Study reveals gaps in flu treatment for high-risk adults

Regenstrief Institute

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INDIANAPOLIS – A multi-state study reveals that many high-risk adults diagnosed with influenza (flu) in emergency departments and urgent care centers are not receiving timely antiviral treatment. Researchers found that only slightly more than half of these patients received antiviral prescriptions, and of those, only 80 percent were filled. This gap in treatment could increase the risk of severe flu complications, particularly for older adults and those with underlying conditions.

The study analyzed prescribing and dispensing patterns of influenza antiviral medications across various demographic groups. Researchers found no significant disparities based on race, ethnicity or socio-economic vulnerability. However, high-risk adults aged 65 and older were less likely to receive timely prescriptions or receive dispensed medications compared to younger high-risk adults.

Patients considered high-risk included those with cardiovascular disease, renal disease, weakened immune systems, or individuals older than the age of 70. For these patients, timely antiviral treatment is critical, as influenza can lead to severe complications beyond the lungs, such as influenza encephalitis, a brain infection that causes inflammation and significant health issues.

"Although effective influenza vaccines are available, many adults remain unvaccinated, and breakthrough cases still occur. Fortunately, we have antivirals that can reduce complications," said study co-author Shaun Grannis, M.D., M.S., vice president for data and analytics at Regenstrief Institute. "This can be a serious disease. Being treated quickly is not only important for individual health but also for public health. If someone has respiratory concerns, I strongly encourage them to contact their healthcare provider as soon as possible."

Patients undergoing rapid flu tests in emergency departments and urgent care centers were more likely to be prescribed and dispensed antivirals. Rapid tests provide results in 5 to 10 minutes, allowing providers to confirm a diagnosis and prescribe antivirals within the recommended 48-hour treatment window.

Antiviral medications work by attacking flu viruses in the body, similar to how antibiotics fight bacterial infections. However, the effectiveness of antivirals declines if treatment begins more than 48 hours after symptoms appear. Many individuals seek care after this window has closed, making providers hesitant to prescribe antivirals. Additionally, some healthcare providers worry about drug interactions, particularly in high-risk patients who take multiple medications (polypharmacy).

The study analyzed electronic health record (EHR) data from 94 urgent care facilities and 142 emergency departments across five states—California, Minnesota, Oregon, Washington, and Wisconsin—through the Centers for Disease Control and Prevention (CDC) VISION Network.

Regenstrief Institute investigators have been pioneers in clinical decision support, and based on the study’s findings, Dr. Grannis suggests that decision support tools could help reduce barriers to timely treatment. "By integrating clinical decision support into electronic health records, we can guide providers to ensure high-risk patients receive antiviral treatment when it’s most effective," he said.

The study, “Patterns in prescribing and dispensing of influenza antivirals among adults with influenza presenting to urgent care and emergency department settings, VISION Network, 2023–2024,” was funded by the CDC and is published in Clinical Infectious Diseases.

All authors and affiliations as listed in the paper:

Katherine Adams1, Shikha Garg1, Sara Y Tartof 2, Stephanie A Irving3, Malini B DeSilva4, Nicola P Klein5, Karthik Natarajan6,7, Kristin Dascomb8, Shaun J Grannis9,  Toan C Ong10, S Bianca Salas2, Lina S Sy2, Bruno Lewin2, Lei Qian2, Allison L Naleway3, Padma D Koppolu3, Charlene E McEvoy4, Omobosola Akinsete4, Inih Essien4, Bruce Fireman5, Ousseny Zerbo5, Karen B Jacobson5, Julius Timbol5, Varsha Neelam1, Emily L Reeves1, Monica Dickerson1, Caitlin Ray1, Ruth Link-Gelles11, Josephine Mak11, Sarah W Ball12, Michael O'Reilly13, Sonja J Olsen1, Mark W Tenforde1.

• 1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States.
• 2 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States.
• 3 Kaiser Permanente Center for Health Research, Portland, Oregon, United States.
• 4 HealthPartners Institute, Minneapolis, Minnesota, United States.
• 5 Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States.
• 6 Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, United States.
• 7 Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, United States.
• 8 Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, United States.
• 9 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States.
• 10 School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
• 11 Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States.
• 12 Westat, Rockville, Maryland, United States.
• 13 Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.

About Shaun Grannis, M.D., M.S.

Dr. Shaun Grannis is vice president of data and analytics at Regenstrief Institute, the Regenstrief Chair in Medical Informatics, and a professor of family medicine at the Indiana University School of Medicine.

  

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Journal

Clinical Infectious Diseases

DOI

10.1093/cid/ciaf178 

Article Title

Patterns in prescribing and dispensing of influenza antivirals among adults with influenza presenting to urgent care and emergency department settings, VISION Network, 2023-2024

Article Publication Date

4-Apr-2025

 

China's malaria-free status offers crucial lessons for other areas

Special BMJ collection explores China's path to elimination and how it may inform strategies elsewhere, but experts warn that funding declines would reverse hard won gains

BMJ Group

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China’s success in achieving malaria-free status in 2021 offers crucial lessons for the global malaria fight, say experts in a special collection of articles published by The BMJ today.

But they also warn that if funding declines, as is expected under US President Trump’s drastic policy changes impacting collective efforts on global health, “the hard won gains of the past two decades would be rapidly reversed.”

The collection examines China’s national strategy, presents case studies from Hainan and Yunnan provinces and the Huai River Basin, and details the evolving interventions that ultimately led to elimination. 

In an editorial to launch the collection, independent experts explain that global and national funding for malaria control has led to major gains in child survival and supported progress towards elimination, with 45 countries and one territory now having achieved this milestone. 

However, they warn that if replenishment of the Global Fund (which supports malaria control) and the Global Alliance for Vaccines and Immunisation (funding for malaria vaccines) declines in 2025, malaria cases and deaths are predicted to increase. 

This collection offers important lessons for countries pursuing malaria control and elimination, especially in Africa, where those goals have broad political support, they say.

For example, in Hainan Province, elimination was achieved through long term use of overlapping interventions—bed nets, indoor spraying, drug administration, and sustained surveillance—that evolved with changing risk levels, showing that persistent but flexible strategies can succeed even in highly endemic areas.

Recognising that success can breed complacency—and resurgence is another important lesson. In the Huai River Basin, early success in the 1980s led to reduced surveillance and funding, resulting in malaria resurgence in the early 2000s. Control was restored only after reintroducing mass drug administration, robust vector control, and community mobilisation, highlighting the danger of prematurely scaling back efforts and the need for long term vigilance.

Other lessons include the importance of cross border collaboration, real time data sharing, and sustained surveillance, while novel approaches to financing are also urgently needed, led by national governments and their ministries of finance and include regional banks and innovative partnerships, they add.

“China’s malaria-free status is a public health triumph, but it is also a call to action. Elimination requires long term tenacity; not just funds, but data driven foresight,” they write. 

“As global malaria efforts face shifting donor priorities and resulting financing gaps, The BMJ’s new collection offers timely insights for policy makers, implementers, and funders alike. China and other countries that have achieved elimination have shown us the destination—now the challenge is translation to action for those left behind,” they conclude.

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Journal

The BMJ

DOI

10.1136/bmj.r758 

Subject of Research

People

Article Title

Learning from China’s journey to achieve malaria elimination

Article Publication Date

22-Apr-2025

 

A common CEO pay strategy is stalling innovation, a new study reveals why

Virginia Tech researchers find that value-based stock grants can weaken motivation and limit corporate growth

Virginia Tech

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(From left) Jin Xu and Pengfei Ye.

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Credit: Photo courtesy of Virginia Tech.

A pay structure meant to drive corporate success may be doing the opposite. A new study finds that one of the most common forms of CEO compensation – value-based equity grants – can actually weaken executive motivation and stifle innovation by discouraging long-term investments.

Virginia Tech researchers Jin Xu and Pengfei Ye analyzed thousands of U.S. firms from 2006-22 to examine how different executive pay structures influence corporate decision-making. The study, published in the Journal of Financial and Quantitative Analysis, reveals that companies tying CEO stock compensation to a fixed dollar amount can unintentionally weaken executives’ motivation to increase shareholder value. That’s because as stock prices rise, executives receive fewer shares, reducing the reward for strong performance.

"Boards of directors often design CEO pay structures to balance retention and risk, but our findings show that value-based equity grants can backfire," said Xu, associate professor at Virginia Tech’s Pamplin College of Business. "These grants may unintentionally discourage executives from making bold, long-term investments."

How CEO pay structures shape business decisions

Companies typically award CEO stock grants in one of two ways. With share-based grants, executives receive a fixed number of shares and benefit directly when stock prices rise — the better the company performs, the more valuable their equity becomes.

In contrast, value-based grants tie compensation to a fixed dollar amount. The number of shares is adjusted to match that value - so if the stock price is high, executives receive fewer shares and if it’s low, they receive more. This means the total value of the grant is effectively capped at the time of the award, limiting the executive’s potential upside even when the company performs well.

"Under value-based compensation, stronger stock performance actually leads to fewer shares for executives," Ye said. "That weakens the reward for driving long-term gains."

The study also found that companies relying on value-based grants tend to invest less in innovation, particularly in research and development, a key engine of long-term growth.

Notably, firms that emphasize value-based pay often prioritize executive retention and compensation predictability over growth-oriented leadership. While this approach can offer short-term stability, it may come at the cost of corporate agility and bold decision-making.

"When companies focus too much on retention, they may create a system where executives play it safe instead of pursuing ambitious growth strategies," said Ye, assistant professor in the Pamplin College of Business.

The role of corporate governance in executive pay

Strong corporate governance is often seen as a safeguard against flawed compensation models. However, the study finds that even in well-governed firms, value-based pay structures still weaken CEO incentives.

"Good governance can prevent many executive pay abuses, but it does not completely fix the disincentives created by value-based equity grants," Xu said. "Even in firms with strong oversight, we still see reduced investment in innovation."

The researchers measured governance strength using established firm-level governance scores, and compared innovation spending — particularly research and development investment — across companies with varying levels of board oversight. Even in companies with stronger governance, value-based pay was still linked to lower innovation.

Companies with strong governance were also more likely to adopt value-based grants, possibly because they have better internal controls. But the data suggest those controls don’t fully offset the disincentive effects. Governance alone isn’t enough to prevent the unintended consequences of these pay structures.

The growing shift toward value-based pay

Over the past two decades, companies have increasingly shifted from share-based to value-based compensation. The study finds that in 2006, 60 percent of firms used value-based equity grants – a figure that grew to 73 percent by 2022. Meanwhile, share-based compensation declined from 40 percent to 27 percent over the same period.

"As more firms adopt value-based pay, they need to recognize the long-term trade-offs," Ye said. "A growing reliance on this model could mean lower innovation and slower corporate growth."

This trend suggests that more companies are prioritizing pay predictability over performance-driven incentives, which could have long-term consequences for corporate growth.

Weighing stability against growth

One of the core tensions in CEO compensation is balancing retention with strategic leadership.

Value-based pay structures offer companies stability and help retain top executives by reducing compensation volatility. But the study shows that this tradeoff often comes at a cost - lower appetite for risk and reduced investment in long-term innovation.

"Retention and strategic incentives should not be at odds with each other," Xu said. "Boards need to design compensation models that not only keep top talent but also push them to drive sustained company growth."

For corporate boards, this presents a clear dilemma: Should they prioritize predictable compensation or structure pay to encourage innovation and forward-looking leadership? The study suggests that a hybrid model, combining elements of both share-based and value-based pay, may offer a better balance between retaining executives and driving long-term performance.

Why this matters for investors and corporate boards

The study underscores a key takeaway for boards and investors alike: compensation structure doesn’t just shape executive pay — it shapes company strategy.

This research highlights the need for boards to evaluate whether pay models truly align executive decision-making with shareholder interests.

Investors, too, should take note. Companies that rely heavily on value-based grants may prioritize stability over bold leadership and long-term growth — potentially signaling weaker future performance.

"As executive pay continues to evolve, investors should take a closer look at not just how much CEOs are paid, but how they are paid," Ye said. "The structure of compensation plays a huge role in shaping corporate behavior."

The study suggests that a hybrid approach—blending elements of value-based and share-based pay - may offer the best path forward, striking a balance between risk management and bold, growth-oriented leadership.

"For companies and investors alike, executive compensation isn’t just about numbers - it’s about strategy," Xu said. "Boards must ask whether their pay structures are fueling innovation or stalling it."

About the study

The study was conducted by Xu and Ye of Virginia Tech Pamplin College of Business, along with Cheng Zhang of Shanghai University of Finance and Economics.

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Journal

Journal of Financial and Quantitative Analysis

Article Title

Value-Based CEO Equity Grants

 

Better feed, fewer burps: UF scientists target dairy gas emissions​

University of Florida

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Dairy cow 

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Credit: UF/IFAS

University of Florida researchers are testing a new type of cattle feed that could help dairy cows release less methane gas from burps and flatulence and use nutrients more efficiently. Because methane traps heat in the atmosphere, reducing these emissions could make dairy farming more environmentally friendly and sustainable. 

Researchers, led by Antonio Faciola, looked at a potential dairy cattle supplementary feed made of flaxseed and pea protein. The study was published WHEN in the Journal of Dairy Science. 

Methane, a potent greenhouse gas, is naturally emitted by cows during digestion, and cows are significant sources of methane worldwide, especially from their burps. When cows’ stomachs make methane, they lose valuable energy that could otherwise be used to make milk or meat. By feeding them in a way that reduces methane output, researchers might be able to help the cow produce more milk while also chasing climate goals. 

 “It’s a win-win situation. Every time we reduce methane, we keep that energy in the cow’s body,” said Faciola, associate professor at UF’s Department of Animal Sciences.  

University of Alaska research assistant professor and former UF post-doctoral student James Vinyard was critical to the study, he said. Vinyard simulated dairy cattle’s digestion in the lab to see how much methane was produced and to examine possibilities of improving that fermentation by adding a supplemental feed. 

The researchers added the flaxseed and pea protein supplement to the dairy cattle’s rumen in a lab and measured how fermentation changed. The supplement, rich in omega-3 fatty acids and proteins, reduced methane production and improved overall digestion, he said. 

“This supplement has multiple potential benefits,” Faciola said. “Not only could it reduce methane emissions, but it might also increase energy availability for cows, potentially leading to increased milk production.” 

Future studies will include feeding the supplement to dairy cows to see if the lab results match with what happens in the field. 

With food security becoming increasingly important concerns, he emphasized the importance of feeding cows more efficiently to meet growing global demands. 

 “We will need to have cows producing more milk with the same amount of food,” he said. “We have to be more efficient to feed more people.” 

The study was funded in part by O&T Farms Ltd., a Canadian farm that produces animal supplements. 

 

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Journal

Journal of Dairy Science

DOI

10.3168/jds.2024-25770 

Article Title

Effects of a flaxseed and pea matrix on in vitro ruminal fermentation, nutrient degradability, and methane emissions

Article Publication Date

22-Apr-2025

 

An AI tool grounded in evidence-based medicine outperformed other AI tools — and most doctors — on USMLE exams

Developed at UB and described in JAMA Network Open, the new tool should ‘augment, but not replace physicians’

University at Buffalo

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Said Elkin: "Artificial intelligence isn’t going to replace doctors, but a doctor who uses AI may replace a doctor who does not."

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Credit: Sandra Kicman/University at Buffalo

BUFFALO, N.Y. — A powerful clinical artificial intelligence tool developed by University at Buffalo biomedical informatics researchers has demonstrated remarkable accuracy on all three parts of the United States Medical Licensing Exam (Step exams), according to a paper published today (April 22) in JAMA Network Open.

Achieving higher scores on the USMLE than most physicians and all other AI tools so far, Semantic Clinical Artificial Intelligence (SCAI, pronounced “Sky”) has the potential to become a critical partner for physicians, says lead author Peter L. Elkin, MD, chair of the Department of Biomedical Informatics in the Jacobs School of Medicine and Biomedical Sciences at UB and a physician with UBMD Internal Medicine.  

Elkin says SCAI is the most accurate clinical AI tool available to date, with the most advanced version scoring 95.2% on Step 3 of the USMLE, while a GPT4 Omni tool scored 90.5% on the same test.

“As physicians, we are used to using computers as tools,” he explains, “but SCAI is different; it can add to your decision-making and thinking based on its own reasoning.”

The tool can respond to medical questions posed by clinicians or the public at https://halsted.compbio.buffalo.edu/chat/.

The researchers tested the model against the USMLE, required for licensing physicians nationwide, which assesses the physician’s ability to apply knowledge, concepts and principles, and to demonstrate fundamental patient-centered skills. Any questions with a visual component were eliminated.

Elkin explains that most AI tools function by using statistics to find associations in online data that allow them to answer a question. “We call these tools generative artificial intelligence,” he says. “Some have postulated that they are just plagiarizing what’s on the internet because the answers they give you are what others have written.” However, these AI models are now becoming partners in care rather than simple tools for clinicians to utilize in their practice, he says.

“But SCAI answers more complex questions and performs more complex semantic reasoning,” he says, “We have created knowledge sources that can reason more the way people learn to reason while doing their training in medical school.”

The team started with a natural language processing software they had previously developed. They added vast amounts of authoritative clinical information gleaned from widely disparate sources ranging from recent medical literature and clinical guidelines to genomic data, drug information, discharge recommendations, patient safety data and more. Any data that might be biased, such as clinical notes, were not included.

13 million medical facts

SCAI contains 13 million medical facts, as well as all the possible interactions between those facts. The team used basic clinical facts known as semantic triples (subject-relation-object, such as “Penicillin treats pneumococcal pneumonia”) to create semantic networks. The tool can then represent these semantic networks so that it is possible to draw logical inferences from them.

“We have taught large language models how to use semantic reasoning,” says Elkin.

Other techniques that contributed to SCAI include knowledge graphs that are designed to find new links in medical data as well as previously “hidden” patterns, as well as retrieval-augmented generation, which allows the large language model to access and incorporate information from external knowledge databases before responding to a prompt. This reduces “confabulation,” the tendency for AI tools to always respond to a prompt even when it doesn’t have enough information to go on.

Elkin adds that using formal semantics to inform the large language model provides important context necessary for SCAI to understand and respond more accurately to a particular question.

‘It can have a conversation with you’

“SCAI is different from other large language models because it can have a conversation with you and as a human-computer partnership can add to your decision-making and thinking based on its own reasoning,” Elkin says.

He concludes: “By adding semantics to large language models, we are providing them with the ability to reason similarly to the way we do when practicing evidence-based medicine.”

Because it can access such vast amounts of data, SCAI also has the potential to improve patient safety, improve access to care and “democratize specialty care,” Elkin says, by making medical information on specialties and subspecialties accessible to primary care providers and even to patients.

While the power of SCAI is impressive, Elkin stresses its role will be to augment, not replace, physicians.

“Artificial intelligence isn’t going to replace doctors,” he says, “but a doctor who uses AI may replace a doctor who does not.”

In addition to Elkin, UB co-authors from the Department of Biomedical Informatics are Guresh Mehta; Frank LeHouillier; Melissa Resnick, PhD; Crystal Tomlin, PhD; Skyler Resendez, PhD; and Jiaxing Liu. 

Sarah Mullin, PhD, of Roswell Park Comprehensive Cancer Center, and Jonathan R. Nebeker, MD, and Steven H. Brown, MD, both of the Department of Veterans Affairs, also are co-authors.

The work was funded by grants from the National Institutes of Health and the Department of Veterans Affairs.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.6359 

Method of Research

Computational simulation/modeling

Subject of Research

Not applicable

Article Title

Semantic Clinical Artificial Intelligence vs Native Large Language Model Performance on the USMLE

Article Publication Date

22-Apr-2025

 

Alcohol use and abusive or neglectful behaviors among family caregivers of patients with dementia

JAMA Network Open

About The Study:

 In this microlongitudinal cohort study of family caregivers of relatives with dementia, hazardous drinking and daily alcohol consumption were significantly and independently associated with increased odds of abusive and neglectful behaviors, highlighting the need for personalized interventions that address caregiving complexities and alcohol use patterns.

Corresponding author: To contact the corresponding author, Carolyn E. Z. Pickering, Ph.D., R.N., email pickering@uth.tmc.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi: 10.1001/jamanetworkopen.2025.6211)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.6211?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=042225

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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Journal

JAMA Network Open