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Diabetes is among the most prevalent chronic conditions in the United States. Challenges in optimal diabetes care include fragmented care, gaps in diabetes self-management education, and high treatment burden. Severe hypoglycemia, a serious and potentially preventable event, indicates the need for treatment optimization. Inadequate or inaccessible care increases hypoglycemia risk. Community paramedics are well-positioned to fill these care gaps by providing focused diabetes self-management education and improving patient self-efficacy. Integrating community paramedics into care teams offers a novel pathway to improve diabetes outcomes. We will conduct a pragmatic 2-group, parallel-arm, randomized clinical trial of a community paramedic-led \"Diabetes Rescue, Engagement, and Management\" program to enhance diabetes self-management in patients with a history of hypoglycemia. The study will enroll 150 adults (≥18 years) with diabetes and a history of level 3 hypoglycemia from 5 counties in Minnesota. Participants identified as having hypoglycemia (from an integrated health system and the primary ambulance service in the area) will be randomly assigned to the program intervention or to usual care. The intervention group will receive community paramedic home visits for approximately 1 month to deliver diabetes self-management education tailored to individual needs. Both groups will receive written diabetes education and resource materials. Outcomes include change in diabetes self-management, hypoglycemia, hyperglycemia, hemoglobin A1c level, diabetes distress, and health-related quality of life, assessed at baseline, 1 month, and 4 months. Qualitative interviews of 16 intervention participants and 16 persons who decline participation will be analyzed to understand the program's effects and reasons for nonparticipation, to inform future program design. ClinicalTrials.gov NCT04874532.

[This corrects the article DOI: 10.1371/journal.pone.0322177.].

To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters, post-encounter interviews, and post-encounter surveys. For the decision of whether to use a spinal cord stimulator device (SCS), a video coding scheme, interview guide, and patient survey were iteratively developed with 30 SCS decision-making encounters in a tertiary academic medical center pain clinic. Burke's grammar of motives was used to classify the attributed source or justification for a potential preference for each preference block. To compare the MIPPs, 13 patients' encounters with their clinician were video recorded and subsequently analyzed by 4 coders using the final video coding scheme. Six of these patients were interviewed, and 7 surveyed, immediately following their encounters. For videos, an average of 66 (range 33-106) sets of utterances potentially indicating a patient preference (a preference block), surveys 33 (range 32-34), and interviews 25 (range 18-30) were identified. Thirty-eight unique themes (75 subthemes), each a preference topic, were identified from videos, surveys 19 themes (12 subthemes), and interviews 39 themes (54 subthemes). The proportion of preference blocks that were judged as expressing a preference that was clearly important to the patient or affected their decision was highest for interviews (72.8%), surveys (68.0%), and videos (27.0%). Videos mostly attributed preferences to the patient's situation (scene) (65%); interviews, the act of receiving or living with SCS (43%); surveys, the purpose of SCS (40%). MIPPs vary in the type of preferences identified and the clarity of expressed preferences in their data sets. The choice of which MIPP to use depends on projects' goals and resources, recognizing that the choice of MIPP may affect which preferences are found.

Objectives/Goals: Persistent gaps in inclusive research demand new approaches. We propose the Individualized and Differential Benefit (IDB) framework to develop tools that prioritize balance and elevate underrecognized voices within today’s research landscape. Methods/Study Population: The IDB framework ensures research benefits all, including individuals within underserved communities. To apply IDB, three criteria must be met: (1) inclusivity: work must apply to all and exclude none; (2) utility: work must benefit all stakeholders; and (3) differential benefit: work must offer greater advantages to individuals from any group who are most in need. This approach aims to elevate everyone while offering a tool to achieve equity. Results/Anticipated Results: Within the poster, we use two examples to illustrate IDB. In the first example, Health Outcome and Population Engineering, or HOPE, exemplifies how health outcomes are achieved with an individualized approach while population differences are modified. In the second example, Population Conscious Analysis, or PCA, is used to display a nuanced approach to analysis that yields an individual benefit while again yielding the opportunity for population-level differences. Discussion/Significance of Impact: IDB reframes public health research by prioritizing individual-level insights to drive precision, equity, and upstream interventions. It enables tailored strategies, community engagement, and scalable solutions that benefit all, but specifically those most in need.

Diabetes is among the most prevalent chronic conditions in the United States. Challenges in optimal diabetes care include fragmented care, gaps in diabetes self-management education, and high treatment burden. Severe hypoglycemia, a serious and potentially preventable event, indicates the need for treatment optimization. Inadequate or inaccessible care increases hypoglycemia risk. Community paramedics are well-positioned to fill these care gaps by providing focused diabetes self-management education and improving patient self-efficacy. Integrating community paramedics into care teams offers a novel pathway to improve diabetes outcomes. We will conduct a pragmatic 2-group, parallel-arm, randomized clinical trial of a community paramedic-led \"Diabetes Rescue, Engagement, and Management\" program to enhance diabetes self-management in patients with a history of hypoglycemia. The study will enroll 150 adults ([greater than or equal to]18 years) with diabetes and a history of level 3 hypoglycemia from 5 counties in Minnesota. Participants identified as having hypoglycemia (from an integrated health system and the primary ambulance service in the area) will be randomly assigned to the program intervention or to usual care. The intervention group will receive community paramedic home visits for approximately 1 month to deliver diabetes self-management education tailored to individual needs. Both groups will receive written diabetes education and resource materials. Outcomes include change in diabetes self-management, hypoglycemia, hyperglycemia, hemoglobin A.sub.1c level, diabetes distress, and health-related quality of life, assessed at baseline, 1 month, and 4 months. Qualitative interviews of 16 intervention participants and 16 persons who decline participation will be analyzed to understand the program's effects and reasons for nonparticipation, to inform future program design.

Background Housing First is an evidence-based practice intended to serve chronically homeless individuals with co-occurring serious mental illness and substance use disorders. Despite housing active substance users, harm reduction is an often-overlooked element during the Housing First implementation process in real-world settings. In this paper, we explore the representation of the Housing First model within the open-access scholarly literature as a potential contributing factor for this oversight. Methods We conducted a rapid review of the US and Canadian open-access Housing First literature. We followed a document analysis approach, to form an interpretation of the articles’ content related to our primary research questions. Results A total of 55 articles on Housing First were included in the final analysis. Only 21 of these articles (38.1%) included explicit mention of harm reduction. Of the 34 articles that did not discuss harm reduction, 22 provided a description of the Housing First model indicating it does not require abstinence from substance use; however, descriptions did not all clearly indicate abstinence was not required beyond program entry. Additional Housing First descriptions focused on the low-barrier entry criteria and/or the intervention’s client-centeredness. Conclusions Our review demonstrated a lack of both explicit mention and informed discussion of harm reduction in the Housing First literature, which is likely contributing to the Housing First research-practice gap to some degree. Future Housing First literature should accurately explain the role of harm reduction when discussing it in the context of Housing First programming, and public agencies promoting Housing First uptake should provide resources for proper implementation and monitor program fidelity to prevent model drift.

Objectives. To examine postgraduation employment trends among graduates of doctoral programs in public health from 2003 to 2015. Methods. We analyzed pooled cross-sectional data from a census of graduates receiving a research doctorate from US accredited institutions. The outcome of interest was employment status. Covariates included public health discipline, sociodemographic characteristics, and institutional attributes. Results. Of 11 771 graduates, nearly two thirds secured employment in either academic (34.8%) or nonacademic (31.4%) settings at the time of graduation. The proportion of those still seeking employment increased over time. Individuals who were White, younger, trained in either biostatistics or epidemiology, or from an institution with the highest level of research intensity were significantly more likely to secure employment. Academic employment was the most common setting for all 5 public health disciplines, but we observed differences in employment patterns (e.g., government, nonprofit, for-profit) across disciplines. Conclusions. Certain characteristics among public health doctoral recipients are correlated with postgraduation employment. More research is needed, but the observed increase in individuals still seeking employment may be attributable to increases in general public health graduates from for-profit institutions.

The hidden curriculum refers to the implicit norms and behaviors in academic environments that can particularly disadvantage scholars from backgrounds underrepresented in the scientific workforce (URSW). Critically, scientific mentors can support URSW mentees by making the hidden curriculum explicit to help these scholars navigate academia more effectively. However, mentors often lack the lived experience or training necessary to understand and fully address relevant hidden curriculum challenges. We developed a set of 16 hidden curriculum competencies specifically for scientific mentors working with URSW mentees. A survey was conducted among diversity, equity, inclusion, and accessibility experts in translational science to assess the perceived importance of each competency. Their feedback was used to refine the final competencies, from which a conceptual framework was developed. Survey results ( = 62) showed broad agreement on the competencies' critical importance for mentoring across diversity, with several competencies, including identifying unconscious biases, acting as allies, and demystifying career pathways, receiving over 90% agreement for their importance for mentoring URSW mentees. Respondents from URSW backgrounds placed greater emphasis ( < 0.05) on several competencies, including understanding mentee perspectives, expanding professional networks, and allyship. The 16 competencies, grouped into four domains (Foundation, Career, Science, and Overcoming Bias), collectively offer a comprehensive approach for mentors to build trust, support mentee career development, overcome practical barriers to mentee engagement in research, and actively combat bias. Our conceptual framework offers structured guidance for mentors and mentor training programs, identifying the skills needed to foster inclusive academic environments and enhance URSW retention and success.

The hidden curriculum encompasses the norms, values, and behaviors within a learning environment. Navigating the hidden curricula of academia is crucial for doctoral trainees, particularly those from underrepresented backgrounds. Faculty mentors have an important role in helping trainees uncover and cope with the hidden curriculum. The purpose of this paper is to explore perceptions of the hidden curriculum among diverse doctoral trainees and mentors. Following a presentation on the hidden curriculum at the Association for Clinical and Translational Science annual meeting in March 2021, attendees were asked to brainstorm ideas for diverse trainees and their mentors. Breakout room discussions were held for specific hidden curriculum topics; participants voted on which topics to discuss from a list of topics defined during the presentation. Ideas from these discussions were presented to the larger group to upvote. Participants (n = 116) voted to discuss the following hidden curriculum topics: \"coping with bias,\" \"assertive communication,\" \"knowing how things work,\" and \"developing a career.\" Many suggestions emphasized the role of institutions in empowering mentors to help diverse trainees and, more generally, to meaningfully support policies and programs that facilitate the career success of trainees and faculty from underrepresented backgrounds. This work generated a list of suggested action items for trainees, mentors, and institutions to ameliorate the hidden curricula of academia, especially for diverse trainees. However, institutions need to support changes that will facilitate these discussions as well as more broadly enable the success of faculty and students from diverse backgrounds.