Individual Management Research Articles

Plant functional structure varies across different management regimes in submontane meadows

Seminatural grasslands are among the most biodiverse habitats in Europe, and they have great conservation value. However, in recent decades, they have been threatened by either intensive fertilization or afforestation or, conversely, by abandonment due to changes in agricultural practices. The impact of management, its frequency or intensity on seminatural grassland communities is traditionally evaluated through views on the composition of communities and their diversity. A better understanding of the functioning of plants in managed grassland ecosystems could be achieved by considering plant functional traits (PFTs). In this study, we investigated whether sites with different management practices differ from each other in terms of the representation of the main PFTs. We studied a permanent plot series of 30 grassland sites in central Slovakia that had been managed or abandoned for over 10 years. Individual management consisted of low-intensity mowing (MGM), medium-intensity grazing (MGP), and abandonment (MGA). Hemicryptophytes, perennials, and semi-rosette species were dominant under all management regimes. We found significant differences in the coverage of the studied PFTs among the sites managed by phytomass removal (mowing, grazing) and abandoned sites. Compared with the MGA sites, mowed and grazed sites were characterised by high proportional coverages of species with medium plant heights (0.3–0.6 m), rosette species, and graminoids. The MGA sites presented high coverages of species with high plant heights (> 0.6 m), competitors, phanerophytes, forbs, geophytes, species with vegetative and seed reproduction types, species with long flowering periods (3 months or more), and species with summer green leaves. The MGM sites supported species with large seeds (seed mass > 2 mg), reproduction type by seed (seeds), and species with short flowering times (1–2 months), whereas the MGP sites supported species with small plant heights (plant height < 0.3 m) and species with persistent green leaves. The communities of submontane Carpathian meadows with different types of management differ in terms of the representation of selected plant functional traits, especially between managed and abandoned sites. This approach is useful not only for understanding the mechanisms involved in the application of different management methods but also for predicting changes in the responses of the functional properties of plants when abandoning grassland habitats.

Features of the clinical and functional state of the nose in patients with chronic polypous rhinosinusitis and impaired sense of smell

Introduction. According to EPOS 2020, сhronic rhinosinusitis with nasal polypsis detected in 2–4.3% of the population, in Russia about 1.5 million people suffer from polyposis. In clinical practice, attention is most often paid to indicators of respiratory function. At the same time, the assessment of olfactory impairment characteristic of CRSwNP is carried out only by answering one of the 22 questions of the SNOT-22 questionnaire, and indicators of olfactory function are rarely taken into account when evaluating the results of objective research methods.Aim. To study the features of the clinical and functional state of the nose in patients with chronic rhinosinusitis and impaired sense of smell.Materials and methods. 50 patients with сhronic rhinosinusitis with nasal polypsis were examined. The study included an assessment of the sense of smell using Sniffin Stiks test-12, a study of respiratory function, performing a video endoscopy of the nose, computed tomography of the nose and paranasal sinuses. A comprehensive assessment of the condition was carried out using the SNOT-22 questionnaire.Results. The subjective assessment of the sense of smell by patients with CRSwNP does not always coincide with the results of identification tests. The results of the SNOT-22 questionnaire often depend on the degree of olfactory impairment. Patients with CRSwNP and anosmia are more likely to complain of postnasal congestion, thick nasal discharge and cough than patients with hyposmia, which is consistent with objective research methods.Conclusions. In patients with Ghronic rhinosinusitis with nasal polypsis and varying degrees of olfactory impairment, heterogeneity of the clinical and functional state of the nasal cavity and paranasal sinuses was noted. When interpreting the results of the SNOT-22 questionnaire, it is advisable to use factor analysis, taking into account the patient’s complaints. To plan individual management of patients with CRSwNP, a comprehensive assessment of the sense of smell is necessary, including identification tests, as well as an additional assessment of the results of computed tomography of the nose and paranasal sinuses and a video endoscopic picture of the nose according to generally recognized scales.

Delivery of Supported Self‐Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme

ABSTRACTBackgroundSupported self‐management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient‐centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self‐management as RouTine (IMP2ART) programme; a UK‐wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient‐centred care) to improve support for asthma self‐management.ObjectiveTo provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient‐centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery.Design, Setting and ParticipantsWe conducted an observational study using video‐recordings of 12 HCPs delivering routine face‐to‐face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP2ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi‐Channel Video Observation (to code and quantify tasks undertaken); the Patient‐Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient‐centeredness and behaviour change counselling used by HCPs).ResultsHCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self‐management activities (5.4%). Areas of patient‐centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP2ART implementation group practices delivered more SSM strategies. Comparison of face‐to‐face and remote consultations found no significant differences in HCP delivery of SSM.ConclusionsHCPs in UK primary care spent half the time in both face‐to‐face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP2ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group.Patient and Public ContributionAsthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant‐facing documents, and discussing implications of study findings.

Management of Full-Term Nulliparous Individuals Without a Medical Indication for Delivery.

This Clinical Practice Update integrates data from a large, randomized controlled trial (the ARRIVE trial [A Randomized Trial of Induction Versus Expectant Management]) and subsequent other related studies into existing American College of Obstetricians and Gynecologists' guidance regarding management of pregnant individuals at 39 0/7-41 6/7 weeks of gestation without a medical indication for delivery. This document updates Practice Bulletin No. 146, Management of Late-Term and Postterm Pregnancies (Obstet Gynecol 2014;124:390-396) and replaces the Clinical Guidance for Integration of the Findings of the ARRIVE Trial: Labor Versus Expectant Management in Low-Risk Nulliparous Women Practice Advisory, originally published in August 2018.

Green Organizational Climate’s Promotion of Managers’ Organizational Citizenship Behavior for the Environment: Evidence from the Portuguese Hospitality Context

Society at large has become increasingly concerned about climate change and sustainable development, so tourism and travel service providers have begun to focus more actively on sustainable development goals. Prior research has shown that supervisors’ support fosters employee green behavior and companies’ environmental performance. This study concentrated on Portuguese hospitality contexts to develop a fuller understanding of how organizations’ green efforts can combine with the individual variables highlighted by the theory of planned behavior (TPB) (i.e., attitudes, subjective norms, and perceived behavioral control) to encourage supervisors’ organizational citizenship behavior for the environment (OCBE). Data on 74 hotel managers were collected with an online survey. Multiple regression analysis revealed that perceived green organizational climate positively correlates with TPB variables, thereby increasing supervisors’ intention to adopt and encourage OCBE in their workplaces. These findings clarify how organizational and individual factors foster managers’ OCBE. The results have practical implications for organizations seeking to promote their managers’ pro-environmental behavior to boost their environmental sustainability.

ANCIENT GREEK EXPERIENCE OF POLITICAL AND LEGAL REGULATION OF OIKONOMIA AS A BALANCE OF INDIVIDUAL AND GENERAL

The paper examines the political and legal means and ethical principles of harmonizing the interests of the individual and the general in the economic activity of ancient Greek society in the 8th–4th centuries BC. Explore the reform of the economic sphere, reveal the meaning of oikonomia, its structural components in the imagination and state legal practice of the ancient Greeks, highlight the shortcomings of legal regulation in matters of capital accumulation to level out the contradictions of the individual and the general. The ancient Greeks were aware of the antagonism between the individual and the general, understood the dynamic essence of their relationship and formed ethical and legal means of harmonizing the manifested contradiction. As a result of the pan-Athenian agreement, polic was determined as the dominant sphere, where oikonomia acted as a separate subject of citizen activity and consisted of three meanings: a) archaic form of blood-family economic activity, closed in itself, despotic in its essence and therefore destructive for the general; b) a household that naturally provides everything necessary for a patriarchal family and provides the opportunity for its owner to become a “master of industrial relations management.” Individual management experience ensures freedom for each citizen and can promote the interests of the general; c) chremastics is an element of оікіа. This type of activity, under the influence of egocentrism and an anti-human position, naturally threatens the common because it destroys the solidarity and democratic foundations of the policy. Therefore, certain types of chremastics (usury) were prohibited, and the type of activity itself was placed under ethical and legal control – in the form of voluntary charity. This policy was not effective and the way of managing authority was replaced by the state-legal way of managing domestic policy. Since the formation of the professional state apparatus and the formation of the Athenian Empire, oikonomia and chremastics have been transformed from a multiple phenomenon of the internal life of policy into a political lever of the external activities of the state. Athens was transformed into a large archaic оікіа – the majority of citizens and the state itself were enriched unlimitedly. Chremastics have become the dominant activity and value of the public sphere in Athens. This became one of the levers of a new imbalance of individual and general interests, the decline of ancient Greek civilization.

Cardiometabolic characteristics of weight cycling: results from a mid-South regional comprehensive health care system.

The objective of this study was to determine the unique clinical and cardiometabolic risk characteristics of weight-cyclers and identify differences between weight-cyclers and individuals with other weight-change trajectories. A deidentified database of 1,428,204 Vanderbilt University Medical Center patients from 1997 to 2020 was included based on having ≥5 years of recorded weights. Patients with a history of malignant neoplasm, bariatric surgery, implausible BMI (e.g., <15 or >80 kg/m2), or missing documented height were excluded, yielding 83,261 participants categorized by weight trajectory, i.e., weight-stable, weight-gainer, weight-loser, or weight-cycler, based on criteria of ≥5% weight-change thresholds. Additionally, quartiles of average successive weight variability were evaluated to determine the effect of absolute differences among successive weight values. Over half (55%) of participants were weight-cyclers, 23% were weight-gainers, 12% were weight-losers, and 10% were weight-stable over 5 years. Although baseline BMI did not differ among groups, weight-cyclers were more likely to have lower high-density lipoprotein cholesterol and higher blood glucose and triglyceride levels and to have been prescribed antihypertensive, dyslipidemia, and/or antidiabetic therapies. They were also younger and more likely to be smokers. Participants with the greatest weight variability (i.e., highest quartile of average successive weight variability) had higher cardiometabolic risk scores. Weight cycling was highly prevalent but yielded no meaningful overall change in body weight after 5 years. These findings support a paradigm shift in weight management in individuals with overweight/obesity toward reducing cardiometabolic risk with or without weight loss.

I am in Charge, But Not Always in Control: A Qualitative Exploration of Female's Beliefs and Knowledge About Their Pelvic Pain.

Beliefs and knowledge about pain can influence how an individual approaches pain management. At present, there have been no investigations into the beliefs and knowledge that females hold about their pelvic pain; therefore, pain intervention approaches may not be targeted at current patient understandings. Exploring beliefs and knowledge may help inform and subsequently improve pain intervention outcomes for pelvic pain by allowing more tailored content to be delivered. This study aimed to identify beliefs and knowledge that females hold about their pelvic pain. Semistructured interviews (n = 12) were conducted. Based on the common sense model, interview questions investigated participants' beliefs and knowledge related to the identity (diagnostic labels), cause, consequence, control, and timeline of their pelvic pain. Transcribed interviews were analyzed using an Interpretive Description Framework. Participants reported holding biopsychosocial understandings of pain; however, many described their own pain experience in a way that was more aligned with the biomedical model of pain, suggesting incongruence in pain understanding. Participants valued their ability to take charge of their pain management, highlighting bodily autonomy and being proactive in pain management approaches. This approach to management did not provide total control over participants' pelvic pain. Pelvic pain was perceived as disruptive of life, both at present and into the future, with the predictability of pain varying over time. This study provides insight into the perspectives of females with pelvic pain. Recommendations for clinicians are provided with a focus on delivering targeted education and equipping patients with helpful representations of their pain.

Sex- and metabolic-specific association between cumulative body mass index and incident chronic kidney disease: a prospective community-based cohort study

Background and AimDifference in metabolic status may cause inconsistent association between body mass index (BMI) and chronic kidney disease (CKD) in men and women. This study aimed to quantify sex-specific association between cumulative BMI (cumBMI) and incident CKD by different metabolic status. Methods and ResultsParticipants free of CKD from the Kailuan Study were followed biennially from baseline (June 2006 to October 2007) to December 2019. cumBMI was calculated by use of follow-up BMI and follow-up time and was divided into low weight (<18.5 kg/m2), normal weight (18.5 to 23.9 kg/m2), overweight (24 to 27.9 kg/m2), and obesity (≥28 kg/m2) according to Chinese criteria. Metabolic health was defined as the absence of hypertension, dyslipidemia, and diabetes at baseline. CKD was defined as having estimated glomerular filtration rate <60 mL/min/1.73m2. This study included 76984 participants, with a mean age of 50.0 ± 11.6 years and 80.0% of men. Overweight (HR=1.24, 95% CI: 1.16–1.31) and obesity (HR=1.94, 95% CI: 1.77–2.12) were associated with higher risk of incident CKD in men regardless of metabolic status. Corresponding population attributable risk percentages for overweight and obesity were 10.3% (95%CI: 7.1–12.9) and 12.7% (95%CI: 10.6–14.7), respectively. However, low weight (HR=1.56, 95% CI: 1.05–2.30) and obesity (HR=1.32, 95% CI: 1.01–1.73) were associated with higher risk of incident CKD in metabolically healthy women but not in metabolically unhealthy women. ConclusionsThis study demonstrated sex- and metabolic-specific associations between BMI and CKD occurrence and advocates an individualized weight management strategy.

The current policy focus shift from a sectoral to a territorial governance of wildfire reduction is aligned with forest owners’ preferences

Land management for wildfire reduction has been said to require new governance arrangements that ensure the coordination at the local level among landowners and between them and other relevant private and public actors. To promote a shift in the policy approach to wildfire mitigation from the current focus on fuel management, within the forestry sector, to a more effective cross-sectoral landscape transformation, this governance problem takes on even greater importance. Given the diversity of owners within a territory, our main goal is to identify a governance arrangement that match the heterogeneity of owners’ preferences for alternative governance options.Based on a face-to-face survey of 497 owners in a fire-prone region, four types of owners have been identified using a cluster analysis based on management practices and socioeconomic context. Our results show that the type of owner helps explaining their preferences for alternative governance options. Owners that are more active (e.g. regular forest interventions) and have stronger links to the forestry sector, through regular timber sales and participation in forest owner organizations, favor the keeping of individual management over the delegation of management on others or the renting or selling of the land. Although many of these owners see forest organizations alone as the best entities to promote wildfire mitigation, the majority would prefer solutions that also integrate local authorities. Owners that are less active (e.g. no forest interventions) and have weaker links to the sector (no timber sales and no enrollment in forest organizations) consider renting or selling the land, and view a combination of both local authorities and forest organizations as the best solution to promote wildfire reduction at the local level.We conclude that a multi-actor (public-private) territorially-based governance model fits both the required transition in the policy approach and the diverse preferences of different owner types.

Association between Neutrophil-to-high-density lipoprotein-cholesterol ratio and gallstones: insights from the national health and nutrition examination survey (2017–2020)

BackgroundInflammatory responses and lipid metabolism make vital impacts on the development of gallstones. This study investigated the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.MethodsThe data analyzed were sourced from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) and comprised of participants with complete data on GSD and NHR. The relationship between NHR and GSD was evaluated with weighted multivariable logistic regression analysis. Additionally, subset analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were conducted.ResultsAmong the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06. The fully adjusted multivariable logistic regression results demonstrated an obvious positive association between NHR and the likelihood of GSD (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197). Consistency of this association was confirmed through subset analyses and interaction tests across various subgroups, including those categorized by smoking status and asthma. Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.ConclusionsNHR shows a positive relationship to an increased likelihood of GSD among Americans. It can act as an easy and cost-effective tool for the early detection and management of individuals at risk for GSD.

Identification of Barriers and Facilitators to the Use of a New Pain Assessment Mobile Health Application by Family Carers of People with Dementia: A Qualitative Study

This study identified potential barriers and facilitators to the implementation of a medical device in the form of a mobile health (mHealth) application, (app) called PainChek®, by family carers of individuals with dementia in the Australian community setting. Focus groups and a phone interview took place with family carers and healthcare professionals. Data were analysed thematically. 6 family carers and 8 healthcare professionals participated across 2 focus groups and 1 phone interview. Themes related to the user, innovation/PainChek®, and contextual factors were identified. Barriers to use included age, physical limitations, cost, technical issues, misinterpretation of how PainChek® works, and influence of family. Facilitators included a willingness to use mHealth Apps and previous experience. Some themes acted as both barriers and facilitators depending on the situation such as the healthcare team's acceptance. Targeted interventions and support strategies, leveraging facilitators are essential to overcome barriers related to user, intervention, and context and to enhance successful PainChek® implementation, thereby improving pain management in individuals with dementia. Future research is recommended to develop effective implementation strategies to utilise the facilitators and overcome the barriers to improve the implementation of PainChek®.

European Association for the Study of Obesity (EASO) Position Statement on Medical Nutrition Therapy for the Management of Individuals with Overweight or Obesity and Cancer.

Obesity, a prevalent and multifactorial disease, is linked to a range of metabolic abnormalities, including insulin resistance, dyslipidemia, and chronic inflammation. These imbalances not only contribute to cardiometabolic diseases but also play a significant role in cancer pathogenesis. The rising prevalence of obesity underscores the need to investigate dietary strategies for effective weight management for individuals with overweight or obesity and cancer. This European Society for the Study of Obesity (EASO) position statement aimed to summarize current evidence on the role of obesity in cancer and to provide insights on the major nutritional interventions, including the Mediterranean diet (MedDiet), the ketogenic diet (KD), and the intermittent fasting (IF), that should be adopted to manage individuals with overweight or obesity and cancer. The MedDiet, characterized by high consumption of plant-based foods and moderate intake of olive oil, fish, and nuts, has been associated with a reduced cancer risk. The KD and the IF are emerging dietary interventions with potential benefits for weight loss and metabolic health. KD, by inducing ketosis, and IF, through periodic fasting cycles, may offer anticancer effects by modifying tumor metabolism and improving insulin sensitivity. Despite the promising results, current evidence on these dietary approaches in cancer management in individuals with overweight or obesity is limited and inconsistent, with challenges including variability in adherence and the need for personalized dietary plans.

Plant-Based Diets and Phytochemicals in the Management of Diabetes Mellitus and Prevention of Its Complications: A Review

Diabetes mellitus (DM) is currently regarded as a global public health crisis for which lifelong treatment with conventional drugs presents limitations in terms of side effects, accessibility, and cost. Type 2 diabetes (T2DM), usually associated with obesity, is characterized by elevated blood glucose levels, hyperlipidemia, chronic inflammation, impaired β-cell function, and insulin resistance. If left untreated or when poorly controlled, DM increases the risk of vascular complications such as hypertension, nephropathy, neuropathy, and retinopathy, which can be severely debilitating or life-threatening. Plant-based foods represent a promising natural approach for the management of T2DM due to the vast array of phytochemicals they contain. Numerous epidemiological studies have highlighted the importance of a diet rich in plant-based foods (vegetables, fruits, spices, and condiments) in the prevention and management of DM. Unlike conventional medications, such natural products are widely accessible, affordable, and generally free from adverse effects. Integrating plant-derived foods into the daily diet not only helps control the hyperglycemia observed in DM but also supports weight management in obese individuals and has broad health benefits. In this review, we provide an overview of the pathogenesis and current therapeutic management of DM, with a particular focus on the promising potential of plant-based foods.

Symptom perception and coping in patients with primary biliary cholangitis: a qualitative study in the context of SOMA.LIV

Patients with primary biliary cholangitis (PBC) suffer from a variety of physical complaints such as fatigue, itching or joint pain. Since little is known about the experience of symptoms and the corresponding coping strategies in this patient group, a qualitative study was conducted in which 15 patients with PBC were interviewed. The patients reported being burdened by numerous physical complaints, some of which require extensive coping and adaptation processes. By means of thematic analysis, two overarching themes could be generated from the data material: "Accepting limitations and shifting boundaries" describes the patients' challenge of redefining their own stress limits and adapting demands and expectations to their own capabilities. "Maintaining normality and reorienting" describes the tension between the desire to maintain normality and the challenge of integrating the symptoms as perceptible signs of their illness into their own self-image. The results illustrate the central role of physical symptoms in the everyday lives of many patients with PBC, the complexity of the experience of symptoms and the challenges of dealing with these symptoms. They also emphasize the supportive and mediating function of healthcare practitioners in individual symptom management.

Personalized blood pressure estimation using multiview fusion information of wearable physiological signals and transfer learning

Continuous blood pressure (BP) monitoring is crucial for individual health management, yet the significant inter-individual variations among patients pose challenges to achieving precision medicine. In response to this issue, we propose a parallel cross-hybrid architecture that integrates a convolutional neural network backbone and a Mix-Transformer backbone. This model, grounded in multi-view physiological signals and personalized fine-tuning strategies, aims to estimate BP, facilitating the capture of physiological information across diverse receptive fields and enhancing network expressive capabilities. Our proposed architecture exhibits superior performance in estimating systolic blood pressure and diastolic blood pressure, with average absolute errors of 3.94 mmHg and 2.24 mmHg, respectively. These results surpass existing baseline models and align with the standards set by the British Hypertension Society, the Association for the Advancement of Medical Instrumentation, and the Institute of Electrical and Electronics Engineers for BP measurement. Additionally, this study explores a personalized model fine-tuning strategy by adjusting specific layers and incorporating individual information, presenting an optimal solution. The model's generalization ability is validated through transfer learning across databases (public and self-made). To enhance the proposed architecture's usability in wearable devices, this study employs a knowledge distillation strategy for model lightweighting, with preliminary application in our designed real-time BP estimation system. This study provides an efficient and accurate solution for personalized BP estimation, exhibiting broad potential applications.

Menstrual management in transgender and gender diverse individuals: psychiatric and psychosocial considerations

Transgender and gender-diverse (TGD) menstruators are individuals assigned female at birth (AFAB)*, who retain the capacity to menstruate and have a gender identity that differs from their natal sex. Reports indicate up to 1.6 million individuals in the US identify as TGD. Until recently, the mainstream menstrual discourse has failed to capture the experience of transmenstruators. However, a better understanding of the menstrual experiences of TGD-AFAB will allow for more individualized patient-centered care. In this review, we provide the relevant data necessary to inform the psychiatric management of menstruation in TGD-AFAB individuals, including experiences of menstruation, preferences for menstrual management, and the impact on mental health. Our review indicates that menstrual care in TGD patients must be tailored to the individual; clinicians should remain open-minded to the unique experience of transmenstruators; gender-affirming menstrual care is necessary to reduce psychological burden. It should not be assumed that TGD-AFAB menstruators are utilizing appropriate contraceptive methods and should receive contraceptive and fertility preservation counseling. We highlight the importance of having these conversations early in the reproductive arch, even before puberty onset. Keeping in mind the gender minority stress model, in the upcoming sections, we discuss the limited body of literature on mood disorders in TGD-AFAB individuals who menstruate, undergo menstrual suppression, or continue to ovulate. The psychological impact of hormonal therapies is also reviewed.

Body weight variability as a predictor of cardiovascular outcomes in type 1 diabetes: A nationwide cohort study.

Intraindividual body weight variability (BWV), that is, the degree of weight fluctuations over time, is associated with an increased risk of cardiovascular diseases (CVDs) in multiple settings. The impact of BWV on cardiovascular risk in type 1 diabetes (T1D) remains unclear, despite the issues relative to weight management in individuals with this condition. Using data from the Swedish National Diabetes Register, we identified individuals with T1D and without CVD at baseline with at least three measurements of body weight taken over three consecutive years. We estimated BWV as quartiles of the standard deviation of weight measures and explored its longitudinal association with the incidence of CVD during a 12.7 ± 4.6 year follow-up through adjusted Cox regression models. The primary endpoint was the composite of nonfatal myocardial infarction, nonfatal stroke and all-cause mortality. We modelled the function of risk in relation to the magnitude of BWV, testing also whether weight trends, that is, increasing, stable or decreasing, age, sex and glycaemic control modified the association between BWV and the outcome. Among the 36 333 individuals with T1D in the register, we identified 19 373 individuals with at least three measures of body weight and without CVD at baseline. Participants with the highest BWV had a 42% increased risk of reaching the primary endpoint compared to those with the lowest BWV (hazard ratio [HR] = 1.42, 95% confidence interval [CI]: 1.24-1.62). In addition, high BWV was significantly associated with a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.28-1.78), a 37% increased risk of peripheral artery disease (HR = 1.37, 95% CI: 1.06-1.77) and a 55% increased risk of hospitalization for heart failure (HR = 1.55, 95% CI: 1.20-2.01). BWV showed a quasi-linear association with the primary endpoint. No interaction was observed when comparing subgroups for weight trends, sex or degree of glycaemic control. In the subgroup of elderly individuals, the association of BWV with the primary endpoint was no longer significant. High BWV is associated with an increased risk of CVD and all-cause mortality in individuals with T1D, independently of canonical risk factors. Weight trends, sex and glycaemic control do not modify such association while older age attenuates it.

Characterization of individuals with atherosclerotic cardiovascular disease, with and without chronic kidney disease: results from a UK electronic health record database

Abstract Introduction Elevated C-reactive protein (CRP) levels are often present in individuals with atherosclerotic cardiovascular disease (ASCVD), including in those who also have chronic kidney disease (CKD), and are associated with an increased risk of major adverse cardiovascular events (MACE). To understand unmet needs in the identification and management of at-risk individuals, we characterized patients with ASCVD in a UK database, according to CKD stage and CRP levels. Methods This study comprised separate retrospective cross-sectional and longitudinal cohort analyses of patients in the Clinical Practice Research Datalink (CPRD) Aurum database, a representative UK database of anonymized primary care records. In the cross-sectional analysis, CPRD Aurum was linked with Hospital Episode Statistics (HES) and Index of Multiple Deprivation data to assess patient characteristics on 1 Jan 2021 (defined as index date). In the cohort analysis, CPRD Aurum was linked with HES and Office for National Statistics mortality data to determine the incidence of 3-point MACE (3P-MACE) over approximately 5 years of follow-up (index date: 1 Jan 2016). Both analyses included individuals ≥ 18 years old with an ASCVD diagnosis in both primary and secondary care in the 5 years pre-index. Data were analysed using descriptive statistics. Patient characteristics were assessed by CKD stage; for individuals with CKD stage 3–4, characteristics were also assessed by CRP levels. Results In total, 225,767 and 230,055 individuals were included in the cross-sectional and cohort analyses, respectively. The prevalence of CKD stage 3–4 among individuals with ASCVD was 24.3% (Table 1). The proportion of individuals with elevated CRP (CRP ≥ 2 mg/L) and anaemia increased for successively higher CKD severity groups; in addition, glycated haemoglobin (HbA1c) ≥ 7% and elevated blood pressure were generally more frequently observed in individuals with CKD than in those without (Table 1). Individuals with ASCVD, CKD stage 3–4 and elevated CRP had higher HbA1c and total cholesterol levels and a greater proportion had obesity, anaemia and elevated blood pressure, compared with individuals with CRP &amp;lt; 2 mg/L (Table 2). Over 5 years’ follow-up, the incidence of 3P-MACE increased with CKD severity (Table 1) and with increasing CRP levels in individuals with ASCVD and CKD stage 3–4 (Table 2). However, only 28% of individuals with ASCVD and CKD stage 3–4 had CRP measurements. Conclusion Adults with ASCVD, CKD and elevated CRP identified from primary and secondary UK care records had a higher disease burden than individuals with CRP levels &amp;lt; 2 mg/L. In the UK, testing CRP levels is not routinely recommended, resulting in a high proportion of missing CRP measurements in this study. Routine testing of CRP may help in identifying patients with residual cardiovascular risk and has the potential to support risk assessment and management of patients with ASCVD and CKD.

Integrating mechanical and cultural methods for weed control in organic chickpea

Abstract The Northern Great Plains of the United States is a major production region for organic pulse crops that are prone to yield losses due to weeds. Weed management in organic systems relies on the integration of several tactics to stack additive effects and for redundancy to deal with variable efficacy of individual weed management practices. To address the need for effective, integrated weed management, we conducted a 2-yr trial that evaluated the effects of planting date, seeding rate, and preemergent weed control practices (shallow tillage and flame weeding) on weed biomass, crop density, and yield in organically managed chickpea (Cicer arietinum L.) in Montana. Stacking weed management practices increased yields. Early planting had the largest effects on yields, increasing them by 1.8- to 3.6-fold compared with planting 10 to 14 d later. Increasing the seeding rate from the standard rate (43 viable seeds m−2) by 50% increased yields by 47% from 889 to 1,304 kg ha−1. Both preemergent weed control practices increased yields by 40% to 50 % relative to the non-weeded controls. By integrating all three practices, yields of organic chickpea increased greater than 6-fold from 318 kg ha−1 in the controls to 2,006 kg ha−1. The effects of weed control treatments on midseason weed biomass were complex and variable. Although efficacy of the cultural (seeding rate and planting date) and physical (preemergent) treatments on weed biomass varied between years and when combined with other treatments, their full integration, that is, early planted, at higher seeding rate, and preemergent weed control, produced consistently lower weed biomass (84% reduction on average) compared with the standard grower practice (later planting, standard seeding rate, no preemergent weed control). The results lend support to the concept of integrating multiple weed management practices to achieve weed control and high yields in organically managed crops.