Search Results (553)

Background: Lipid management is a key aspect of secondary atherosclerotic cardiovascular disease (ASCVD) prevention. However, real-world studies show that ~72–88% of patients with ASCVD fail to meet their low-density lipoprotein cholesterol (LDL-C) target. Nonstatin agents are available as add-on therapies that can be utilized when maximally tolerated statins are insufficient to achieve LDL-C goals. This retrospective study aimed to evaluate the current prescribing habits of nonstatins as add-on therapy to statins for secondary ASCVD prevention at a federally qualified health center (FQHC). Methods: Patients were included if they had a history of clinical ASCVD, ≥1 lipid panel obtained during the study period, and were prescribed any intensity statin. Results: Among 398 included participants, 11.1% were prescribed nonstatin therapy and 35.9% were meeting a LDL-C target of <70 mg/dL. There was a significant association between being prescribed ezetimibe based on the type of healthcare coverage (p = 0.04) and a higher number of ASCVD qualifying indications (p < 0.01). Conclusions: Overall, nonstatins were found to be underutilized for LDL-C management in this underserved population. Future initiatives should target ways to optimize nonstatin therapy to optimize secondary ASCVD prevention. Full article

Background: Urgent care clinics (UCCs) embedded within primary healthcare settings play a vital role in managing acute, non-life-threatening conditions in children. However, limited data exist on medication prescribing patterns in such settings in the Kingdom of Saudi Arabia (KSA), particularly regarding antibiotic use. This study aimed to describe the epidemiology of pediatric urgent care visits and identify factors associated with prescribing within a model primary healthcare (PHC) center. Methods: A retrospective chart review was conducted for all urgent care visits made by pediatric patients (<14 years) at a model PHC center in the KSA for all visits in 2024. Sociodemographic variables, visit timing, diagnosis, and prescription data were extracted from electronic health records. Multivariable logistic regression was used to analyze predictors of medication prescribing. Results: Of the 1016 pediatric urgent care visits, 62.5% resulted in medication prescriptions, and 23.62% of those visits included at least one antibiotic, primarily penicillins (71.33%). Cephalosporins and tetracyclines were not prescribed. Prescriptions were 67% more likely among adolescents and 70% less likely among infants when compared to school-aged children (95% CI = 1.04–2.67 and 95% CI = 0.15–0.61, respectively). Respiratory and ENT-related diagnoses accounted for most prescriptions. No significant sex-based differences in prescribing were observed. Conclusions: The epidemiological patterns observed indicate that respiratory and ENT conditions, as well as seasonal peaks in autumn and winter, are the main drivers of prescribing in pediatric urgent care. These findings have implications for strengthening disease surveillance, anticipating service demand, guiding preventive interventions such as vaccination and health education, and supporting evidence-based planning of primary care resources. Full article

Background/Objectives: Geographical variations in outcomes and oral anticoagulant (OAC) initiation among patients with nonvalvular atrial fibrillation (NVAF) in the United States (US) have been characterized; however, regional effects on OAC persistence are unknown. The study described variation in persistence with OACs among patients with NVAF across different US regions. Methods: The Komodo Healthcare Map was used to evaluate adult patients with NVAF, elevated stroke risk, and ≥1 pharmacy claim for an OAC between 1 January 2015 and 31 August 2022. Patients initiating treatment with an OAC (treatment-naïve) and having ≥12 months continuous enrollment were included. Persistence rates were assessed at 6, 9, 12 and 18 months among OAC- and direct OAC (DOAC)-naïve patients by 3-digit zip codes. Results: Of the 260,001 (Northeast = 72,507, Midwest = 59,979, South = 83,880, West = 42,778, Other/Unknown = 857) OAC-naïve patients identified, 82.2% were DOAC-naïve while 17.8% initiated warfarin. Mean follow-up time was 1101 (median = 964) and 1073 days (median = 938) in OAC and DOAC cohorts, respectively, while mean time to discontinuation was 342 (median = 190) and 329 days (median = 181), respectively. At 12 months, persistence rates ranged from 40.3% to 78.8% for OAC-naïve patients and 40.6% to 81.4% for DOAC-naïve patients. Average OAC and DOAC 12-month persistence rates were highest in the Northeast (63.5% and 63.7%, respectively) and lowest in the South (57.1% and 56.9%, respectively). Conclusions: Variations in 12-month persistence were consistent with existing evidence on geographic variation in NVAF-related disease burden and treatment initiation. Understanding geographic trends in prescribing patterns may provide insights into differences in treatment persistence that are relevant for clinicians seeking to address real-world barriers to care. Full article

Steel corrosion plays a major role in the geochemical evolution at the canister/bentonite interface of the engineered barrier systems of geological radioactive waste repositories. The interactions between corrosion products and bentonite can significantly affect bentonite properties and performance. These interactions have been investigated by resorting to in situ tests conducted in underground laboratories, such as the FEBEX (Full-scale Engineered Barrier Experiment) test. The FEBEX in situ test, which was conducted at the Grimsel underground research laboratory in Switzerland from 1997 to 2015, demonstrated substantial corrosion of the steel liner in areas without a heater, primarily due to the presence of O₂. Here we report a reactive transport model that simulates steel corrosion products and their interactions with bentonite. The model builds on a previously published conceptual geochemical model and addresses its limitations by integrating a more detailed representation of temperature and unsaturated flow conditions, leveraging prior thermo–hydrodynamic–mechanical–chemical (THMC) models. Given the prevailing uncertainties in O₂ and redox conditions during the test and the limited data on liner corrosion and gas conditions at the liner–bentonite interface, liner corrosion was modeled by using a prescribed time-dependent function for the corrosion rate. Goethite, hematite, and magnetite were the Fe minerals allowed to precipitate in the model. The corrosion rate and the specific surface area of the hematite and magnetite were calibrated based on the profiles of goethite, hematite, and total Fe (including dissolved, exchanged and sorbed forms) observed at the post mortem analysis of the FEBEX in situ test. The model reproduces the observed goethite and hematite precipitation near the liner but underestimates the measured values at greater distances from the liner. The pattern of total calculated Fe concentrations reproduce the measured values except at a distance between 15 and 50 mm from the liner. Goethite is the predominant corrosion product in the model results, even under reducing conditions, owing to kinetic constraints on magnetite and hematite precipitation and to the enhanced stability of goethite driven by pH increase and thermal evolution. Full article

Longleaf pine forests are economically important habitats that stabilize and enrich the soil and store carbon over long periods. When mixed with oaks, these forests provide an abundance of lichen habitats. The tree canopy lichens promote greater moisture capture and retention and encourage canopy insects. Ground lichens limit some vascular plant germination and growth, promoting a more open and healthy pine community. There is a longstanding mutualistic relationship between longleaf pine habitat and lichens. Longleaf pine habitat has a long history of natural summer burning, which promotes a diverse understory and limits tree densities. Lichen diversity exceeds vascular plant diversity in many mature longleaf pine habitats, yet information on the impacts of prescribed fire on lichen species in these habitats is limited. We assessed lichen diversity and abundance before and after a prescribed ground fire in a longleaf pine/wiregrass habitat near Ocala, Florida. Pre-burn, we found greater lichen abundance and diversity on hardwoods, primarily oak species, than on pines. Post-burn, lichen abundance on hardwoods dropped overall by 28%. Lichen abundance on conifers dropped overall by 94%. Ground lichen species were basically eliminated, with a 99.5% loss. Our study provides insights into retaining lichen diversity after a prescribed burn. Hardwood trees, whether alive or standing dead, help retain lichen biodiversity after burning, whereas conifer trees do not support as many species. Landscapes may need to be actively managed by raking pine needle litter away from ground lichen beds, moistening the ground, or removing some lichen material before the burn and returning it to the site post-fire. Based on these results, we suggest retaining some oaks and conducting burns in a mosaic pattern that retains unburned areas. This will allow for lichens to recover between burns, significantly enhancing biodiversity and the ecological health of these longleaf pine communities. Full article

Background: Medically unexplained oral symptoms/syndromes (MUOS), such as Burning Mouth Syndrome and Persistent Idiopathic Facial Pain, present significant management challenges due to the lack of standardized treatments and high-level evidence. While pharmacotherapy is often employed, real-world data on treatment adherence—a pragmatic proxy for effectiveness and tolerability—remain sparse, especially in Japan. This study aimed to describe the real-world prescribing patterns of antidepressants and dopamine receptor partial agonists (DPAs) for MUOS and retrospectively investigate their association with treatment continuation. Methods: This retrospective observational study analyzed data from patients initiating pharmacotherapy for MUOS at a specialized clinic in Japan (April 2021–March 2023). We used Cox proportional hazards models to evaluate treatment continuation for amitriptyline monotherapy and antidepressant–aripiprazole adjunctive therapy. The primary outcome was the time to discontinuation. Dosage effects were modeled using B-splines to capture nonlinearity. Results: Among 702 MUOS patients who started pharmacotherapy, 493 received amitriptyline as the first prescription, and 108 received aripiprazole as an adjunctive therapy. For amitriptyline monotherapy, a nonlinear relationship was observed between dosage and discontinuation risk, with a relatively lower hazard around 25 mg/day across age groups. In the antidepressant–aripiprazole adjunctive group, the overall hazard ratio for discontinuation was higher (HR = 4.75, p < 0.0005) compared to non-adjunctive therapy, likely due to indication bias reflecting more treatment-resistant cases. However, within the aripiprazole adjunctive group, a U-shaped relationship was identified between maximum aripiprazole dosage and discontinuation risk, with the lowest hazard (HR ≈ 0.30) observed at approximately 1.7–1.8 mg/day. Mild side effects such as drowsiness, dry mouth, constipation, tremor, insomnia, and weight gain were noted, but no severe adverse events occurred. Conclusions: This real-world data analysis suggests specific dosage ranges (amitriptyline ≈ 25 mg/day; aripiprazole augmentation ≈ 1.7–1.8 mg/day) are associated with longer treatment continuation in MUOS patients. Treatment continuation reflects a crucial balance between symptom relief and tolerability, essential for managing these chronic conditions. It is critical to emphasize that these findings are descriptive and observational, derived from a specialized setting, and do not constitute prescriptive recommendations. They highlight the importance of individualized dosing. Definitive evidence-based strategies require validation through prospective randomized controlled trials. Full article

In 1982 a conservation project was initiated to restore glade communities in the Missouri Ozarks with a special emphasis on collared lizards (Crotophytus collaris), a state threatened species at the time. Starting in 1984, collared lizards were translocated onto restored glade habitats on Stegall Mountain in the Ozarks. The populations persisted but did not colonize other glades on Stegall until 1994, when prescribed fires included not only the glades, but also the surrounding woodland. Starting in 1999, landscape-level burns connected Stegall to three nearby mountains. The goal of this study was to test the hypothesis that expanding prescribed burns to the forested woodlands between Stegall Mountain and nearby mountains would create dispersal corridors for the colonization of glades on new mountains. Indeed, all three mountains were colonized and direct dispersal of marked lizards from Stegall was observed following the prescribed fires. Inter-mountain colonization dynamics and patterns varied: one was absorbed into the Stegall meta-population, another experienced a founder event followed by rapid colonization, and the third underwent repeated failed colonization attempts before successful establishment years later. These diverse patterns were consistent with differences in landscape resistance in the inter-mountain corridors rather than in geographical distance. Intra-mountain colonization patterns indicated that lizards assessed glade quality based on multiple factors. High landscape resistance resulted in a young age structure in the initial colonizing population. This young age structure interacted with the territorial behavior of collared lizards, age of reproduction, and probability of dispersal. This strong interaction between landscape resistance in the dispersal corridor and social behavior in the colonizing population is a novel factor in predicting colonization dynamics. Moreover, these results highlight the importance of social behavior on dispersal decisions versus habitat quality alone. Full article

Introduction: Chronic kidney disease (CKD) affects roughly 10% of the global population and significantly increases cardiovascular risk. While renin–angiotensin system inhibitors (RASi) remain a therapeutic mainstay, recent evidence supports the renoprotective value of sodium–glucose cotransporter-2 inhibitors (SGLT2i) and finerenone. This study evaluated the real-world use of guideline-directed medical therapy (GDMT) among patients with cardiorenal disease in Greece and explored factors influencing prescribing patterns. Methods: The Hellenic Cardiorenal Morbidity Snapshots (HECMOS 1 and 2) enrolled all cardiology inpatients across Greece on 3 March, 2022, and 5 June, 2024. Comorbidities and medication data were based on self-report and chart review. CKD patients eligible for SGLT2i and finerenone were identified per guideline criteria. Multivariable logistic regression was used to identify predictors of SGLT2i use. Results: From a total of 923 and 1222 patients enrolled in HECMOS 1 and 2, CKD was present in 26% and 27%, respectively. SGLT2i use prior to hospitalization rose from 15% in HECMOS 1 to 30.4% in HECMOS 2. In HECMOS 1, diabetes mellitus was the strongest predictor of SGLT2i use (OR 12.01, 95% CI 3.31–45.56, p < 0.001), while heart failure predicted use in HECMOS 2 (OR 4.10, 95% CI 1.70–9.88, p = 0.002). Finerenone was prescribed in only 1.7% of eligible patients in HECMOS 2. RASi usage among CKD patients remained stable across both cohorts (42.1% vs. 41.7%), with renal dysfunction showing no impact on prescribing patterns. Conclusions: SGLT2i use in patients with CKD and cardiovascular disease doubled over 2 years, indicating progress in implementing GDMT. However, overall use of disease-modifying therapies remains suboptimal, underscoring the need for further improvement in real-world care. Full article

Ventilation corridors can play an important role in removing harmful air pollution in cities; however, there are social pressures to use this corridor land for new buildings. The presented study employs RANS fluid flow simulations with the k-$ϵ$ turbulence model to investigate how the addition of buildings in the historical ventilation corridor impedes CO traced pollution removal. The urban complex situated near Raclawicka Street in Warsaw is selected as a case study for which two urban layouts dating from 2006 and 2017 are compared. The investigation includes varying ambient wind speeds and direction, with a prescribed CO-air mixture source representing a supply of road pollution. The results provide aerodynamic and dispersion characteristics and identify several generic trends indicating that the orthogonal urban layouts help to remove the pollution faster, especially when compared to courtyard building configurations, and that the introduction of occasional wide gaps between buildings can also speed up the pollution removal in the direction perpendicular to the gaps. Furthermore, for this urban complex the addition of new buildings had predominantly a local impact. The results showed that for light and mild winds, ambient speeds have little impact on dispersion patterns, but the effects of a dynamic ambient wind reversal are pronounced. Full article

Background/Objectives: In hypertension (HTN), lifestyle modification is important for controlling blood pressure (BP) and lipidemic profile. The HINTreat trial showed that an anti-inflammatory diet was associated with improved endothelial function, after six months of intensive nutritional treatment. Methods: This post hoc analysis of the HINTreat trial examined how adherence to various nutritional patterns like the Mediterranean Diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH) diet, and anti-inflammatory diet, had impact on the blood lipids profile and the CVD risk. Patients with stage 1 HTN, allocated either on intensive lifestyle treatment (ILT) or usual care (UC) standard treatment, participated in the analysis. From the original sample size of the HINTreat trial, all patients that were prescribed lipid lowering medication at any time of the study period were excluded from the total analysis; thus, the intervention and the control groups consisted of 33 and 28 patients, respectively. Nutritional intakes were assessed with repeated 24 h recalls from the previous day, and dietary indexes and scores were calculated as follows: MedDiet score, DASH index, and Dietary Inflammatory Index (DII). After six months of intervention, changes in the nutritional indexes and their effect on the lipidemic profile and CVD risk were analyzed. Results: In the ILT group, reductions were noted in Ambulatory Blood Pressure Monitoring (ABPM) for day systolic BP (SBP) (−12.7 mmHg) and diastolic BP (DBP) (−8.4 mmHg), total cholesterol (TC) (−35.4 mg/dL), triglycerides (TG) (−21.4 mg/dL), LDL cholesterol (LDL-C) (−27.5 mg/dL) concentrations, and CVD risk score (−1.5%), p < 0.001 for all. Multiple regression analysis showed that dietary quality indices independently influenced improvements in blood lipid profile and cardiovascular disease (CVD) risk among patients receiving ILT. Specifically, a higher Mediterranean Diet (MedDiet) score was significantly associated with reductions in TC (B = −7.238, p < 0.001), TG (B = −4.103, p = 0.035), and LDL-C (B = −6.431, p = 0.004). The DASH index was positively associated with TG levels (B = 9.913, p = 0.010), suggesting a more complex relationship that may require further investigation. In addition, DII was positively associated with increased CVD risk (B = 0.973, p < 0.001). Conclusions: The findings suggest that ILT can improve BP levels, target blood lipids concentrations, and reduce CVD risk in patients with stage 1 HTN. Full article

This paper proposes novel designs of dual-layer flower-shaped heave plates, featuring both aligned and staggered configurations with three, six, and nine petals. Numerical simulations were conducted to study the hydrodynamic effects of these various heave plate designs integrated with the OC4 DeepCwind semisubmersible floating offshore wind turbine platform under prescribed heave oscillations. The overset mesh technique was employed to treat the floating platform’s motions. Comprehensive assessments of vertical force, radiated wave patterns, vorticity fields, added mass, and damping coefficients were conducted. The results revealed that the novel flower-shaped staggered heave plates significantly outperformed conventional circular plates in terms of damping coefficients. Specifically, the damping coefficient of flower-shaped staggered heave plates was greater than that of circular heave plates, while the aligned configuration exhibited a lower damping coefficient. The damping coefficient increased with a reduction in the number of petals for the staggered heave plates. Among the evaluated designs, the dual-layer flower-shaped staggered heave plates with three petals demonstrated the highest effectiveness in attenuating heave motion of the floating platform. The utilization of novel dual-layer flower-shaped staggered heave plates is therefore a promising practice aimed at damping the heave motion of platforms in rough seas. Full article

Antimicrobial resistance is an increasing concern in companion animal practice; however, effective mitigation strategies in veterinary referral hospitals remain underexplored. This study investigated whether antimicrobial stewardship interventions guided by hospital-specific resistance patterns and prescribing data could improve resistance outcomes in a secondary care veterinary setting. Using data from 2016 to 2018 at the University of Tokyo Veterinary Medical Center, a targeted intervention was developed and implemented in early 2019, and its impact was evaluated until 2024. The intervention included Gram staining-based presumptive pathogen estimation, antibiogram-guided antimicrobial selection, clinician education, and regular feedback on prescribing practices. By 2020, overall antimicrobial use had reduced by over 50%, with marked reductions in the use of carbapenems and fluoroquinolones. By 2022, the prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp. decreased from 53% to 24% and 78% to 7%, respectively. However, methicillin-resistant staphylococci remained prevalent in approximately 50% of cases. These findings suggest that hospital-tailored antimicrobial stewardship programs may be associated with meaningful reductions in resistance among gram-negative pathogens, although causality cannot be confirmed due to the observational study design. Moreover, additional strategies are necessary to address persistent resistance in gram-positive organisms. Full article

Background/Objectives: Osteoporosis remains a leading cause of morbidity in postmenopausal women, yet many high-risk individuals remain undiagnosed or untreated. This study aimed to assess the prevalence of osteoporosis and osteopenia, treatment patterns, and skeletal fragility indicators in a large cohort of postmenopausal women undergoing DXA screening. Methods: We analyzed data from 1669 postmenopausal women aged 40–89 years who underwent DXA evaluation. BMD status was categorized as normal, osteopenia, or osteoporosis. Treatment status was classified based on active antiosteoporotic therapy, calcium/vitamin D supplementation, hormonal therapy (historical use), or no treatment. Logistic regression models were used to explore independent predictors of osteoporosis and treatment uptake. Results: A total of 45.0% of women had osteoporosis and 43.5% had osteopenia. Despite this, 58.5% of the population, over half of women with osteoporosis, were not receiving any active pharmacologic treatment. Bisphosphonates were the most prescribed therapy (17.9%), followed by calcium/vitamin D supplements (20.6%). A prior history of fragility fractures and radiological bone lesions were significantly associated with lower BMD (p < 0.05). Historical hormone replacement therapy (HRT) use was not associated with current BMD (p = 0.699), but women with HRT use reported significantly fewer fractures (p < 0.001). In multivariate analysis, later menopause age and low BMD status predicted higher odds of receiving active treatment. Conclusions: Our findings highlight a substantial care gap in osteoporosis management, with treatment primarily initiated reactively in more severe cases. Improved screening and earlier intervention strategies are urgently needed to prevent fractures and reduce the long-term burden of osteoporosis. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Background: Among all ambulatory antibiotic prescriptions, about 20% are non-visit-based (ordered outside of an in-person clinical encounter), and about 30% are not associated with an infection-related diagnosis code. Objective/Methods: To identify the rationale for ambulatory antibiotic prescribing, we queried the electronic health record (EHR) of a single, large health system in the Midwest United States to identify all oral antibiotics prescribed from November 2018 to February 2019 and examined visit, procedure, lab, department, and diagnosis codes. For the remaining antibiotic prescriptions—mostly non-visit-based, no-infectious-diagnosis-documented—we randomly selected and manually reviewed the EHR to identify a prescribing rationale and, if none was present, surveyed prescribers for their rationale. Results: During the study period, there were 47,619 antibiotic prescriptions from 1177 clinicians to 41,935 patients, of which 2608 (6%) were eligible non-visit-based, no-infectious-diagnosis-documented. We randomly selected 2298. There was a documented rationale for 2116 (92%) prescriptions. The most common documented reasons—not mutually exclusive—were patient-reported symptoms (71%), persistence of symptoms after initial management (18%), travel (17%), and responding to lab or imaging results (11%). We contacted 160 clinicians who did not document any prescribing rationale in the EHR and received responses from 62 (39%). Clinicians’ stated reasons included upcoming or current patient travel (19%), the antibiotic was for the prescriber’s own family member (19%), or the clinician made a diagnosis but did not document it in the EHR (18%). Conclusions: Non-visit-based, no-infectious-diagnosis-documented antibiotic prescriptions were most often in response to patient-reported symptoms, though they also occur for a variety of other reasons, some problematic, like in the absence of documentation or for a family member. Full article