搜索结果：Michigan

This data article describes a two-wave longitudinal panel dataset that supports research on the public acceptance of Precision Livestock Farming (PLF) technology in swine production among adult residents of three U.S. pork-producing states. The dataset comprises two structured comma-separated-value files - panel_long_analysis.csv (n = 2565 person-wave observations; 37 variables) and panel_wide_analysis.csv (n = 345 balanced-panel respondents; 64 variables) - alongside four fully documented R analysis scripts. Data were collected via a two-wave online and mail survey administered by the Michigan State University Office for Survey Research (MSU-OSR) to adult residents of Iowa, Michigan, and North Carolina: Wave 1 in Fall 2022 (n = 1287) and Wave 2 in Fall 2023 through Spring 2024 (n = 1278). These three states together account for the majority of U.S. pork production but their residents constitute approximately 7% of the U.S. population; the deposit is therefore best characterized as a regional U.S. dataset on publics most proximate to active swine production, not as a nationally representative sample. Sampling used a 50/50 urban-rural address stratification within each state. The survey instrument measured PLF acceptance via an eight-item belief index (plf_index) and general attitudes toward agriculture and technology via a ten-item index (att_index), together with binary livestock familiarity indicators, social proximity to farmers, and standard sociodemographic covariates. A balanced sub-panel of 345 respondents who completed both waves enables within-person analysis of attitude dynamics. To recover the theoretical n = 690 person-wave panel, the deposited analysis pipeline applies multiple imputation by chained equations (MICE; m = 50, predictive mean matching for continuous and Likert items, logistic regression for binary covariates) and pools regression estimates via Rubin's rules; a listwise-deletion sample of n = 414 person-wave observations is preserved as a sensitivity benchmark. The deposited data support pooled ordinary least squares, individual fixed-effects, state × wave fixed-effects, random-effects, and first-difference panel model estimation, as well as principal components analysis, reliability assessment, distribution diagnostics, cross-sectional sub-group comparisons, and geographic analyses. All files are structured in UTF-8 CSV format with a detailed variable codebook documented herein. To the best of our knowledge, this is the first publicly available longitudinal panel dataset on U.S. general public acceptance of PLF technology in swine production. All files are deposited on Zenodo under a CC BY 4.0 license.

The integration of artificial intelligence (AI) tools in healthcare offers significant opportunities to improve patient care. However, underrepresented groups such as the Arab/Middle Eastern North African (MENA) community in the United States have historically been excluded in health data and conversations regarding AI tool implementation and development. We present our experience with the Arab/MENA community exploring attitudes about the use of AI in healthcare, focusing on our engagement and recruitment efforts as well as relevance for learning health systems science. We conducted a virtual democratic deliberation session (n = 33) in partnership with the Arab Community Center for Economic and Social Services (ACCESS) in Michigan, as part of a larger study involving five sessions (n = 159). In partnership with ACCESS staff, we collaboratively developed study materials and recruited Arab/MENA community members to share their perspectives on AI in healthcare. Qualitative thematic analysis was used to identify the community's perspectives, priorities, and barriers to the use of AI in healthcare. The deliberation session highlighted four key themes related to the use of AI tools: (1) transparency in AI development was viewed as essential to building community trust, (2) human connection, with concerns that increased reliance on AI could replace empathy and weaken patient-provider interactions, (3) the role of healthcare providers, with preference on providers using AI as a supportive tool rather than replacing direct care, and (4) representation due to concerns over whether AI systems would reflect the experiences and needs of the Arab/MENA community in healthcare. Community-based partnerships are essential for advancing responsible AI implementation in healthcare and building a learning health system. Our experiences highlight the importance of transparency, cultural sensitivity, and meaningful community involvement to build trust and address the needs of underrepresented groups as AI evolves.

A 4-year-old, female spayed domestic shorthair cat was presented to the Michigan State University emergency service for evaluation of vomiting 4 days after exposure to vitamin D supplements. On intake, the patient was found to have ionized hypercalcemia and azotemia. The patient was hospitalized for calciuresis therapy including fluid diuresis, diuretics, steroids, bisphosphonates and a nasogastric feeding tube. She was discharged and presented for a recheck evaluation and was then hospitalized a second time for the same therapy as her first hospitalization. Eventually the patient was discharged for at-home care with subcutaneous fluids and oral medications because of financial constraints. Approximately 52 days after exposure, the cat was noted to have persistently normal ionized calcium and all medications were discontinued. This case provides a unique example of acute vitamin D toxicosis in a cat and a financially conservative approach in treating a toxicity with a significant half-life.

Perforator flaps play a vital role in soft tissue repair; however, they face challenges due to anatomical variability. Although computed tomography angiography (CTA)-based three-dimensional visualization can assist in surgical planning, it is limited by image quality and vessel extraction accuracy. This study presents advanced 3D techniques designed to enhance accuracy and evaluates their clinical outcomes. This case series investigated the clinical applications and outcomes of enhanced three-dimensional visualization for anterolateral thigh perforator (ALTP) flaps in 12 patients (13 flaps) treated between January 2021 and December 2024. Technical enhancements included: 1) optimized CTA protocols (adjusted voltage based on body mass index, high-contrast injection, and nitroglycerin administration); 2) an "Indirect Extraction Method" with a reduced threshold (105-115 HU) for small vessel reconstruction; 3) manual tracing of perforators; 4) "Digital Reverse Flap Design" (an expanded wound model projected onto the donor site); and 5) 3D-printed surgical guides for enhanced precision. The outcomes assessed were perforator accuracy, flap fit, survival, and complications. All flaps were successfully transplanted in the present study. Perforator localization was excellent (<1 cm) (81.3%, n = 13/16) and moderate (1-2 cm) (18.8%, n = 3/16). Surgical findings were consistent with 3D planning in 100% of cases regarding perforator type, source artery, and pedicle route. The flap fit was excellent (84.6%, n = 11/13) and moderate (15.4%, n = 2/13). The survival rate was 100% (n = 13/13). Foot function, assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) score, was good in both cases. Hand function, measured by the Michigan Hand Outcomes Questionnaire (MHQ), was rated as excellent or good in 60% (n = 6/10) of cases. Complications occurred in two cases (12.5%), including infection (n = 1) and delayed fracture healing (n = 1). The advanced 3D technique enhances perforator localization, flap design, and surgical precision, resulting in high success rates. Limitations of the present study include a small sample size and its retrospective design.

Diabetic peripheral neuropathy is a frequent and disabling complication of type 2 diabetes mellitus (T2DM). Early identification of subclinical neuropathy is crucial to prevent progression. F-wave parameters, by assessing proximal and distal motor pathways, may serve as sensitive indicators of early nerve dysfunction. To evaluate F-wave parameters in patients with T2DM and analyse their relationship with clinical neuropathy severity (Michigan Neuropathy Screening Instrument-MNSI and Vibration Perception Threshold-VPT) and metabolic control indices. This hospital-based cross-sectional study included 226 participants (184 diabetics and 42 non-diabetic controls). All subjects underwent detailed clinical evaluation, biochemical profiling, neuropathy assessment using MNSI and VPT, and electrophysiological testing including F-wave analysis of the tibial nerve. Parameters studied were F-min latency, F-max latency, chronodispersion, F-estimate, F-wave/M-wave (F/M) amplitude ratio and persistence. Comparisons were made among three groups-non-diabetic controls, diabetics without neuropathy and diabetics with neuropathy. Correlation and receiver operating characteristic (ROC) analyses were performed to assess diagnostic and predictive utility. F-min, F-max and F-estimate latencies were significantly prolonged in diabetic subjects compared with controls (p<0.001), with stepwise worsening from non-diabetic to neuropathic groups. Chronodispersion showed minor, non-significant change, and F/M amplitude ratio exhibited mild elevation in diabetics (p<0.05). F-wave persistence remained comparable across groups. Significant positive correlations were observed between F-min latency and VPT (r=0.424, p<0.001), MNSI score (r=0.198, p=0.012) and glycated haemoglobin (HbA1c) (r=0.366, p=0.031). ROC analysis identified F-min latency (area under the curve, AUC=0.729) and F-max latency (AUC=0.710) as the most accurate discriminators for neuropathy. Prolonged F-wave latencies, particularly minimum latency and F-estimate, are sensitive markers of early motor nerve involvement in T2DM. These parameters correlate with clinical and metabolic indices of neuropathy and can enhance detection of subclinical diabetic neuropathy when routine nerve conduction studies are normal.

Despite its known effectiveness, pre-exposure prophylaxis (PrEP) remains underutilized, particularly among Black women who experience disproportionately high rates of human immunodeficiency virus (HIV). This quality improvement (QI) project evaluated the impact of a provider education intervention, combined with a culturally tailored patient educational video, on PrEP prescribing, uptake, and documentation at an urban sexually transmitted infections (STI) clinic in Detroit, Michigan. Using a pre-post design, data were collected for 3 months before and after implementation of the intervention. Among 549 eligible Black women, PrEP prescribing increased from 3.6% pre-intervention to 11.4% post-intervention (p = 0.001). Among a small sample, nearly one-third of post-intervention patients who were prescribed PrEP received the medication within 30 days, compared with zero pre-intervention. This difference did not reach statistical significance (p = 0.08), likely due to limited sample size, but may be clinically meaningful. Documentation using the recommended International Classification of Diseases, 10th Revision (ICD-10) code Z29.81 for PrEP-related encounters improved from 21.5% to 88.3% (p < 0.001). Multivariable logistic regression analyses showed that post-intervention encounters were independently associated with higher odds of PrEP prescribing within 7 days of the clinical encounter and higher odds of the recommended ICD-10 code Z29.81 being utilized for PrEP-related services. Findings suggest that combining culturally responsive strategies with patient and provider education may improve PrEP prescribing, uptake, and documentation practices. The intervention was successful in addressing persistent disparities while offering a scalable model for similar clinical settings.

The relationship between gingival biotype (GB) and bone thickness is paramount for optimal maxillary implant outcomes. This study aimed to determine the correlation between GB and buccal bone thickness (BBT) and buccal bone height (BBH) in candidates for immediate maxillary implant placement using cone-beam computed tomography (CBCT). This cross-sectional study assessed 54 patients from the Periodontology Department at Ilam University of Medical Sciences Dental School. Gingival thickness (GT), buccal bone measurements (BBT and BBH), and clinical parameters, including keratinized gingival width (KGW) and papillary height (PH), were recorded using Michigan probes and CBCT scans. Statistical analyses (Mann-Whitney and Kruskal-Wallis tests) were conducted to evaluate associations between variables, with P<0.05 considered significant. Of the participants, 62.96% had a thick GB and 37.04% had a thin GB. Thin biotypes were significantly more prevalent among females (P<0.05). The thick GB group exhibited significantly greater KGW and overall mean BBT compared to the thin GB group (P<0.05). Conversely, no statistically significant differences were observed between thick and thin biotypes regarding overall mean BBH or PH (P>0.05). A thick gingival biotype is anatomically associated with greater buccal bone thickness and keratinized gingival width. However, there were no statistically significant differences in buccal or papillary bone height between the different gingival biotypes. Thin gingival biotypes are more prevalent among females.

Carbon stocks and stock changes in harvested wood products (HWPs) are an important part of land sector greenhouse gas (GHG) estimation and reporting. HWPs broadly categorized as products in-use (e.g., solid wood and paper products) and in solid waste disposal sites (SWDS; e.g., landfills), store carbon transferred from harvested trees. In the United States (US), estimates of carbon in HWPs have historically been reported in the US GHG Inventory and included in submissions to the United Nations Framework Convention on Climate Change. These data have been obtained from national and international statistics on production and consumption of forest products and incorporated into a compilation system to estimate carbon in products in-use and in SWDS. In contrast, estimates of carbon in forest ecosystems have been obtained from nationwide forest inventory (NFI) data collected and maintained by the US Forest Service, Forest Inventory and Analysis (FIA) program. Here we describe a case study for the northern Lake States region of the US (Michigan, Minnesota, Wisconsin) where harvest data from the FIA program were integrated into HWP compilation systems. This advance improves consistency and continuity with forest ecosystem from NFI plots with estimates of HWPs. Over the 1900-2024 time period, total estimated net accumulation (i.e., balance of additions from transfers of harvested wood from forest ecosystems and losses from decay of wood harvested in the past) of carbon stored in products in-use was 277.0&#x2009;&#xb1;&#x2009;17.5 Million Metric Tons (MMT) Carbon (C) and in SWDS was 155.2&#x2009;&#xb1;&#x2009;9.8 MMT C. We estimate that HWPs from the region represent a carbon sink of 4.9&#x2009;&#xb1;&#x2009;0.1 MMT C in 2024. These estimates include HWPs produced in the region and exported domestically or internationally, as well as any HWPs produced and retained in the region, but not imports. The proposed methodology enables disaggregation with coarse national and state-level FIA data, and allows for integration of more specific, entity-level data to improve precision and reduce uncertainty in HWPs estimates in the US and improves consistency and continuity with forest ecosystem estimates across spatial and temporal scales.

Several clinical risk models have been proposed to stratify hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis C virus (HCV) after sustained virologic response (SVR). However, validation efforts have focused on monocentric or country-specific cohorts, and it is unclear if clinical risk models can be broadly applied to global populations. We characterised regional variation in model performance for HCC risk stratification in post-SVR patients. Four HCC clinical risk models (aMAP score, FIB-4 index, GES score, and Toronto HCC risk index [THRI]) were analysed in six real-world cohorts, which included 8796 post-SVR patients from different geographic regions globally. Model discrimination was assessed using Harrel's c-statistic index. HCC incidence rates were compared across low-, intermediate-, and high-risk groups for each model. Distributions of patient characteristics and HCC incidence rates varied across geographic regions. Predictive performances of models were comparable within each cohort despite the model with the highest c-statistics differing by regions. Performance was lower than those from original reports overall; c-statistics of models across most regions remained below 0.70. There remains a continued need to improve discrimination and calibration of clinical models to stratify HCC risk in post-SVR patients. Accuracy of models may differ by geographic region, underscoring the importance of external validation to assess transportability of models and suggesting no single model can be universally applied. The risk of hepatocellular carcinoma (HCC) remains elevated in patients with hepatitis C virus (HCV) even after the eradication of HCV. Stratifying the risk of HCC development in patients with cured HCV is crucial. There have been several models for predicting HCC development based on routine clinical variables. However, the predictive performances of all four models were suboptimal in real&#x2010;world clinical settings with large variations across global geographic regions.

Coronary cameral fistulas are rare abnormal connections between one or more coronary arteries and any chamber of the heart, occurring in less than 1% of the population. Cameral fistulas are classically asymptomatic and an incidental finding. Etiology is most commonly congenital but can also be acquired secondary to cardiac surgery or trauma. Cardiac catheterization with coronary angiography remains the diagnostic modality of choice. We present a case of a symptomatic patient presenting with dyspnea and hypertension diagnosed with an incidental mid-left anterior descending to right ventricle cameral coronary fistula. We discuss current literature on the management of this anatomic anomaly.

Better cardiovascular health (CVH) is associated with better cognitive function, but limited data exist on its association with cerebrovascular disease (CVD) burden using the Life's Essential 8 (LE8) metric, particularly among Hispanic/Latino adults. LE8 scores (range: 0 to 100) were calculated at baseline (2008 to 2011). Brain magnetic resonance imaging volumetric outcomes (2017 to 2022) included cerebral small vessel disease (cSVD) burden (infarcts, cerebral microbleeds, high white matter hyperintensity [WMH] burden, enlarged perivascular spaces), gray matter (GM), and WMH volumes. Survey-weighted regression models examined associations between LE8, adjusting for demographic factors. Among 2211 participants (mean age [SE]&#xa0;=&#xa0;57.6 [8.0] years, 58.5% female), higher LE8 score was associated with reduced cSVD burden and lower odds of infarcts and WMH burden. Higher LE8 scores were associated with greater total and frontal GM and lower WMH volumes. Better CVH was associated with reduced CVD burden and greater GM volume in Hispanic/Latino adults.

Streptococcus suis (S. suis) is an emerging zoonotic agent that now rivals classical food-borne pathogens in its global clinical burden of meningitis and septic shock. Recent epidemiological syntheses covering more than 30 countries now list over 1600 laboratory-confirmed human cases with a pooled case-fatality of about 12%, climbing beyond 18% in East Asia. The widely cited pooled case-fatality estimate derives from a PRISMA-guided systematic review and meta-analysis that searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar through December 2012 and pooled study-level event rates using inverse-variance methods with random-effects models when heterogeneity was present. We critically synthesize recent molecular, cellular, and translational studies to define how this swine commensal breaches host epithelial and blood-brain barriers (BBBs), subverts innate immunity, and disseminates systemically. Newly identified virulence mechanisms include serine-threonine kinase-driven claudin-5 cleavage, vimentin-dependent transcytosis, quorum-sensing control of biofilm maturation, and metabolic reprogramming that fuels neutrophil evasion. We integrate multiomics signatures with structural data to map conserved targets such as IdeSui and capsular polysaccharide that underpin next-generation conjugate and nanoparticle vaccines. Diagnostic advances spanning CRISPR-based assays and high-resolution imaging are assessed for their capacity to enable point-of-care detection. We also highlight host transcriptomic signatures that can be integrated into microfluidic chips, allowing syndromic discrimination between S. suis and pneumococcal meningitis within 40&#x2009;min, a critical window for targeted therapy. Finally, we present a prevention framework uniting farm biosecurity, rational antibiotic stewardship, probiotic and bacteriocin interventions, and community education. Collectively, the review delivers an up-to-date roadmap for mitigating S. suis transmission and disease, highlights outstanding knowledge gaps in host-pathogen interactions, and outlines translational priorities needed to transform bench discoveries into effective public health countermeasures.

The diagnosis of gastric sleeve stenosis (GSS) is often delayed due to the lack of readily available objective criteria. The aim of this study was to assess whether fluoroscopic parameters obtained during endoscopy may offer a widely available method to assess GSS. This was a retrospective analysis of a single-institution, prospective database of patients who underwent endoscopic evaluation of suspected GSS. Endoscopic severity of GSS, defined by the presence of stenosis and angulation at the level of the incisura, was systemically assessed by a trained bariatric endoscopist. The width of the incisura and angle between the proximal and distal sleeve were measured fluoroscopically. Balloon diameter measurements were obtained at different balloon volumes during impedance planimetry testing and correlated with incisura width. A total of 63 procedures were included. When stratified by endoscopic impression of stenosis, the mean (&#xb1;&#x2009;standard deviation) width of the incisura in patients with no stenosis was 17.1&#x2009;&#xb1;&#x2009;6.5&#xa0;mm, mild stenosis was 13.1&#x2009;&#xb1;&#x2009;5.1&#xa0;mm, moderate stenosis was 12.4&#x2009;&#xb1;&#x2009;2.6&#xa0;mm, and severe stenosis was 8.6&#x2009;&#xb1;&#x2009;2.1&#xa0;mm (p&#x2009;<&#x2009;0.001). When stratified by endoscopic impression of angulation, the mean (&#xb1;&#x2009;standard deviation) width of patients with no angulation was 101&#x2009;&#xb1;&#x2009;29 degrees, mild angulation was 80&#x2009;&#xb1;&#x2009;28 degrees, moderate angulation was 76&#x2009;&#xb1;&#x2009;22 degrees, and severe angulation was 68&#x2009;&#xb1;&#x2009;20 degrees (p&#x2009;=&#x2009;0.21). The width of the incisura correlated with balloon diameter on impedance planimetry (all p&#x2009;<&#x2009;0.05). Fluoroscopic analysis in GSS supports endoscopic impressions of stenosis severity and complements impedance planimetry measurements. This approach offers a more widely available method for diagnosis of GSS.

Rapid Sequence Induction (RSI) is commonly performed in the operating room to quickly secure the airway and minimize aspiration risk, especially in patients undergoing abdominal surgery. Current practice patterns of medications and RSI techniques used by anesthesiologists are not well-described. This observational cohort study utilized the Multicenter Perioperative Outcomes Group database to evaluate RSI practices on adult patients undergoing abdominal surgery from 2015 to 2022. The primary aim was to describe modern RSI practices. We evaluated peri-induction medication use and intubation techniques. We hypothesized that over time, rocuronium would become the most utilized agent. Additionally, we investigated how the choice of neuromuscular blocking agent (NMB) affected outcomes using mixed-effects models and targeted maximum likelihood estimation. The primary endpoint was 30-day mortality. Secondary endpoints included post-induction hypoxia, pulmonary complications, and acute kidney injury (AKI). Across 13 institutions and 82,772 cases, 9,352 (11.3%) had a documented RSI. The most common NMB was succinylcholine (70.5%). However, the use of succinylcholine significantly decreased over the study period (85.4% of RSI cases in 2015; 37.3% in 2022, p < 0.0001), replaced by rocuronium. Patients usually received coadministration of multiple sedatives. Video laryngoscopy was more frequently used (16.2% of RSI vs 8.0% of non-RSI cases, p<0.0001). Rocuronium was not associated with a different risk of mortality (relative risk 0.85; 95% confidence interval 0.67 - 1.09), hypoxia (1.04; 0.61-1.77), pulmonary complications (0.93; 0.81-1.06), or AKI (1.05; 0.84-1.31) as compared to succinylcholine. Across institutions in the United States, rocuronium has been increasingly used for RSI, eventually overtaking succinylcholine. Rocuronium use was not associated with a different risk of mortality, hypoxia, pulmonary complications, or AKI.

暂无摘要（点击查看详情）

Surgical training is defined by an uncompromising pursuit of excellence, forged through discipline, endurance, and mentorship. However, the boundary between formative rigor and destructive pressure remains ethically and pedagogically fraught. Using Damien Chazelle's film Whiplash as an allegorical lens, this essay examines the psychological extremes of high-performance mentorship and their parallels within surgical education. The film's depiction of mentorship as both crucible and coercion illuminates a central tension in surgical culture: whether greatness can be cultivated without harm, and how mentors can demand excellence without eroding the well-being or dignity of trainees. By reflecting on the costs of performance culture, the responsibilities of surgical mentors, and the necessity of challenge in professional formation, this perspective argues for a model of mentorship that preserves rigor while rejecting cruelty. Excellence in surgery, as in music, is neither accidental nor painless, but it must be guided by integrity rather than domination.

Research on community health effects of Animal Feeding Operations (AFOs) frequently relies on prevalence-based effect measures, particularly for chronic respiratory outcomes. Interpreting these measures as indicators of comparative disease occurrence requires specific structural population assumptions, yet it remains unclear whether such assumptions are reported in this literature. We conducted a Mini Review of observational studies identified through a previously published systematic review and an ongoing living systematic review to assess whether prevalence studies of AFO exposures and community health explicitly reported the assumptions required to interpret prevalence ratios or prevalence odds ratios as approximations of comparative incidence. Eligible studies used prevalent disease status and reported comparative prevalence-based effect measures. We assessed whether authors discussed assumptions related to population stability, outcome duration, temporal ordering, reverse causality, and disease rarity. Across 15 included studies, none explicitly reported or discussed these structural population assumptions, despite routinely presenting covariate-controlled effect estimates. Greater transparency in reporting population-level assumptions is needed to support valid causal interpretation of prevalence-based effect measures in AFO research and to better inform public health decision-making.

Biological research, including dual-use research of concern and pathogens with enhanced pandemic potential, faces mounting regulatory scrutiny that may impact pandemic preparedness and scientific progress. At a 2024 deliberative workshop in Reno, Nevada, biosafety professionals, biosecurity experts, and life sciences researchers discussed potential barriers to effective governance, including ambiguous regulatory definitions, resource disparities between regulated institutions, and fragmented oversight frameworks that impose burdens without improving safety or security. By incorporating biosafety professionals' expertise into policymaking, fostering a collaborative dialogue over punitive and inconsistent enforcement, and securing ongoing funding for biosecurity programs, we call for actionable strategies to reduce risk while advancing safe, secure, and transformative biotechnological breakthroughs in the life sciences and strengthening national security.

Emergency medicine (EM) residency programs must strive to teach adaptive expertise (AE) so that graduates can apply existing knowledge to innovatively address novel problems. The Master Adaptive Learner (MAL) framework describes a structured approach for the development of AE, yet its practical application in medical education, and specifically in EM training, is limited. This study aimed to explore how first-year EM residents approach identifying, prioritizing, and filling knowledge gaps during the planning phase of the MAL framework. We conducted a prospective qualitative study using a simulation-based learning exercise at two U.S. academic medical centers across two consecutive years. The simulation placed EM interns in a realistic emergency department scenario where they had to independently address knowledge gaps before engaging in guided discussions. Data were collected through surveys and focus groups, transcribed, and thematically analyzed. Knowledge gaps were categorized by type (factual, conceptual, procedural, metacognitive), and success in filling selected gaps was recorded. Intern rationales for gap prioritization and resource selection were examined. Fifty-seven EM interns participated, identifying 305 knowledge gaps, with factual gaps being most common. Participants successfully filled 90% of their top-priority knowledge gaps using resources such as UpToDate and WikEM. Rationales for gap prioritization emphasized clinical urgency (e.g., airway management) and readiness to engage in decision-making and communication. Resource selection was driven by familiarity and perceived efficiency. Interns often explored multiple resources, highlighting intellectual curiosity and desire for conceptual application of knowledge. This study demonstrates that EM interns possess developing skills aligned with the MAL planning phase and can effectively address knowledge gaps through structured learning simulations. Simulation-based exercises offer an impactful method for contextualizing medical education theory and preparing residents for future clinical challenges. These findings support the integration of MAL principles into early residency curricula to promote adaptive expertise development.