Management Program Research Articles

Perceptions and factors influencing exercise interventions in elderly patients with debilitating spinal surgery and healthcare professionals: A qualitative study

BACKGROUND Older spine surgery patients have a high incidence of debilitation, which can be managed with certain exercises. AIM To investigate the current status and influencing factors related to the knowledge of exercise intervention among patients and professionals. METHODS Descriptive research methods were used to classify and summarize patients and professionals’ perceptions and factors affecting exercise interventions. Data were analysed using the Colaizzi seven-step analysis method to distill and refine themes. RESULTS A total of 7 themes were identified: (1) The current status of patients' exercise is unsatisfactory; (2) patients' health literacy is low, coupled with a lack of social and family support; (3) there are numerous challenges with systematic exercise interventions; (4) healthcare professionals acknowledge the importance and need for exercise interventions; (5) there's a pronounced willingness among patients to participate in exercise intervention programs; (6) healthcare professionals believe that exercise interventions are beneficial; and (7) participants offered invaluable insights and suggestions on perioperative exercise during spinal surgery. CONCLUSION To investigate the current status and influencing factors related to the knowledge of exercise intervention among patients and the related healthcare professionals to provide a reference for the construction of exercise management programs for these patients.

A Study on One-Time Inspection for Aging Management of Operating Nuclear Power Plants

One-time inspection is used to confirm the effectiveness of nuclear power plant aging management programs such as water chemistry, fuel oil chemistry, and selective leaching program that is designed to prevent or minimize aging degradation during the plant operation. This paper represents one-time inspection experience of selected components and susceptible locations within the scope of water chemistry and fuel oil chemistry aging management programs. Prior to performing one-time inspection, sample sizes of components to be inspected were determined based on combination of materials, environment and aging effect. Examination techniques and relevant operating experience were analysed to obtain technical basis for further implementation of one-time inspection aging management programs. Existing correlation curves between sample size and total population number were reviewed to prepare further inspections for entire operating plants and ensure safety level of components subject to one-time inspection program.

Global, regional, and national burden of thalassemia, 1990–2021: a systematic analysis for the global burden of disease study 2021

Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs. Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs). Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI-0.22 to-0.14), 0.25 (95% UI-0.30 to-0.19), 0.48 (95% UI-0.60 to-0.28), and 0.49 (95% UI-0.62 to-0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC=9.2%, 95% CI: 4.8%-13.8%, P<0.001), ASIR decreased (APC=-7.68%, 95% CI:-10.88% to-4.36%, P<0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC=4.8%, 95% CI: 0.1%-9.6%, P<0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia. The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia's global impact. National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.

TDK részvétel motivációi a Debreceni Egyetem Tehetséggondozó Programjában résztvevő hallgatók körében

Recognition and support of outstanding students are among the most important tasks of higher education, as they can thereby be motivated to pursue a career in academia. In our study, we examined the willingness of members of the Talent Management Program (DETEP) at the University of Debrecen to participate and present at scientific student conferences. Our research was based on a questionnaire survey. The sample consisted of respondents who had previously participated in local TDK conferences (n=128). Based on our results, we can conclude that students who have participated three or more times in TDK events are considering a future career in academia. Respondents who have participated only once mainly participate for the purpose of the competition According to the results between achieving the ranking and the experience of participating in the TDK, participation is experienced as a positive experience if they manage to achieve a ranking at the local conference. Additionally, achieving a ranking also affects the feeling of gaining an advantage during studies and faculty recognition among the respondents.

Anorectal Manometry in Pediatric Colorectal Surgical Care

Background: Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. Methods: An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. Key Results: A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. Conclusions: AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling.

Non-target effects of neurotoxic insecticides on Ganaspis cf. brasiliensis, a classical biological control agent of the spotted wing Drosophila

BackgroundThe spotted wing drosophila, Drosophila suzukii, is an invasive pest causing significant economic losses worldwide. Current pest control strategies mainly rely on insecticides, which negatively impact fruit marketability and the sustainability of integrated pest management (IPM) programs. In addition, pesticides can have dramatic consequences on non-target species when persisting in the environment at low concentrations after field applications. In this context, chemical control can strongly interfere with the releases of the G1 strain of the Asian larval parasitoid Ganaspis cf. brasiliensis, which is currently the adopted classical biological control agent to manage D. suzukii infestations worldwide.MethodsProbit analysis was used to assess the baseline toxicity of acetamiprid, cyazypyr, lambda-cyhalothrin, phosmet, and spinosad on G1 G. cf. brasiliensis adults through residual contact exposure in the laboratory. Then, adult parasitoids were exposed to insecticide low Lethal Concentrations (LC5 and LC30) and their mortality was checked daily to assess the survival of treated wasps.ResultsLambda-cyhalothrin showed the highest toxicity on the parasitoid with a LC50 of 1.38 × 10–3 g active ingredient (a.i.) /L, while cyazypyr seemed the safer active ingredient with an estimated LC50 of 0.20 g a.i./L without affecting parasitoids at sublethal doses. Spinosad and phosmet significantly reduced wasp survival at both LC30 and LC5, while lambda-cyhalothrin and acetamiprid affected parasitoid lifespan only at LC30. Spinosad, lambda-cyhalothrin and phosmet LC30 caused the major survival reductions, followed by acetamiprid LC30. The least significant reduction in parasitoid survival was 21.6% by spinosad LC5.ConclusionsOverall, this study highlighted the importance of carefully selecting insecticides to minimize adverse effects on non-target organisms. In particular, cyazypyr was the most promising candidate to integrate inoculative biological control with chemical treatments. By contrast, the application of phosmet, spinosad and lambda-cyhalothrin should be avoided alongside parasitoid field releases. Although acetamiprid is less used against D. suzukii in the field than the other tested molecules, it should be used with caution due to its sublethal toxicity on the parasitoid. These results provide the first evidence of G. cf. brasiliensis susceptibility to insecticides in order to promote sustainable and efficient pest management strategies.

Do time preferences predict diabetes outcomes? A combined survey and register-based study.

Identifying determinants of heterogeneity in health outcomes continues to be a focus in the health economic literature. In this study, we analyze whether time preferences predict health outcomes in individuals with type 1 diabetes (T1D) who use insulin pump therapy to manage their condition. We collect data on time preferences using a hypothetical matching task and estimate aggregate as well as individual-level discounting parameters using the exponential, hyperbolic, and quasi-hyperbolic discounting models. These parameters are then regressed against essential diabetes-related health outcomes obtained from registries and medical records, including glycemic control, kidney function, BMI, and number of hospital contacts. Our analyses indicate that all three discounting models fit the data equally well. Except for hospital contacts, we find robust evidence that impatience, as reflected by higher discounting, predicts worse health outcomes. Additionally, present bias is associated with worse kidney function. Our findings suggest that time preferences can explain some of the heterogeneity in health among individuals with T1D and call for increased attention on the role of time preferences in the design of disease management programs for individuals with chronic conditions.

Advancing RNAi for Sustainable Insect Management: Targeted Solutions for Eco-friendly Pest Control

Insect pests pose significant challenges to agriculture, forestry, and public health, causing substantial economic losses and threats to food security. Traditional pest control methods, such as chemical insecticides, have limitations due to the development of insecticide resistance, negative impacts on non-target organisms, and environmental concerns. RNA interference (RNAi) has emerged as a promising approach for developing targeted and environmentally safe insect control strategies. This review explores the potential of RNAi-based methods for pest management, discussing the mechanism of RNAi in insects, factors influencing its efficiency, and various delivery strategies. We highlight the advantages of RNAi, such as species-specific targeting and reduced off-target effects, while also addressing challenges and limitations, including variability in RNAi efficiency among insect species and potential resistance development. The review examines the environmental safety and risk assessment of RNAi-based insect control, current applications, and future prospects. We also discuss the socio-economic impact and public perception of RNAi technology, as well as research gaps and future directions. The integration of RNAi-based insect control into integrated pest management programs is crucial for developing sustainable and effective pest control solutions. By providing a comprehensive overview of the current state and future potential of RNAi-based insect control, this review aims to inform research, policy, and practice in this rapidly evolving field.

Short- and long-term effects of commercial formulations of imidacloprid, spirotetramat, and mixtures of these active ingredients on pupae of Diaeretiella rapae (Hymenoptera: Braconidae) and its progeny.

Compatibility studies of insecticides and natural enemies usually focus on short-term lethal effects, without considering the long-term sublethal effects (including progeny). Even less-explored are the effects of commercial insecticides formulated with more than one active product. Short- and long-term lethal and sublethal effects were studied for the first time on the progeny of commercial formulations of spirotetramat, imidacloprid and a commercial mixture of these active ingredients on pupae of Diaeretiella rapae (M'ntosh) (Hymenoptera: Braconidae), an endoparasitoid of aphids considered to be a potential biological control agent. Insecticides were exposed topically on aphid mummies in which the parasitoid was in the pupal stage. Imidacloprid reduced adult emergence by more than 30% and prolonged intra-host development time with respect to control from half the maximum recommended field dose (MFRD). Spirotetramat and commercial mixture only showed significant effects on these endpoints at doses above the MFRD. The tested formulations did not affect adult longevity, sex ratio, and percentage of parasitism in the exposed generation. At low concentrations the active ingredients in the commercial mixture behave synergistically, whereas at medium and high concentrations they behave antagonistically. Considering the 10% lethal dose (LD10), imidacloprid showed the highest hazard coefficient, whereas the commercial mixture was more hazardous when considering the LD50 and LD90. The commercial mixture and imidacloprid induced higher adult emergence and altered the sex ratio in the progeny. The following order of toxicity on D. rapae can be established: imidacloprid > commercial mixture > spirotetramat. Joint use of this species with imidacloprid and commercial mixture should be avoided in integrated pest management programs. © 2024 Society of Chemical Industry.

Micronutrition and diabetes: a new view at prevention and treatment

Worldwide, millions of people suffer from diabetes. Our study aimed to describe the sample’s weight status and the effects of providing individualized micronutrient prescriptions and nutritional counseling to individuals with diabetes. Of the 46 patients (26 women and 20 men) enrolled in this study between 2014 and 2021, 41% had insulin-resistant diabetes and were over the age of 18. In compliance with the World Health Organization guidelines, anthropometric measurements were taken. The impedencemeter was used to measure the visceral fat. Diabetes affected 41% of the patients, with women making up the majority (74%). An impedencemeter’s average measurement of 6 for visceral fat loss was encouraging, and a glycated hemoglobin analysis of diabetics revealed an average loss of 1.6%. A good sign for lowering the therapeutic load is that 16% of diabetic patients were able to stop taking any medication at all, and 79% of patients were able to reduce their dosage. This study served as a strong foundation for the creation of customized nutritional management programs in Morocco to enhance the metabolic health of patients who are obese and insulin-resistant.

Density‐dependent trophic consequences of invasive mrigal carp on native mud carp in Chinese fresh waters

Abstract Understanding the strength, direction and consequences of the trophic impacts of invasive fish on functionally analogous native fishes is important in invasion impact assessment and for informing management programmes. As functionally analogous native and invasive fishes can share prey resources, there is high potential for competitive interactions, which could affect trophic niche sizes and positions. The highly invasive mrigal carp Cirrhinus mrigala and native mud carp Cirrhinus molitorella now co‐exist in many freshwaters in southern China, raising concern on the consequences for mud carp. The trophic interactions of the two species and their consequences (for growth rates and trophic niche sizes as the isotopic niche, calculated using δ13C and δ15N) were tested in a pond enclosure experiment based on additive and substitutive treatments using fish in allopatric and sympatric contexts, with results compared with invaded wild communities. In the experiment, specific growth rates decreased significantly as fish abundance in treatments increased. These density‐dependent effects were observed in both species and were independent of whether the treatment was allopatric or sympatric. In allopatric treatments, isotopic niches of mud carp increased in size with fish number. Conversely, in sympatric treatments, mud carp isotopic niche size decreased with increased mrigal carp number. For mrigal carp, isotopic niche sizes decreased as fish number increased in both allopatric and sympatric treatments. In sympatric experiment treatments, the isotopic niches of mud carp and mrigal carp were always divergent. This was, however, in contrast to four invaded wild communities, where the isotopic niches of the two fishes always had some overlap. Experimental and field data suggest that although native mud carp could be impacted by mrigal carp, these impacts might only manifest when the species are at very high abundances and inter‐specific competitive interactions could be intense. These results also suggest the two species have mechanisms that reduce their inter‐specific interactions to minimise their competitive interactions, thus any ecological impacts from mrigal carp might manifest more from indirect than direct processes.

Implementation and Outcomes of Multidisciplinary Diabetes Management Program Among Type 2 Diabetic Patients: A Comparative Study

Implementation and Outcomes of Multidisciplinary Diabetes Management Program Among Type 2 Diabetic Patients: A Comparative Study

Population-wide impact of a pragmatic program to identify and manage individuals at high-risk of cardiovascular disease: a cluster randomized trial in 120 villages from Northern China

ObjectivesTo explore the population-wide impacts of an evidence-based high-risk strategy for prevention of cardiovascular diseases in resource-poor populations.MethodsA cluster randomized controlled trial was conducted among 120 villages in rural China, with 60 on intervention and 60 on usual care as controls, for 2 years. The intervention emphasized training village doctors to identify high-risk individuals and administering standardized treatments focusing on hypertension management. A random sample of 20 men aged ≥50 years and 20 women aged ≥60 years was drawn from each village before randomization for the baseline survey, and another independent random sample with the same age and sex distribution was drawn at 2 years for the post-intervention survey. The primary outcome was the population mean systolic blood pressure (SBP). Secondary outcomes included the proportions of patients who received regular primary care, antihypertensive medications, aspirin, or lifestyle advice.ResultsA total of 5,654 high cardiovascular risk individuals were identified and managed by village doctors in intervention villages for 15 months on average, with mean SBP lowered by 19.8 mmHg and the proportion with blood pressure under control increased from 22.1% to 72.7%. The primary analysis of the two independent samples (5,050 and 4,887 participants each) showed that population-wide mean SBP in intervention villages did not differ from that in control villages at 2 years (mean difference = 1.0 mmHg, 95% CI: −2.19, 4.26; P = 0.528), though almost all secondary outcomes concerning primary care indicators significantly increased in intervention villages.ConclusionsIn our study, the pragmatic cardiovascular risk management program targeting on high-risk individuals significantly improved the quality of primary care. However, its impact on population blood pressure level and the burden of hypertension-related diseases appeared very limited. Clinical Trial RegistrationClinicalTrial.gov identifier, NCT01259700.

Occurrence and antimicrobial resistance pattern of Escherichia coli and Salmonella species isolated from domestic and peridomestic rodents

E. coli and Salmonella species are bacterial pathogens contributing to opportunistic infections, food poisoning, and urinary tract infections. Recently, research has shown that pathogens have repeatedly been found in rodents. Environmental interaction between human, livestock, and rodents is possibly disseminating these bacteria and their antimicrobial resistance. Therefore, this study aimed to determine the prevalence and antimicrobial resistance patterns of E. coli and Salmonella spp. isolated from domestic and peri-domestic rodents in Iringa municipality, Tanzania. A total of 153 rodents were captured from January to March 2023 and clarified at the species level using identification keys. Rectal swabs were collected. E. coli and Salmonella spp. were isolated by culture methods and identified by biochemical tests and conventional PCR. The antimicrobial susceptibility test was done by disk diffusion method using five antimicrobials, including tetracycline, ciprofloxacin, gentamicin, ceftriaxone, and trimethoprim-sulfamethoxazole. Seven resistant genes were tested by PCR, which were blaCTX-M, blaSHV, sul1, sul2, tetA, acrA, and aac(3)-1. Three rodent species, Rattus rattus (75.2%), Mastomys natalensis (23.5%), and Mus musculus (1.3%), were captured. 17 (11.1%) E. coli were detected, and no Salmonella spp. were isolated. All 17 isolates were susceptible to gentamycin and resistant to sulphamethoxazole/trimethoprim (52.9%). Four E. coli isolates exhibited multidrug resistance (MDR), whereby 75% of these MDR isolates originated from the same area. Six resistant genes were detected: blaCTX-M, sul1, sul2, tetA, acrA, and aac(3)-1, where the acr(A) resistant gene was the most abundant. There were co-occurrences of the resistant genes per isolate, such as sul2, acrA, and aac(3)-1. This study reveals the antimicrobial resistance of E. coli isolated from rodents, providing preliminary data on the prevalence and antimicrobial resistant features of these pathogens in their respective reservoirs in Iringa municipality. The study recommends observing regular antimicrobial resistance screening and improving rodent management and control programs in the studied area.

Toxicity of Bioactive Compounds of Strychnos pseudoquina (Loganiaceae) in Spodoptera frugiperda (Noctuidae)

The objective of this study was to assess the toxicity of leaf and bark extracts of Strycns pseudoquina and their fractions, as well as flavonoids isolated from its bark, in a population of Spodoptera frugiperda. Crude bark and leaf extracts, as well as fractions of these extracts, were obtained using a rotary evaporator and different solvents; the ethyl acetate fraction was obtained, and flavonoid compounds were isolated, consisting mostly of 3-O-methylquercetin and minimally of strychnobiflavone. The crude extracts, extract fractions, and isolated flavonoids were applied separately to maize leaves, which were offered to S. frugiperda larvae; then, biological parameters of this insect population were evaluated. Toxic effects of topical applications of the isolated flavonoids on the larvae were also evaluated. The results highlighted the larvicidal effects of the crude bark extract and its fractions and the significant toxicity of this crude extract (LC50 = 0.048%), which was six times more toxic to larvae than its ethyl acetate fraction (LC50 = 0.288%). The investigated flavonoids showed no significant larvicidal effect. The pronounced larvicidal effect of S. pseudoquina bark crude extract and its fractions on S. frugiperda indicates that this plant presents an insecticidal potential to be explored in integrated pest management programs.

Evaluation of insecticide residues against spotted lanternfly (Hemiptera: Fulgoridae).

Lycorma delicatula White (Hemiptera: Fulgoridae), spotted lanternfly, is a univoltine, phloem-feeding, polyphagous and invasive insect in the United States. Although a primary host for this species is Ailanthus altissima (Mill.) Swingle, tree of heaven, L. delicatula also feeds on many other plant species, including cultivated grapevines. As this species continues to spread, it is important to develop effective management tools. Here, we evaluated the residual efficacy of 4 insecticides commonly used in tree fruit management programs: dinotefuran, bifenthrin, carbaryl, and thiamethoxam. First, all mobile life stages (early instars, late instars, and adults) of L. delicatula were exposed for 1h to dry insecticide residues (18h old) applied to glass or A. altissima bark surfaces. While some mortality was detected immediately following the 1h exposure period, 100% mortality occurred within 24h for all materials and life stages exposed on both glass and bark surfaces. To evaluate longer residual activity of these materials, groups of adult L. delicatula were introduced into cages containing A. altissima trees treated with the same individual insecticides and exposed 6h to residues that were 18h or 7 days old. Paired, untreated A. altissima served as controls. In these bioassays, 48h mortality for 18h old residue reached 95% for thiamethoxam and 100% for bifenthrin and dinotefuran. Seven-day-old bifenthrin and dinotefuran residues again yielded 100% mortality, while thiamethoxam resulted in 58% mortality, and carbaryl yielded only 13.3% and was not significantly different from the control. These results clearly document the efficacy of specific insecticide applications as management tools against L. delicatula.

#1884 Slowing kidney disease with weight loss: a randomised controlled feasibility study (SLOW-CKD Feasibility Study)

Abstract Background and Aims Obesity is a modifiable risk factor for chronic kidney (CKD) and progression to kidney failure. Low energy diets (LEDs) (800 to 1000 kcal/day) are an established weight management strategy and have demonstrated the ability to facilitate 10 to 15 kg weight loss and induce diabetes remission. However, the use of LEDs in adults with CKD is limited and there have been no randomised controlled trials (RCT) exploring their use. Before initiating a definitive trial, there is first a need to assess feasibility and safety. The primary aim of this study was to test the feasibility, acceptability and safety of a low energy diet and weight management program in individuals with obesity and CKD. Method The SLOW-CKD Feasibility Study, a 6-month multi-centre RCT in kidney outpatient clinics in Brisbane Australia, targeted adults with stages 1-3 CKD and a body mass index (BMI) ≥ 30 kg m2 with proteinuria (urinary albumin to creatinine ratio &amp;gt;3 mg/mmol). Participants wererandomised (1:1). The LED group followed a 3-month LED (800-1000 kcal/day) with meal replacements and low-calorie foods, with fortnightly dietitian support. Following this, participants entered a 3-month weight maintenance phase,emphasising healthy eating and commencing a physical activity program guided by an exercise physiologist. The usual care group was offered weight loss support through the kidney clinic, involving referral to a dietitian or weight loss program if agreeable. Primary outcomes included safety (study related serious adverse events [SAEs] and adverse events [aEs]) and feasibility (recruitment rate, retention rate, target weight loss). Secondary outcomes explored changes in anthropometry and clinical measures, patient-reported outcomes, and participant experiences through semi-structured interviews. Pre-defined safety and feasibility outcome criteria are presented in Table 1. Results Overall, 49 participants consented to participate (mean age 52.4 ± 3.8 years, 57% male). The incidence of SAEs was low and comparable between the two groups. There were two SAEs in the LED group (hypoglycaemia and acute kidney injury both requiring hospital admission) and one in the control (hypoglycaemia requiring hospital admission). The most common AE was hyperkalaemia with three episodes (&amp;gt;6.0 mmol/L) in each group. Two of the three feasibility criteria were met deeming the intervention feasible—see Table 1. Mean weight loss for the initial 3-month study period was 10.6 kg ± 5.1 kg in the LED group and 0.7 kg ± 4.3 for the usual care group (p = &amp;lt;0.00). Conclusion Our findings provide important preliminary evidence that LEDs are relatively safe, feasible, and demonstrate promising efficacy as a treatment option for obesity in adults with CKD. A definitive RCT exploring the use of LEDs to improve clinical outcomes and slow progression of CKD is warranted.

Attempts to teach ethics to police leaders and managers at the Police College: a lesson from history

ABSTRACT This practitioner and experience-based insider account outlines the reasons for the introduction in the late 1970s of a named ‘ethics package’ to the content of courses of study at the Police College, Bramshill. The context of the College, and the modal characteristics of its client groups of middle and senior ranking police officers are highlighted. In 1978 an ‘ethics package’ began to be constructed in order to make a significant contribution to the ‘professional’ knowledge and practices commensurate with the role-requirements of police leadership. An outline of the intellectual basis guiding and informing the content of the ‘ethics package’ is provided. The paper then identifies some of the persistent and often disappointing responses to the continuing attempts to include something called ‘ethics’ on the various programmes of study at Bramshill. From 1992 onwards ‘ethics’ was to make various appearances on the leadership and management courses but its status was always fragile partly because of the various regime changes that befell the institution. In 1994 a formal educational action-research process, was begun which sought to position ‘ethics’ on the ‘Police Management Programme’ such that the subject would not be set aside. However, after six years of commitment and endeavour, the feedback from course participants never achieved the level of positive response needed to achieve the fundamental aim of the research project. The paper concludes with a very brief summary of some of the reasons why presenting something called ‘ethics’ to experienced police officers was – and perhaps remains – intrinsically difficult.

Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study

IntroductionNon-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades....

Examining local community socio-economic benefits from community forest programmes in Namibia

ABSTRACT Although academic debates since the 1990s have focused on the outcomes of community forest management interventions these debates have not been widespread within the African context. Literature on a hybrid business model to enable socio-economic security for communities has generally been inadequate. This study examined the socio-economic benefits derived from the Okongo and Uukolonkadhi community forests in Namibia to better understand the local communities’ perceptions of forest management beneficiation. Semi-structured interviews were conducted with residents of these community forests and key government and civil society informants involved with forest management programmes. Although there is an enabling framework in place for benefit sharing, these are unequal, and most residents are unaware of the benefit distribution plans. The government also lacks sufficient economic and technical resources to support communities in developing inclusive hybrid business models. Scholarship must consider the divergent southern geographic contextual challenges to better understand forest beneficiation outcomes.