialysis (HD). These restrictions result in a complex diet that becomes difficult for patients to understand and to follow. Therefore, we aimed to identify dietary needs, and barriers and facilitators that influence the adherence to dietary recommendations as perceived by patients on HD and their caregivers. MethodsSeventy-two Spanish patients on HD and fifty-seven caregivers participated in this explorative study by replying a questionnaire consisting of 20 and 10 questions respectively. The responses were assessed using a Likert scale varying from 1 to 5 (strongly agree, agree, neither disagree or disagree, disagree, strongly disagree, respectively) to evaluate the perception of patients and caregivers regarding dietary needs, barriers and facilitators to adhere to the recommended diet. For analysis purposes, the responses were grouped in three categories (agree, neither agree or disagree, disagree). ResultsSeventy percent of the patients agreed that knowing the food sources of potassium, protein and phosphate was a need for them to know to be able to adhere to the dietary recommendations. Moreover, patients stated that not being able to eat what they liked, and feeling thirsty, were important barriers. For caregivers, the support of a renal dietitian was mentioned as an important facilitator to assist those they cared for to adhere to the diet. ConclusionsKnowing food sources of potassium, phosphate, and protein, exploring foods patients like to eat and adjusting fluid intake to avoid feeling thirsty were identified as important by the patients. These findings can be used to develop strategies and educational material to improve the dietary adherence in patients undergoing HD. Moreover, the presence of a renal dietitian was identified as an important resource by the caregivers.

P035 SOCIAL DETERMINANTS OF HEALTH AND CONTROL OF HYPERTENSION

Background and Objectives: Recent national blood pressure (BP) survey data of adults in Canada and United States show a troubling decline in the control of hypertension, particularly in women, the elderly and those with low income, less education and under-using health services. Social determinants of health (SDH) can be important barriers to controlling hypertension. Studies assessing associations of BP control and SDH have focused on one or a few domains. Objectives of this study are to screen treated hypertensive patients for a wide range of SDH, test for correlations and assess the effects of high-quality treatment on SDH and BP control relationship. Method: We created and applied a screening tool to gather personal information on 14 SDH from consecutive consenting eligible patients attending a complex hypertension care clinic. Logistic regression was used to assess association of each SDH domain with BP control. Results: Of 90 patients enrolled, 88 completed the 6-month study. At baseline, mean age (standard deviation) was 64 (14) years, 64% male, 69% white, 25% experiencing financial hardship, mean BMI 30.4 kg/m2 (5.9), mean automated office BP 138/78 (23/14), mean number of co-morbid conditions 4.2 (2.0) and 55% had treatment-resistant hypertension. From baseline to exit, BP fell to 127/73 (17/12), p<0.001, mean number of antihypertensive drug classes increased from 3.06 (1.43) to 3.23 (1.30), p=0.049 but BMI remained unchanged. There were no associations between uncontrolled hypertension and any of the 14 SDOH domains at baseline. However, at exit financial status was associated with uncontrolled hypertension on univariate analysis (p=0.022) and on multivariate analysis. Stress (p=0.063) and optimism status (p=0.085] showed a similar trend. These analyzes indicated better BP control among those with poorer financial status, higher stress levels or more pessimistic outlook. Conclusion: None of the SDOH were associated with uncontrolled hypertension at baseline. However good medical care and follow-up appeared to have improved BP control, noticeably in those experiencing financial hardship. Explanation of findings requires further study.

27 - Financial and time constraints identified as the most important barriers to obesity management in primary care in Australia.

27 - Financial and time constraints identified as the most important barriers to obesity management in primary care in Australia.

A Physically Constrained Model-Based Moisture Amplification Approach for Probable Maximum Precipitation (PMP) Estimation

Abstract The flood that would result from the greatest depth of precipitation “meteorologically possible” or probable maximum precipitation (PMP) is used in the design of dam spillways and other high-risk structures. Historically, PMP has been estimated by scaling precipitation totals obtained from severe historical storms, assuming more moisture could have been available. Over the last decade, numerical weather prediction models have been used to instead predict precipitation resulting from the addition of moisture in the simulations [called relative humidity maximization (RHM)]. Despite the major improvement they represent, two important barriers limit the applicability of model-based methods: first, the existence of different moisture amplification approaches that produce different estimates, and second, the need for a regional implementation of those techniques that were developed for individual basins. Taking Oregon’s mountainous coastal watersheds affected by atmospheric river storms as a case study, we develop a moisture amplification approach, which we call relative humidity perturbation (RHP) ratio that is physically constrained by historical maximum moisture. We find that both the magnitude and location of moisture increase matter and that RHP ratio produces lower amplified precipitation totals but storms that are more consistent with observed events than other methods such as RHM. We additionally find that it is possible to position a storm near-optimally over several basins in a homogeneous area, enabling the production of regional PMP estimates. The understanding we develop of the control moisture exerts on PMP-magnitude precipitation totals allows us to develop a more physically based methodology for the development of reliable storm amplification guidance.