Successful Intervention Research Articles

Considerations and expectations for the administration of dispersible arpraziquantel to young children: a landscape analysis.

Schistosomiasis is a serious public health problem in many African countries and beyond. Preventive chemotherapy with praziquantel is a successful public health intervention that is recommended for all communities at risk, commonly reached through large-scale mass drug administration campaigns. However, preschool-age children are currently not routinely targeted for treatment due to operational challenges related to dosing and administration with the standard drug formulation. In response to the need for a suitable, child-friendly treatment, the multistakeholder Pediatric Praziquantel Consortium has developed a novel dispersible tablet with improved taste and smaller size. To prepare the introduction and inform future uptake of the novel paediatric formulation in endemic countries, we conducted a landscape analysis to explore perspectives, opinions and experiences of key stakeholders on operational and practical issues in relation to drug dosing and administration. Our findings confirm that child-friendly drug formulations mitigate several operational constraints related to the dosing and administration in young children. The introduction of this novel child health intervention into routine platforms and programs requires solid training and careful communication by engaging with communities, caregivers, healthcare workers and decision-makers to ensure acceptance and future uptake of treatment.

The chemokine CX3CL1 promotes intraperitoneal tumour growth despite enhanced T-cell recruitment in ovarian cancer.

T-cell recruiting chemokines are required for a successful immune intervention in ovarian cancer, and also for the efficacy of modern anticancer agents such as PARP inhibitors. The chemokine CX3CL1 recruits tumour-suppressive T-cells into solid tumours, but also mediates cell-cell adhesions, e.g. of tumour cells, through its membrane-bound form. So far, its role in ovarian cancer has only been rudimentarily addressed. We show that high CX3CL1 expression significantly correlates with worsened survival in human high-grade serous ovarian cancer (n=219). In preclinical ovarian cancer, CX3CL1 plays a dual role, as it enhances the adaptive anti-tumour response, but overall still promotes tumour growth, the latter as a feature of the intraperitoneal environment. Moreover, PARP inhibitors are able to increase CX3CL1 release from human ovarian cancer cells. Collectively, our study shows that CX3CL1 is a driver of intraperitoneal tumour growth in ovarian cancer, a feature that may compromise the anticancer effect of CX3CL1-inducing PARP inhibitors.

Surgical approach to a biliary tract cyst in an elderly cat.

Choledochal cyst or biliary tract cyst is a pathological condition characterized by abnormal dilation of the hepatobiliary system. In veterinary medicine, case descriptions and histological characterizations of this biliary malformation are scarce, requiring reliance on data from human medicine. A presumptive diagnosis typically involves imaging studies, with histopathological examination required for confirmation. Treatment often involves surgical intervention to remove the cyst and restore normal biliary function. A 15-year-old mixed-breed domestic female cat presented with vomiting and anorexia. Ultrasonographic examination revealed a dilation adjacent to the caudal aspect of the gallbladder. The patient underwent surgical intervention, during which a sacculation in the cystic duct region was identified and completely excised. Histopathological analysis confirmed the diagnostic suspicion of a biliary tract cyst. Despite the limited veterinary literature, the success of the surgical intervention, involving complete cyst removal, was evident. The patient remains stable and fully recovered twelve months post-surgery.

Tuberculosis and people who use drugs: why focus on this overlooked population is important and why adapted interventions are necessary.

People who use drugs show a higher incidence and prevalence of tuberculosis than people who do not use drugs in areas where Mycobacterium tuberculosis is endemic. However, this population is largely neglected in national tuberculosis programmes. Strategies for active case finding, screening, and linkage to care designed for the general population are not adapted to the needs of people who use drugs, who are stigmatised and difficult to reach. Moreover, access to care, linkage to care, and treatment adherence are challenging for such a marginalised population. Learning from the HIV field about successful interventions targeting this group, we advocate for the implementation of tuberculosis interventions adapted for people who use drugs, highlighting the key role that community-based approaches could have in both design and implementation. Alongside reducing health inequities by reducing the excess tuberculosis burden among people who use drugs, these targeted interventions can also reduce tuberculosis transmission at the population level.

Remote patient monitoring in heart failure: Acomprehensive meta-analysis of effective programme components for hospitalization and mortality reduction.

Methods of non-invasive remote patient monitoring (RPM) for heart failure (HF) remain diverse. Understanding factors that influence the effectiveness of RPM on HF-related and all-cause hospitalizations, mortality, and emergency department visits is crucial for developing successful RPM interventions. This meta-analysis aims to synthesize and compare existing literature on RPM components that impact HF-related and all-cause hospitalizations, mortality and emergency department visits in HF patients. A systematic search of electronic databases (PubMed, EMBASE, CENTRAL) identified randomized controlled trials from January 2012 to June 2023, comparing non-invasive RPM interventions for HF with usual care. A random-effects meta-analysis assessed outcomes, and additional analyses identified effective RPM components. A total of 41 studies with 16 312 patients (mean follow-up: 9.88 ± 6.37 months) were included. RPM was associated with lower mortality risk (pooled odds ratio [OR] 0.81 95% confidence interval [CI] 0.69-0.95; I2 = 0.39) and reduced first HF hospitalization risk (pooled OR 0.78, 95% CI: 0.70-0.87; I2 = 0.21) compared to usual care. RPM interventions with a self-management module (p < 0.001) and education module (p = 0.028) significantly lowered HF-related hospitalizations. Video calls during RPM interventions further reduced HF-related (p = 0.047) and all-cause hospitalizations (p < 0.001). This meta-analysis confirms the efficacy of RPM in reducing HF-related hospitalizations and mortality. Effective components include self-management, education modules, and video communication. However, heterogeneity among interventions challenges the overall evaluation. Modernizing RPM with advanced technologies like non-invasive sensors, artificial intelligence, and cardiac telerehabilitation could enhance its potential.

Proteomic Profiling Towards a Better Understanding of Genetic Based Muscular Diseases: The Current Picture and a Look to the Future.

Proteomics accelerates diagnosis and research of muscular diseases by enabling the robust analysis of proteins relevant for the manifestation of neuromuscular diseases in the following aspects: (i) evaluation of the effect of genetic variants on the corresponding protein, (ii) prediction of the underlying genetic defect based on the proteomic signature of muscle biopsies, (iii) analysis of pathophysiologies underlying different entities of muscular diseases, key for the definition of new intervention concepts, and (iv) patient stratification according to biochemical fingerprints as well as (v) monitoring the success of therapeutic interventions. This review presents-also through exemplary case studies-the various advantages of mass proteomics in the investigation of genetic muscle diseases, discusses technical limitations, and provides an outlook on possible future application concepts. Hence, proteomics is an excellent large-scale analytical tool for the diagnostic workup of (hereditary) muscle diseases and warrants systematic profiling of underlying pathophysiological processes. The steady development may allow to overcome existing limitations including a quenched dynamic range and quantification of different protein isoforms. Future directions may include targeted proteomics in diagnostic settings using not only muscle biopsies but also liquid biopsies to address the need for minimally invasive procedures.

Iron deficiency anemia: A global public health concern

Iron deficiency anemia (IDA) remains a significant global public health concern, affecting populations across both developing and developed nations. The World Health Organization (WHO) estimates that in 2019, approximately 1.62 billion people were affected by anemia, with iron deficiency being the most common cause. This condition disproportionately impacts vulnerable groups, including women, children, and populations in low- and middle-income countries. In the United States, the Centers for Disease Control and Prevention (CDC) reports a substantial prevalence of IDA, particularly among certain demographic groups, including pregnant women and young children (CDC, 2020). The impact of IDA is particularly evident in regions like India, where the Indian Council of Medical Research (ICMR) highlights concerning trends and the need for targeted interventions to address iron deficiency, particularly among women and children. Studies suggest that improved iron status in populations is essential for reducing the prevalence of IDA and its associated complications, such as cognitive impairment, fatigue, and weakened immune function. Recent advances in diagnostics, including point-of-care testing, have improved the identification and management of anemia in primary healthcare settings. Addressing IDA involves comprehensive strategies such as iron supplementation, dietary improvements, and public health initiatives like the Weekly Iron and Folic Acid Supplementation Program in India. The global efforts to combat nutritional anemia underscore the importance of multifaceted approaches to prevention and control. Ultimately, tackling IDA in India will require a multi-sectoral approach, with collaboration between government agencies, healthcare providers, research institutions, and local communities to ensure the widespread success of interventions in reducing iron deficiency and improving overall health outcomes.

Refugee status as taboo: how humanitarian intervention impeded refugee recognition in Vietnam before the Orderly Departure Program (1979)

The management of the Vietnamese refugee crisis, when the United Nations High Commissioner for Refugees (UNHCR) resettled approximately three million refugees between 1975 and 1997, remains a cornerstone of UNHCR’s self-representation and an oft-cited example of successful intervention to this day. However, the focus on resettlement obscures the fact that UNHCR’s engagement in Vietnam started well before the end of the war, in 1973, in the form of humanitarian aid. This essay argues that UNHCR’s early engagement with Vietnam intended to realize the organization’s international ambitions, namely, to further globalize its reach. After its successful war of decolonization, Vietnam attained a special position in the Global South as well as in the communist bloc that allowed UNHCR to build new relationships beyond the West. The essay makes extensive use of archival material, not only from UNHCR’s archives and Western countries, such as the United States and Great Britain, but also from the Vietnamese National Archives, to show how in these early stages the usage of the word “refugee” became a taboo for UNHCR officials and the communist Vietnamese authorities alike. This reluctance to recognize those leaving Vietnam as refugees impeded their chance at protection, while it allowed UNHCR to intervene in the crisis on behalf of the Vietnamese government. Hence, rather than a saviour of refugees from Vietnam, UNHCR let its own interests prevail, violating its mandate to protect refugees. Examining international crisis management and foreign intervention in Vietnam, this essay demonstrates that UNHCR attempted to exploit the crisis to exponentially expand its own size and globalize its reach to both the post-colonial and the communist worlds. Paradoxically, only when UNHCR changed course, adopting the Orderly Departure Program of 1979, did the Office expand to become one of the leading agencies within the UN system.

Living Up to Popular Expectations during Intervention: Filling Voids and Confronting Spoilers in the Central African Republic and Beyond

ABSTRACT The scholarly consensus has moved from asking if to how peacekeeping can be successful. Nevertheless, from Afghanistan to Mali, popular dissatisfaction is bringing international interventions to a dramatic end, while new and more ruthless foreign actors are stepping in. I suggest tying peacebuilding studies back to what really matters: fulfilling the expectations of those affected by violence. To do so, I study and compare four local security arenas in the Central African Republic and find that people raise differing expectations depending on whether they witness a local void or a local spoiler. Respondents appreciate substitution when they see a justified void. When respondents perceive a spoiler situation, they expect confrontation. Submissiveness of interveners to a spoiler is quickly interpreted as collusion and thus met with resistance. Intervention actors must balance filling voids and confronting spoilers simultaneously during changes of domestic actors’ (in)action and in public opinion. These findings further our understanding of why successful interventions on paper are resisted on the ground.

Successful Surgery of a Pancreatic Insulinoma Misdiagnosed as a Neuropsychiatric Disorder for 9 Years: A Case Report

Insulinoma is a rare functional pancreatic neuroendocrine tumour that is usually sporadic and solitary. It can have a varied presentation. Neuroglycopenic manifestations of hypoglycemia due to insuline hypersecretion can mimic neurological or psychiatric disorders, thus often a diagnosis and treatment delay. Insulinoma is a potentially curable condition, but it can be fatal if left unrecognized. We report a case of A 45-year-old woman who had a 9-year delay before diagnosing insulinoma after being initially assessed with anxiety–depressive disorder. The case report below provides a detailed review of the diagnosis, tumour localization, and the successful surgical intervention implemented for the patient.

Lasting benefits of a web-based training in understanding informal arguments

Being able to comprehend informal arguments in scientific texts is important for scientific literacy in higher education. Successful intervention studies demonstrating that these skills can be trained in university students have not yet provided evidence that gains of explicit training can be maintained beyond immediate post-training assessment. In this study, we tested whether the gains in argument structure comprehension achieved using a self-directed, web-based training intervention could be maintained over several weeks as an indication of sustained improvement in scientific literacy. We also explored characteristics of students and their engagement with the training intervention that resulted in significant and sustained improvements of their argument structure comprehension skills. One hundred students took part in a voluntary supplement to their university courses, completing an online pretest, a 45-minute training session, a posttest (n = 88), and a follow-up test (n = 31). Training effects at posttest were compared with an active control group. The results suggest that the training group exhibited significant gains in argument structure comprehension. These gains were maintained across a four-week period. Students with low starting ability profited the most from the training and gains in argument comprehension were greatest for complex arguments. Training results were positively related to student motivation and this effect was fully mediated by their engagement with the training exercises. The results demonstrate that training gains can be maintained after immediate post-training assessment and suggest that training is particularly effective for low-performing students, for complex arguments, and when students are motivated and engage with the training exercises.

Home literacy interventions and children's emergent literacy and oral language skills: A systematic review and discussion of underlying mechanisms

AbstractFamily literacy interventions, encompassing both meaning‐ and code‐based activities, have generally demonstrated positive outcomes in fostering children's literacy and oral language skills. Despite the overall positive impact, the effectiveness of these interventions varies, and the distinction between the specific mechanisms underlying each approach to home literacy activities remains unclear. This article systematically reviews existing evidence on home literacy interventions, aiming to provide a clearer understanding of meaning‐ and code‐based activities' roles in promoting children's literacy and oral language development. Our findings suggest that code‐based activities are more effective in enhancing literacy skills, while meaning‐based activities, particularly shared and dialogic reading, most effectively support oral language development. However, a strict separation between the two was not supported, as many studies implemented multiple intervention types concurrently. The most successful interventions included active conversational turns and clear strategies for parental involvement. Further research is needed to disentangle the specific contributions of code‐ and meaning‐based activities in home literacy interventions.

Evaluating the impact of faculty development programs at the workplace by using reflective critique writing technique

BackgroundThe professional development of faculty members is essential for improving the quality of education. Faculty development programs play a very vital role in continued professional development of faculty. Reflective Critique writing is an important tool for evaluation of faculty development programs, as it provides opportunities for self-reflection, self-critique and self-awareness. The experience of Reflective Critique writing, needs to be explored in order to encourage the faculty to engage in this practice and pursue their personal & professional growth. Aim of study is to determine the effectiveness of Reflective Critique writing in improving the teaching skills of faculty members after a formal faculty development program & to explore their experience using reflective critique technique to improve their professional & personal life.MethodIt was a mixed method study and design used was Explanatory Sequential Design. Quantitative part is Quasi experimental studies and Qualitative part is Exploratory. Purposive sampling technique was used for Quantitative part (27 faculty members) & Convenience sampling technique (10 faculty members) for Qualitative part of the studies. Case based learning facilitation skills workshop was conducted as a part of faculty development program in which participants were also trained on writing Reflective Critique texts on the “what, so what & now what” model. Participants also went through pre & posttest of the workshop & wrote their first Reflective Critique text. First evaluation for seeing improvement in teaching skills, learning transfer & behavior changes with Reflective Critique writing was carried out after 3 months at workplace (round 1) & second evaluation on the same pattern was carried out after 6 months of workshop at workplace (round 2). Participants wrote 3 Reflective Critique texts in total. At the end of the study, participants experience of Reflective Critique writing was explored in depth by semi-structured interviews of 10 faculty members.ResultsResults included the grading of reflective capacity of participants on REFLECT rubric & comparison of pre & posttest results. REFLECT rubric grading showed that in 3rd Reflective Critique writing almost 80% of the participants became critical reflectors, improving from an initial 60% progress in first writing, showing the effectiveness of the training program & increased effectiveness of teaching skills, learning transfer & behavior change at workplace. Evaluation was taken up to level 3 of the Kirkpatrick model. Results of pre & posttest showed marked improvement in results with a significant p-value indicating the success of intervention. Hence the data analysis showed the improved teaching skills, enhanced learning transfer at workplace with a positive behavior change which clearly indicated the effectiveness of Reflective Critique in improving the teaching skills of the participants & behavior change at workplace as well as their personal & professional development. Participants experience of Reflective Critique writing was explored further in the qualitative part of the studies and results showed multiple themes including ongoing teaching skills, increased higher order thinking and making sense of experience. Participants labelled Reflective Critique as: The Game Changer.ConclusionReflective Critique writing enabled the participants to get a deeper critical evaluation of the faculty development program, which in return enhanced their overall performance at workplace.

Lymphatic leaks – success of intranodal lymphangiogram first strategy

BackgroundLymphatic leaks are associated with significant mortality and morbidity. Intranodal lymphangiography (ILAG) involves the direct injection of ethiodised lipid into the hilum of lymph nodes. It is diagnostic procedure that can have therapeutic effects secondary to a local sclerosant effect. The aim of the study is to describe the technical and clinical success of ILAG and adjunctive lymphatic interventions performed as first line interventional techniques for lymphatic leaks refractory to conservative and medical management in a multicentre cohort of patients with symptomatic large volume lymphatic leaks.MethodsMulticentre retrospective study of all lymphatic interventions performed between 2017–2023 in patients with large volume lymphatic leaks (> 500 ml a day). Intranodal lymphangiography was performed initially with technical success defined as opacification of the lymphatics at the aortic bifurcation and demonstration of lymphatic leak on the index ILAG procedure or immediate post procedural CT was recorded. Lymphatic embolisation was performed with a combination of direct puncture or transvenous cannulation with glue and or coil embolisation of the thoracic duct or leak point and in cases with refractory leak. Clinical success was defined as reduction in drain output to less than 20 mL per 24 h, or no further insensible lymph leak. Time to clinical success after ILAG and adjunctive embolisation was recorded.ResultsILAG alone lead to clinical success in 14 of 32 (44%) patients after a median of 14 days. Subsequent embolisation was performed in 12 refractory cases; this was successful in 8 (67%) at median of 8 days. Overall clinical success of all lymphatic interventions was 69% (22 of 32 patients) at a median of 11 days (IQR 5–34). No statistically significant correlation between the site of leakage, aetiology or embolisation technique correlated with clinical success. Decision to proceed to repeat ILAG or an adjunct procedure was made on a clinical basis, following multidisciplinary discussion.ConclusionsILAG can be employed a first line interventional therapeutic technique to treat clinically significant lymphatic leaks that are refractory to conservative and medical management. Adjunctive procedures, including embolisation, can be considered as part of clinical decision making after a period of 1–2 weeks’ watchful waiting in continuingly refractory cases.

Impact of preoperative stenting in management of bilateral ureteral stones.

This study aims to evaluate the impact of preoperative stenting on surgical outcomes and complications in patients with bilateral ureteric stones, specifically assessing its role in reducing the need for subsequent interventions. A retrospective analysis was conducted at a tertiary center over eight years, involving 82 patients with bilateral ureteric stones. Patients were divided into two groups: Group 1 (no preoperative stenting) and Group 2 (preoperative stenting). Key data collected included demographics, preoperative stone sizes, preoperative serum creatinine levels, operative details, postoperative complications, and stone-free rates (SFR) at two weeks post-surgery. Statistical analyses were performed using SPSS 25.0. Of the 54 patients analyzed (27 in each group), the mean age was 48.8 ± 12.7 for Group 1 and 52.3 ± 15.2 for Group 2. Group 2 exhibited significantly higher preoperative serum creatinine levels (p = 0.016). Secondary interventions were needed for 8 patients in Group 1 versus 3 in Group 2 (p = 0.042). The SFR was 67% in Group 1 and 78% in Group 2 (p = 0.361), indicating no statistically significant difference. Preoperative stenting may enhance the success of surgical interventions for bilateral ureteric stones, potentially reducing the need for further procedures. Further prospective studies are needed to validate these findings and optimize management strategies.

Contrasting Summertime Trends in Vehicle Combustion Efficiency in Los Angeles, CA and Salt Lake City, UT.

Policy interventions and technological advances are mitigating emissions of air pollutants from motor vehicles. As a result, vehicle fleets are expected to progressively combust fuel more efficiently, with a declining ratio of carbon monoxide to carbon dioxide (CO/CO2) in their emissions. We assess trends in traffic combustion efficiency in Los Angeles (LA) and Salt Lake City (SLC) by measuring changes in summertime on-road CO/CO2 between 2013 and 2021 using mobile observations. Our data show a reduction in CO/CO2 in LA, indicating an improvement in combustion efficiency that likely resulted from stringent regulation of CO emissions. In contrast, we observed an increase in CO/CO2 values in SLC. While slower progress in SLC compared to LA may be partially due to a later adoption of vehicle emission regulations in Utah compared to California, differing driving conditions and fleet composition may also be playing a role. This is evidenced by increased CO/CO2 in LA during the COVID-19 pandemic, which led to faster driving speeds and changes to the fleet composition. Our results demonstrate the success of California's CO-reducing policy interventions and illustrate the impacts of traffic characteristics on vehicle combustion efficiency and air pollutant emissions.

Emotional Eating Interventions for Adults Living With Overweight and Obesity: A Systematic Review and Meta-Analysis of Behaviour Change Techniques.

Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes. This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted. In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = -0.99 [95% CI: -0.73 to -1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (-4.09 kg [95% CI: -2.76 to -5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE ('incompatible beliefs', 'goal setting outcome'. 'review outcome goals', 'feedback on behaviour' and 'pros/cons'). Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.

Pharmacological enhancement of slow-wave activity at an early disease stage improves cognition and reduces amyloid pathology in a mouse model of Alzheimer's disease.

Improving sleep in murine Alzheimer's disease (AD) is associated with reduced brain amyloidosis. However, the window of opportunity for successful sleep-targeted interventions, regarding the reduction in pathological hallmarks and related cognitive performance, remains poorly characterized. Here, we enhanced slow-wave activity (SWA) during sleep via sodium oxybate (SO) oral administration for 2 weeks at early (6 months old) or moderately late (11 months old) disease stages in Tg2576 mice and evaluated resulting neuropathology and behavioral performance. We observed that the cognitive performance of 6-month-old Tg2576 mice significantly improved upon SO treatment, whereas no change was observed in 11-month-old mice. Histochemical assessment of amyloid plaques demonstrated that SO-treated 11-month-old Tg2576 mice had significantly less plaque burden than placebo-treated ones, whereas ELISA of insoluble protein fractions from brains of 6-month-old Tg2576 mice indicated lower Aβ-42/Aβ-40 ratio in SO-treated group vs. placebo-treated controls. Altogether, our results suggest that SWA-dependent reduction in brain amyloidosis leads to alleviated behavioral impairment in Tg2576 mice only if administered early in the disease course, potentially highlighting the key importance of early sleep-based interventions in clinical cohorts.

Characterization of children's prospective prescription review and exploration of factors influencing the success of interventions.

Medication safety is crucial in clinical care. Although many hospitals have implemented prospective prescription review systems to manage medication use, the impact of these systems on pediatric patients is not yet fully understood. We explore the characteristics and economic impacts of pediatric prospective prescription review and identify factors influencing intervention success rates. This study adopted a cross-sectional design. Prospective prescription review tasks were compared in the outpatient of our hospital between 2021 and 2023 to assess medication rationalization rates and cost variability. Data were collected using the PASS PharmReview system, including patient information, medication indications, prescribing physicians, intervention pharmacists, prescription rationality rate, and medication costs. SPSS 26.0 software was used to compare changes in medication rationality and medication costs between the initial (2021) and stable (2023) periods and to analyze factors affecting intervention success during the stable period by the logistic regression model. The study included 11,533,807 prospective prescription review tasks. The medication rationalization rate increased from 92.0% to 95.7% (p < 0.05) between the initial (n = 5,392,551) and stabilization periods (n = 6,141,256). Outpatient medication costs per capita decreased by 3.2%, from ¥320.7 to ¥310.5. Factors influencing intervention success included the following: the greater age is negatively associated with success(p < 0.001, odds ratio (OR) = 0.98); internal medicine demonstrates a superior intervention success rate compared to the surgical department (p < 0.001, OR = 1.37); higher physician titles were associated with lower success rates (p < 0.001, OR = 0.59); and success increased with pharmacists of higher educational levels (p < 0.001, OR = 1.18). Implementing a prospective prescription review system in pediatric outpatient settings improves medication rationality and reduces errors and costs, with intervention success influenced by patient age, department, physician titles, and the educational level of pharmacists.

Health and Safety Training for Immigrant Dairy Workers in the Upper Midwest.

This project implemented Seguridad en las Lecherías, an award-winning, bilingual (Spanish and English), 5-module curriculum approved by the Occupational Safety and Health Administration. The intervention aimed to increase safety knowledge among immigrant dairy workers, encourage a safety culture, and identify challenges faced by the dairy farming community in Minnesota and South Dakota. A total of 360 Hispanic immigrant workers from 19 participating dairies were trained. Pre- and post-assessments revealed a statistically significant increase in knowledge after each training. Producers and managers provided positive feedback noting improved awareness of safety and positive behavior changes to reduce farm incidents. A flexible approach to implementation was essential to the intervention's success, including synchronizing training with workers' shifts. Overall, this application of the Seguridad en las Lecherías curriculum suggests that comprehensive, culturally responsive safety training delivered in the language spoken by workers can have a positive impact on workers' safety knowledge, practices, and behavior on dairy farms. Continued efforts to prioritize and reinforce worker safety are vital to the sustainability and well-being of the dairy farming community in the region and beyond.