Local Centers Research Articles

Diagnosis, Management and Outcome of Truncus Arteriosus Communis Diagnosed during Fetal Life-Cohort Study and Systematic Literature Review.

Background/Objectives: Truncus arteriosus communis (TAC) is a rare congenital heart defect characterized by a single arterial trunk that supplies systemic, pulmonary, and coronary circulations. This defect, constituting approximately 1-4% of congenital heart diseases, poses significant challenges in prenatal diagnosis, management, and postnatal outcomes. Methods: A retrospective analysis was conducted at the local tertiary referral center on cases of TAC diagnosed prenatally between 2019 and 2024. Additionally, a systematic literature review was performed to evaluate the accuracy of prenatal diagnostics and the presence of associated anomalies in fetuses with TAC and compare already published data with the local results. The review included studies that especially described the use of fetal echocardiography, the course and outcome of affected pregnancies, and subsequent management strategies. Results: The analysis of local prenatal diagnoses revealed 14 cases. Of the 11 neonates who survived to birth, the TAC diagnosis was confirmed in 7 instances. With all seven neonates undergoing surgery, the intention-to-treat survival rate was 86%, and the overall survival rate was 55%. By reviewing published case series, a total of 823 TAC cases were included in the analysis, of which 576 were diagnosed prenatally and 247 postnatally. The presence of associated cardiac and extracardiac manifestations as well as genetic anomalies was common, with a 22q11 microdeletion identified in 27% of tested cases. Conclusions: Advances in prenatal imaging and early diagnosis have enhanced the management of TAC, allowing for the detailed planning of delivery and immediate postnatal care in specialized centers. The frequent association with genetic syndromes underscores the importance of genetic counseling in managing TAC. An early surgical intervention remains crucial for improving long-term outcomes, although the condition is still associated with significant risks. Long-term follow-up studies are essential to monitor potential complications and guide future management strategies. Overall, a coordinated multidisciplinary approach from prenatal diagnosis to postnatal care is essential for improving outcomes for individuals with TAC.

유치원 방과후 과정 운영 질 제고를 위한 사례연구

Objectives This study aimed to enhance the quality of after-school programs in kindergartens by visiting kindergartens with exemplary after-school operations and examining their management practices. Methods Through the cooperation of officials from regional education offices, kindergartens with notable after-school program operations were recommended, and eight kindergartens across the country were visited. Data related to the operational cases of each kindergarten were collected, and interviews were conducted with principals and teachers. The study examined how after-school programs are conducted through various procedures, processes, and interactions within different kindergarten contexts. Results The results indicated that high-quality after-school programs in kindergartens were managed through various methods, including the operation of professional learning communities, adherence to play-centered after-school programs true to their essence, the appointment of dedicated after-school teachers, community-linked after-school programs, and the establishment of care systems for children. Care systems for children were often established in rural kindergartens and operated in forms such as all-day care, Saturday care, intensive care during farming seasons, and care linked to local children's centers. Conclusions This study suggests the need for a change in perception about after-school programs among principals and curriculum teachers, recognition and training support for after-school teachers and connection with local communities.

New Brunswick HEARS: outcomes of a community-delivered hearing intervention adapted for older adults in Atlantic Canada

Objective To assess acceptability and benefit of a community-based hearing intervention delivered at no cost to lower-income older adults with untreated hearing loss in New Brunswick, Canada. Design Mixed method pre-post intervention study investigating aspects of communication function and social support at baseline and three months post-intervention. Study Sample 124 of 175 independent-living older adults screened at the study site and in local community centres in low-income neighbourhoods were recruited into the study. Results In 70 (56.5%) participants self-identified as female and 54 (43.5%) as male, with mean age of 74.5 years, mean effect sizes measured from baseline to 3-months post-intervention were 0.99 (large) for HHIE-S, 0.58 (medium) for DSSI, and 1.02 (large) for LSEQ indicating significant improvement in self-perceived communication function, social support and listening self-efficacy, respectively. Conclusion The HEARS program is feasible to implement, despite Covid-19 pandemic related challenges, highly acceptable to participants, and associated with a range of benefits that include improved communication function, self-efficacy and social support. The success of HEARS in a new population in a second Canadian province indicates its adaptability and suitability for scaling to extend the reach of hearing services for older adults who may not otherwise access care.

Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial

BackgroundDue to poorer exercise tolerance, it may be challenging for frail older adults to engage in moderate- or vigorous-intensity exercise. While low-intensity exercise interventions may be more feasible, its effectiveness for such population group remains unclear. We examined the effectiveness and implementation of community-based Baduanjin Qigong, a low-intensity exercise program in older adults with varying frailty status.MethodsA two-arm, multicenter assessor-blind parallel group randomized controlled trial was conducted at three local senior activity centers. Fifty-six community-dwelling older adults with low handgrip strength were randomly allocated to either the intervention (IG) or wait-list control (CG) group. The IG underwent a supervised 16-week Baduanjin exercise program at a frequency of 2–3 × 60 min sessions/week. The CG was instructed to maintain their usual activity and received a monthly health education talk. The primary outcome measures were knee extension strength, vital exhaustion, and fear of falling. Secondary outcome measures include physiological falls risk, handgrip strength, gait speed, timed up and go test, 30-second sit-to-stand, quality of life, depression, and frailty. All outcome measures were assessed at baseline and 4-month follow-up.ResultsOverall, there were no statistically significant differences in all outcome measures between CG and IG at 4-month follow-up. However, in exploratory compliance analysis, a statistically significant group x time interaction was found for vital exhaustion (B = -3.65, 95% CI [-7.13, -0.16], p = .047) among participants with at least 75% attendance. In post-hoc within-group comparisons, IG showed improved vital exhaustion by 4.31 points (95% CI [1.41, 7.20], d = 0.60). The average participant attendance rate was 81.3%. No major adverse events occurred, and all participants reported positive experiences with the exercise intervention.ConclusionsOur study demonstrated that Baduanjin is a safe, feasible, and acceptable exercise program that can be successfully implemented in community settings for older adults with varying frailty status. With good adherence, Baduanjin exercise could potentially be effective in alleviating vital exhaustion. However, the effectiveness of Baduanjin on physical performance, psychological measures and frailty in community-dwelling older adults remains equivocal.Trial registrationClinicalTrials.gov NCT04549103. Registered September 16, 2020.

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting.

The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial. To explore how patients and families navigate palliative care and the problems they experience. An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis. Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia. Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices. Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

Analyzing and Optimizing the Distribution of Blood Lead Level Testing for Children in New York City: A Data-Driven Approach.

This study investigates blood lead level (BLL) rates and testing among children under 6 years of age across the 42 neighborhoods in New York City from 2005 to 2021. Despite a citywide general decline in BLL rates, disparities at the neighborhood level persist and are not addressed in the official reports, highlighting the need for this comprehensive analysis. In this paper, we analyze the current BLL testing distribution and cluster the neighborhoods using a k-medoids clustering algorithm. We propose an optimized approach that improves resource allocation efficiency by accounting for case incidences and neighborhood risk profiles using a grid search algorithm. Our findings demonstrate statistically significant improvements in case detection and enhanced fairness by focusing on under-served and high-risk groups. Additionally, we propose actionable recommendations to raise awareness among parents, including outreach at local daycare centers and kindergartens, among other venues.

Assessment of Knowledge and Practices Related to Non-Surgical Management of Osteoarthritis Among Patients in the Rural Community of Sri Ganganagar, Rajasthan.

Introduction: Osteoarthritis (OA) is a degenerative joint disease that represents a major public health challenge, especially in rural communities where access to advanced healthcare is limited. This study aims to assess the knowledge, attitudes, and practices (KAP) related to the non-surgical management of osteoarthritis among patients in the rural district of Sri Ganganagar, Rajasthan, India. Method: A cross-sectional descriptive study was conducted among 234 adult OA patients aged 45 and above, residing in selected rural areas of Sri Ganganagar. Participants were recruited using convenience sampling from local health centers and community clinics. The data were analyzed using descriptive statistics, Chi-square tests, and correlation analyses to explore associations between demographic variables and KAP levels. Results: The study revealed that 29.9% of participants had adequate knowledge about OA, while 18.8% had inadequate knowledge. Regarding practices, 21.4% of participants demonstrated good practices in managing their OA symptoms, whereas 20.9% exhibited poor practices. Significant associations were found between age and education level with both knowledge and practice levels (p < 0.05). A moderate positive correlation was observed between age and knowledge score (r = 0.45, p = 0.002), and a strong positive correlation was found between knowledge and practice scores (ρ = 0.60, p < 0.001). Conclusion: The findings underscore the need for targeted health education programs in rural communities like Sri Ganganagar to bridge knowledge gaps and improve adherence to non-surgical OA management practices. Enhancing patient education and integrating healthcare providers in the patient education process could significantly improve OA management and patient outcomes in rural settings.

Exploring everyday racist symbolism in community recreation spaces: a critical race content analysis

ABSTRACT There has been a palpable shift in the public’s collective consciousness about the realities of racism in recent years. Community recreation organizations, like all other institutions, are not exempt from promoting racial inequity through taken for granted policies and practices. The purpose of this study was to explore some of the racist symbolism found within everyday artifacts at local community centres in a sub-urban area of Ontario, Canada. A Critical Race Content Analysis methodology was used to analyze bandages, promotional materials, and sunscreen. This study found that bandages in first aid supplies were exclusively for White skin tones, images in promotional materials featured mostly White people, and the sunscreen products stocked were not made for dark skinned folx. A discussion on the implications of each finding is provided followed by limitations and recommendations for research and practice.

Investigating the exciton dynamics in InGaN/GaN core-shell nanorods using time-resolved cathodoluminescence.

This study examines the exciton dynamics in InGaN/GaN core-shell nanorods using time-resolved cathodoluminescence (TRCL), which provides nanometer-scale lateral spatial and tens of picoseconds temporal resolutions. The focus is on thick (>20 nm) InGaN layers on the non-polar, semi-polar and polar InGaN facets, which are accessible for study due to the unique nanorod geometry. Spectrally integrated TRCL decay transients reveal distinct recombination behaviours across these facets, indicating varied exciton lifetimes. By extracting fast and slow lifetime components and observing their temperature trends along with those of the integrated and peak intensity, the differences in behaviour were linked to variations in point defect density and the degree and density of localisation centres in the different regions. Further analysis shows that the non-polar and polar regions demonstrate increasing lifetimes with decreasing emission energy, attributed to an increase in the depth of localisation. The semi-polar facet instead showed a spectral independence of the lifetime which could not be rationalised by an absence of exciton localisation. This investigation provides insights into the intricate exciton dynamics in InGaN/GaN nanorods, offering valuable information for the design and development of optoelectronic devices.

The Analysis of Risk Factors in Toddlers on The Occurrence of Stunting In Pidie

Nutritional issues in toddlers continue to be a primary concern in population settings. Among these issues are stunting, wasting, and overweight (World Health Organization, 2020). Stunting remains a major nutritional problem in developing countries such as Indonesia. Stunting, or chronic malnutrition, is a nutritional issue resulting from prolonged inadequate nutrient intake from food (Andriani et al., 2017). Short stature in toddlers (stunting) is determined by body length or height that is less than -2 SD according to WHO global references for children compared to other children of the same age (World Health Organization, 2013). The global prevalence of stunted toddlers, according to WHO, is 21.9%. According to the Indonesian Nutrition Status Survey (SSGI) by the Ministry of Health, the prevalence of stunted toddlers in this province was 31.2% last year. The highest incidence of stunting in Aceh is in Kota Subulussalam, which had the highest prevalence of stunted toddlers in Aceh in 2022, reaching 47.9%. This number jumped 6.1 points from 41.8% in 2021. Pidie Regency, with 27.8%, ranks fifth highest in Aceh. This study used a cross-sectional design with a sample of 334 toddlers chosen using the Slovin formula. Sampling was conducted randomly among mothers of underweight toddlers in local health center in Pidie Regency, which has a toddler population of 1,979. Statistical software SPSS 23 with Chi-square was used for data analysis. The findings from this study, derived from bivariate statistical analysis using the Chi-square test at a 95% confidence level, yielded a p-value of 0.268 (p > 0.05). This indicates that the Antenatal Care variable does not affect the risk of stunting. For the immunization variable, the test results showed a p-value of 0.515 (p > 0.05), indicating no relationship between immunization and the risk of stunting. For the exclusive breastfeeding variable, a p-value of 0.038 (p < 0.05) was obtained, indicating that exclusive breastfeeding affects the risk of stunting. The maternal nutrition during pregnancy variable resulted in a p-value of 0.037 (p < 0.05), indicating that maternal nutrition affects the risk of stunting. As for the parenting pattern variable, the test resulted in a p-value of 0.007 (p < 0.05), indicating that parenting patterns greatly influence the risk of stunting.

Cumulative incidence of vancomycin-resistant Enterococcus faecium detection by patient characteristics or possible exposures: prioritization of patients for active screening culture

The target population for active surveillance culture (ASC) of vancomycin-resistant Enterococcus species (VRE) by stool or rectal swabs has not been fully determined during VRE outbreaks in healthcare settings in non-VRE endemic situation. We evaluated cumulative incidences of VRE detection during a vancomycin-resistant Enterococcus faecium outbreak to determine reasonable target populations for ASC. Cases included inpatients whose first VRE-positive sample was obtained at Shizuoka General Hospital between February 2022 and January 2023, during which we conducted admission screening for possible high-risk patients, biweekly screening of all inpatients, admission and discharge screening in the high-care unit, and screening of contacts in each ward by using stool or rectal samples. We calculated cumulative incidences of VRE detection for those screened by patient characteristics or possible exposure. Among 60 cases identified, 55 (92%) were by ASC. Cumulative incidence was higher for contacts (6.4%, 15/234) than for those identified by other screening methods (0.5%, 40/8565). Among the patients identified through admission screening, those previously hospitalized in areas of reported VRE outbreaks had the highest cumulative incidence (6.6%, 5/78) followed by patients requiring toilet assistance (3.7%, 6/161). A bundle approach including ASC and prompt contact precautions by the hospital infection control team, local public health centre, and local and national infection control experts helped terminate the outbreak in seven months. Patients with contacts, prior hospitalization in areas with known VRE outbreaks, and who need toilet assistance appear to be high-risk populations for VRE detection and are candidates for ASC.

Community service initiative: Empowering Mothers in Wongsorejo, Banyuwangi, East Java to Prevent Stunting Through Education and Complementary Feeding Circle Demonstrations

The challenge of stunting in Indonesia remains critical, with the National Basic Health Research of 2018 indicating a high prevalence rate of 30.8%. Addressing stunting effectively requires targeted interventions and behavior change strategies. This community service project aimed to tackle stunting in Wongsorejo, Banyuwangi, East Java, through a comprehensive approach focused on nutrition and complementary feeding practices. The initiative was structured around three main activities: a seminar on stunting, counseling on complementary feeding, and a cooking demonstration. The seminar aimed to enhance understanding of stunting, including its causes, consequences, and preventive measures, with a specific focus on the role of mothers. The counseling sessions were designed to educate mothers about the implementation of complementary feeding circles to ensure their infants receive adequate nutrition. The cooking demonstration provided practical guidance on preparing nutritious complementary foods using local ingredients. This community service project targeted mothers in the Wongsorejo area, along with representatives from local health centers and community leaders. The objective was to improve knowledge and practices related to stunting prevention, nutrition, and healthy feeding habits. Methods included educational seminars, interactive counseling, and practical demonstrations. Overall, this project seeks to empower mothers with the necessary knowledge and skills to combat stunting, thereby contributing to improved child health and nutrition in the Wongsorejo community. The effectiveness of these activities was evaluated through pre- and post-intervention assessments.

애착외상경험을 가진 내담자의 상담과정에 대한 근거이론 연구

The purpose of this study is to understand what clients with attachment trauma experience experienced in short-term counseling with an integrated approach, explore the process of change, and build a substantive theory based on this. I'm doing it. For the purpose of the study, among adult clients aged 18 or older who had past attachment trauma experiences and who visited a local counseling center for various superficial complaints and received counseling, 13 people who voluntarily expressed their willingness to participate in the study were selected as final participants. The data collected through in-depth interviews using a semi-structured questionnaire were analyzed according to the grounded theory method suggested by Strauss and Corbin, and as a result of the analysis, 114 concepts, 40 subcategories, and 18 categories were ultimately derived. The research results based on data analysis are summarized as follows. First, the central phenomenon experienced by participants who experienced attachment trauma during short-term counseling in an integrated approach was ‘struggling to face a torn heart.’ Second, the core category of the counseling process of participants who experienced attachment trauma was ‘reconstructing attachment trauma into a story of acceptance and change.’ This study provides clues to a more in-depth understanding of people who have experienced attachment trauma and appropriate and effective treatment intervention, and provides a paradigm to approach attachment trauma research at an ontological level. It is significant in that it can provide basic data and practical knowledge to centers or public institutions that provide consultation.

Service Quality Perceived by Athletes: The Case of Local Government Youth Centre

Meeting the needs in social life is given to local governments by the state. Local governments are responsible for meeting the social needs of individuals. Today, youth center areas are built by local governments to meet the social needs of young people and to create social areas. These are areas opened by local governments to protect the mental and physical health of all young people, to provide socio -cultural support, to contribute to the education of young people in line with their interests and to develop their skills. Athletes mostly use these areas for their physical development. These explanations and expressions, in our research, athletes local administrations youth in the centers perceived service of the quality examination is intended. In our research, we used a 10-question personal information forum (Gender, Educational Status, Branch, Monthly Income Status, Age, Your Mother's Educational Status, Your Father's Educational Status, Your Mother's Profession, Your Father's Profession) created by the researchers. The "Perceived Service Quality Scale in Youth Centers" , whose validity and reliability study was conducted by Polat et al. (2013), consisting of 23 items and a 5-point Likert type consisting of three sub-dimensions ( Physical Environment Quality , Interaction Quality, Output Quality ) , was used. The sample of the research consists of 349 (n=145 Female, n=204 Male) volunteer athletes who are actively involved in three different sports branches (n=177 Athletics, n=116 Table Tennis, n=116 Cycling). The data of the research, which was designed as an analytical cross-sectional type, was collected face to face after receiving approval from the Siirt University Social Sciences and Humanities Research Ethics Committee. The data obtained in the research were evaluated in the SPSS 25.0 package program. As a result of the normality analysis of the scale, it was seen that the significance values were greater than 0.05 and it was decided to use non-parametric analyzes in the analysis. In our research, Kruskal Wallis H Test and Man Witney U Test were applied. In the statistical analysis, there was a statistically significant difference in the variables of gender, education level, monthly income level, your mother's education level, your father's education level and the sub-dimensions of the perceived service quality scale in youth centers and the scale general scores. It was observed that there was no statistical difference in the sub-dimensions of the scale of perceived service quality in youth centers and the overall scores of the scale with the variables of profession, your father's profession. As a results;In line with the findings obtained in our research, athletes local administrations youth in the centers perceived service of the quality mom and father education status , gender , education status , monthly income status with statistical aspect difference it shows detection has been made .

Health Care Utilisation in a Cohort of Patients with Primary and Secondary Antibody Deficiency in the United Kingdom

IntroductionThis study investigates the frequency of hospital attendances, emergency care attendances and geographical influences on service interaction in cohorts of patients with primary and secondary antibody deficiency, to inform future service planning and delivery.MethodsThe COVID-19 in Antibody Deficiency (COV-AD) study was a United Kingdom study that enrolled 525 participants between April 2021 and September 2022. Data on health care utilisation was extracted from a screening cohort of participants at one participating site (Birmingham, UK). Hospital attendance (i.e. all outpatient and inpatient care episodes, including hospital-based IVIG treatment) and emergency care attendance patterns were analysed. Geographical differences in travel times to hospitals and associated costs were considered for all participants at all recruiting sites.ResultsIndividuals with antibody deficiency had a median of 7 hospital attendances per year. A diagnosis of secondary antibody deficiency, and antibody deficiency severe enough to require treatment with immunoglobulin replacement were associated with an increased frequency of hospital attendance. 12.7% of the cohort attended the Emergency Department at least once in the preceding twelve months. Individuals with secondary antibody deficiency were at greater risk of requiring emergency care over the preceding one-year and five-year periods. Individuals receiving subcutaneous immunoglobulin lived further from their local immunology centre and were more likely to engage with the COV-AD research study remotely, via dried blood spots sampling.ConclusionThis study highlights the utilisation of emergency and secondary care usage amongst patient with immunodeficiency and may inform service adaptation and development to better accommodate patient needs and circumstances.

Effects of an 8-Week Active Play Intervention on Body Composition and Fundamental Motor Skills in Preschool Children.

Objective: Examine the effect of an 8-week teacher-guided active play intervention on preschoolers' body composition and fundamental motor skills. Methods: Participants were from two local preschool centers randomly assigned to either the intervention (n = 25, 3.91 ± 0.53 years) or the control group (n = 25, 3.69 ± 0.81 years). All measures were assessed at baseline (week 0), post-intervention (weeks 9-11), and follow-up (weeks 30-33). Bioelectrical Impedance assessed body composition (fat mass (FM) and fat-free mass (FFM)). The Peabody Developmental Motor Scales, Second Edition (PDMS-2) assessed fundamental motor skills (gross motor quartile (GMQ)). Results: A significant Group × Time interaction for GMQ at post-intervention (p = 0.03), with the intervention group scoring significantly higher on GMQ. A significant main effect of Time (p < 0.001) indicated that GMQ increased in both groups across the 33-week period. For FM, a significant main effect of Time at both post-intervention (p < 0.05) and follow-up testing (p < 0.001) indicated that participants increased FM over the 33-week period. Lastly, there was a significant main effect of Time for FFM at post-intervention (p = 0.003) and follow-up (p < 0.001). Interestingly, there was a significant Group × Time interaction (p < 0.05) at follow-up testing showing that FFM increased over time but significantly more for the control group. Conclusions: Results indicate that active play interventions might be a successful pathway to improve gross motor skills in young children. Further research is needed to understand the effect that active play interventions have on body composition in preschoolers.

Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates

Sodium nitrite is a curing agent increasingly used for self-harm and suicide, and multiple locales have reported increasing cases. However, approaches to forensic investigation of these cases are not standardized, and current modes of surveillance in the United States may be inadequate. To define a potential standard approach for identifying sodium nitrite deaths based on forensic confirmation, and compare findings based on this standard to poison center surveillance. This retrospective case series of sodium nitrite exposures and deaths was conducted in 2 urban medical examiner jurisdictions in New York State from 2000 to 2022. The population-based sample included individuals from (1) medical examiner reports of decedents where the cause of death was sodium nitrite and (2) poison center reports of intentional exposures to sodium nitrite. Sodium nitrite as either cause of death (medical examiner reports) or intentional exposure (poison center reports). Medical examiner determination of sodium nitrite deaths was considered the criterion standard and relied largely on confirmatory blood nitrite testing. Poison center records were assessed for intentional exposures to sodium nitrite. In this case series of 36 decendents, median (range) age was 28 (20-57) years; 23 (63.8%) were male; 6 (16.7%) were African-American, 5 (13.9%) were Chinese, 13 (36.1%) were White, and 4 (11.1%) had unknown race; and 6 (16.7%) were Hispanic. No deaths were found from 2000 to 2018, and yearly increases in deaths from 2019 to 2022; these deaths were largely missed by local poison center surveillance. Most cases (83.3% [n = 30]) had postmortem blood nitrite concentrations available, and multiple decedents had evidence of suicide kit recommendations from internet sources. In this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. These findings suggest that poison center surveillance underestimates confirmed deaths from sodium nitrite; public health authorities should rely on multiple data sources when analyzing this problem, and forensic analyses should be standardized.

Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B046.

Mobile Critical Care in Resource-Limited Settings: An Unmet Need.

Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.

Burn Care in the Street: A Survey of the Current Landscape of Burn Care Provided by Street Medicine Teams.

People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.