High-intensity Interval Research Articles

Effect of different light conditions on the growth response of sugar beet to NaCl

ABSTRACT It is known that sugar beet, derived from a halophytic wild ancestor, is highly salt-tolerant and that moderate concentrations of NaCl enhance its growth. However, the mechanisms of this improved growth performance by NaCl are not fully understood. In this study, we investigated the effects of NaCl on sugar beet growth under different light conditions and examined the relationship between light-induced oxidative stress and the beneficial effects of NaCl. Sugar beet seedlings in pots filled with fertilized soil were grown with different light intensities (low: 150–250 μmol m−2s−1 or high: 600–1,000 μmol m−2s−1) and NaCl treatments (irrigation with water with or without 50 mM NaCl) for 10 days. The enhanced sugar beet growth by NaCl application was only observed in plants with high light intensity treatments. Moreover, high light intensity treatment increased the shoot concentration of malondialdehyde, an indicator of oxidative stress, while NaCl application decreased it. While there was a positive correlation between Na concentration and the compatible solute glycine betaine in the shoots and roots under both light intensities, a significant negative correlation between the concentrations of glycine betaine and malondialdehyde was found only in the shoots under high light intensity. Because it is known that glycine betaine activates antioxidant enzyme activities and reduces oxidative stress responses, glycine betaine synthesized in response to NaCl accumulation may have reduced the oxidative stress caused by high light intensity in the shoots, which may have caused the enhanced growth in sugar beet. Furthermore, the growth promotion by NaCl accumulation was accompanied by a significant decrease in NO3–N concentration, which suggested that NaCl application affects nitrogen metabolism in sugar beet.

Quality of Life as a Non-mortality Patient-centred Outcome in the Critically Ill: A Retrospective Analysis

Objectives: Mortality is a common gauged endpoint in critically ill patients. Reduced quality of life is an aligned repercussion of protracted critical illness. Baseline status, severity of illness and its trajectory influence the outcomes. Patient-oriented outcomes are those that matter the most to a patient. However, quite often, family approves of trade-offs with survivorship in the Indian context. We looked at non-mortality outcomes in patients on high-intensity life-sustaining interventions admitted to the intensive care unit (ICU) despite poor prognosis and died on full support or survived to be completely dependent. Materials and Methods: In this retrospective chart review study, we studied patients (1) who spent more than 1 month in the hospital enduring a myriad of distressing physical and psychological vicissitudes, (2) whose primary illness was fairly advanced (3) and either succumbed or survived to be impeded in their response to cognitive assessment and with severe functional impairment. Patient demographics, comorbidities, pre-morbid functional status, burden of critical illness, use of life-sustaining therapies, functional dependence in the last week of ICU stay, best neurological status in the last week pre-death or discharge, dying trajectories and economic analysis were noted. Results: Trends of clinical progress of 23 patients were deliberated. The mean age of males was 65 years and 61 years for females. Five patients had a Barthel index score of 10–20, indicating total dependency and two patients had a score of 21–60, indicating severe dependency. Two patients were cognitively impaired at baseline. The worst neurological status in the week before death or discharge was eye1, motor1, and verbaltracheostomised. Thirteen patients succumbed during ongoing treatment. Conclusion: Daily discussions on the dynamics of illness progression need to take place with family on a regular basis for patients managed in ICU. Realistic perceptions and grounded expectations from the families and caregivers are necessary for patient-centred outcomes.

Mental health trajectories across COVID-19 and beyond: South African occupational health surveillance data (2019–2023)

There are inconsistent reports on the impact of the COVID-19 pandemic and its associated social restrictions on mental health, with initial suggestions of an increased prevalence of mental disorders in South Africa. However, the longitudinal trajectories of mental health responses across the COVID-19 pandemic are not clear. The primary aim of this study was to describe the trajectories of self-reported common mental disorders, as determined by repeat administration of clinical screening tools across five consecutive years (from 2019 to 2023). A secondary aim was to consider associations with demographic factors such as gender and age. Point prevalence estimates were obtained from a South African occupational mental health surveillance programme in a stable workplace population. Trajectories of common mental disorders across COVID-19 were determined using the Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7 to identify Major Depressive Disorder and Generalised Anxiety Disorder, respectively. Prevalence estimates for depression and anxiety disorders initially remained stable before increasing towards mid-2021 and returning to pre-COVID-19 estimates by end-2022. Suicidal ideation decreased early into the pandemic but returned to pre-COVID-19 levels by 2021. The study suggests that on a practical level, readily available access to mental health care remains an important mechanism to protect mental health during and after major societal disruptor events. This can further be supported through regular monitoring and through providing high-intensity early intervention for at least 18 to 24 months following such events.

Degradation of (1→3)(1→6)-α-D-dextran by ultrasound: Molecular weight, viscosity and kinetics

The (1→3)(1→6)-α-D-dextran (alternating dextran) produced by Leuconostoc citreum SK24.002 is a novel functional exopolysaccharide, and its low molecular weight derivatives have potential applications in the food, pharmaceutical, and chemical industries. In this work, we used sonication, a green polysaccharide disruption method, to study the degradation process of this dextran by changing the intensity and duration of the sonication treatment and the concentration of the dextran solution. The molecular weight and viscosity of the dextran products were measured with a high-performance size exclusion column chromatography–multi-angle laser light scattering–refractive index system and by rheometry, respectively. The degradation efficiency of dextran was directly affected by the duration and intensity of the ultrasonic treatment and the concentration of the dextran solution. The polydispersity index fluctuated as the duration of the sonication treatment increased. The combination of a high intensity (672 W/cm2) and long (120 min) sonication treatment and a low solution concentration (3 g dextran/100 mL) was most effective for reducing the apparent and complex viscosities of dextran. The storage modulus of dextran was always slightly larger than its loss modulus, indicating that it formed a gel-like structure. The second-order kinetic model (1/Mwt - 1/Mw0 = kt) was the best fit to explain the degradation dynamics of dextran by sonication at intensities of 168 W/cm2–834 W/cm2 and with dextran solution concentrations of 1 g/100 mL – 7 g/100 mL. Our findings show that sonication is an effective way to reduce the molecular weight of alternating dextran.

Impact of three weeks of integrative neuromuscular training on the athletic performance of elite female boxers.

To investigate the effects of integrative neuromuscular training (INT) on the athletic performance of elite female boxers. A before-and-after controlled experiment was conducted on 37 elite Chinese female boxers (Age: 26.00±3.11 years). All included athletes have competed at the international level. The INT intervention was administered 11 times per week for 3 weeks. This training includes strength training, explosive training, core stability, agility exercises, high intensity intervals and sprint intervals. Basic physical fitness tests, including the deep squat and bench press one-repetition maximum (1RM), vertical long jump, 30 m sprint run, 400 m run, 3,000 m run, 1-minute hexagonal jump, and 3-minute double shake; as well as specialized striking ability tests, including single-punch striking and 10-second, 30-second, and 3-minute continuous punching, were conducted before and after the intervention. Compared with pre-intervention baseline data, significant differences were found in the athletes' post-intervention baseline physical fitness, including squat and beach press (1RM), vertical jump, 30 m sprint run, 400 m run, 3,000 m run, 1-minute hexagonal jump, and 3-minute double shake (p<0.05). Additionally, 10-second, 30-second, and 3-minute continuous punching were significantly different compared with pre-intervention (p<0.05). However, no significant differences were found in single punch power (p>0.05). The 3-week INT can significantly improve the maximum strength, vertical explosive power, linear acceleration, agility, and continuous punching abilities of Chinese elite female boxers. The use of INT in physical training may enhance their athletic performance.

High-Intensity Gait Training Intervention for Children With Cerebral Palsy: A Case Series.

The purpose of this pilot case series was to describe participation in high-intensity gait training (HIGT) and changes in (1) gait speed/endurance, (2) aerobic capacity, and (3) walking ability in children diagnosed with cerebral palsy (CP). Three children with CP participated in HIGT for 5weeks in lieu of their routine physical therapy. Outcome measures were collected at baseline and post-intervention. Post-intervention, all had at or above the minimal clinically important difference for 10-m walk test speed and 6-minute walk test distance. Two participants performed above the minimal clinically important difference in 7.5-m shuttle run test level and Gross Motor Function Measure-88 Dimension E score. This case series demonstrates short-term improvements in the walking outcome measures with participation in HIGT. Further research is needed with a larger and more diverse randomized controlled trial to determine parameters and long-term effects of HIGT in this population.

Effectiveness of a school-based high-intensity interval training intervention in adolescents: study protocol of the PRO-HIIT cluster randomised controlled trial.

High-intensity interval training (HIIT) is an effective strategy for improving a variety of health and fitness outcomes within school settings. Incorporating HIIT into existing physical activity opportunities appears practically feasible, yet the process evaluation and effectiveness of this strategy needs to be further evaluated. Therefore, a PRO-HIIT intervention will be conducted to evaluate the effectiveness of a 12-week school-based HIIT intervention on cardiorespiratory fitness, physical activity, body composition, muscular strength, bone health, cognitive function, wellbeing and academic performance among 12-13-year-olds. Eight classes of year 7 students (12-13-year-olds) from a secondary school in Ningbo, China, will be recruited and randomly allocated into an intervention or control group. While the control group maintains their usual activities, a 6 to 10 min HIIT session will be embedded in the physical education or physical activity lessons five days a week for 12 weeks for the intervention group. Training workshops will be conducted for participants, teachers, and research staff for facilitating the intervention. Outcome data will be collected at three time points: pre- and post-intervention, and two months (summer holiday) upon completion of the intervention. Linear mixed models will be used to analyse the impact of groups (intervention and control), timepoints (pre-, post- and two-month after intervention) and group by time interactions. The implementation process of the intervention will be evaluated using a process evaluation framework. Ethics approval is obtained from the Ningbo University Ethics Committee (TY2024002). Results from PRO-HIIT study will be disseminated via peer-reviewed journals, scientific conferences as well as local education system. The study protocol has been retrospectively registered on ClinicalTrials.gov Protocol Registration and Results System (NCT06374732), https://clinicaltrials.gov/study/NCT06374732.

Efficacy and safety of ambulatory, weekly, high-intensity intravenous diuretic strategy for congestion-refractory heart failure patients: insights from the DEA-HF prospective randomized clinical trial

Abstract Background Congestion and volume overload are strongly associated with low quality of life and pose a significant risk for both rehospitalization and mortality in heart failure (HF) patients. Despite the widespread use of diuretics in HF, the use of weekly, intravenous (IV), high-intensity diuretic treatment has not been prospectively studied in the setting of ambulatory congestion-refractory patients. Purpose To assess the efficacy and safety of weekly high-intensity diuresis regimens in a practical setting of ambulatory day care for chronically congested HF patients. Methods We performed a sub-analysis on data from a prospective, randomized, cross-over controlled study (DEA-HF) originally designed to compare diuresis regimens in the setting of an HF ambulatory daycare unit who had signs of congestion or volume overload despite adherence to guideline-directed medical therapy. Each patient received three different IV diuretic regimens, in one of six randomized sequences: IV furosemide 250mg; IV furosemide 250mg + oral metolazone 5mg; and IV furosemide 250mg + IV acetazolamide 500mg. All regimens given on the same chronological week were pooled, and diuresis efficacy was assessed by measuring excreted urine volume and sodium weight 6 hours post treatment initiation. Additional assessment at one week post each treatment included serum levels of NT-ProBNP, body weight and creatinine as well as congestion score based on the presence of ascites, pleural effusion and pedal edema. Statistical analysis was based on linear mixed models while accounting for the random effect of patient identity. Results A total of 42 patients were recruited. The mean age was 72±9 years, twenty-one subjects (50%) had LVEF ≥ 50%. 74% of patients were NYHA III class. All patients were on contemporary guidelines-directed HF therapy. Analysis of excreted sodium weight and urine volume revealed values of 4202.1±180.1 mg (Mean±SEM) and 1.77±0.07 liter per visit, respectively. No significant differences in efficacy were detected among treatments given in consecutive weeks (P= 0.80 and 0.69 for differences in sodium weight and urine volume, respectively). After 4 weeks, log(NT-ProBNP) was significantly decreased (P=0.044), accompanied by a significant decrease of 2.4±0.62 kg in body weight (P=0.0004) and of 0.92±0.44 points in congestion score (P=0.037). Serum creatinine level was only slightly increased by 0.19±0.04 mg/dl (P=0.0001), demonstrating the overall safety of the high-intensity diuresis strategy. Conclusions In ambulatory, congestion refractory HF patients a strategy based on high-intensity, weekly diuresis therapy was safe and effective for three consecutive weeks. The natriuresis response to the treatments was maintained, NT-ProBNP levels and congestion score were decreased. The strategy may be instrumental for ambulatory HF patients that require diuretic therapy intensification and may allow to prevent hospitalization.

Impact of High-Intensity Statin on Atrial Fibrillation After Off-Pump Coronary Artery Bypass.

There is uncertainty regarding the impact of high-intensity statins on postoperative outcomes in patients undergoing surgical myocardial revascularization. This study was conducted to evaluate the impact of high-intensity statin treatment on the occurrence rate of new-onset postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Six hundred thirteen patients (66.8±9.8 years, male:female = 476:137) who underwent isolated OPCAB were retrospectively enrolled. Hypertension (n = 409, 66.7%), diabetes mellitus (n = 343, 59.6%) and chronic kidney disease (n = 138, 22.5%) were common comorbidities. Statins and beta-blockers were administered to all patients until the day of surgery and resumed within 6 hours after surgery. Risk factors associated with POAF were analyzed, including the use of high-intensity statins (atorvastatin 40 mg-80 mg or rosuvastatin 20 mg), as well as baseline characteristics and preoperative risk factors. High-intensity statins were used in 158 patients (25.8%). POAF occurred in 184 patients (30.0%). The use of high-intensity statins was not correlated with preoperative levels of low-density lipoprotein (P = 0.135) or high sensitivity C-reactive protein (P = 0.365). Multivariate logistic regression analysis revealed that the use of high-intensity statins was significantly associated with a reduced occurrence of POAF (P = 0.022, odds ratio [95% confidence interval] = 0.592 [0.378-0.926]). Age, acute coronary syndrome, insulin-dependent diabetes mellitus and chronic kidney disease were also significantly associated with POAF. Preoperative administration of high-intensity statins was associated with a 41% reduction in the occurrence rate of POAF in patients who underwent OPCAB.

Readiness Framework for Behavioral Strategies: Assessing Low-Intensity Approaches Prior to High-Intensity Interventions

Challenging behavior can impact the learning environment and prevent educators and students from demonstrating behavioral and academic success. Schools and districts may implore a framework of tiered systems of support to respond to students struggling behaviorally or academically. These systems provide a decision-making process to aid educators’ use of low-intensity strategies before utilizing high-intensity strategies. This process can help school teams use their time and resources efficiently. This article presents a flowchart outlining guiding questions within a problem-solving process as the first step in remedying behavior of concern. This flowchart can be utilized by schools with an existing tiered framework or can support the decision-making process for schools that do not utilize a tiered system of support. A vignette is also included to demonstrate its practical use in the classroom.

Reducing Learning and Psychosocial Disparities in Latino Children with Cancer: A Randomized Intervention Trial.

We developed a high-intensity parenting intervention (HIP) to help parents support the academic success of childhood cancer survivors (CCSs), who often face post-treatment challenges affecting their school-related functioning. This randomized controlled trial (NCT03178617) evaluated HIP's efficacy compared to lower-intensity, single-session, treatment-as-usual services (LIP) in Latino families. Primary outcomes were parenting efficacy and CCSs' school functioning; secondary outcomes included parenting knowledge and measures of CCSs' academic performance, attention, and functioning outside of school. 106 Latino survivors of childhood leukemia and lymphoblastic lymphoma (aged 6-12 years) and their parents were randomly assigned to HIP (n = 54) or LIP (n = 52). Linear mixed-effects models evaluated group differences across baseline, 6-month (T2), and 12-month (T3) assessments. Parenting efficacy and knowledge improved significantly in the HIP arm, resulting in higher scores vs LIP at T2 and T3 (P ≤ .01). No significant between-group differences were found in child school functioning; however, HIP children showed significantly better social functioning and performance on one measure of attention (CPT-3 commissions) at T3 (P < .05). While HIP adherence challenges were observed, with only 33 (61%) completing the intervention, exploratory analyses suggest that benefits were most evident among those who fully engaged. Satisfaction and perceived benefit were greater for HIP vs LIP at both time points (P < .05). Our results suggest the potential value of parent-directed behavioral interventions like HIP for CCSs and their families. Further studies are needed to address participation barriers and enhance engagement to maximize and sustain benefits.

High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes.

Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.

Delivery room resuscitation and short-term outcomes in very preterm infants: a multicenter cross-sectional study in China.

To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs). A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated. Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death. Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.

Impact Of High-intensity Exercise Interventions On Internet Addiction Among College Students

Impact Of High-intensity Exercise Interventions On Internet Addiction Among College Students

Treatment intensity, age and outcome in mechanical ventilated very old patients admitted to Intensive Care Unit.

The global population is aging, and the proportion of elderly patients admitted to Intensive Care Units (ICUs) is increasing. In this scenario, achieving a balance between judicious utilization of a limited and high-cost resource and providing optimal intensity of care presents a challenge, given that in very elderly patients, the value of ICU care is uncertain. The aim of our study is to evaluate the survival of older patients admitted to ICU who require mechanical ventilation (MV) at different levels of treatment intensity. A comprehensive longitudinal ICU database was retrospectively analyzed at a single tertiary center, from January 2008 to December 2014, of ICU subjects 80 years old or older who required mechanical ventilation. From January 2009 to December 2014, 482 subjects were admitted to the ICU and required mechanical ventilation. Among them, 376 (78%) were aged between 80 to 89 years, and 106 (22%) were aged 90 years or older, with a mean age of 85.84 (4.56). The mean APACHE II score was 21.53 (7.42), and the mean SOFA score was 5.75 (3.38). The total mortality during ICU admission was 46%, and the hospital mortality was 58%. Only age higher than 90 years (1.41(1.05;1.91), P = .02) and APACHE score (1.03(1.01;1.05), P < .001) were associated with mortality after adjustments. The TISS score was analyzed in tertiles and was not related to mortality in univariate analysis or after adjustments. Our data indicate that in older subjects using MV, higher intensity of treatment does not seem to translate into a survival benefit. This finding highlights the importance of considering individualized treatment plans for elderly patients in the ICU.

High-Intensity Exercise Training Impact on Cardiorespiratory Fitness, Gait Ability, and Balance in Stroke Survivors: A Systematic Review and Meta-Analysis.

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes.

Insights on prevalence and incidence of anemia and rapid up-titration of oral heart failure treatment from the STRONG-HF study.

Anemia is one of the most frequent comorbidities in patients with heart failure (HF), which potentially can interfere with the effect of guideline-recommended HF medical therapy and can be associated with the use of neurohormonal blockers. The aim of this analysis was to determine the prevalence and changes of anemia status in the STRONG-HF study, its association with clinical endpoints, and possible interaction of the presence of anemia with the efficacy and safety of high-intensity HF treatment. The design and main results of the study have been previously described. Patients were randomized within 2days prior to anticipated hospital discharge after HF worsening in a 1:1 fashion to either high-intensity care (HIC) or usual care (UC). Baseline characteristics, clinical and safety outcomes, and treatment effect of HIC vs. UC on the primary and secondary outcomes were compared in groups based on baseline anemia. In addition, dynamics of hemoglobin during the study follow-up and predictors of incident anemia at 90days were investigated. The proportion of anemia in 1077 STRONG-HF patients at enrollment was 27.2%, while at 90days, it changed to 32.1%. The primary composite outcome occurred in 18.2% of patients without baseline anemia, and 22.5% of patients with baseline anemia (unadjusted HR 1.27; 95% CI 0.90-1.80), a difference that did not reach statistical significance. However, patients with baseline anemia had significantly less improvement of EQ-VAS questionnaire values from baseline to day 90 (adjusted LS-Mean difference -2.34 (-4.37, -0.31), P = 0.02). During the study, anemia developed in 19.4 and 14.6% in HIC and UC groups, respectively. The opposite phenomenon-recovery of anemia-occurred in 27.6 and 28.8% in HIC and UC groups (P = 0.1379). The predictors of incident anemia at 90days were male sex, geographical region other than Europe, ischemic etiology, higher glucose, and elevated uric acid at baseline. The percentages of optimal doses of renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists were not different between anemic and non-anemic patients. High-intensity care strategy did not increase rate of incident anemia at 90days and reduced the rate of primary and secondary endpoints regardless of baseline hemoglobin. Hemoglobin level and status of anemia have a dynamic nature in the acute HF patients in the post-discharge period dependent on multiple factors. High-intensity HF treatment is safe and beneficial regardless of baseline hemoglobin level and presence of anemia. The improvement of quality of life is significantly lower in anemic HF patients implying specific attention to correction of this condition.

Impact of a 12-week high-intensity interval training intervention on cardiac structure and function after COVID-19 at 12-month follow-up.

In patients previously hospitalised for COVID-19, a 12-week high-intensity interval training (HIIT) intervention has previously been shown to increase left ventricular mass (LVM) immediately after the intervention. In the present study, we examined the effects of the same HIIT scheme on LVM, pulmonary diffusing capacity, symptom severity and functional capacity at 12-month follow-up. In this investigator-blinded, randomised controlled trial, 12weeks of a supervised HIIT scheme (4×4min, three times a week) was compared to standard care (control) in patients recently discharged from hospital due to COVID-19. At inclusion and at 12-month follow-up, LVM was assessed by cardiac magnetic resonance imaging (cMRI, primary outcome), while pulmonary diffusing capacity for carbon monoxide (DLCOc, secondary outcome) was examined by the single-breath method. Symptom severity and functional status were examined by the Post-COVID-19 Functional Scale (PCFS) and King's Brief Interstitial Lung Disease (KBILD) questionnaire score. Of the 28 patients assessed at baseline, 22 completed cMRI at 12-month follow-up (12.4±0.6months after inclusion). LVM was maintained in the HIIT but not the standard care group, with a mean between-group difference of 9.68 [95% CI: 1.72, 17.64] g (P=0.0182). There was no differences in change from baseline to 12-month follow-up between groups in DLCOc % predicted (-2.45 [-11.25, 6.34]%; P=0.578). PCFS and KBILD improved similarly in the two groups. In individuals previously hospitalised for COVID-19, a 12-week supervised HIIT scheme resulted in a preserved LVM at 12-month follow-up but did not affect pulmonary diffusing capacity or symptom severity.

Ecophysiology of Mediterranean Chestnut (Castanea sativa Mill.) Forests: Effects of Pruning Studied through an Advanced IoT System

Chestnut (Castanea sativa Mill.) forests in the Mediterranean region are facing increasing abandonment due to a combination of factors, ranging from climate change to socioeconomic issues. The recovery of chestnut ecosystems and their preservation and valorization are key to ensuring the supply of the wide spectrum of ecosystem services they provide and to preventing detrimental environmental shifts. The study’s objective was to provide evidence on the effects of different management options on the ecophysiology of chestnut forests, with diverse pruning intensities (low, medium, and high intensity versus no pruning) tested in an abandoned chestnut stand in central Italy with the aim of recovering and rehabilitating it for fruit production. Innovative Internet of Things (IoT) ‘Tree Talker’ devices were installed on single trees to continuously monitor and measure ecophysiological (i.e., water transport, net primary productivity, foliage development) and microclimatic parameters. Results show a reduction in water use in trees subjected to medium- and high-intensity pruning treatments, along with a decrease in the carbon sequestration function. However, interestingly, the results highlight that trees regain their usual sap flow and carbon sink activity at the end of the first post-pruning growing season and fully realign during the following year, as also confirmed by the NDVI values. As such, this paper demonstrates the efficacy of recovering and managing abandoned chestnut forests, and the initial setback in carbon sequestration resulting from pruning is rapidly remedied with the advantage of reviving trees for fruit production. Additionally, the reduced water demand induced by pruning could represent a promising adaptation strategy to climate change, bolstering the resilience of chestnut trees to prolonged and intensified drought periods, which are projected to increase under future climate scenarios, particularly in the Mediterranean region.

Better Care, Same Cost - Reducing Unplanned Care for Multi-visit Patients: A Payer-Provider Model.

Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care. To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care. Using propensity methods, a comparison group was constructed using insurer membership files. Comparisons were performed using a difference-in-differences analysis. Patients enrolled in ECP through December 2019 were considered eligible for the study (n = 357). All patients had five or more ED visits in the past year or two or more inpatient hospitalizations in the past year prior to enrollment. ECP is a high-intensity outpatient intervention intended to reduce avoidable unplanned care such as ED visits and inpatient hospital stays through home visits, chronic/acute disease management, and intensive care coordination. The primary outcomes of interest were events per 100 members per year of ED use with return to home, unplanned inpatient and observational status admissions, and unplanned behavioral health inpatient admission, and cost of care per member per month. Overall total unplanned care encounters were significantly reduced with a difference-in-difference of 320 unplanned care encounters per 100 members per year in the intervention group (p < 0.05). The ECP group showed statistically significant decreases in costs of unplanned ED, unplanned observation admission, and unplanned inpatient behavioral medicine costs, but statistically significant increases in overall pharmacy costs and lab costs. Changes in total costs of care for the ECP group were not statistically different than the control group (p = 0.55). ECP showed significant reduction of unplanned care for MVP patients.