Management Interventions Research Articles

The role and clinical applications of exosomes in cancer drug resistance

Tumor-secreted exosomes are heterogeneous multi-signal messengers that support cancer growth and dissemination by mediating intercellular crosstalk and activating signaling pathways. Distinct from previous reviews, we focus intently on exosome-therapeutic resistance dynamics and summarize the new findings about the regulation of cancer treatment resistance by exosomes, shedding light on the complex processes via which these nanovesicles facilitate therapeutic refractoriness across various malignancies. Future research in exosome biology can potentially transform diagnostic paradigms and therapeutic interventions for cancer management. This review synthesizes recent insights into the exosome-driven regulation of cancer drug resistance, illuminates the sophisticated mechanisms by which these nanovesicles facilitate therapeutic refractoriness across various malignancies, and summarizes some strategies to overcome drug resistance.

Long-term effects of non-pharmacological interventions in adolescents and young adults with type 1 diabetes: A systematic review and meta-analysis.

Consistent diabetes control is crucial for patients with type 1 diabetes (T1D) to prevent diabetic complications. Analyzing the long-term effects of non-pharmacological interventions can improve diabetes management. To examine the long-term effects of non-pharmacological interventions in adolescents and young adults with T1D through a systematic review and meta-analysis of randomized controlled trials (RCTs). The searches, without any year limitations, were conducted in seven databases. Two reviewers independently performed data extraction and risk of bias assessments. The meta-analysis was conducted using the RevMan 5.4 program and R Studio. The study was registered with PROSPERO (CRD42024503185). A total of 40 studies were included in the systematic review, of which 28 were included in the meta-analysis. Notably, non-pharmacological interventions were effective in improving glycated hemoglobin (HbA1c) at 6 months and self-care at >12 months of follow-up. Subgroup analyses revealed that combined interventions encompassing self-care behavior management, education, and psychological interventions could enhance self-care. Additionally, a combination of face-to-face and telephonic communication was effective in improving HbA1c. Non-pharmacological interventions are effective in improving HbA1c levels and self-care in adolescents and young adults undergoing long-term treatment. However, few studies have analyzed their effects on cardiovascular disease risk factors. Future studies should investigate the long-term effects of non-pharmacological interventions.

Nitrogen deposition and heathland management cause multi‐element stoichiometric mismatches, reducing insect fitness

Abstract Increased nitrogen and acidifying deposition negatively affect biogeochemical cycles and nutrient stoichiometry, particularly in oligotrophic habitats. In heathlands, management aims to mitigate effects of deposition by topsoil removal (sod‐cutting) or by liming to increase soil pH. However, these management efforts may further exacerbate macro‐ and micronutrient stoichiometric mismatch, with cascading effects on heathland insects. Here, we investigate the physiological mechanisms by which deposition and management affect insects, focusing on nutrient uptake and excretion. We combined a phosphorus (P) addition and liming experiment in previously sod‐cut heathland with laboratory‐rearing experiments using the field cricket (Gryllus campestris L., 1) as a model species. We hypothesized that P addition would benefit cricket performance by reducing food N:P ratio. Conversely, we hypothesized that liming would reduce performance by decreasing food Mn:Mg and/or Fe:Mg ratios. Elemental uptake efficiency, consumption and reproduction, as well as cricket field density, were significantly higher under increased P availability, confirming insect P limitation in the field. Liming decreased food Mn:Mg ratio and reduced reproductive success, eliminating any beneficial effects of P addition. Moreover, cricket stoichiometry better explained growth rates than the amount of food consumed. The best model highlighted cricket N and Mn content, with increasing N content negatively influencing growth, while the opposite was true for Mn. We found no support for liming‐induced Fe limitation. We propose that both P and Mn limit crickets independently. Specifically, P limitation affects growth via reduced ribosomal content, and Mn limitation impacts growth by limiting arginase activity and hence restricting the recycling of amino acids. Our study shows that restoration management can fail to restore habitat quality for insects and may even amplify mismatches in macro and micronutrient stoichiometry. To address this, the addition of not only P but also Mn may be required as follow‐up management, but reducing N‐emission remains imperative as this removes the need for disruptive management interventions. Read the free Plain Language Summary for this article on the Journal blog.

Protocol for scoping review: Mapping the landscape of acute pain management in sports-related musculoskeletal injuries.

Acute pain management is critical in sports-related musculoskeletal injuries to facilitate recovery and minimize long-term impact. While current practices vary, incorporating both pharmacological and non-pharmacological approaches, the quality and breadth of existing evidence have not been thoroughly assessed. This scoping review aims to explore the clinical role of different pain management strategies and provide a comprehensive overview of the field. The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) guidelines. Searches will be conducted in major peer-reviewed databases and relevant gray literature. Studies involving athletes of any level undergoing treatment for acute musculoskeletal injuries will be considered. Data extraction will include study and participant characteristics, intervention details, reported outcomes, efficacy comparisons, and economic analyses. This review will provide a descriptive synthesis of the data, utilizing statistical analysis, figures, and tables where relevant to introduce the different treatment modalities. In line with PRISMA-P and PRISMA-ScR guidelines, this scoping review incorporates studies of diverse designs. The data synthesis involves descriptive statistics and narrative presentations, aimed at exploring the relationship between study results and research objectives. This scoping review will evaluate various pain management interventions for acute musculoskeletal injuries in sports, mapping the current evidence and identifying gaps in research. The findings will help inform clinical practices and guide future research efforts to optimize pain management strategies in sports medicine.

Sentiment analysis in infodemic management: leveraging the eppm Risk communication model

Infodemics are the rapid spread of false or misleading information related to public health emergencies, often through digital platforms. They can cause confusion, fear, and even harm to public health. This study investigates the application of sentiment analysis for infodemic management during disease outbreaks. Leveraging the Extended Parallel Process Model (EPPM) of risk communication, the research aims to categorize rumors based on their perceived threat level (high, medium, or low). Machine learning is employed to analyze infodemic text data collected from two Nigerian states (Oyo and Bauchi) to assess threat appraisal according to the EPPM model. The findings can inform targeted interventions for effective infodemic management before, during, and after outbreak of diseases.

The complexity of compliance—Diverse responses to octopus fishery closures in Zanzibar

Abstract Marine protected areas like periodic closures are increasingly used to improve both fisheries management and biodiversity conservation, and often secondarily, human well‐being. Yet rule breaking, whether formal regulations, or community‐agreed norms, continues to negate expected management and conservation outcomes, remaining a major challenge. Although compliance scholarship today is expanding beyond non‐economic explanations of (non)‐compliance behaviour, approaches and theory used fail to show the diversity of perceptions and dispositions that can underpin motivations. A deepening engagement with behavioural sciences like sociology, psychology or behavioural economics is increasingly recognized as key in tackling compliance issues in marine protected areas. In this paper, we contribute to such a strand of compliance scholarship by presenting the responses and positions to (non‐) compliance, rules/regulations and authorities of different people, for example, fishers, traders and others involved in an area‐based fishery management intervention in Zanzibar, Tanzania. We take a qualitative approach aligning with an interpretive research ethic to carry out story circles, photo‐elicitation tasks and focus groups at three sites enacting periodic octopus closures. Theory drawn from sociology, anthropology and cognitive sciences was used to interpret how participants justified were motivated by or dispositioned towards rules, rule makers and rule breakers. Generally, the area‐management intervention was supported by participants, signalling the potential for future compliance most commonly based on the recognition of a degraded marine ecosystem in need of protection. However, the diverse and dynamic responses by different livelihood groups (i.e. traders and fishers) indicated on which basis and through which logics compliance behaviour was condoned or legitimated. This type of insight can help managers gauge or anticipate the potential for non‐compliance in participatory approaches that can impact the health of marine ecosystems. Recommendations include providing discussion spaces for conservation participants' (not just fishermen or fishery organizations) own meanings to be understood and not assumed. Meanings which create and shape relations, actions and concepts in marine protected area processes and thus directly impact the uptake and sustainability of conservation interventions. Read the free Plain Language Summary for this article on the Journal blog.

Alginolyticus Virulence: An Overview

Introduction: Marine habitats harbor the gram-negative, halophilic Vibrio alginolyticus. Usually connected with aquatic life, it poses a serious health risk to humans, especially seafood and marine workers. Marine economic animals like prawns, fish, and shellfish can develop serious illnesses with rapid progression and significant fatality rates. Pathogenic relatives such as Vibrio cholerae and Vibrio parahaemolyticus, which carry genes for several virulence factors, have inherited its virulence, thereby increasing its clinical importance. No effective treatments exist to stop V. alginolyticus dissemination and infection; therefore, studying its virulence mechanisms is crucial to understanding its pathogenicity and improving prevention and therapy. Objectives: To analyze the virulence factors and antibiotic resistance mechanisms of Vibrio alginolyticus to improve prevention and control strategies for managing infections in aquaculture and public health settings. Methods: This study is a literature review synthesising findings from recent research on V. alginolyticus. Sources include peer-reviewed articles, clinical studies, and microbiological research focusing on virulence factors and antibiotic resistance. Data collection involved searching databases like PubMed, Scopus, and Web of Science, filtering for studies on V. alginolyticus’s virulence mechanisms, antibiotic resistance, and impacts on public health and aquaculture. We selected key studies to gain a comprehensive understanding of the pathogenic characteristics and resistance profiles of the bacterium. Results: The results show that V. alginolyticus uses many ways to be strong, like quorum sensing, making virulence proteins, secreting haemolysin, and making biofilms, which make it more dangerous to humans and marine animals. Several resistance genes and efflux systems contribute to its antibiotic resistance, thereby impeding the effectiveness of treatment. Studies also show that biofilm formation and quorum sensing facilitate survival in hostile environments, making infections more challenging to manage. Conclusions: Understanding the virulence factors and antibiotic resistance mechanisms of Vibrio alginolyticus is crucial for developing effective control strategies. This bacterium’s rapid spread and severe impact on marine life and human health necessitate new approaches in aquaculture management and clinical interventions. Enhanced monitoring and targeted research are essential to curb its spread and prevent infection, ultimately improving aquaculture productivity and reducing public health risks associated with this pathogen.

A PROSPECTIVE STUDY ON MANAGEMENT OF CARDIOGENIC SHOCK WITH PERCUTANEOUS CORONARY INTERVENTION

Cardiogenic shock following acute myocardial infarction (AMI) is a critical condition with high mortality rates. Percutaneous coronary intervention (PCI) has emerged as a key intervention, but the outcomes and associated risk factors, including comorbidities such as hypertension, diabetes, and smoking, remain essential to understand for optimizing treatment and improving prognosis. Objective: To evaluate outcomes and identify risk factors in patients with cardiogenic shock secondary to acute myocardial infarction managed with percutaneous coronary intervention. Methods: A prospective observational study was conducted at a tertiary care hospital involving 70 patients aged 60 years and above who presented with cardiogenic shock due to AMI within 24 hours of symptom onset. Data were collected on demographics, clinical indicators of shock severity, and mechanical complications, including pump failure, papillary muscle rupture, ventricular septal rupture (VSR), and free wall rupture. The incidence of comorbidities, such as hypertension, diabetes, and smoking status, was documented. Mortality and recovery patterns were assessed during hospitalization and post-discharge. Statistical analysis was performed to examine associations between comorbidities and adverse outcomes. Results: The mean age of the cohort was 68.8 ± 4.5 years, with a male predominance of 57.1%. Key complications included pump failure in 31.4%, papillary muscle rupture in 11.4%, papillary muscle dysfunction in 34.3%, VSR in 7.1%, and free wall rupture in 4.3% of patients. Overall mortality was 12.9%. Hypertension was present in 67.1% of patients, diabetes in 61.4%, and smoking in 21.4%, all of which correlated with higher complication rates and adverse outcomes. Conclusion: Early PCI management in patients with cardiogenic shock secondary to AMI is associated with favorable survival rates. However, comorbidities such as hypertension and diabetes significantly increase complication rates. These findings underscore the importance of timely intervention and risk-targeted management to improve survival outcomes in high-risk patients.

Interventional Management of a Rare Case of Complex Congenital Heart Disease in an Adult Patient: A Case Report

Congenital heart disease (CHD), which accounts for about one-third of all congenital defects and affects approximately 1% of all live births worldwide, has maintained a stable incidence rate while experiencing a decrease in mortality rates since 1990. Despite advancements in fetal cardiac ultrasound examinations and routine pulse oximetry screening of newborns, a significant proportion of CHD patients may still be undiagnosed until adulthood. This oversight can lead to considerable morbidity and mortality due to physical limitations and reduced quality of life. In this case report, we describe a 29-year-old woman who was initially misdiagnosed as having an inoperable case of CHD and was referred to our center with symptoms of palpitations and exertional dyspnea. During her evaluation, she was diagnosed with severe pulmonary hypertension associated with patent ductus arteriosus (PDA), pre-ductal aortic coarctation, ventricular septal defect (VSD), and bicuspid aortic valve, all of which had been overlooked since infancy. Following initial medical treatment for pulmonary hypertension, a simultaneous transcatheter approach was employed, during which the PDA was closed using an occluder device, and the coarctation was repaired concurrently with a self-expanding stent. Eight months later, her VSD was successfully closed using a muscular VSD occluder device through an interventional technique. This case underscores the importance of adult CHD fellowship training, which enables cardiologists specializing in this field to accurately diagnose and treat complex cases of CHD that may have been missed during infancy and early childhood. This timely intervention ultimately led to the complete relief of her symptoms and prevented progression to Eisenmenger syndrome.

Climatic drought and trophic disruption in an endemic subalpine Hawaiian forest bird

Overexploitation, habitat conversion, and introduced species have caused unprecedented extinctions and heavily degraded native bird populations in island ecosystems. In the Hawaiian Islands, stemming these losses has proven difficult as the highly specialized avifauna are often impacted – among other things – by poorly understood trophic disruptions as well as persistent climatic shifts. Here we investigate these dynamics by examining the trophic positions of 7 different taxa of producers and consumers across the last century in the subalpine māmane (Sophora chrysophylla) forest ecosystem on the island of Hawaiʻi. From museum collections and contemporary sampling, we analyzed the stable nitrogen (δ15N) values of producers and consumers to identify trophic and source amino acids and derive trophic enrichment constants specific to this food web. This enables us to reconstruct the diet of the palila (Loxioides bailleui), a critically endangered finch whose population recently declined 90 %. Our results show that from 1890 to 2006, the palila trophic position declined from 2.6 to 2.2, with cascading implications for its diet. Bayesian mixing model reconstructions indicate that palila trophic position changes likely arose from a 76 % decline (69.3 % to 16.6 % of diet) in the consumption of native moth caterpillars, and a 172 % increase (30.7 % to 83.4 %) in native plants. From the available ecosystem variables, exploratory Bayesian multiple regressions selected surface temperature changes, and the interactions of surface temperatures with drought and caterpillar parasitism as the primary drivers of these trophic changes. Despite the predicted increases of warming and drought, management interventions may build resiliency in this unique island ecosystem.

The expression of MUC5AC in patients with rhinosinusitis: A systematic review and meta-analysis.

To understand the connection between Muc5AC expression and the likelihood of rhinosinusitis, with the goal of providing insights into its prospective use as a biomarker. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for studies up to November 2023 to conduct a literature review. After screening and quality assessment, eligible studies meeting the criteria were included. Muc5AC expression and rhinosinusitis association was analyzed by STATA 14.0. Including weighted mean difference and 95% confidence interval, were reported. The meta-analysis included 16 studies with 1448 rhinosinusitis patients. MUC5AC expression was significantly up-regulated in both chronic rhinosinusitis with nasal polyps (CRSwNP; WMD: 0.52; 95% CI: 0.41-0.63) and chronic rhinosinusitis without nasal polyps (CRSsNP; WMD: 0.42; 95% CI: 0.28-0.56) patients compared to controls. IHC positive area analysis corroborated these findings, with elevated MUC5AC levels in CRSwNP (WMD: 25.61; 95% CI: 22.41-28.81) and CRSsNP (WMD: 39.74; 95% CI: 25.6-53.88) patients. Subgroup analysis based on tissue type (nasal tissue fluid and sinus mucosa) consistently supported the overall results. Our meta-analysis robustly demonstrates a significant association between elevated MUC5AC expression and rhinosinusitis risk. This finding underscores the potential of MUC5AC as a molecular marker, providing valuable insights for future research and potential therapeutic interventions in rhinosinusitis management. CRD42024518932.

Exploring Drivers of Land Use/Land Cover Transformations in Goang Watershed Ethiopia: Integrating Local Community Perceptions with Remote Sensing Data

Land use/land cover (LULC) changes driven by human activities are major environmental challenges in many developing regions. This study assessed local community perceptions and household-level drivers of LULC change in northwest Ethiopia. The study combined remote sensing analysis of LULC change with household surveys to understand local perspectives and the socioeconomic, biophysical, and institutional factors influencing household engagement in deforestation activities. The household survey data was collected from 384 randomly selected household heads, as well as from focus group discussions and key informant participants. The remote sensing component used ERDAS IMAGINE 2014 software to classify satellite images and assess LULC changes over time. The quantitative socio-economic data was analyzed using descriptive statistics and econometric methods of the multivariate probit (MVP) model, while the qualitative data was presented using content analysis. The study revealed that population growth, poverty, and food insecurity were the major underlying driving factors, while agricultural land expansion, settlement growth, fuelwood collection, overgrazing, and forest fires were the major underlying causes of LULC change. The MVP model result indicated that gender, off-farm income, access to training, family size, educational level, and agroecology were key determinants of households’ participation in deforestation drivers such as forestland clearing for agriculture, fuelwood collection, timber harvesting, and overgrazing. These findings highlight the need for integrated land use policies and programs that address the socioeconomic and biophysical root causes of LULC change. This study recommends supporting alternative livelihoods, promoting fuel-efficient technologies, and tailoring interventions to different social groups and agroecological contexts of sustainable land use planning and natural resource management in the study site. Future studies should compare perceptions and drivers of land use change across different regions to identify common patterns and unique challenges. This approach will enhance understanding and inform targeted interventions for sustainable land management.

Fecal Microbiota Transplantation: Insights into Colon Carcinogenesis and Immune Regulation.

Colorectal cancer (CRC) constitutes a significant global health challenge, with recent studies underscoring the pivotal role of the gut microbiome in its pathogenesis and progression. Fecal microbiota transplantation (FMT) has emerged as a compelling therapeutic approach, offering the potential to modulate microbial composition and optimize treatment outcomes. Research suggests that specific bacterial strains are closely linked to CRC, influencing both its clinical management and therapeutic interventions. Moreover, the gut microbiome's impact on immunotherapy responsiveness heralds new avenues for personalized medicine. Despite the promise of FMT, safety concerns, particularly in immunocompromised individuals, remain a critical issue. Clinical outcomes vary widely, influenced by genetic predispositions and the specific transplantation methodologies employed. Additionally, rigorous donor selection and screening protocols are paramount to minimize risks and maximize therapeutic efficacy. The current body of literature advocates for the establishment of standardized protocols and further clinical trials to substantiate FMT's role in CRC management. As our understanding of the microbiome deepens, FMT is poised to become a cornerstone in CRC treatment, underscoring the imperative for continued research and clinical validation.

Early Detection of Left Ventricular Dysfunction With Machine Learning-Based Strain Imaging in Aortic Stenosis Patients.

Aortic stenosis (AS) is a common cardiovascular condition where early detection of left ventricular (LV) dysfunction is essential for timely intervention and optimal management. Current echocardiographic measurements, such as ejection fraction (EF), are insensitive to minor changes in LV function, and strain imaging is typically limited to the global longitudinal strain (GLS) parameter due to robustness issues. This study introduces a novel, fully automatic algorithm to enhance the detection of LV dysfunction in AS patients using multiple strain imaging parameters. We applied supervised machine-learning techniques to classify data from 82 severe AS patients, 96 chest pain subjects, and 319 healthy volunteers. Our model significantly outperformed EF and GLS in distinguishing AS patients from healthy volunteers (area under the curve [AUC] = 0.97 vs. 0.88 and 0.82, respectively). It also surpassed EF and GLS in differentiating AS patients from chest pain subjects (AUC = 0.95 vs. 0.90 and 0.55, respectively). This novel, clinically interpretable model leverages the potential of strain imaging to enhance diagnostic accuracy and guide clinical decision-making in LV dysfunction, thereby improving clinical practice.

Understanding population dynamics and management strategies for a newly emerging pest Carea sp. in Eucalyptus plantations in Indonesia through a mathematical model

In this current study, we investigate the population dynamics of Carea sp. (Lepidoptera: Nolidae), a newly emerging pest in Indonesian Eucalyptus plantations, utilizing the MELP-SI-B mathematical model based on the first reported outbreak in 2022. The larval infestation of Carea sp. has been observed to stunt plant growth and can even lead to plant mortality. The proposed model incorporates pest management interventions, including chemical control with pesticides and biological control through the introduction of natural predators. Analysis of the deterministic compartment model revealed four locally asymptotically stable equilibrium points, validated using eigenvalue approach and application of the center manifold theorem. Bifurcation diagrams are presented to elucidate the relationships between all equilibrium points. An optimal control problem is explored within this model, considering three scenarios: chemical control without predators, simultaneous chemical control with predators, and chemical control followed by predator management. The results of the optimal control strategy analysis highlight the critical importance of timing the initial chemical control application for effective pest management. Notably, this study reveals that a combined approach involving chemical control (without predators) followed by predator management during the post-chemical control period yields the most favorable outcomes among the examined strategies.

Monitoring and reporting adverse events in pragmatic clinical trials testing nonpharmacological pain management interventions.

Monitoring and reporting adverse events in pragmatic clinical trials testing nonpharmacological pain management interventions.

Proactive care management of AI-identified at-risk patients decreases preventable admissions.

We assessed whether proactive care management for artificial intelligence (AI)-identified at-risk patients reduced preventable emergency department (ED) visits and hospital admissions (HAs). Stepped-wedge cluster randomized design. Adults receiving primary care at 48 UCLA Health clinics and determined to be at risk based on a homegrown AI model were included. We employed a stepped-wedge cluster randomized design, assigning groups of clinics (pods) to 1 of 4 single-cohort waves during which the proactive care intervention was implemented. The primary end points were potentially preventable HAs and ED visits; secondary end points were all HAs and ED visits. Within each wave, we used an interrupted time series and segmented regression analysis to compare utilization trends. In the pooled analysis of high-risk and highest-risk patients (n = 3007), potentially preventable HAs showed a statistically significant level drop (-27% [95% CI, -44% to -6%]), without any corresponding change in trends. Potentially preventable ED visits did not show a substantial level drop in response to the intervention, although a nonsignificant differential change in trend was observed, with visit rates decelerating 7% faster in the intervention cohorts (95% CI, -13% to 0%). Nonsignificant drops were observed for all HAs (-19% [95% CI, -35% to 1%]; P = .06) and ED visits (-15% [95% CI, -28% to 1%]; P = .06). A care management intervention targeting AI-identified at-risk patients was followed by a onetime, significant, sizable reduction in preventable HA rates. Further exploration is needed to assess the potential of integrating AI and care management in preventing acute hospital encounters.

Population Health Management and Guideline-Concordant Care in CKD: A Secondary Analysis of K-CHAMP.

Gaps in guideline-concordant care for chronic kidney disease (CKD) lead to poor outcomes. The Kidney Coordinated HeAlth Management Partnership (K-CHAMP) cluster randomized trial tested the effect of a population health management intervention versus usual care on CKD progression and evidence-based care delivery in the primary care setting. K-CHAMP included adults aged 18-85 years with eGFR <60 mL/min/1.73m2 and moderate-high risk of CKD progression who were not seeing a nephrologist. The multi-faceted intervention included nephrology e-consult, pharmacist-led medication management, and patient education. In this post-hoc analysis, we evaluate the effectiveness of K-CHAMP on guideline-concordant care processes (blood pressure and glycemic control, annual albuminuria testing), and medication exposure days (ACEi/ARB, moderate-high intensity statin, SGLT-2i, GLP-1RA). Given multiplicity of outcomes, Benjamini-Hochberg method was used to control false discovery rate (FDR). All 1,596 (754 intervention, 842 usual care) enrolled patients (mean age 74±9 years, eGFR 37±8 mL/min/1.73m2, 928 (58%) female, 127 (8%) Black) were analyzed. After a median 17-month follow-up, intervention arm patients had significantly higher exposure days per year to SGLT-2i (56 vs 32 days, relative benefit 1.72, 95% CI 1.14-2.30) and GLP-1RA (78 vs 29 days, relative benefit 2.65, 95% CI 1.59-3.71) compared to usual care in adjusted analysis. At study initiation in 2019, similar proportion of patients were prescribed SGLT-2i and/or GLP-1RA in intervention and control arm (8% vs 6% respectively, rate ratio 1.23, 95% CI 0-2.99), but by 2022, prescription of these medications was significantly higher in intervention arm (44% vs 27% respectively, rate ratio 1.63, 95% CI 1.32-1.94). There was no significant difference in any process measures or exposure days to ACEi/ARB in patients with albuminuria or moderate-high intensity statin. K-CHAMP was effective in accelerating implementation of SGLT-2i and GLP-1RA but did not increase ACEi/ARB in patients with albuminuria or moderate-high intensity statin use, or improve blood pressure control, glycemic control, or albuminuria testing in individuals with CKD in the primary care setting.

Reach and Engagement With Population Health Management Interventions to Address COVID-19 Among Safety-Net Health Care Systems.

Interventions designed to address COVID-19 needed to be rapidly scaled up to the population level, and to address health equity by reaching historically marginalized populations most affected by the pandemic (e.g., racial/ethnic minorities and rural and low socioeconomic status populations). From February 2021 to June 2022, SCALE-UP Utah used text messaging interventions to reach 107 846 patients from 28 clinics within seven safety-net health care systems. Interventions provided informational and motivational messaging regarding COVID-19 testing and vaccination, and were developed using extensive community partner input. (Am J Public Health. 2024;114(11):1207-1211. https://doi.org/10.2105/AJPH.2024.307770).

Tree Trimming Effects on 3-Dimensional Crown Structure and Tree Biomechanics: A Pilot Project

AbstractBackgroundAlong electric distribution corridors in urban-exurban landscapes, forest edges are susceptible to damage associated with storm events. Disturbances and management interventions designed to preempt their effects (e.g., tree trimming) alter characteristics of tree structure and morphology (e.g., branch and crown structure), which may be associated with tree failure and likelihood of associated infrastructure damage. This study assessed the relationship between 3-dimensional tree crown structure and tree biomechanics and characterized the effect of utility tree trimming on tree sway dynamics using terrestrial laser scanning (TLS).MethodsIn this study we extracted and analyzed measures of crown structure (i.e., crown asymmetry, crown area, total volume, crown diameter to height ratio, and crown evenness) for individual trees during leaf-off conditions before and after implementation of tree trimming and linked these measures to tree biomechanics data, to evaluate how commonly implemented trimming practices affect both tree sway frequency and displacement—important indicators of tree stability.ResultsResults illustrated the effects of common tree trimming practices on tree crown structure, but there were not consistent changes to tree movement characteristics directly following tree trimming across our 24 study trees. However, we found that the associated changes in crown structure through tree trimming affected tree displacement in moderate wind conditions. Additionally, we found there were no significant differences between frequencies across treatment types.ConclusionsThis pilot project lays the foundation for understanding the intricate relationship between 3-dimensional crown structure and tree biomechanics following roadside tree trimming.