Multipronged Approach Research Articles

Reducing the harms of cannabis use in youth post-legalization: insights from Ontario youth, parents, and service providers

BackgroundCanada has one of the highest prevalence of cannabis use globally, particularly among young adults aged 20–24 (50%) and youth aged 16–19 (37%). In 2018, Canada legalized recreational cannabis with the aim of protecting youth by restricting their access and raising public awareness of health risks. However, there has been limited qualitative research on the perceptions of harms associated with youth cannabis use since legalization, which is crucial for developing effective harm reduction strategies. This qualitative study examined perceptions of cannabis use among youth from the perspectives of youth, parents, and service providers. We explored how participants described the perceived risks or harms associated with youth cannabis use, as well as how they described their own and others’ approaches to reducing cannabis-related risks and harms.MethodsThis qualitative study used a community-based participatory research approach in partnership with Families for Addiction Recovery (FAR), a national charity founded by parents of youth and young adults with addiction issues. Virtual semi-structured interviews were conducted, and the data were analyzed using thematic analysis.ResultsThe study included 88 participants from three key groups (n = 31 youth, n = 26 parents, n = 31 service providers). Two main themes emerged regarding perceived risks or harms associated with cannabis use: (1) concerns about cannabis-related risks and harms, including addiction, brain development, impact on family, and various adverse effects on areas such as motivation, concentration, finances, employment, education, physical and mental health; and (2) minimization of risks and harms, featuring conflicting messages, normalization, and perceptions of cannabis being less harmful than other substances. Additionally, two themes related to harm reduction approaches were identified: (1) implementation of harm reduction, and (2) challenges in implementing a harm reduction approach. Specific challenges for each participant group were noted, along with structural barriers such as unavailable and inaccessible services, easy access to cannabis, inadequate public education, and insufficient information on lower-risk cannabis use guidelines.ConclusionsYouth cannabis use is a significant public health concern that requires a multi-pronged approach. Developing youth-centered harm reduction strategies that recognize the developmental needs and vulnerabilities of youth, as well as the important role of families, is imperative.

Functional implications of the exon 9 splice insert in GluK1 kainate receptors

Kainate receptors are key modulators of synaptic transmission and plasticity in the central nervous system. Different kainate receptor isoforms with distinct spatiotemporal expressions have been identified in the brain. The GluK1-1 splice variant receptors, which are abundant in the adult brain, have an extra fifteen amino acids inserted in the amino-terminal domain (ATD) of the receptor resulting from alternative splicing of exon 9. However, the functional implications of this post-transcriptional modification are not yet clear. We employed a multi-pronged approach using cryogenic electron microscopy, electrophysiology, and other biophysical and biochemical tools to understand the structural and functional impact of this splice insert in the extracellular domain of GluK1 receptors. Our study reveals that the splice insert alters the key gating properties of GluK1 receptors and their modulation by the cognate auxiliary Neuropilin and tolloid-like (Neto) proteins 1 and 2. Mutational analysis identified the role of crucial splice residues that influence receptor properties and their modulation. Furthermore, the cryoEM structure of the variant shows that the presence of exon 9 in GluK1 does not affect the receptor architecture or domain arrangement in the desensitized state. Our study thus provides the first detailed structural and functional characterization of GluK1-1a receptors, highlighting the role of the splice insert in modulating receptor properties and their modulation.

Functional implications of the exon 9 splice insert in GluK1 kainate receptors.

Kainate receptors are key modulators of synaptic transmission and plasticity in the central nervous system. Different kainate receptor isoforms with distinct spatiotemporal expressions have been identified in the brain. The GluK1-1 splice variant receptors, which are abundant in the adult brain, have an extra fifteen amino acids inserted in the amino-terminal domain (ATD) of the receptor resulting from alternative splicing of exon 9. However, the functional implications of this post-transcriptional modification are not yet clear. We employed a multi-pronged approach using cryogenic electron microscopy, electrophysiology, and other biophysical and biochemical tools to understand the structural and functional impact of this splice insert in the extracellular domain of GluK1 receptors. Our study reveals that the splice insert alters the key gating properties of GluK1 receptors and their modulation by the cognate auxiliary Neuropilin and tolloid-like (Neto) proteins 1 and 2. Mutational analysis identified the role of crucial splice residues that influence receptor properties and their modulation. Furthermore, the cryoEM structure of the variant shows that the presence of exon 9 in GluK1 does not affect the receptor architecture or domain arrangement in the desensitized state. Our study thus provides the first detailed structural and functional characterization of GluK1-1a receptors, highlighting the role of the splice insert in modulating receptor properties and their modulation.

The impact of a payer-provider joint venture on healthcare value.

To examine how a novel payer-provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value-based payment, care management, and non-financial supports, impacted healthcare value and payer and provider group experiences. We conducted a mixed-methods study. We used a quasi-experimental longitudinal difference-in-differences design to examine the impact of the JV (which started in January 2016 and ended in December 2020) on healthcare utilization, quality, and spending, using members in Maine (ME) as a control group. We also analyzed patient uptake of the JV's care management program using routinely collected administrative data and assessed payer and provider group leaders' perspectives about the JV via semi-structured interviews. We used administrative and claims data from 2013 to 2019 in a commercially insured population under 65 years in NH and ME. We also used administrative data on care management eligibility and uptake and conducted semi-structured interviews with payer and provider group leaders affiliated with the JV. The JV was associated with no sustained change in medical utilization, quality, and spending throughout the study period. In the first year of the JV, there was a $142 (95% confidence interval: $41, $243) increase in pharmaceutical spending per member and a 13% (4.4%, 25%) relative increase in days covered for diabetes medications. Only 15% of eligible members engaged in care management, which was a key component of the JV's multi-pronged approach. In a disconnect from the empirical findings, payer and provider group leaders believed that the JV reduced healthcare costs and improved quality. Our findings provide evidence for future payer-provider JVs and demonstrate the importance of having a valid control group when evaluating JVs and value-based payment arrangements.

Unveiling the intermolecular forces and unique properties of [EMIM][EtSO4] + [EMIM][MeSO3]

This study delves into the intricate interplay of intermolecular forces governing the archetypal ionic liquid mixture [EMIM][EtSO4] + [EMIM][MeSO3] through a synergistic integration of experimental and computational techniques. High-precision measurements of density, viscosity, and thermal conductivity across a temperature and compositional landscape unveil the system’s phase behavior and miscibility. Complementary insights into the microscopic interactions, including hydrogen bonding and ion-specific effects, are gleaned from molecular dynamics simulations and quantum mechanical calculations. This multipronged approach fosters a comprehensive understanding of the underlying forces dictating the observed thermophysical properties, propelling fundamental knowledge in the realm of ionic liquid mixtures and paving the way for the rational design of tailor-made ionic liquids with targeted properties for diverse fields, ranging from chemical engineering to energy storage.

Ethical considerations in surgical research conducted in African LMICs: a comprehensive narrative review

Introduction: Surgical research has revolutionized healthcare by improving the efficacy, safety, and efficiency of surgical interventions. This research has the potential to significantly impact healthcare delivery in Africa, where surgical diseases pose a major public health burden. Studies suggest surgery alone could reduce the global disease burden by 11%, with a substantial portion stemming from conditions prevalent in sub-Saharan Africa like traumatic injuries, childbirth complications, and surgical infections. However, conducting surgical research in Africa presents unique ethical challenges. The continent’s diverse socio-economic environments and rich cultural contexts necessitate careful consideration of ethical principles. Traditional research models often don’t translate well to African settings, raising concerns about informed consent, community engagement, and benefit-sharing. Aim: This review aims to shed light on various ethical dilemmas posed within surgical research, conducted in African countries. Further, standard practices and recommendations that involve a multi-pronged approach to mitigate said issues were explored. Materials and methods: A meticulous analysis of the existing literature pertaining to the ethical issues proffered in Africa was performed. Databases employed comprised PubMed/MEDLINE, Embase, Scopus, and EBSCOhost. Pertinent case studies were also reviewed to comprehend said issues, providing comprehensive recommendations. Results: In addressing the ethical challenges in the research, the importance of resource limitation, sociocultural factors, informed consent barriers, technological obsolescence, training deficits, power dynamics, vulnerable populations, regulatory oversight, and compliance was highlighted. The proposed approaches include conducting focused research lectures and practical workshops on surgery, organizing surgical boot camps for medical students, interns, and residents, promoting research in related fields such as anesthesia, radiology, and pathology, ensuring the presence of on-site surgeons as needed, and arranging outreach surgical and educational camps for patients. Conclusion: Promoting community engagement and training local researchers and surgeons are crucial for navigating the unique ethical landscape in Africa. By prioritizing ethical considerations, surgical research can contribute to improved healthcare outcomes and a more equitable healthcare system across the continent.

Medical students and house officers’ perception, attitude and potential barriers towards artificial intelligence in Egypt, cross sectional survey

BackgroundArtificial intelligence (AI) is one of the sectors of medical research that is expanding the fastest right now in healthcare. AI has rapidly advanced in the field of medicine, helping to treat a variety of illnesses and reducing the number of diagnostic and follow-up errors.ObjectiveThis study aims to assess the perception and attitude towards artificial intelligence (AI) among medical students & house officers in Egypt.MethodsAn online cross-sectional study was done using a questionnaire on the Google Form website. The survey collected demographic data and explored participants’ perception, attitude & potential barriers towards AI.ResultsThere are 1,346 responses from Egyptian medical students (25.8%) & house officers (74.2%). Most participants have inadequate perception (76.4%) about the importance and usage of AI in the medical field, while the majority (87.4%) have a negative attitude. Multivariate analysis revealed that age is the only independent predictor of AI perception (AOR = 1.07, 95% CI 1.01–1.13). However, perception level and gender are both independent predictors of attitude towards AI (AOR = 1.93, 95% CI 1.37–2.74 & AOR = 1.80, 95% CI 1.30–2.49, respectively).ConclusionThe study found that medical students and house officers in Egypt have an overall negative attitude towards the integration of AI technologies in healthcare. Despite the potential benefits of AI-driven digital medicine, most respondents expressed concerns about the practical application of these technologies in the clinical setting. The current study highlights the need to address the concerns of medical students and house officers towards AI integration in Egypt. A multi-pronged approach, including education, targeted training, and addressing specific concerns, is necessary to facilitate the wider adoption of AI-enabled healthcare.

Beyond Benchmarking: A Diagnostic Inquiry into the Underlying Determinants of Low Performance in Philippine PISA Science

The Philippines’ consistently low performance in the Program for International Student Assessment (PISA) Science Assessment has sparked concerns about the country’s educational quality and competitiveness. The science scores are due to socioeconomic status, teacher quality, resource deficiencies, and systemic issues. A multi-pronged approach with evidence-based interventions is recommended to improve scientific literacy. This paper conducts a diagnostic inquiry into the underlying determinants contributing to Filipino students’ underachievement in PISA science. Drawing from an extensive literature review, the analysis identifies several interrelated factors spanning multiple levels of the educational system. Socioeconomic status, motivation, self-efficacy beliefs, and language proficiency emerged as significant predictors at the student level. School-level determinants include resource deficiencies, lack of qualified science teachers, and inadequate instructional practices. Furthermore, systemic issues like fragmented policy implementation, curriculum misalignment, and insufficient investment in education undermine performance. The paper argues for a holistic, multi-pronged approach targeting these diverse determinants through evidence-based interventions and policy reforms to enhance scientific literacy and elevate educational outcomes in the Philippines.

Government schemes empowering Indian women: A study in the reference of Bihar

Many schemes being run by the government to empower women are now bearing fruit. These schemes are not only empowering the women of villages in India but they are also becoming aware of their rights. Bihar is the best example of this. Where today women's status has increased not only in jobs but also in the family. Women's respect and self-respect have both increased. Calling women weak is now a thing of the past. Women's interference and their participation has increased in every field of society and family. Today no family will be able to live happily by ignoring women. The schemes being run by the Government of India and the Government of Bihar to make women empowered and self-reliant have a big role behind this. In a developing state like Bihar, where earlier women not only used to go out under the veil but they also used to have less participation in the decisions of the family and society, but now this has become a thing of the past. Now women have become aware of their rights. Many laws have been made at the government level to protect their safety and their rights, which have proved to be a boon for the interests of women. After the liquor ban in Bihar, the safety of women has improved further. It is known that there is a liquor ban in Bihar since the year 2016. The effect of which has proved to be significant in the progress of women. In India, the population of women in the year 2024 is 48.4 percent. At the same time, the population of men is 51.6 percent. In India, there are 1,020 women for every 1,000 men. This is the first time that the population of women in India has exceeded that of men. Many schemes of the central government are only for women. At the same time, the Nitish government of Bihar is also running many schemes for women empowerment. The Modi government has taken many steps towards women empowerment. The benefits of which have been received by the women of the country on a large scale. Gender justice is an important commitment of the government enshrined in the Constitution of India. Several steps have been taken by the government in the last few years to promote a gender-just society and increase the representation of women in various sectors. In the last few years, India has been witnessing a rapid shift from women-led development to women-led development in the vision of a new India. Towards this end, the government has adopted a multi-pronged approach to address women's issues on a life-cycle continuum, encompassing educational, social, economic and political empowerment, so that they can become equal partners in rapid and sustainable national development. India is currently one of the 15 countries in the world to have a woman head of state. Several schemes for women empowerment in Bihar are being run by the Government of Bihar and the Government of India. Many of these schemes are related to sectors such as employment, agriculture and health. These schemes have been formulated keeping in view the situation of women in Bihar so that their participation in society can be increased. Without women empowerment, women cannot get the place in Bihar, country and society, which they have always been entitled to. Without women empowerment, she cannot fight centuries old traditions and evils. She cannot free herself from bondages and take her own decisions.

A Comprehensive Strategy to Address Anxiety and Depression among Young People

Anxiety is defined as anxiety, nervousness, or restlessness caused by the anticipation of internal and external dangers. Adolescent depression and anxiety are a global problem, with WHO data showing that 14% of young people aged 10-19 face mental health problems worldwide. Depression and anxiety in adolescents are complex diseases that arise from the interaction of multiple factors, including biological, psychological, socio-cultural, and social factors. Adolescent depression and anxiety can be solved through proper measures. We propose a multi-pronged approach to address this mental health crisis, along with actionable solutions from principally the physical and psychological aspects. We aim to mitigate the negative consequences and foster an environment where young people can thrive emotionally, academically, and socially.

Effective Strategies to Improve the South African Police Service's (SAPS) Capacity to Reduce Crime and Enhance Public Safety

This research delves into the critical issues of crime reduction and police service improvement in South Africa. South Africa faces a significant challenge: high crime rates, particularly violent crime and gender-based violence. This undermines public safety and necessitates a multifaceted approach to achieve a safer society. This research explores evidence-based strategies for crime reduction and police service improvement within the South African context. Main Topics: Crime reduction strategies we examine how evidence-based policing, situational crime prevention, and social crime prevention can be adapted and implemented effectively in South Africa. Strengthening the South African Police Service (SAPS): We analyze how to enhance the SAPS through improved resource allocation, specialized training programs, and a focus on community policing and trust- building. Key Arguments crime reduction requires a multi-pronged approach that addresses both criminal behavior and the underlying social factors that contribute to it. Evidence-based policing, situational crime prevention, and social crime prevention offer promising strategies when tailored to the specific contexts of South African communities. Strengthening the SAPS through improved resources, training, and community relations is crucial for building trust and enhancing public safety. Approach This research employs a literature review approach, analyzing existing research on crime reduction strategies, police service improvement, and the South African context. Significance this research has the potential to inform policymakers, police leadership, community organizations, and future research endeavors. By identifying effective strategies and outlining practical recommendations, this research can contribute to a safer and more just South Africa. Audience this research is targeted towards a broad audience, including Policymakers involved in developing and implementing crime reduction strategies. Police leadership seeking to improve the effectiveness and efficiency of the SAPS. Community organizations working to address crime and promote safety in their neighborhoods. Researchers interested in furthering the understanding of crime and policing in South Africa. Conclusion by critically examining crime reduction strategies and exploring ways to strengthen the SAPS, this research lays the groundwork for a safer and more secure South Africa. Implementing the recommendations outlined here can contribute to a future where all South Africans feel safe and secure in their communities.

Cardiometabolic outcomes in patients with overweight and obesity undergoing weight loss trials : a network meta-analysis

Abstract Objective Cardiometabolic outcomes are intrinsically linked with obesity. According to a study by Jayedi A et al. a 5kg weight gain could increase CVD mortality and MI risk by 11% and 18% respectively, with most overweight and obese patient also suffering from cardiometabolic derangements. This network meta-analysis evaluates cardiometabolic effects bought about by glucagon-like peptide 1 receptor agonists (GLP-1 RA) and other weight loss drugs in an overweight and obese population. Methods Cochrane CENTRAL, Embase and Medline were searched for randomised clinical trials (RCTs) on GLP-1 RA and United States Food and Drug administration weight loss drugs. A network meta-analysis was performed, using risk ratios(RR) to compare the efficacy of the interventions against one another. Network diagrams and surface under the cumulative ranking curve analysis were generated for the following cardiometabolic outcomes ( LDL, HDL, TC, TG, HbA1c, FPG, SBP and DBP). Results Among the cardiometabolic outcomes analysed, the GLP-1RA’s consistently ranked on top, with tirzepatide followed by semaglutide and then liraglutide. In terms of glycaemic control, tirzepatide 15, 10 and 5mg ranked first in a dose dependent manner(SUCRA = 0.8480, 0.8410, 0.6725) followed by semaglutide1.7mg(SUCRA= 0.6232). Tirzepatide 15mg did not achieve statistical significance compared to semaglutide 1.0mg (MD: -0.77, 95%CI: -2.04 to 0.50) or liraglutide1.8mg (MD: -0.64, 95%CI: -1.68 to 0.41). In reducing blood pressure, tirzepatide exhibiting a dose dependent reduction with Tirzepatide 15mg, (SUCRA =0.9457),10mg(SUCRA=0.9069)and 5mg(SUCRA=0.8419) followed by semaglutide 1.7mg (SUCRA =0.7415) then liraglutide 1.8mg(SUCRA = 0.5521).Tirzepatide 15mg demonstrated statistical significance compared to semaglutide 1.0mg (MD: -3.53, 95%CI: -6.78 to -0.27) and liraglutide 3.0mg (MD: -3.47, 95%CI: -5.59 to -1.36). The GLP-1RA’s also exhibited superiority in lipid reduction for TC and TG, with tirzepatide reducing TC (SUCRA = 0.7867) and TG(SUCRA = 0.9843) followed by semaglutide 1.7 mg (SUCRA = 0.7796) for TC and tirzepatide 10 mg (SUCRA = 0.9018) for TG. Orlistat 120mg(SUCRA =0.8789) and 60mg(SUCRA= 0.8458) were superior in reducing LDL, with tirzepatide 15mg(SUCRA =0.7806) and then semaglutide 2.4mg(SUCRA=0.7260) coming in behind. Naltrexone 32mg/Bupropion 360mg(SUCRA = 0.8757) ranked first followed by tirzepatide(SUCRA=0.8593) in increasing HDL, however the increase was not statistically significant (MD: 0.00, 95%CI: -0.04 to 0.05). Conclusion GLP-1 RAs’ superiority in addressing cardiometabolic parameters that are often deranged in patients with overweight and obesity highlights the need for weight lost medication transitioning from one that decreases and suppresses appetite or prevent the absorption of lipids to one that targets the altered metabolic mileu of patients with overweight and obesity, highlighting the multipronged approach needed to treat this metabolic disease.

Clays as Micro-Electrodes in Environmental Detoxification

AbstractIn-situ reduction of contamination in soil and groundwater is an ongoing challenge that often requires a multi-pronged approach for effective and efficient clean-up. Spontaneous or assisted electrochemical reactions that break down certain pollutants held on clay surfaces can render natural clays a unique and powerful ally in environmental mitigation of contaminated soils. Application of a low-level DC electric field (mV/cm) has been shown to facilitate transformation of some compounds and ionic species through redox reactions in addition to transporting them through the pores in wet clay soils. Results from previous tests suggest that the natural electrochemical processes that promote pollutant sloughing or chemical breakdown can be enhanced for targeted treatment by applying low-level electric field to the contaminated soil with clay content. The central idea of this hypothesis is that clay, due to its surface charge and electrostatic interaction with adjacent pore fluid, acts as a “micro-electrode” through the diffused double layer (DDL) interactions when subjected to an external electric field. This hypothesis, proven viable, may unlock potential ability of natural clays to generate beneficial reactions for detoxification of contaminated sub-surfaces. Evidence from past laboratory experiments accompanied by a proposed electrical model of clay behaving as a micro-electrode are presented in this paper. The laboratory experiment results support the proposed electrical model.

Can schools and libraries curb the functional illiteracy crisis? Insights from the Netherlands

ABSTRACT Increasing parts of the world population have rudimentary reading and writing skills but limited command of grammar, syntax and spelling. This functional illiteracy has detrimental effects on labor market participation, population health and political stability. Geographies of illiteracy also include affluent societies like the Netherlands, a country that is not only illustrative of a widespread phenomenon, but arguably also a bellwether of things to come elsewhere in the world if these developments are not reversed. This exploratory paper focuses on two institutional spaces where the literacy crisis is conventionally addressed: schools and public libraries. We argue that while each has a contribution to make, neither institution is currently able to curtail the trend, partially because preferred literacy promotion methods are incongruent with rapidly evolving changes in the literacy landscape, especially regarding youth communication. We consider three possible responses to our current literacy crisis and conclude that efforts to curb functional illiteracy require a pragmatic and multi-pronged approach, and perhaps even some counterintuitive strategies.

Impact of the EduIntegrity Suite on Academic Integrity: A Qualitative Study

The EduIntegrity Suite, a collection of tools designed to promote academic integrity, has garnered significant interest within educational institutions. This study explores the Suite's perceived effectiveness and its influence on various stakeholders through a mixed-methods approach. Semi-structured focus group interviews were conducted with students, educators, and administrators at institutions utilizing the Suite. Student discussions explored their perceptions of the Suite's impact on their learning environment and potential concerns. Educators discussed how the Suite influenced their teaching practices and addressed suspected misconduct. Administrator focus groups provided insights into the decision-making process for implementing the Suite, its effectiveness, and its broader cultural influence. An online component complemented the focus groups, involving a comprehensive review of documents and websites related to the Suite. Company websites and product information for the Suite's individual tools were examined. Academic resources discussing the Suite's functionalities and potential applications were reviewed. News articles and blog posts offering insights from educators, administrators, and students regarding their experiences were explored. The findings highlight the Suite's multifaceted functionalities, including plagiarism detection, grammar and citation checking, originality reports, and remote proctoring services. While students acknowledged the Suite's potential deterrent effect, concerns about workarounds and a shift in focus from learning to detecting cheaters were also voiced. Administrators, however, emphasized the Suite's potential as a tool for promoting a culture of academic integrity, not just detecting plagiarism. Transparency and clear communication emerged as crucial for fostering trust and student acceptance. The EduIntegrity Suite appears to offer a promising approach to academic integrity when implemented strategically and combined with effective pedagogical practices. However, the success hinges on a multi-pronged approach that addresses student concerns, utilizes the Suite's functionalities effectively, and fosters a culture of ethical learning within the institution. To achieve this, institutions can prioritize clear communication about the Suite's purpose and limitations, support and develop staff with the Suites functionality and ethical consideration. Moreover, encourage educational initiatives that promote critical thinking, responsible research practices, and proper citation skills. Collaboration between educators and administrators can leverage the Suite's capabilities to create a more supportive and ethically sound learning environment.

Water scarcity and public health concerns in rural India: a case study of Nongpok Sekmai and surrounding villages

This study examines the critical issue of water scarcity and its impact on public health in Nongpok Sekmai and surrounding villages in India. Despite government initiatives to provide universal tap water access by 2024, these villages lack safe drinking water. Traditional sources like open wells are contaminated, and the primary river is drying up due to illegal sand mining and gravel extraction activities upstream. This situation results in a significant public health burden, with villagers facing financial strain due to waterborne diseases and the need to purchase water for basic needs. The study also examines the negative link between on-premise access to safe water and mothers' time spent on water collection. The study highlights the need for a multi-pronged approach. Renewed government efforts to implement the tap water initiative or provide alternative clean water sources like filtration plants or community wells are crucial. Additionally, stricter enforcement is needed to curb illegal mining activities and ensure river sustainability. Furthermore, exploring community-based solutions like rainwater harvesting and raising awareness about waterborne diseases and sanitation practices can empower the population. Addressing this water crisis demands a collaborative effort from the government, local communities, and environmental agencies. This study employed a mixed-methods approach, utilizing visual photographic analysis and community engagement to investigate water contamination in Nongpok Sekmai river, Manipur. The findings highlight key contamination indicators such as turbidity, algae blooms, and floating debris, while also addressing the health and social impacts perceived by the local population.

Examining the Influence of Corruption on the Practice of Trophy Hunting in South Africa

This study examines the perceived influence of corruption on the practice of trophy hunting in South Africa, the largest trophy exporter in Africa. Corruption is a major problem in South Africa, where it takes the form of bribery and embezzlement. To investigate its perceived effects on the practice of trophy hunting, semi-structured interviews were conducted with 15 trophy hunting stakeholders in South Africa. Interviews were conducted via Zoom, recorded, transcribed, and coded using a qualitative content analysis. Six of the 15 respondents had personally witnessed corruption in the trophy hunting industry in South Africa, and 13 respondents had heard accounts of corruption witnessed or experienced by others. Respondents identified several perceived problems caused by corruption in the trophy hunting industry and suggested ways to mitigate corruption. Based on these results, a multi-pronged approach for addressing corruption within the trophy hunting industry in South Africa may be necessary.

The Mortality of Politics: An American Paradox

Introduction: The USA has the poorest health statistics of any high-income country. Political polarization has risen dramatically; newer safety net programs (the Affordable Care Act [ACA]) are unevenly provided because many Republican-leaning states refused expanded Federal coverage. Democratic programs have reduced physician leadership of medicine. Both have been deleterious. Here, we investigated associations among four key health measures two of which directly impact pregnancy outcomes and two that affect all patients by percentage of each state that voted for the Republican versus Democratic candidate in the 2020 presidential election. Methods: For each state, we used public, non-partisan databases to assess the incidence of COVID, maternal, and infant mortality per 100,000 population and average life expectancy. Correlations among these four outcome variables and percentage Republican vote were calculated (r), contextualized by measuring associations with related variables including COVID vaccination rates, access to medical care, and incidences of heart disease, obesity, diabetes, gunshot deaths, and automotive fatalities. Results: COVID mortality, maternal and infant mortality, and life expectancy were highly correlated with percentage Republican (“red”) vote per state. If “red” states had vaccination rates equivalent to Democratic-leaning (“blue”) states, 72,000 deaths could have been avoided. Overall, “red” states have lower health metrics, reduced access to care, and higher comorbidities. Conclusion: The percent Republican vote was strongly associated, but not the whole answer, with worse health outcomes for multiple key measures of public health including mortality, access to care, and various comorbidities. Overall, the ACA has improved patient access to care but has also led to “maternity care deserts” disproportionately in rural areas in “red” states. Translating insurance coverage into improved care and outcomes requires further analysis and will require multi-pronged approaches including expanding coverage and incentivizing quality care.

Identifying Gaps and Barriers in Alzheimer's Disease and Related Dementia Research and Management in Low- and Middle-Income Countries: A Survey of Health Professionals and Researchers.

The significant increase in Alzheimer's disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders.

8757 Contingency Planning in the Event of Insulin Pump Failure or Malfunction - a Quality Improvement Initiative

Abstract Disclosure: S. Avula: None. H. Hashmi: None. A.R. Ankireddypalli: None. S. Inkollu: None. M. Salim: None. A. Ahmed: None. J. Kohlenberg: None. T. Harindhanavudhi: None. Background: People using insulin pump therapy are at risk of adverse outcomes, including hyperglycemia and diabetic ketoacidosis, in the event of pump failure or malfunction. A standing prescription for subcutaneous basal insulin, which can be filled as needed, has the potential to prevent these adverse outcomes. Aim: We aimed to increase the percentage of standing prescriptions for subcutaneous basal insulin by 20 % over 6-month duration for people using insulin pump therapy. Methods: Pre-intervention: We retrospectively obtained baseline electronic health record data for people with diabetes on insulin pump therapy in our health system (M Health Fairview, University of Minnesota) from January 1, 2022, to December 31, 2022. Intervention: Over a six-month duration, a multifaceted intervention was implemented. (1) During the rooming process for endocrinology appointments, the medical assistants inquired if the person using insulin pump therapy had a standing prescription for basal insulin in the event of insulin pump failure or malfunction. If not, the medical assistant encouraged the person with diabetes to review this with their Endocrinologist. (2) Informational brochures, placed in the exam rooms, encouraged people using insulin pump therapy to discuss a standing order for basal insulin. (3) Emails were sent to all endocrinology providers to encourage discussion of the provision of a standing prescription for basal insulin for people on insulin pump therapy. Post - intervention: We recorded the number of people with a standing prescription for subcutaneous basal insulin from 5/1/2023 to 5/14/2023. Results: The total number of patients with diabetes on insulin pumps prior to the intervention was 256. Of 256 patients with insulin pump therapy, 109 patients (42.6%) had standing basal insulin prescribed. A post-intervention chart review of patients with diabetes on an insulin pump was conducted for a total of 69 patients, of which 56 patients (81.2%) had backup basal insulin prescribed. The estimation of difference was - 0.3858 (p= <0.05; 95% CI for difference -0.4961, -0.2754). Conclusion: This multipronged approach increased the prescription availability and awareness among providers and patients for a standing order of basal insulin in the event of insulin pump failure or malfunction from 42% to 81%. Limitations of this study include the limited duration of intervention and the need to send repeated reminders to all providers, including clinic staff. The next plan is to create a best practice alert in EMR to alert providers to have a backup basal insulin plan for anyone on an insulin pump. Create a custom dot phrase of insulin backup plan in EMR. Presentation: 6/3/2024