Practice Characteristics Research Articles

Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits

Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending. To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results. This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024. Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic. Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending. In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01). This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

Esophageal Function Testing Patterns in the Evaluation and Management of Lung Transplantation: Results of a National Survey.

We surveyed esophageal motility laboratories affiliated with adult pulmonary transplant centers to determine esophageal function testing (EFT) practices. Gastroesophageal reflux and esophageal dysmotility are associated with worse lung transplant outcomes, yet no consensus guidelines for EFT exist in this population. A deidentified online survey was sent to gastrointestinal motility laboratory directors of 49 academic and community-affiliated medical centers that perform lung transplants. Practice characteristics, including annual lung transplant volume and institutional EFT practices pre-lung transplantation and post-lung transplantation were queried. Respondents were categorized by transplant volume into small and large programs based on median annual volume. Among 35 respondents (71% response rate), the median annual transplant volume was 37, and there were 18 large programs. Institutional EFT protocols were used pretransplant by 24 programs (68.6%) and post-transplant by 12 programs (34.2%). Among small and large programs, 52.9% and 72.2% always obtained high-resolution manometry before transplant, respectively. Endoscopy before transplant was performed more often in small programs (n=17, 100%) compared with large programs (n=15,83.3%). Pretransplant endoscopy ( P =0.04), barium esophagram ( P <0.01), and high-resolution manometry ( P =0.04) were more common than post-transplant. In contrast, post-transplant reflux monitoring off-therapy was more common than pretransplant ( P =0.01). In general, pulmonologists direct referrals for EFT and gastroenterology consultation (n=28, 80.0%), with symptoms primarily prompting testing. In the absence of established guidelines, substantial variability exists in pretransplant and post-transplant EFT, directed by pulmonologists. Standardized EFT protocols and gastroenterologist-directed management of esophageal dysfunction has potential to improve lung transplant outcomes.

Characteristics of walk-in clinic physicians and patients in Ontario: Cross-sectional study.

To describe family physicians who primarily practise in a walk-in clinic setting and compare them with family physicians who provide longitudinal care. A cross-sectional study that linked results from a 2019 physician survey to provincial administrative health care data in Ontario. The characteristics, practice patterns, and patients of physicians primarily working in a walk-in clinic setting were compared with those of family physicians providing longitudinal care. Ontario. Physicians who primarily worked in a walk-in clinic setting in 2019, as indicated by an annual physician survey. Physician demographic and practice characteristics, as well as their patients' demographic and health care utilization characteristics, were reported according to whether the physician was a walk-in clinic physician or a family physician who provided longitudinal care. Compared with the 9137 family physicians providing longitudinal care, the 597 physicians who self-identified as practising primarily in walk-in clinics were more frequently male (67% vs 49%) and more likely to speak a language other than English or French (43% vs 32%). Walk-in clinic physicians tended to have more encounters with patients who were younger (mean 37 vs 47 years), who had lower levels of prior health care utilization (15% vs 19% in highest band), who resided in large urban areas (87% vs 77%), and who lived in highly ethnically diverse neighbourhoods (45% vs 35%). Walk-in clinic physicians tended to have more encounters with unattached patients (33% vs 17%) and with patients attached to another physician outside their group (54% vs 18%). Physicians who primarily work in walk-in clinics saw many patients from historically underserved groups and many patients who were attached to another family physician.

Utilization of genomic tumor testing (GTT) among community oncologists participating in SWOG S2108CD.

320 Background: As targeted therapy options increase in oncology, GTT use is also increasing; however, the strategies and barriers to ordering GTT can vary across clinics. S2108CD is a cluster randomized trial comparing an educationally enhanced genomic tumor board intervention to usual practice to increase evidence-based genome-informed therapy based on GTT results. This analysis seeks to understand the utilization of GTT by physicians in rural and community oncology clinics. Methods: Physicians at sites enrolled on S2108CD completed baseline questionnaires collecting demographics, practice characteristics, and physicians’ experience with and use of GTT in practice. We also conducted semi-structured interviews at baseline and mid-study with select physicians in both arms to understand how and when physicians are ordering GTT and how it guides treatment decision making. Descriptive statistics were generated for survey data. Interviews were analyzed using conventional content analysis to identify recurring themes. Results: Surveys were completed by 117 physicians across 18 Recruitment Centers, with 57 from the usual practice and 60 from the intervention arm. Interviews were conducted with 10 physicians at baseline and 10 within 12-18 months of start of the study. Physicians reported feeling confident in determining whether GTT is clinically appropriate for a patient (42% moderately confident, 50% very confident). Some physicians utilize GTT from multiple vendors, with the following vendors used most frequently: Tempus (50% of physicians), Caris Life Sciences (61%), Foundation Medicine (62%) and Guardant Health (69%). Over two-thirds of physicians reported that professional guidelines were “very important” in the decision to utilize GTT. Reasons for not ordering GTT included “not relevant for the patient” (36%) and “difficulty in obtaining sufficient tissue” (20%) as “often” reasons. Notably, lack of access and cost/insurance coverage were “never” or “rarely” a reason for not ordering GTT in 80% physicians. Long waits to receive GTT results reportedly caused a delay in making patient care decisions (47% sometimes and 26% often). Physicians rely on the following sources to learn about new GTT panels: scientific meetings (91%), peer-reviewed literature (92%), and professional societies (90%). Interview data confirmed that physicians are generally confident ordering GTT but there is variability in the processes for ordering GTT and receipt of GTT results amongst clinics. Conclusions: Physicians enrolled on S2108CD self-reported high genomic confidence in ordering GTT. Access to GTT and coverage of GTT do not appear to be barriers to utilization. However, physicians did report delays in decision-making due to result turn-around times, which were sometimes attributed to length of time to tissue sendout and receipt of results into health record. Funding : NIH/NCI/NCORP grant UG1CA189974. Clinical trial information: NCT05455606 .

A Comprehensive Analysis of the Physician Assistant/Associate Orthopedics Workforce

Background: For over half a century, physician assistants/associates (PAs) in orthopedics have been a source of specialized medical and surgical labor. Given the increasing demand for orthopedic surgeons and the concurrent growth of PAs, we analyzed the characteristics of PAs in orthopedics to understand how they compare with PAs across all other medical and surgical roles in the United States. Methods: In this national cross-sectional study, we used 2022 PA workforce data from the National Commission on the Certification of Physician Assistants. Our investigation included descriptive and bivariate data assessing PAs in orthopedics versus all other medical fields on various factors related to demographics, education/training, practice characteristics, and other important traits. Results: In this analysis, 12,599 (10.7%) of 117,748 board certified PAs who responded working in a clinical specialty indicated participating in orthopedics in 2022. The proportion of PAs practicing in orthopedics increased by nearly 39% from 2015 to 2022. Slightly more than half of PAs in orthopedics were female (52.9%), and the average age was 38 years. Most (55.3%) PAs in orthopedics work in offices and clinics, and a third (37.0%) are hospital based. PAs in orthopedics earn about 9% more than all other PAs; over half (50.5%) report working more than a 40-hour week. PAs in orthopedics report less burnout than their counterparts and are less likely to leave their principal clinical position. Conclusions: Orthopedics ranks as the third largest specialty for PAs in the United States. Furthermore, the number of PAs selecting to practice in orthopedics has escalated during orthopedic surgeon shortages. The economics and diverse roles emerging among PAs in orthopedics suggest that this specialty may be expanding.

Modeling Memory Institutions: The Ainu Case Study

ABSTRACTThis study aimed to construct a model of memory institutions (libraries, archives, and museums) as a lens for analyzing contemporary collective memory practices related to the Ainu people. First, we developed a pilot model to organize the current phenomena and practices of collective memories and suggest a respective circulation mechanism consisting of three core elements: media, collective representations, and collective memory. Additionally, employing this pilot model, we conducted close readings of 449 pieces of literature and illustrated the characteristics of collective memory practices and phenomena in a case study of the Ainu. Our findings indicate that 1) the traditional collective memory of the Ainu has gradually shifted toward recognizing them as a unique ethnic group, and 2) by translating their oral literature into diverse media, the Ainu have reshaped their cultural identity.

Research on ultra-high temperature sensor and cold end compensation error

Abstract An ultra high temperature sensor and cold end compensation error are proposed. Aiming at the ultra-high temperature and relatively complex harsh environment of spacecraft, a sensor probe structure which can withstand the high temperature of 2500°C is presented in this paper. According to the practical application characteristics of the sensor with high measurement accuracy, the author proposed a high-precision cold end compensation method. Through this compensation technology, the ultra-high temperature sensor maintains high-precision temperature measurement in the full temperature range. The simulation analysis of the sensor structure and temperature test show that the sensor can not only realize temperature measurement at ultra-high temperature, but also control the nonlinear error to 0.6% of the full scale. The accuracy of the whole temperature range is controlled within 0.92% of the full scale, which meets the practical requirements.

Evolving Trainee Participation in Radiologists’ Workload: A National Medicare-Focused Analysis From 2008 to 2020

PurposeIncreasing volumes and productivity expectations, along with practice type consolidation, may be impacting trainees’ roles in the work effort of radiologists involved in education. We assessed temporal shifts in trainee participation in radiologists’ workload nationally. MethodsAll US radiologists interpreting noninvasive diagnostic imaging for Medicare fee-for-service beneficiaries were identified from annual 5% Research Identifiable Files from 2008 to 2020 (n = 35,595). Teaching radiologists were defined as those billing services using Medicare’s GC modifier, indicating trainee supervision. Billed work relative value units were used to determine the percentage of teaching radiologists’ total workload with trainee participation. Mean trainee participation in workload was calculated for teaching radiologists overall and stratified by radiologist and practice characteristics determined using National Downloadable Files. ResultsThe percentage of radiologists involved in teaching increased from 13.6% (2008) to 20.4% (2020). Among teaching radiologists, mean total workload increased 7% from 2008 to 2019 and decreased in 2020 to 2% below 2008’s level; mean teaching workload decreased 19% from 2008 to 2019 and decreased in 2020 to 31% below 2008’s level. Mean trainee participation in teaching radiologists’ total workload decreased from 35.3% (2008) to 26.3% (2019) and 24.5% (2020). Teaching radiologists showed decreased mean trainee participation when stratified by gender, experience, subspecialty, geography, practice type, and practice size. ConclusionsThe percentage of US radiologists involved in resident teaching has increased, likely reflecting academic practice expansion and academic-community practice consolidation. However, a declining percentage of teaching radiologists’ total workload involves trainees; this dispersion effect could have implications for education quality.

Are clinical decision support systems seen as helpful to First Contact Practitioners (FCPs) working in musculoskeletal health?

BackgroundThere is increasing burden on musculoskeletal (MSK) First Contact Practitioners (FCPs) working in primary care. One possible solution is to use digital technologies such as clinical decision support systems (CDSS). The primary objective of this study was to understand the potential for MSK FCPs to use a CDSS to support their practice in the United Kingdom. DesignAn exploratory sequential mixed methods design, using a cross sectional survey questionnaire and a subsequent focus group.Following ethical approval responders were recruited via professional networks to complete an online survey. A subsequent focus group enabled an in-depth exploration of survey results. Descriptive statistics were used to summarise survey data and thematic analysis with normalisation process theory used to describe findings. MethodsA snowball sampling method was used to invite MSK FCPs to complete the survey, using email, adverts and social media. The questionnaire captured responders’ demographic and professional practice characteristics, their knowledge and use of CDSS and their views and experiences regarding CDSS in MSK practice. ResultsThere were 75 responders to the survey and six participants in the focus group. The majority of responders 67% (n = 50/75) reported to be in favour of integrating a CDSS into their practice. Three themes were: 1) ensuring CDSS address efficiency concerns, 2) using CDSS to reduce unwarranted variation in practice, and 3) ensuring CDSS sustainability. ConclusionsCDSSs have potential value for FCPs working in MSK primary care settings. Eight summary recommendations advise future developments of CDSS for FCPs working in MSK primary care practice. Contribution of the Paper•This is the first known study evaluating the usefulness of clinical decision support systems (CDSS) for musculoskeletal (MSK) First Contact Practitioners (FCPs).•CDSS have potential value for MSK FCPs providing they are integrated into existing digital note systems and save clinic consultation time.•Eight recommendations advise future integration of CDSS into MSK FCP practice.

중학생의 사이버불링에 대한 학교상담사의 대처 경험과 성장에 관한 연구

The purpose of this study is to deeply explore the coping experiences of school counselors regarding cyberbullying among middle school students and their subsequent growth. To achieve this research objective, in-depth interviews were conducted with 20 school counselors who have experience in dealing with cyberbullying. The raw data was conceptualized and categorized using a continuous comparison method. In this study, data were analyzed using the method of grounded theory. As a result of open coding, 79 concepts, 21 subcategories, and 9 categories were derived and arranged in a paradigm model. The central phenomenon experienced by school counselors regarding cyberbullying among middle school students is ‘facing crisis situations,’ which includes ‘recognizing the limitations of the school counselor's role and the unfamiliarity of cyberspace.’ The analysis went through four stages, and the relationships between the categories were confirmed to classify participants into ‘complete rebirth growth type,’ ‘experiential growth type,’ ‘infrastructure-building rebirth type,’ and ‘incomplete rebirth growth type.’ This study is significant in that it provides educational and counseling implications for coping with cyberbullying by deeply exploring and concretizing the practical characteristics and actual appearances of school counselors' coping experiences with cyberbullying among middle school students.

Application of Case Teaching Method in Basic Accounting Teaching in Colleges and Universities

Case teaching method has the characteristics of high efficiency and simplicity, and is one of the common teaching methods. Nowadays, it is widely used in every classroom and in the teaching of major universities. Because the basic accounting course has the characteristics of strong practice, so the case teaching method is applied in the teaching of basic accounting course. This paper first analyzes the application of case teaching method in basic accounting teaching, expounds its shortcomings, and focuses on the analysis of solutions in order to improve the quality of basic accounting teaching.

Methods used for caries detection and diagnosis in Ontario dental practices: a cross-sectional survey

BackgroundEarly detection of caries is essential for applying non-surgical treatment procedures and preventing the formation of cavitated lesions leading to unnecessary removal of tooth structure. Understanding dentists’ preferences for caries detection tools can inform stakeholders about their strategies and knowledge of contemporary, evidence-based caries management approaches. However, there is a lack of research exploring the detection methods of caries commonly used by dentists in Ontario, Canada. The objective of this study was to investigate the methods of caries detection and diagnosis preferred by dentists in Ontario.MethodsA 21-item self-reported survey was mailed to one thousand Ontario dental practices in the Winter of 2022. Descriptive and bivariate data analysis were performed to determine the associations between: demographics and professional practice characteristics (explanatory variables), and methods for detecting and diagnosing dental caries (outcome variables) using SPSS Statistics 29.0.ResultsA total of 325 dentists (33%) responded to the survey, with 274 answering all of the questions completely. The highest proportion of respondents were 35–44 years of age (32.8%) and male (53.4%). More than half of the respondents reported using a dental explorer to assess primary occlusal caries (57.6%), secondary caries (57.1%), and cervical caries (57.5%). Likewise, 57.9% of the participants reported using dental radiographs to diagnose proximal caries. Among additional caries detection tools, digital radiography (89.8%) and traditional radiography (84.7%) were the most used methods/modalities, while cone beam computed tomography was the least (12.8%). Most study participants did not use any caries classification system (77.7%) or caries risk assessment tool (85.3%).ConclusionsParticipants preferred conventional methods for caries detection, instead of contemporary visual-tactile caries lesions classification and/or caries risk assessment systems. These findings indicate a need for continuing dental education programs tailored to evidence-based caries management approaches.

Characteristics of middle cerebral artery aneurysms treated endovascularly in a clip-favored institution.

The emergence of flow disruptors has brought a dynamic transition in the selection of treatment for middle cerebral artery (MCA) aneurysms, and the number of MCA aneurysms clipped is acceleratingly decreasing. Still, retreatment after endovascular treatment is still a dilemma, which may necessitate surgical clipping. It is all the more important to elucidate characteristics of MCA aneurysms that make clipping unfavorable. Thus, the practical characteristics of MCA aneurysms treated endovascularly in a clip-favored institution before the usage of flow disruption devices were investigated. This is a retrospective, single-center observational study. The clinical and imaging characteristics of treated MCA aneurysms from January 2012 to May 2022 were analyzed. A total of 83 aneurysms were included; 70 aneurysms (84%) were clipped, and 13 (16%) were treated endovascularly. Eighteen aneurysms (22%) were ruptured (clipping, 12; endovascular, 6). The reasons for an endovascular treatment were as follows: distal (3); subacutely ruptured with burdens of spasm (2); multiple aneurysms (6: another clipped in 3, coiled in 1, and conservatively managed in 2); no access to the operating room due to COVID-19 (1); and retreatment after coiling (1). Endovascular group aneurysms were smaller (maximum diameter 5.2 vs 7.3 mm, p < 0.01, as well as dome, neck, and height) without differences in the dome/neck and aspect (height/neck) ratios. In a subgroup analysis of 78 MCA bifurcation aneurysms, the endovascular group was still smaller (dome 4.4 vs 5.8 mm, p = 0.025; neck 2.8 vs 3.9, p = 0.03). In a limited series from a clip-favored institution before the flow disruption era, factors guided to endovascular treatments on MCA aneurysms were rather anatomical and clinical factors such as distal location, subacutely ruptured, multiple, or retreatment after coiling, than morphological factors such as dome/neck and aspect ratios albeit smaller size.

Barriers to HIV rapid start among New Jersey providers

Background Rapid Start ensures that persons with HIV initiate antiretroviral therapy in less than seven days after diagnosis. Benefits of Rapid Start include timely linkage to medical care, viral suppression in a shorter time and improved retention to medical care. Despite these benefits, there is a slow uptake of Rapid Start, in New Jersey. Objective Identify barriers to Rapid Start among New Jersey providers. Methods An electronic survey, consisting of 28 questions, with the following domains was administered to New Jersey providers, using Qualtrics: provider and practice characteristics (10), knowledge (1), barriers (8) and attitudes to diverse patient types (9). The results were analyzed using descriptive statistics due to small numbers over strata. Approval to conduct the survey was obtained from the William Paterson University Institutional Review Board. Results There were 69 responses to the survey. Providers were at least 45 years old (48%), female (44/60, 73%), nurse practitioners or physician assistants (41/59, 69%). Overall, 44/63 (70%) providers did not correctly identify that integrase inhibitors had the lowest prevalence of transmitted drug resistance. Newly diagnosed patients were referred for medical care in 37 (65%) of the medical sites. Only providers from Ryan White (federally funded clinics for persons with HIV) (64%) and non-Ryan White (73%) public sites reported co-located HIV testing sites. Seventy percent of medical sites offered same-day medical appointments. However, a lower proportion of private (62%), public Ryan White (55%), and other medical sites (36%) offered same-day appointments compared to public non-Ryan White sites (82%). Despite having staff available 40 h per week (91%), only 55% of Ryan White sites offered extended office hours in the early morning, evenings, or on Saturdays. When compared to providers in public non-Ryan White sites, a lower proportion of providers in Ryan White sites were comfortable doing Rapid Start either on the day of or within one week of diagnosis, 82% and 72%, respectively, or starting antiretroviral therapy before genotype results were available, 55% and 46%, respectively. Overall, providers were not comfortable with Rapid Start for persons engaging in condomless sex (60%). Conclusions Policy and administrative decisions are needed to eliminate barriers at the clinic level. An HIV clinical scholar program, to increase providers knowledge, may increase uptake of Rapid Start.

Analysis of Good Teaching Practices with the Integration of Virtual Environments at the Upper Secondary Level

This article analyzes the practices of integration with virtual learning environments, and focuses on knowing the teaching practices used with virtual environments in the Upper Middle Level (NMS) of the University of Guanajuato (UG). The purpose of this article is first to review the literature and obtain some teaching models on good teaching practices in virtual education that allow identifying characteristics of effective practices, and as a second purpose the results of a specific case study on the incorporation of practices with the use of virtual learning environments are analyzed. A bibliographic review of 3 proposals with 9 evaluation characteristics is analyzed, in which it was found that some of the teaching practices with the integration of virtual environments are: constant student-teacher communication, timely information feedback, flexibility in education and interactivity. Based on these proposals, a descriptive study was defined that was supported by the collection of data from an instrument applied to 20 teachers of the Upper Middle Level of the University of Guanajuato and the results allowed the identification of some effective teaching practices in the management of virtual environments.

The Effects of the Additional Roles Reimbursement Scheme (ARRS) staff in England on Prescription Patterns and Patient Satisfaction.

In 2019, the Additional Roles Reimbursement Scheme (ARRS) was introduced in England as a crucial component of the government's manifesto pledge to enhance access to general practice. The primary objective was to recruit 26,000 extra personnel through new roles into general practice. This study aimed to analyse the effects of ARRS staff on prescription rates and patient satisfaction. The study was a retrospective panel data analysis combining data from the General Workforce Minimum Dataset and National Health Service (NHS) Digital datasets about primary care practices and their activity from 2018 until 2022. The study included data from more than 6000 general practices. A linear regression analysis was conducted to determine the association between ARRS staff and prescription rates and patient satisfaction, controlling for patient and practice characteristics. The results showed that ARSS roles tend to be more frequent in larger general practices, with fewer full-time general practitioners per patient, and with more overseas trained general practitioners. The use of ARRS staff was significantly associated with lower prescription rates (β=-0.52, p<0.000) and higher patient satisfaction (β=3.2, p<0.000), after controlling for patient and practice characteristics. This study suggests that ARRS has the potential to have a positive role in primary care, notably through reduced prescription rates and improved patient satisfaction. Further research is needed to explore the long-term effects of ARRS on primary care, including patient outcomes and health care costs, and the potential barriers to its implementation.

Dual-type heterogeneous interface design enables customized tuning of dielectric parameters of multifunctional, lightweight, flexible absorbers for broadband electromagnetic wave absorption

With the boom in 5 G technology comes widespread concern about electromagnetic (EM) interference and the safe use of electronics. Conventional electromagnetic wave (EMW) absorbing materials in the form of coatings are often inflexible and poorly adapted to different EM environments. Diversified application scenarios require EMW absorbing materials with a wide absorption band and multifunctional properties. Herein, the frequency dispersion (FD) requirements of the EM parameters of the broadband absorber in different frequency bands are determined by EM simulation. Based on the dominant role of interface polarization on FD, we designed different types of heterogeneous interfaces to meet the needs of strong FD in the low-frequency band and weak FD in the high-frequency band. Through the optimized design of heterogeneous interfaces, CC@ZnO/ZnS composites exhibit excellent EMW absorption performance, achieving flexible, ultrathin (2.1 mm), ultralight (10 wt%), and broadband (7.02 GHz), which is superior to EMW absorbing materials of similar compositions. In addition, the composites have good piezoelectric/inverse piezoelectric properties, which can convert EM energy into mechanical energy while absorbing EMW, thus realizing applications in multifunctional fields such as sensors, controllers and energy converters. More noteworthy is the sample's highly efficient thermal insulation, flame retardant and anti-frosting properties, demonstrating important advantages for service in harsh environments. Therefore, CC@ZnO/ZnS composites not only have good practical application characteristics while realizing broadband absorption, but also are expected to achieve multifunctional applications in different fields.

Abstract A066: Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019)

Abstract Introduction: The HPV vaccination rates among Asian American adolescents were found to be below optimal levels. Understanding the high-risk demographics and the various factors influencing HPV vaccine acceptance is essential for addressing disparities and enhancing vaccination rates in this population. This study aimed to investigate HPV vaccine uptake in adolescents aged 13 to 17 across six major Asian American ethnic groups using nationally representative data. Methods: The study analyzed data from the National Immunization Survey- Teen (2015-2019), comprising 3,968 Asian American adolescents from Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese backgrounds. Provider and practice characteristics were examined alongside HPV vaccine initiation and completion rates within each subgroup. Results: Findings revealed that while the overall initiation rate among Asian American adolescents was 66.65%, significant variations existed among subgroups, ranging from 57.3% in Asian Indians to 71.22% in Chinese adolescents. Similarly, completion rates ranged from 30.89% in Asian Indians to 48.14% in Chinese adolescents, with an aggregated completion rate of 40.37% for the total Asian American sample. Household survey data generally showed lower initiation and completion rates compared to provider-reported data but still reflected subgroup disparities. Conclusion: Across all ethnic groups, a common barrier to HPV vaccination was the lack of physician recommendation. However, slight variations in this barrier were observed among subgroups. These findings underscore the importance of considering socioeconomic, cultural, and acculturation-related factors in designing effective public health and clinical interventions to promote HPV vaccination among Asian American adolescents. Citation Format: Lin Zhu, Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma. Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019) [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 A066.

Process evaluation of two large randomized controlled trials to understand factors influencing family physicians’ use of antibiotic audit and feedback reports

BackgroundUnnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback. The trial results showed that A&F was associated with significantly reducing antibiotic prescribing. Still, the effect size was small, and the modifications to the A&F interventions tested in the trials were not associated with any change. Herein, we report a theory-informed qualitative process evaluation to explore potential mechanisms underlying the observed effects.MethodsOntario family physicians in the intervention arms of both trials who were sent A&F letters were invited for one-on-one interviews. Purposive sampling was used to seek variation across interested participants in personal and practice characteristics. Qualitative analysis utilized inductive and deductive techniques informed by the Clinical Performance Feedback Intervention Theory.ResultsModifications to the intervention design tested in the trial did not alter prescribing patterns beyond the changes made in response to the A&F overall for various reasons. Change in antibiotic prescribing in response to A&F depended on whether it led to the formation of specific intentions and whether those intentions translated to particular behaviours. Those without intentions to change tended to feel that their unique clinical context was not represented in the A&F. Those with intentions but without specific actions taken tended to express a lack of self-efficacy for avoiding a prescription in contexts with time constraints and/or without an ongoing patient relationship. Many participants noted that compared to overall prescribing, A&F on antibiotic prescription duration was perceived as new information and easily actionable.ConclusionOur findings indicate that contextual factors, including the types of patients and the setting where they are seen, affect how clinicians react to audit and feedback. These results suggest a need to test tailored feedback reports that reflect the context of how, where, and why physicians prescribe antibiotics so that they might be perceived as more personal and more actionable.Trial registrationClinical Trial registration IDs: NCT04594200, NCT05044052.

Polymer Capacitor Films with Nanoscale Coatings for Dielectric Energy Storage: A Review

Enhancing the energy storage properties of dielectric polymer capacitor films through composite materials has gained widespread recognition. Among the various strategies for improving dielectric materials, nanoscale coatings that create structurally controlled multiphase polymeric films have shown great promise. This approach has garnered considerable attention in recent years due to its effectiveness. This review examines surface-coated polymer composites used for dielectric energy storage, discussing their dielectric properties, behaviors, and the underlying physical mechanisms involved in energy storage. The review thoroughly examines the fabrication methods for nanoscale coatings and the selection of coating materials. It also explores the latest advancements in the rational design and control of interfaces in organic–inorganic, organic–organic, and heterogeneous multiphase structures. Additionally, the review delves into the structure–property relationships between different interfacial phases and various interface structures, analyzing how nanoscale coatings the impact dielectric constant, breakdown strength, conduction and charge transport mechanisms, energy density and efficiency, thermal stability, and electrothermal durability of polymeric capacitor films. Moreover, the review summarizes relevant simulation methods and offers computational insights. The potential practical applications and characteristics of such nanoscale coating techniques are discussed, along with the existing challenges and practical limitations. Finally, the review concludes with a summary and outlook, highlighting potential research directions in this rapidly evolving field.