Artificial intelligence (AI) is the science and engineering of making intelligent machines,especially intelligent computer programs. It is related to the similar task of using computers to understand human intelligence, but AI does not have to confine itself to methods that are biologically observable. While no consensual definition of AI exists, it is broadly characterized as the study of computations that allow for perception, reasoning, and action. The growing technology of expert systems applies AI to solve complex problems in education, business, medicine, and more, improving quality and efficiency. The digital divide limits educational equity worldwide, as many lack access to stable internet and modern devices, constraining access to AI educational tools. Lightweight AI frameworks accessible via common communication media aim to democratize education while reducing environmental costs associated with print-based learning.

Introduction: food insecurity is increasing at an alarming rate, contributing to gender variation in illness and undermining the 2030 nutrition goals. Evaluating its components could aid interventions aimed at addressing gender-specific diseases such as hypertension. This study assessed gender differences in food insecurity and its association with elevated blood pressure (EBP) in Ondo State, Nigeria. Methods: this community-based cross-sectional study used a four-stage systematic random sampling to select 769 adults aged 18 years and older. Food insecurity experience scale survey module components (Worried, Healthy, Fewfoods, Skipped, Ateless, Ranout, Hungry, and Wholeday) were defined, and participants were categorized into: food secure (0 point) and food insecure (≥1 point). Obesity and abdominal adiposity were determined by body mass index (≥30kg/m2) and waist-height ratio (≥0.5), respectively. The EBP was defined as BP≥140/90mmHg. Multivariable logistic regression was performed at p<.05 Results: a proportion of 54.9% men and 45.1% women participated in the study. Their mean ages and monthly incomes (±standard deviation) were 32.3±11.6 years, 33.9±11.7 years, and $51.1±41.0, $46.9±37.3, respectively. Women were more food insecure (44.1%, 35.8%) and experienced Worried (34.9%, 23.9%), Healthy (34.3%, 25.8%), Fewfoods (22.8%, 18.0%), Skipped (36.0%, 26.3%), Ateless (25.4%, 20.4%), Ranout (14.4%, 10.2%), Hungry (11.8%, 10.1%) and Wholeday (5.8%, 4.5%) than men, respectively. Men (9.2%) had EBP more than women (8.6%). The EBP was associated with marital status (aOR=2.53, CI=1.09, 5.87, p=.03), worried (aOR=6.33, CI=2.25, 17.78, p=<.001), ranout (aOR=5.98, CI=1.02, 35.01, p=.04) and abdominal adiposity (aOR=2.44, CI=1.38, 5.31, p=.03) among men, but occupation (aOR=1.41, CI=1.04, 1.91, p=.03) and physical inactivity (aOR=3.63, CI=1.04, 14.30, p=0.04) among women. Conclusion: gender difference was observed in food insecurity, which significantly contributed to EBP among men, while occupation and physical inactivity predisposed women to EBP. Interventions in controlling hypertension should incorporate schemes that address lack and inadequate access to food, and maintain a healthy body weight through a quality diet and physical exercise among Nigerian adults.

Most people in the world lack access to medical imaging including for assessment of pulmonary disease. We sought to improve access to pulmonary imaging by developing a rapid automated system for triage of pulmonary disease using lung ultrasound requiring neither a radiologist nor experienced sonographer utilizing volume sweep imaging (VSI) and artificial intelligence (AI). We conducted a retrospective study of lung ultrasound VSI data collected from May 2019 to January 2020. AI analysis utilizing a convolutional neural network and random forest-based machine learning classifier was performed on 70 normal lung ultrasound VSI video clips and 49 abnormal lung ultrasound VSI video clips obtained by individuals without prior ultrasound experience. The accuracy of the AI was assessed for the ability to distinguish between normal and abnormal lung ultrasound video clips. Among test VSI clips (n = 36 clips), AI achieved 91.7% accuracy, 85.7% sensitivity, 95.5% specificity, and an F1 score of 0.89 for an abnormal lung ultrasound VSI clip. Among test subjects (n = 20) from which these clips were obtained, 90.0% accuracy, 87.5% sensitivity, 91.7% specificity, and an F1 score of 0.88 were achieved. Lung ultrasound VSI integrated with AI shows potential to provide preliminary triage of pulmonary disease allowing a system for rapid automatic triage of pulmonary disease requiring neither a radiologist nor sonographer.

HighlightsWhat are the main findings?Vaginal pessaries worked with high success, improvements in quality of life, and few side effects.Most women were satisfied and felt their symptoms improved.What are the implications of the main finding?Pessaries can be used as an easy, safe first choice for women with prolapse.Offering pessary care in more hospitals could reduce the need for surgery.Background: Pelvic organ prolapse (POP) significantly impairs women’s quality of life (QoL), particularly in resource-limited settings where surgical options may be restricted. Vaginal pessaries provide a conservative and cost-effective treatment, yet local evidence on their effectiveness in Vietnam remains scarce. Methods: In this six-month prospective study, 130 women with stage II–IV POP received vaginal pessaries. QoL was evaluated using validated PFDI-20 and PFIQ-7 questionnaires, and changes in symptoms, satisfaction, and adverse events were analyzed. Results: Most women presented with advanced POP (65.4% stage III, 19.2% stage IV). Ring pessaries were most frequently used (64.6%), followed by Gellhorn (23.9%) and Donut (11.5%). Successful fitting was achieved in 95.4% of participants, with six women discontinuing use due to expulsion or discomfort. QoL scores improved significantly after six months: mean PFDI-20 total decreased from 78.5 ± 51.4 to 42.2 ± 38.3 (p < 0.001), and PFIQ-7 total decreased from 62.6 ± 43.2 to 25.1 ± 22.9 (p < 0.001), with all subscales showing consistent improvement. Nearly all women (98.5%) reported symptomatic improvement, and 95.4% were satisfied with treatment. Correlation analyses showed no significant relationships between POP stage and obstetric factors (vaginal delivery, macrosomia, and episiotomy). In multivariate regression analysis including only age, BMI, and POP stage, none were significantly associated with QoL improvement. Conclusions: Vaginal pessary use was safe, highly effective, and well tolerated, leading to symptom and QoL improvements among Vietnamese women with advanced POP. These findings support pessary use as a first-line management option, especially for women who are elderly, have comorbidities, or lack access to surgery.

Abstract Early childhood educators are at high risk of depression and lack access to evidence-based care, which may result in increased multi-level outcomes from child expulsion, impaired educator well-being, workplace turnover, and health care costs. Identifying educators at the highest risk of depression is crucial for targeted intervention and policy, yet research with nationally representative populations is limited. Addressing this gap, we estimated the prevalence of depression among center-based educators with the 2019 National Survey of Early Care and Education Workforce Survey (n = 4,709). Depression was measured with the Center for Epidemiological Studies Depression-7. We also examined depression prevalence by social characteristics, including gender, parenting role, income, age, marital status, education, and race/ethnicity. We found that 9.6% of educators had depression, compared to 7-8.5% of adults nationwide. Educators who were younger or non-Hispanic had the highest depression risk; marginal significance emerged for those with three or more children under five years old. More research is needed to understand depression after the COVID-19 pandemic, and workplace wellness programs and policy should consider targeting depression interventions towards educators at the highest risk.

Abstract Native Americans (NAs) experience significant disparities in diet-related conditions, including obesity, hypertension, and diabetes. Many NA communities are food insecure and lack access to fresh fruits and vegetables. While public health interventions have focused primarily on behavioral change, these strategies are limited without structural changes to the local food system. The Go Healthy Study is a community-based participatory research study using an innovative, multilevel community supported agriculture intervention to improve diet and reduce chronic disease risk factors among NA adults. This 16-week, randomized, wait-list controlled trial includes the following components: 1) a weekly box of fresh produce; 2) a healthy eating and traditional foods curriculum with recipes incorporating the produce; 3) NA traditional foods cooking demonstration videos; and 4) a kitchen “starter kit” with basic cooking equipment. Eligible participants include NA adults residing within the Osage Nation with a body mass index (BMI) ≥ 25 kg/m2. We expect approximately 400 adults to participate in the Go Healthy Study. Data are collected at baseline and follow-up upon completion of the intervention. The primary outcomes are to improve systolic blood pressure and low-density lipoprotein cholesterol and increase fruit and vegetable intake. Secondary outcomes include BMI, hemoglobin A1c, food security, and health status. This manuscript describes the study rationale, design, intervention components, timeline, and measures.

Background: Most people in the US lack access to infectious disease (ID) expertise, with 80% of counties lacking an ID physician. This is problematic as in-person ID consultation has been shown to improve clinical outcomes such as mortality with certain invasive infections, with Staphylococcus aureus bacteremia (SAB) as the paradigm. Telemedicine consultation has emerged as a tool to expand access in rural and underserved communities though its impact on clinical outcomes is less well established. This study characterizes the impact of a Tele-ID program in improving care for patients with SAB at a network of academic-affiliated rural hospitals that do not have access to in-person ID consultation. Methods: This was a retrospective cohort study of patients with SAB who were initially evaluated at 3 academic-affiliated rural hospitals between 7/1/22 and 6/30/24. A cohort of patients who received a Tele-ID consult was compared against a cohort that did not. The primary outcome was adherence to the standard of care for SAB, defined as documentation of clearance of blood cultures, receipt of an echocardiogram, and receipt of an appropriate course of antibiotics. Secondary outcomes included clinical outcomes such as mortality and readmission rates. Results: A total of 260 discrete episodes of SAB were screened for inclusion, with 122 episodes meeting inclusion criteria. Seventy five patients (61.5%) who received a Tele-ID consult were compared against 47 patients (38.5%) who did not. Patient characteristics were overall similar in these groups, though those receiving Tele-ID consultation were more likely to have end-stage renal disease (15% vs 0%, p < .01) and indwelling hardware (56% vs 21%, p < .01). Tele-ID consultation was associated with a higher likelihood of receiving standard of care for SAB (91% vs 15%, p < .01). This finding was consistent across all hospitals and among the individual components of the primary outcome. In addition, Tele-ID consultation was associated with significantly decreased SAB-related 30-day mortality (7 vs 24%, p < .01) and SAB-related 90-day mortality (8 vs 25%, p < .01). No significant difference was observed in rates of readmission or relapsed bacteremia. Conclusion: In this retrospective cohort study of 122 patients with SAB cared for in rural, academic-affiliated hospitals, Tele-ID consultation was associated with a significantly increased likelihood of receiving standard of care and decreased mortality. This data will inform policy at regional hospitals, such as supporting a mandatory ID consult for SAB and implementation of a SAB bundle.

BackgroundIn today's post-revolution era, with demographic, cultural, and social changes, Tunisian society is witnessing several transformations: There's a rise in young single mothers and early sexual activity. A quarter of the population comprises young Tunisians who struggle with limited access to education and healthcare. Only 19.1% know how to prevent Sexually Transmitted Diseases (STDs), and 16% lack access to contraception. This insufficient sexual health knowledge exposes them to risks such as STDs, unintended teenage pregnancies, unsafe abortions, infertility, and even death. This study aims to assess young Tunisians' understanding of contraception, sexual behavior, information-seeking methods, and STD prevention.MethodsA cross-sectional survey involving 100 high school students aged 15–18 was conducted from February to March 2022. It gathered information on their knowledge of contraceptives, sexual health, experiences, and access to services and products. The survey used hard-copy questionnaires. All statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) software, version 26.0 IBM.ResultsA total of 100 participants were included, with a sex ratio of 0.92. most of them (35%) were 18 years old. Results showed that the majority (86%) of the students confirmed that they had not received any courses on contraception. Most students, 84%, said they obtained information about contraceptive methods from websites, while 63% mentioned friends as their source. The majority of participants, 62%, reported not using contraception, while 15% had used methods like condoms or withdrawal before. Both genders were mostly aware of the pill (89%) and male condom (85%) as common contraceptive methods. Over two-thirds of the participants stated that the male condom was the contraceptive method effective in preventing STD.ConclusionThe majority of the adolescents displayed misconceptions regarding contraceptive methods and the prevention of STDs. The use of these methods remains significantly restricted. This study emphasizes the importance of increasing awareness of sexual health among adolescents. It recommends establishing accessible centers offering comprehensive services and guidance on contraception, sexuality, and pregnancy planning.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23030-6.

BackgroundDespite many adolescents experiencing mental health concerns, a substantial portion lack access to evidence-based treatments (EBTs) for psychopathology; this issue is magnified for adolescents belonging to communities considered marginalized. One way to ameliorate this is by adapting existent EBTs—typically delivered in research settings—so that they are feasible and scalable in adolescent settings, such as high schools. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents may be particularly suited for this purpose due to its transdiagnostic, modular approach and its focus on adolescent clients.ObjectiveThis study aimed to iteratively adapt and implement the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents in 3 Title 1 high schools, with a focus on feasibility and scalability of the intervention in diverse high school settings.MethodsFor initial adaptation, members of participating high school communities will be presented with original, unadapted intervention materials and asked to provide qualitative feedback on how to make the program more appropriate and feasible for their schools (aim 1). After initial adaptations are implemented, an open-trial pilot case series will assess the appropriateness and feasibility of the resulting program: the Unified Protocol for Emotional and Academic Challenges in Education (aim 2). Initial outcome data and qualitative feedback from pilot case series participants will then inform final adaptations for the randomized controlled trial—in which the adapted program will be compared to high schools’ mental health services as usual (aim 3). The adapted program’s effectiveness will be evaluated by using a mixed methods approach, and feasibility will be preliminarily assessed through cost-effectiveness analyses (aim 4).ResultsData collection for the study was concluded in May 2025, with primary outcome analyses anticipated to be completed by August 2025.ConclusionsThis protocol may serve as a promising guide for adapting youth EBTs in more accessible, diverse settings, as well as result in a useful prevention program for youth with emotional concerns.Trial RegistrationClinicalTrials.gov NCT06056674; https://clinicaltrials.gov/study/NCT06056674International Registered Report Identifier (IRRID)DERR1-10.2196/74080

This scoping review will describe dementia coaching programs, models, and practices for unpaid caregivers of community-dwelling persons living with dementia. Unpaid caregivers of community-dwelling individuals with dementia often experience significant physical and emotional stress due to the complex nature of caregiving, yet many lack access to support tailored to their needs. Dementia coaching has emerged as a potential solution offering personalized guidance to help caregivers set goals, build coping strategies, and manage care responsibilities. However, wide variation in how dementia coaching is defined and delivered has created uncertainty around its implementation. A scoping review is needed to map the current landscape, identify existing programs, models, and practices, and highlight gaps in the literature to inform future service development. This scoping review will include qualitative, quantitative, mixed methods studies, guidelines, policies, opinion papers, and gray literature on dementia coaching for unpaid caregivers of community-dwelling individuals with dementia, with no restrictions on language or publication date. This review will follow the JBI methodology for scoping reviews. Published literature will be located using MEDLINE (Ovid), Embase (Ovid), CINAHL with Full-Text (EBSCOhost), APA PsycINFO (EBSCOhost), ERIC (EBSCOhost), Social Abstracts in Gerontology (EBSCOhost), and Scopus. References of included studies will be hand-searched and gray literature identified via ProQuest Dissertations and Theses (ProQuest), Google Scholar, Google, and relevant dementia- and caregiver-related websites. Two authors will independently screen and extract data, with a third resolving any discrepancies. Findings will be shared through narrative summaries, tables, charts, and publications. OSF https://osf.io/u6vj8.

Snakebite-related deaths are major concerns in populations worldwide that lack access to medical care. Current treatment of snakebites includes administration of polyspecific and polyvalent heterologous equine antiserum. Swift diagnosis of the species of snake responsible is essential to initiate a specific treatment. We generated murine monoclonal and rabbit polyclonal antibodies against the venom of the 3 most common venomous snakes in southern India: the Russell viper, the saw-scaled viper, and the Indian cobra. We developed an enzyme-linked immunosorbent assay to distinguish the snake by analyzing the exudates from the snakebite wound. Monoclonal antibody EC3 reacts specifically with a 45- to 50-kDa venom protein of the saw-scaled viper, antibody NNH6 reacts with 12-kDa venom protein of the Indian cobra, and antibody RVV20 reacts with a 16-kDa venom protein of the Russell viper. We tested the exudates from snakebite wounds in 24 consecutive patients admitted to the Tirunelveli Medical College Hospital with snakebite. Our assay detected 18 patients with Russell viper bite and 1 each for cobra and saw-scaled viper. Our study shows the feasibility of an enzyme-linked immunosorbent assay-based method to identify the 3 major venomous snakes in southern India and holds promise for prompt administration of snake-specific and mechanism-based treatment.

Social determinants of health (SDOH) can have profound impacts on children, though many lack access to SDOH programs. Our objective was to determine feasibility and outcomes of a SDOH program for families of children seen in an emergency department (ED) serving an under-resourced rural population. This prospective cohort study assessed for 11 domains of SDOH among families of pediatric ED patients. Families with positive screens were contacted following their ED visit and provided resources. Fisher exact and Chi-square tests were used to identify sociodemographic factors associated with SDOH and resource requests. Of the 95 surveys administered, 42% were positive for ≥1 SDOH, most frequently food scarcity (27%). Forty percent of families with positive SDOH needs screens requested services, of which remote resource assistance was performed successfully with 75%. Families with an unemployed primary caregiver ( P =.04) and Medicaid insurance ( P <.001) were more likely to screen positive for SDOH needs. Forty percent of respondents were from surrounding rural counties and were less likely to request resources ( P =.01). SDOH needs are common among families utilizing EDs for their children's health care. EDs serving under-resourced rural communities can be leveraged to address SDOH needs, and further research is needed to evaluate their impacts on rural families.

Skid Row in downtown Los Angeles is home to one of the nation’s largest concentrations of unhoused individuals, with approximately 3,800 people experiencing homelessness as of 2024, around 70% of whom are unsheltered (1). This community faces significant challenges in accessing and utilizing medical care, resulting in fragmented and episodic treatment. A 2023 study reported that homeless individuals in California made over 650,000 emergency department (ED) visits between 2019 and 2020, representing about 3% of all hospital encounters in California (2). This reliance on emergency services is often due to the lack of consistent primary care access; other contributing factors include transportation issues, lack of insurance, and discrimination in healthcare settings (3). Mental health and substance use disorders further complicate healthcare utilization. A statewide study found that 45% of homeless adults described their health as “poor or fair”, and 60% reported having a chronic disease (2). Despite these health challenges, many lack access to consistent primary care, leading to ED usage for conditions manageable in outpatient settings (4). These patterns are reflected locally in Los Angeles’ Skid Row. In a 2023 study, 78% of surveyed individuals reported having health insurance — most commonly MediCal — yet 75.7% expressed interest in accessing additional health screenings (5). This discrepancy between insurance coverage and preventive care utilization highlights systemic barriers even when basic coverage exists. Barriers to accessing care are multifaceted. A 2021 review identified obstacles such as lack of insurance, transportation, and healthcare discrimination, which deter homeless individuals from seeking treatment (3). These factors contribute to underutilization of available services, even when present in the community (6). In conclusion, the utilization of medical care among unhoused individuals in Skid Row is hindered by a combination of systemic barriers, including limited access to regular providers, high reliance on emergency services, and significant unmet needs in mental health and substance use treatment. Addressing these challenges requires targeted interventions to improve access to consistent, comprehensive, and integrated healthcare services for this vulnerable population. ​ Works Cited ​ 1. “Skid Row.” Homeless Initiative, County of Los Angeles, 20 Mar. 2025, homeless.lacounty.gov/skidrow/. Accessed 19 May 2025. ​ 2. Kushel, Margot, and Tiana Moore. Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness, UCSF Benioff Homelessness and Housing Initiative, June 2023, homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf. ​ 3. Omerov, Pernilla, et al. “Homeless Persons’ Experiences of Health‐ and Social Care: A Systematic Integrative Review.” Health &amp; Social Care in the Community, vol. 28, no. 1, 16 Sept. 2019, pp. 1–11, doi:10.1111/hsc.12857. ​ 4. Ward, Jason. Study of Unhoused People in Three Key Los Angeles Communities Finds Numbers Did Not Grow; Population’s Needs Remain High | Rand, RAND, 2 July 2024, www.rand.org/news/press/2024/07/02.html. Accessed 19 May 2025. 5. Elhaija, Ahmad, et al. “Identifying the Service Needs of Homeless Individuals in the Skid-Row Community.” Journal of Social Distress and Homelessness, vol. 33, no. 1, 10 Mar. 2023, pp. 258–262, doi:10.1080/10530789.2023.2187273. ​ 6. Feldman, Brett J., et al. “From the Hospital to the Streets: Bringing Care to the Unsheltered Homeless in Los Angeles.” Healthcare, vol. 9, no. 3, Sept. 2021, p. 100557, doi:10.1016/j.hjdsi.2021.100557.

We provide the first evidence on the long-run returns to private equity in emerging and frontier markets using the cash flows from every equity investment made by the International Finance Corporation across 130 countries over 58 years. Risk-adjusted returns are comparable to the S&amp;P 500, at least from 1961 until 2010. Returns improve with economic growth but decline as banking systems deepen and countries relax capital controls. These results are consistent with the thesis that financial frictions have prevented the flow of capital from rich to poor countries and that the persistence of impact investors’ performance may rely on identifying or creating new markets that lack access to capital. This paper was accepted by Agostino Capponi, finance. Conflict of Interest Statement: Shawn Cole served five days as a “Short Term Consultant” to the IFC in 2018–19 and in a non-compensated advisory role for Y Analytics, a subsidiary of impact investor TPG/Rise. Martin Melecky, Florian Mölders, and Tristan Reed are employees of the World Bank Group. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.03313 .

Access to clean drinking water is a fundamental human right, yet millions worldwide lack access to safe and portable water. Waterborne pathogens like E. coli and fecal coliform pose significant health risks. In this project we develop a disinfection dosage system using neem (Azadirachta indica) extract to treat septic tank over flow water, rich in pathogens and contaminants which cause surface water and ground water contamination. Our system leverages neem extract's antimicrobial properties, demonstrated through membrane filtration tests, which show significant microbial load reduction. This innovative approach offers a sustainable, effective, and eco-friendly solution for treating septic tank overflow water, promoting public health and mitigating waterborne diseases.

Green spaces in educational environments have been shown to significantly enhance children’s cognitive, emotional, and behavioral outcomes. Yet, in India, many government schools - especially those in rural or low-income urban areas - lack access to nature-rich environments due to infrastructural and economic constraints. This study explores the transformative potential of low-cost greening interventions, such as the use of locally available seeds (e.g., pulses, methi), soil enrichment, and rock-bordered gardening plots, in barren schoolyards. It investigates how such ecological enhancements contribute to the mental well-being, attention span, and academic engagement of children from underserved communities. Drawing on interdisciplinary research in environmental psychology, neuroscience, and educational policy, this paper synthesizes findings from global and Indian contexts to assess how nature-based solutions can be adapted to high-density, low-resource settings. Additionally, it evaluates the sustainability and scalability of these interventions by focusing on their affordability, community participation, and integration into school curricula. The results suggest that even minimal interventions - like planting drought-resistant plants or creating green perimeters with rock borders - can lead to measurable improvements in mood, stress reduction, and executive functioning. By aligning ecological restoration with educational development, this study offers a practical blueprint for reimagining school environments as green sanctuaries that nurture both minds and ecosystems. The findings have far-reaching implications for policy-makers, NGOs, and school leaders seeking to enhance learning outcomes and emotional resilience through nature-driven approaches in India’s most neglected school systems.

An integrated farming system that combines the horticulture and beef cattle subsectors based on the zero-waste principle is one of the innovative solutions to reduce negative environmental impacts while increasing production efficiency. Barru Regency, with its potential in horticulture and livestock, is a strategic area for the implementation of this system. However, the success of its implementation highly depends on the active involvement of various stakeholders. This study aims to examine stakeholders' perspectives on the development of a zero waste integration system of horticultural crops and cattle in Barru Regency. A qualitative approach was used to explore the perceptions, interests, roles, and challenges faced by stakeholders in the implementation of this system. Data were collected through in depth interviews, including Focus Group Discussions (FGD), participatory observations, and document studies. The informant sources identified in this study consist of 15 cattle farmers, 10 horticulture farmers, 2 field extension officers, 1 government official, and 1 academics. The data were analyzed using thematic analysis methods. The research findings show that 80% of farmers perceive waste reuse as economically beneficial, and 40% lack access to composting and biogas technology. Based on these findings, synergy among actors, regulatory strengthening, and inclusive policy support are needed to realize a sustainable zero-waste farming system.

Introduction and Objective: CGM is standard of care for people with insulin-treated type 2 diabetes (T2D), but many lack access to this beneficial technology. Through NYC Care, a healthcare access program for New York City’s public hospital system, uninsured New Yorkers can access CGM as of July 2024 via a pilot DME benefit. Our goal was to evaluate the feasibility of implementing CGM for uninsured people at a diverse, multilingual urban safety net hospital-based primary care diabetes clinic where patients experience many social determinants of health (SDOH) barriers to optimal glycemic management. Methods: Retrospective chart review was used to identify individuals with NYC Care and T2D prescribed basal insulin and CGM during the review period (Jul-Dec 2024). Results: 52 individuals met inclusion criteria with mean age 53±7 years; 33% female; baseline a1c 10±2%; 81% non-English speakers; 30% treated with short-acting insulin; 73% treated with GLP-1RAs. Of the 52 individuals prescribed CGM, 41 started using it as of this analysis; 39 of those users have completed (n=27) or are scheduled for (n=12) clinician data review. Identified benefits of CGM included: detection of hypoglycemia, improved glycemia; CGM review leading to medication titration; and better insight into T2D management. CGM challenges included: non-use; device malfunctions; skin irritation; technological limitations; clinic visit no-shows; challenges with obtaining supplies; and other barriers (substance use, unstable housing, food insecurity, and hospitalization). Conclusion: Results demonstrate that CGM may benefit vulnerable populations with T2D on insulin with SDOH barriers. Further study will elucidate challenges to CGM uptake and use as well as mitigation strategies to improve glycemic management in safety-net clinic populations with elevated a1c and SDOH barriers. Disclosure J. Tanenbaum: None. C. Chen: Other Relationship; Merck &amp; Co., Inc. D. Kim: None. J.B. Lee: None. A. Dasilva: None. Y. Liang: None. C. Uzor: None. S. Bongalos: None. O. Sonubi: None. N. Levy: None. Funding Merrin Master Clinician Fellowship, NYU Grossman School of Medicine

In today's Mexico, approximately 50% of children experience multidimensional poverty, with Indigenous children particularly affected; half of them live in extreme poverty and nearly all lack access to social security. The current political landscape threatens to exacerbate these issues. Reductions in public spending and the dismantling of federal child health programmes are likely to further hinder children's development, well-being and health by limiting access to vital services like childcare, education and healthcare. Children's hospitals in Mexico may increasingly depend on philanthropy and civil society support, however, the relationship between the State and the philanthropic sector is not without problems. This paper presents a case study of 'social assistance' in Mexico, by exploring the structure and organisation of two non-for-profit groups and their relationship with a children's hospital and healthcare staff in the southeast of Mexico through semi-structured interviews and document analysis. It aims to explore the challenges and tensions that arise in the collaboration between the State and philanthropic organisations, particularly in the context of sustaining and enhancing children's hospitals. Our study reveals that the philanthropic sector has tried to compensate for some of the enormous needs that historical and more recent challenges imply to the most vulnerable families when seeking medical attention for their children. However, philanthropic efforts are ultimately sustained by the same families through a 'co-responsibility model'. There is an urgent need for public policies based on human rights and social reform, which simplify bureaucratic processes and support philanthropic organisations in aiding vulnerable groups beyond the healthcare system's scope. Our case studies suggest that today philanthropic organisations not only complement the activities of the public health system by giving support to the families of the patients, but also substitute the State in the delivery of very basic medical care people should have the right to receive.

IntroductionThe optimal surgical approach for right ventricular outflow tract obstruction in Tetralogy of Fallot aims to preserve the native pulmonary valve annulus, as this is associated with better long-term outcomes. Pediatric humanitarian patients often present with a delayed diagnosis and lack access to preoperative palliative treatments, reducing the likelihood of pulmonary valve annulus preservation and potentially compromising long-term outcomes. This study aims to identify independent predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients undergoing corrective surgery for Tetralogy of Fallot.MethodsBetween January 2019 and May 2023, pediatric humanitarian patients with Tetralogy of Fallot underwent surgical correction at our center. We performed a comparative analysis of preoperative, intraoperative, and postoperative variables, followed by univariate and multivariate logistic regression to identify independent predictors of pulmonary valve-sparing repair.ResultsA lower body mass index (OR = 0.711; p = 0.021; 95% CI = 0.533–0.949), a larger pulmonary valve annulus measured in centimeters (OR = 28.653; p = 0.008; 95% CI = 2.360-347.890) and a higher Z-score of pulmonary valve annulus (OR = 1.606; p = 0.023; 95% CI = 1.067–2.418) were identified as independent predictors of pulmonary valve-sparing repair.ConclusionSuccessful pulmonary valve-sparing repair was associated with lower BMI and a larger pulmonary valve annulus (both measurements in centimeters and Z-score). These findings may help guide clinical and policy strategies to promote more equitable and effective surgical care in resource-limited settings.