Short-term Reduction Research Articles

Impact of Heating Conventional Cigarettes with a Novel Device on Health-related Biomarkers and Cigarette Use Patterns among Chinese Adult Smokers Unwilling to Quit: A Pilot Randomized Controlled Trial.

We evaluated the impact of heating conventional cigarettes with a novel heated tobacco product (HTP) device on biomarkers and cigarette use patterns in Chinese adult smokers unwilling to quit smoking. In this pilot randomized controlled trial, 50 eligible participants were allocated to either Control group (smoking conventional cigarettes) or HTP device group (switching to using heated conventional cigarettes by the HTP device). Participants in the HTP device group went through a 2-day run-in period then used heated conventional cigarettes exclusively for 5 days, followed by flexible use for 14 days. Five biomarkers of exposure (BoEs) were measured at baseline and on Day 7. Thirteen biomarkers of biological effect (BoBEs) were measured at baseline and on Day 21. Safety, daily cigarette consumption, craving, withdrawal symptoms, and device acceptability, were assessed. BoE levels decreased by 26.4 % to 71.4% from baseline in the HTP device group, while BoBE levels did not significantly change in either group. In the HTP group, 56% exclusively used heated conventional cigarettes during the flexible use period, experiencing reduced cravings and withdrawal symptoms, while dual users consumed more cigarettes. Mild to moderate device-related reactions were reported in 36% of users. Satisfaction, taste, and harm reduction belief scores averaged 7.4, 6.6, and 8.7 (out of 10), respectively. Switching to heated cigarettes with the HTP device may reduce short-term exposure to smoke toxicants. However, it can lead to increased tobacco use among dual users. Further investigation is needed to confirm these preliminary findings. This study is the first to evaluate the impact of heating conventional cigarettes with a novel heated tobacco product (HTP) device on health-related biomarkers and cigarette use patterns among Chinese adult smokers. This novel HTP device can directly heat conventional cigarettes without the necessity for specifically designed tobacco products, avoiding potential additive risks of traditional HTPs. If the results of this study could be further verified by randomized controlled clinical trials with larger sample sizes, this novel HTP device could serve as a short-term harm reduction alternative for smokers unwilling to quit.

Impact of copper sulphate treatment on cyanobacterial blooms and subsequent water quality risks

Control of algal blooms and associated biologically-induced water quality risks in drinking reservoirs is problematic. Copper sulphate (CuSO4) treatment is one intervention that has been utilised for >100 years. Evidence indicates a favourable short-term reduction in Cyanobacterial biomass (e.g. bloom termination), but here we indicate that it may also increase longer-term water quality risk. In 2022, we investigated the impacts of CuSO4 spraying on Cyanobacterial communities and nutrient levels within a drinking water supply reservoir using environmental DNA (eDNA) to assess community shifts, alongside monitoring nutrient fractions, orthophosphate (OP) and total phosphate (TP), post-treatment. CuSO4 application successfully reduced Cyanobacterial abundance, however elimination of Cyanobacteria resulted in a shift in bacterial dominance favouring Planctomycetota throughout the summer and a combination of Actinobacteriota and Verrucomicrobiota, throughout autumn. As Cyanobacterial abundance recovered post-treatment, Cyanobacterial genera demonstrated greater diversity compared to only three Cyanobacterial genera present across samples pre-treatment, and included taxa associated with water quality risk (e.g. taste and odour (T&O) metabolite and toxin producers). The increase in Cyanobacteria post-treatment was attributed to an increase in biologically available nutrients, primarily a significant increase in OP. Overall, findings suggest that the significant shift in biodiversity likely induces a less stable ecosystem with greater plasticity of response to changing environmental and biogeochemical variables. Legacy implications of CuSO4 spraying, in terms of shifts in ecosystem and nutrient balance over time, may have implications for drinking water quality, but importantly also for reservoir management options. As such, the effects of CuSO4 spraying should be considered carefully before consideration as a contender for in-reservoir biological control.

A Randomized Controlled Trial Comparing Mentalization-Based Therapy With the Unified Protocol in the Treatment of Psychopathy and Comorbid Borderline + Antisocial Personality Disorders.

Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm. Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months. Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT. Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term. Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.

Screen Media Use and Mental Health of Children and Adolescents

Excessive screen media use has been associated with poorer mental health among children and adolescents in several observational studies. However, experimental evidence supporting this hypothesis is lacking. To investigate the effects of a 2-week screen media reduction intervention on children's and adolescents' mental health. This prespecified secondary analysis of a cluster randomized clinical trial with a 2-week follow-up included 89 families (with 181 children and adolescents) from 10 Danish municipalities in the region of Southern Denmark. All study procedures were carried out in the home of the participants. Enrollment began on June 6, 2019, and ended on March 30, 2021. This analysis was conducted between January 1 and November 30, 2023. Families were randomly allocated to a screen media reduction group or a control group. The 2-week screen media reduction intervention was designed to ensure a high level of compliance to the reduction in leisure-time screen media use. Participants allocated to the intervention group had to reduce their leisure-time screen media use to 3 hours per week or less per person and hand over smartphones and tablets. The main outcome was the between-group mean difference in change in total behavioral difficulties, measured by the Strengths and Difficulties Questionnaire at 2-week follow-up. Results were estimated using mixed-effects tobit regression models. Analyses were carried out as both intention to treat and complete case. In the sample of 89 families including 181 children and adolescents (intervention group [45 families]: 86 children; mean [SD] age, 8.6 [2.7] years; 42 girls [49%]; control group [44 families]: 95 children; mean [SD] age, 9.5 [2.5] years; 57 girls [60%]), there was a statistically significant between-group mean difference in the total difficulties score, favoring the screen media reduction intervention (-1.67; 95% CI, -2.68 to -0.67; Cohen d, 0.53). The greatest improvements were observed for internalizing symptoms (emotional symptoms and peer problems; between-group mean difference, -1.03; 95% CI, -1.76 to -0.29) and prosocial behavior (between-group mean difference, 0.84; 95% CI, 0.39-1.30). This secondary analysis of a randomized clinical trial found that a short-term reduction in leisure-time screen media use within families positively affected psychological symptoms of children and adolescents, particularly by mitigating internalizing behavioral issues and enhancing prosocial behavior. More research is needed to confirm whether these effects are sustainable in the long term. ClinicalTrials.gov Identifier: NCT04098913.

Effects of the combination of various pharmacological treatments and exercise on knee osteoarthritis: a systematic review and network meta-analysis.

The combination of pharmacological and non-pharmacological interventions is strongly recommended by current guidelines for knee osteoarthritis. However, few systematic reviews have validated their combined efficacy. In this study, we investigated the effects of the combination of pharmacological agents and exercise on knee osteoarthritis. Randomized controlled trials that investigated the efficacy of pharmacological agents combined with exercise for knee osteoarthritis were searched in PubMed, Embase, and Cochrane Library up to February 2024. The network meta-analysis was performed within the frequentist framework. Standardized mean difference (SMD) with 95% CI was estimated for pain and function. Grading of recommendations, assessment, development, and evaluations were used to evaluate the certainty of evidence. In total, 71 studies were included. The combination therapy outperformed pharmacological or exercise therapy alone. Among the various pharmacological agents combined with exercise, mesenchymal stem cell injection was ranked the best for short-term pain reduction (SMD: -1.53, 95% CI: -1.92 to -1.13, high certainty), followed by botulinum toxin A, dextrose, and platelet-rich plasma. For long-term pain relief, dextrose prolotherapy was the optimal (SMD: -1.76, 95% CI: -2.65 to -0.88, moderate certainty), followed by mesenchymal stem cells, platelet rich in growth factor, and platelet-rich plasma. Exercise programs should be incorporated into clinical practice and trial design. For patients undergoing exercise therapies, mesenchymal stem cell, dextrose, platelet-rich plasma, platelet rich in growth factor, and botulinum toxin A may be the optimal agents.

Far-red light effects on plant photosynthesis: from short-term enhancements to long-term effects of artificial solar light

Abstract Background and Aims Long-term exposure over several days to Far-Red (FR) increases leaf expansion, while short-term exposure (minutes) may enhance the PSII operating efficiency (ϕPSII). The interaction between these responses at different time scales, and their impact on photosynthesis at whole-plant level is not well understood. Our study aimed to assess the effects of FR in an irradiance mimicking the spectrum of sunlight (referred to as artificial solar irradiance) both in the long and short-term, on whole-plant CO2 assimilation rates and in leaves at different positions in the plant. Methods Tomato (Solanum lycopersicum) plants were grown under artificial solar irradiance conditions with either a severely reduced or normal fraction of FR (SUN(FR-) vs. SUN). To elucidate the interplay between the growth light treatment and the short-term reduction of FR, we investigated this interaction at both the whole-plant and leaf level. At whole-plant level, CO2 assimilation rates were assessed under artificial solar irradiance with a normal and a reduced fraction of FR. At the leaf level, the effects of removal and presence of FR (0FR and 60FR) during transition from high to low light on CO2 assimilation rates and chlorophyll fluorescence were evaluated in upper and lower leaves. Key Results SUN(FR-) plants had lower leaf area, shorter stems, and darker leaves than SUN plants. While reducing FR during growth did not affect whole-plant photosynthesis under high light intensity, it had a negative impact at low light intensity. Short-term FR removal reduced both plant and leaf CO2 assimilation rates, but only at low light intensity and irrespective of the growth light treatment and leaf position. Interestingly, the kinetics of ϕPSII from high to low light were accelerated by 60FR, with a larger effect in lower leaves of SUN than in SUN(FR-) plants. Conclusions Growing plants with a reduced amount of FR light lowers whole-plant CO2 assimilation rates at low light intensity through reduced leaf area, despite maintaining similar leaf-level CO2 assimilation to leaves grown with a normal amount of FR. The short-term removal of FR brings about significant but marginal reductions in photosynthetic efficiency at the leaf level, regardless of the long-term growth light treatment.

Effects of Tryptophan Supplementation in Diets with Different Protein Levels on the Production Performance of Broilers.

Tryptophan plays an important role in the pig industry but has the potential to improve performance in the poultry industry. The purpose of this study was to examine the effects of tryptophan supplementation in diets with different protein levels on the feed intake, average daily gain (ADG), and feed conversion ratio (F/G) of broilers. A total of 180 twenty-one-day-old broilers (half male and half female) were weighed and randomly allocated to twelve groups, with six male and six female groups. Each group consisted of 15 broilers. The broilers were fed low- (17.2%), medium- (19.2%), or high- (21.2%) protein diets with or without extra tryptophan (up to 0.25%) during the 28-day experiment. Food intake and body weight were measured weekly during the trial period. Male broilers fed a medium-protein diet containing more tryptophan showed a lower F/G. In the low-protein diet groups, additional tryptophan caused a significant reduction in the feed intake of female broilers during the first two weeks. Moreover, the serum GLP-1, cholesterol, and bile acid levels, as well as the expression of FXR mRNA in the ileum, were significantly increased. Additionally, the FXR mRNA in the hypothalamus and the GCG and GLP-1R mRNAs in the ileum tended to increase in these broilers. In summary, the tryptophan concentration in the diet can influence the feed intake and metabolism of broilers. Under a standard diet, an appropriate amount of tryptophan is beneficial to the F/G of male broilers, while under a low-protein diet, tryptophan supplementation may cause a short-term reduction in the feed intake of female broilers by increasing serum GLP-1 and bile acid signals.

Effects of physical activity planning interventions on reducing sedentary behavior in parent-child dyads: A randomized controlled trial.

Effects of parent-child dyad interventions on behavior remain unclear. This randomized controlled trial investigated if, compared with a control condition, three types of physical activity (PA) planning interventions (individual "I-for-me," dyadic "we-for-me," and collaborative "we-for-us") would reduce sedentary behavior (SB) time in parents and their children. The study involved 247 dyads comprising parents (aged 29-66) and their children (aged 9-15), randomized into one of the three types of PA planning-intervention arms or the control condition. Mixed models were applied to analyze data from a preregistered trial (NCT02713438) with the outcome of accelerometer-measured SB time, assessed at 1-week and 36-week follow-ups. Although children's SB remained unaffected by the planning interventions, a small reduction of SB time was found among parents in the collaborative (p = .048) and individual (p = .042) planning conditions. The effects were observed at the 1-week follow-up only. While short-term reductions in parents' SB were achieved, these were not sustained long-term. PA planning interventions delivered to parent-child dyads did not substantially reduce children's SB, which may be due to young people's needs of increased independence from their parents.

Combined short-term and long-term emission controls improve air quality sustainably in China

The effectiveness of national policies for air pollution control has been demonstrated, but the relative effectiveness of short-term emission reduction measures in comparison with national policies has not. Here we show that short-term abatement measures during important international events substantially reduced PM2.5 concentrations, but air quality rebounded to pre-event levels after the measures ceased. Long-term adherence to strict emission reduction policies led to successful decreases of 54% in PM2.5 concentrations in Beijing, and 23% in atmospheric nitrogen deposition in China from 2012 to 2020. Incentivized by “blue skies” type campaigns, economic development and reactive nitrogen pollution are quickly decoupled, showing that a combination of inspiring but aggressive short-term measures and effective but durable long-term policies delivers sustainable air quality improvement. However, increased ammonia concentrations, transboundary pollutant flows, and the complexity to achieving reduction targets under climate change scenarios, underscore the need for the synergistic control of multiple pollutants and inter-regional action.

Balneotherapy and cortisol levels: an updated systematic review and meta-analysis.

The main objective of this review is to examine the impact of balneotherapy on serum and salivary cortisol concentrations. A systematic search was conducted in PubMed, Scopus, Web of Science, PEDro, and Google Scholar. The databases were screened from inception up until April 2024. After screening the scientific literature, 845 articles were retrieved and 17 studies, involving a total of 765 participants, were eventually included in the review. Among them, four were randomized controlled trials, five were non-randomized studies, and eight were pre-post studies with no control group. The evidence gathered in this review indicates a significant short-term reduction in cortisol levels in healthy individuals undergoing balneotherapy, particularly those experiencing high levels of stress. Conversely, in patients with rheumatic conditions (especially if elderly), increases in cortisol levels induced by balneotherapy can act as beneficial hormetic stress, reducing inflammatory mediators and improving pain and functional quality of life. The meta-analysis shows an overall trend of reduction in stress hormone levels, more pronounced in the intervention group undergoing mud-balneotherapy compared to the control group, a finding that, however, does not reach statistical significance (g=-0.11 [95% CI: -0.30; 0.08]; p > 0.05). Current scientific evidence demonstrates that balneotherapy has a positive impact on the regulation of cortisol levels. The regulation of the hypothalamic-pituitary-adrenal axis and the beneficial effects observed on health parameters and quality of life allow mud-balneotherapy to be classified as eustressful stimuli useful in preventing stress-related pathologies in healthy individuals and in alleviating symptoms in patients with chronic conditions. Future research on the topic is advised.

Genomic tailoring of autogenous poultry vaccines to reduce Campylobacter from farm to fork

Campylobacter is a leading cause of food-borne gastroenteritis worldwide, linked to the consumption of contaminated poultry meat. Targeting this pathogen at source, vaccines for poultry can provide short-term caecal reductions in Campylobacter numbers in the chicken intestine. However, this approach is unlikely to reduce Campylobacter in the food chain or human incidence. This is likely as vaccines typically target only a subset of the high genomic strain diversity circulating among chicken flocks, and rapid evolution diminishes vaccine efficacy over time. To address this, we used a genomic approach to develop a whole-cell autogenous vaccine targeting isolates harbouring genes linked to survival outside of the host. We hyper-immunised a whole major UK breeder farm to passively target offspring colonisation using maternally-derived antibody. Monitoring progeny, broiler flocks revealed a near-complete shift in the post-vaccination Campylobacter population with an ~50% reduction in isolates harbouring extra-intestinal survival genes and a significant reduction of Campylobacter cells surviving on the surface of meat. Based on these findings, we developed a logistic regression model that predicted that vaccine efficacy could be extended to target 65% of a population of clinically relevant strains. Immuno-manipulation of poultry microbiomes towards less harmful commensal isolates by competitive exclusion, has major potential for reducing pathogens in the food production chain.

Association of relative resection volume with patient-reported outcomes applying different levels of oncoplastic breast conserving surgery – A retrospective cohort study

IntroductionThe American Society of Breast Surgeons (ASBrS) recently classified oncoplastic breast conserving surgery (OBCS) into two levels. The association of resection ratio during OBCS with patient-reported outcomes (PRO) is unclear. Materials and methodsPatients with stage 0-III breast cancer undergoing OBCS between 01/2011-04/2023 at a Swiss university hospital, who completed at least one postoperative BREAST-Q PRO questionnaire were identified from a prospectively maintained institutional database. Outcomes included differences in PROs between patients after ASBrS level I (<20 % of breast tissue removed) versus level II surgery (20–50 %). ResultsOf 202 eligible patients, 129 (63.9 %) underwent level I OBCS, and 73 (36.1 %) level II. Six patients (3.0 %) who underwent completion mastectomy were excluded. The median time to final PROs was 25.4 months. Patients undergoing ASBrS level II surgery were more frequently affected by delayed wound healing (p < 0.001). ASBrS level was not found to independently predict any BreastQ domain. However, delayed wound healing was shown to reduce short-term physical well-being (estimated difference −26.27, 95 % confidence interval [CI] −39.33 to −13.22, p < 0.001). Higher age was associated with improved PROs. ConclusionASBrS level II surgery allows the removal of larger tumors without impairing PROs. Preventive measures for delayed wound healing and close postoperative follow-up to promptly treat wound healing disorders may avoid short-term reductions in physical well-being.

Short term step-reduction induces mitochondrial impairments which are not restored after reambulation, in habitually active adults

Inactivity causes physiological impairments to skeletal muscle mitochondria and disrupts metabolic homeostasis, which has predominantly been investigated through models of severe disuse. The impacts of less-restrictive inactivity through step-reduction (SR) suggests a decline in markers of mitochondrial content without a loss of function (Edwards et al. [2021]. J Appl Physiol, 131, 1653-1662). However, the impact of varying durations of SR and reambulation (RA) on skeletal muscle oxidative capacity are poorly understood. Therefore, this study aimed to investigate the effects of 14 days of SR, followed by 14 days of RA on markers of mitochondrial content and function, and also explore correlations between these markers. A cohort of 12 habitually active adults were studied from previous research (Bowden Davies et al. [2018]. Diabetologica, 61, 1282-1294), for which ethical approval was obtained from NRES Committee North West – Liverpool Central (REC:14/NW/1147). Skeletal muscle biopsy samples from the vastus lateralis were obtained at baseline (BSL), after SR and following RA, which were analysed through immunoblotting/calorimetric assays for markers of mitochondrial content (citrate synthase (CS) activity) and function (OXPHOS, PDH and CPT1A). In vivo mitochondrial function tests using 31P magnetic resonance spectroscopy (31P-MRS) was conducted in a subset of 7 participants. Markers of mitochondrial content and function were significantly reduced following SR (15-34% lower; low to medium effect size 0.3-0.5; COX I (P = 0.009), COX III (P = 0.03), COX IV (P = 0.03), 31P-MRS (P = 0.04)). COX III (P = 0.01) and 31P-MRS (P = 0.03) were lower after RA when compared to BSL. Although not significant, other markers of mitochondrial content and enzymes involved in glucose and fatty acid oxidation were numerically lower after SR (CS activity 17% lower, PDH 23% lower, CPT1A 15% lower). The changes in several complexes of OXPHOS, PDH and CPT1A were positively correlated with CS activity (r2= 0.35 to 0.53, P &lt; 0.05) and 31P-MRS (r2 = 0.46 to 0.76, P &lt; 0.05). The results suggest that a short term reduction in physical activity causes impairments to both mitochondrial content and function which are not completely restored after RA, although further studies are needed to understand the mechanisms that underpin these changes. The findings highlight the deleterious physiological consequences of just reducing physical activity, which manifests as metabolic diseases such as type 2 diabetes in the long run. This prompts for the revision of physical activity guidelines to include the importance of minimising sedentary time.

Navigating the Nexus: Insights from the COVID-19 Pandemic for Climate Change Mitigation

This study explores the intricate interplay between global warming, climate change, the COVID-19 pandemic, air pollution, and climate change mitigation. Drawing on lessons learned from the pandemic, we delve into the complex web of environmental challenges and policy responses. The COVID-19 crisis has highlighted the importance of early and determined action, broad public support, equitable policies, global cooperation, and transparent decision-making. While short-term emissions reductions have been observed, addressing climate change requires sustained, transformative change on a global scale. Our analysis underscores the urgency of applying the pandemic’s insights to combat climate change, recognising the interconnectedness of environmental, economic, and public health challenges.

Adding thread-embedding acupuncture to auricular acupuncture enhances short-term weight reduction in overweight and obesity: A double-blinded, randomized, sham-controlled trial

BackgroundAuricular acupuncture (AA) has been widely used in overweight and obesity management due to its safety and effectiveness. The combination of other acupuncture therapies with thread-embedding acupuncture (TEA) has shown enhanced effects. However, there is a lack of evidence regarding AA plus TEA for overweight and obesity. This study was conducted to address this question. MethodsA randomized placebo-controlled trial was conducted involving 66 overweight or obese participants, divided into two groups: 33 received AA plus TEA, and 33 received AA plus sham TEA over eight weeks. The primary outcome was body weight (BW) reduction. Secondary outcomes included changes in body mass index (BMI) and waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), food cravings questionnaire-trait-reduced (FCQ-Tr) and food craving visual analog scale (VAS) scores. Safety outcomes were adverse events (AEs). ResultsAfter eight weeks, BW decreased by a mean (SD) of -4.45 (1.29) kg and -2.05 (1.33) kg in the AA plus TEA and AA plus sham TEA groups, respectively (MD [95 % CI]: 2.40 [1.75; 3.05]). BMI, WC, WHR, and food craving VAS score decreased significantly more in the AA plus TEA group than in the AA plus sham TEA group. No significant differences were found in FCQ-Tr and HC between groups. Seven AEs were recorded that were mild and resolved without treatment. ConclusionThe addition of TEA to AA is a safe and effective management of overweight and obesity. Further studies should incorporate dietary and lifestyle modifications and follow-up after the intervention to assess long-term effectiveness. Trial registrationThe study protocol had been registered on ClinicalTrials.gov (NCT06091761).

Reshaping energy horizon of Iran: investigating economic sanctions, export diversification, and environmental resilience.

Employing robust methodologies, including principal component analysis, autoregressive moving average, Fourier bootstrap dynamic autoregressive distributed lag, error correction model, and the Breitung-Candelon spectral Granger causality test, this study scrutinizes the impact of export diversification (EXD) on Iran's ecological footprint (EF) from 1997 to 2020, considering economic sanctions (ESI), trade openness (TOP), energy consumption per capita (ECpc), globalization (KOF), and real GDP per capita (RGDPpc). Findings consistently affirm a positive environmental impact of EXD, revealing a nuanced temporal pattern. Notably, the short-term impact (- 0.645) is more pronounced than its long-term counterpart (- .020). Increased industrial activities due to globalization (10% rise) lead to 4.26% and 1.64% EF degradation in the long and short term. Conversely, due to Iran's heavy reliance on fossil fuels, a 10% rise in ECpc correlates with 1.63% and 3.81% long- and short-term environmental quality reduction. ESI demonstrates a dual impact, improving short-term environmental quality but contributing to long-term degradation. Frequency-domain causality analysis highlights EXD and KOF as short- and long-term causes of EF, ESI, and TOP as medium- to long-term causes and RGDPpc as a long-term cause. These findings emphasize the need for sustainable policies, stringent environmental standards, and a balanced approach to fostering economic growth while preserving the environment.

Semaglutide for management of obesity in adolescents: efficacy, safety, and considerations for clinical practice.

The purpose of this review is to describe the existing limited data related to the use of semaglutide in adolescents with obesity, supplementing with findings from adult studies of semaglutide use. Semaglutide, as a once weekly subcutaneous injection for weight management, effectively reduces body mass index (BMI) while improving hyperglycemia, elevated alanine aminotransferase levels, hyperlipidemia, and quality of life in youth with obesity. As of this review, only one large randomized clinical trial of semaglutide in youth has been completed, with a follow-up duration of 68 weeks. Thus, long-term data on the safety in adolescents is limited, particularly regarding the risks of cholelithiasis, pancreatitis, suicidal ideation, and disordered eating. Due to the cost of semaglutide, particularly in the United States, limited cost effectiveness analyses have demonstrated unfavorable incremental cost-effectiveness ratios for semaglutide relative to phentermine-topiramate as an alternative antiobesity medication in adolescents. Semaglutide represents an important advance in the pediatric obesity management, with clear short-term reductions in BMI and improvement in metabolic parameters. However, its long-term safety and efficacy for youth with obesity remain to be demonstrated. Additional research is needed to assess trends in utilization and adherence to minimize the risk of worsening socioeconomic disparities in pediatric obesity.

Transforming Health Care Delivery: Innovations in Payment Models for Interprofessional Team-Based Care.

By examining the strengths, limitations, and implications of different payment models we seek to inform policymakers, practitioners, and educators on the path toward patient-cen-tered, efficient, and sustainable primary health care deliv-ery. Health care payment model reform should be viewed as an investment in future health asset capacity and equity production rather than an immediate return on investment for short-term health care cost reduction.

A New Wave Breaking Benchmark On Rubble Mound Breakwaters

The potential of predictive maintenance for critical port infrastructure, reducing risks and extending its life cycle, remains to be unlocked by suitable quantitative information that fosters predictive maintenance and sustained investments towards progressive climate-proofing of the infrastructure. The PI-BREAK (Predictive Intelligent system for BREAKwater maintenance) project will apply state-of-the-art monitoring and modelling techniques to the maintenance of the Punta Lucero rubble mound breakwater in the port of Bilbao, Spain. This critical infrastructure is crucial to the welfare of coastal communities and the project aims to demonstrate how predictive maintenance can enhance port safety and efficiency, while also supporting economic recovery through low carbon footprint adaptation to future scenarios. By combining short-term risk reduction (for service limit states) with long-term structural reliability (for ultimate limit states) PI-BREAK will develop a sequenced maintenance model to progressively extend the breakwater life span with controlled risk levels and impacts.

Reducing Indoor Particulate Air Pollution Improves Student Test Scores: A Randomized Double-Blind Crossover Study.

Short-term exposure to air pollution is associated with a decline in cognitive function. Standardized test scores have been employed to evaluate the effects of air pollution exposure on cognitive performance. Few studies aimed to prove whether air pollution is responsible for reduced test scores; none have implemented a "gold-standard" method for assessing the association such as a randomized, double-blind intervention. This study used a "gold-standard" method─randomized, double-blind crossover─to assess whether reducing short-term indoor particle concentrations results in improved test scores in college students in Tianjin, China. Participants (n = 162) were randomly assigned to one of two similar classrooms and completed a standardized English test on two consecutive weekends. Air purifiers with active or sham (i.e., filter removed) particle filtration were placed in each classroom. The filtration mode was switched between the two test days. Linear mixed-effect models were used to evaluate the effect of the intervention mode on the test scores. The results show that air purification (i.e., reducing PM) was significantly associated with increases in the z score for combined (0.11 [95%CI: 0.02, 0.21]) and reading (0.11 [95%CI: 0.00, 0.22]) components. In conclusion, a short-term reduction in indoor particle concentration led to improved test scores in students, suggesting an improvement in cognitive function.