Can these salt substitutes prevent complications of hypertension?

This study suggests the blood pressure-lowering effects of potassium-enriched salt substitutes may reduce cardiovascular morbidity and mortality.

Genetic influences on epilepsy outcomes: A whole-exome sequencing and health care records data linkage study.

OBJECTIVE: This study was undertaken to develop a novel pathway linking genetic data with routinely collected data for people with epilepsy, and to analyze the influence of rare, deleterious genetic variants on epilepsy outcomes. METHODS: We linked whole-exome sequencing (WES) data with routinely collected primary and secondary care data and natural language processing (NLP)-derived seizure frequency information for people with epilepsy within the Secure Anonymised Information Linkage Databank. The study participants were adults who had consented to participate in the Swansea Neurology Biobank, Wales, between 2016 and 2018. DNA sequencing was carried out as part of the Epi25 collaboration. For each individual, we calculated the total number and cumulative burden of rare and predicted deleterious genetic variants and the total of rare and deleterious variants in epilepsy and drug metabolism genes. We compared these measures with the following outcomes: (1) no unscheduled hospital admissions versus unscheduled admissions for epilepsy, (2) antiseizure medication (ASM) monotherapy versus polytherapy, and (3) at least 1 year of seizure freedom versus <1 year of seizure freedom. RESULTS: We linked genetic data for 107 individuals with epilepsy (52% female) to electronic health records. Twenty-six percent had unscheduled hospital admissions, and 70% were prescribed ASM polytherapy. Seizure frequency information was linked for 100 individuals, and 10 were seizure-free. There was no significant difference between the outcome groups in terms of the exome-wide and gene-based burden of rare and deleterious genetic variants. SIGNIFICANCE: We successfully uploaded, annotated, and linked genetic sequence data and NLP-derived seizure frequency data to anonymized health care records in this proof-of-concept study. We did not detect a genetic influence on real-world epilepsy outcomes, but our study was limited by a small sample size. Future studies will require larger (WES) data to establish genetic variant contribution to epilepsy outcomes.

Benefits of participation in a community of practice focused on evaluation and programmatic improvement for environmental educators.

One of the biggest challenges environmental education (EE) practitioners face is having timely and systematically-collected evaluation data to inform the design and improvement of existing programs. One potential way to provide systematic evaluations of programs and build evaluation capacity for practitioners is through a facilitated community of practice (CoP). We developed a CoP involving 37 organizations who were pivoting to online EE programs within the United States due to the COVID-19 pandemic. Our goals were to build organizational capacity in evaluation and adaptive management to improve these organizations' online EE programs. We describe our CoP design, challenges associated with its implementation, and the benefits reported by participants in the CoP. Participants reported that they improved their evaluation skills and attitudes towards evaluation and developed social capital with a new network of colleagues. They also reported positive changes in practice, both individually and organizationally; considered new outcomes for their programs; and learned about using evaluation data to systematically improve programs. Educators shared their learning both within and outside of their organizations. Those who were more regularly involved in this community reported more positive benefits than others who were less involved. We share our reflections on the process and make suggestions for other evaluators to consider in similar CoP designs.

A culturally responsive evaluation framework and its application in environmental education.

Despite the many challenges inherent in conducting high-quality evaluations in the field of environmental education (EE), there is a growing recognition of the importance of evaluation, not only to gauge program success, but also to use evaluation results to improve programming, support organizational learning, and ensure programs are meeting the needs of diverse audiences. The challenges to conducting high-quality evaluations are exacerbated by historical issues of inequity and systemic racism that are pervasive in the United States and globally. We reviewed the literature on culturally responsive approaches to evaluation to propose a culturally responsive evaluation framework and consider its application in EE. This framework helps EE organizations and evaluators consider how issues of race, power, privilege, and inequity influence the evaluation process and the validity of evaluation findings. Implementing this framework may be resource-intensive, but it has the potential to improve evaluation processes and produce actionable results to further address issues of diversity, equity, and inclusion in the field of EE. We call for organizations that support EE efforts to recognize the importance of this approach, and provide adequate resources to encourage its implementation.

Epilepsy mortality in Wales during COVID-19.

PURPOSE: The COVID-19 pandemic has increased mortality worldwide and those with chronic conditions may have been disproportionally affected. However, it is unknown whether the pandemic has changed mortality rates for people with epilepsy. We aimed to compare mortality rates in people with epilepsy in Wales during the pandemic with pre-pandemic rates. METHODS: We performed a retrospective study using individual-level linked population-scale anonymised electronic health records. We identified deaths in people with epilepsy (DPWE), i.e. those with a diagnosis of epilepsy, and deaths associated with epilepsy (DAE), where epilepsy was recorded as a cause of death on death certificates. We compared death rates in 2020 with average rates in 2015-2019 using Poisson models to calculate death rate ratios. RESULTS: There were 188 DAE and 628 DPWE in Wales in 2020 (death rates: 7.7/100,000/year and 25.7/100,000/year). The average rates for DAE and DPWE from 2015 to 2019 were 5.8/100,000/year and 23.8/100,000/year, respectively. Death rate ratios (2020 compared to 2015-2019) for DAE were 1.34 (95%CI 1.14-1.57, p<0.001) and for DPWE were 1.08 (0.99-1.17, p = 0.09). The death rate ratios for non-COVID deaths (deaths without COVID mentioned on death certificates) for DAE were 1.17 (0.99-1.39, p = 0.06) and for DPWE were 0.96 (0.87-1.05, p = 0.37). CONCLUSIONS: The significant increase in DAE in Wales during 2020 could be explained by the direct effect of COVID-19 infection. Non-COVID-19 deaths have not increased significantly but further work is needed to assess the longer-term impact.

A Pilot Randomized Trial of a Brief Intervention to Prevent Suicide After Inpatient Psychiatric Discharge.

OBJECTIVE: Risk for suicide is high after psychiatric hospitalization. The World Health Organization's Brief Intervention and Contact (BIC) program has shown efficacy in preventing suicide. A version adapted for the U.S. Department of Veterans Affairs (VA) was studied to determine preliminary effects. METHODS: Patients receiving psychiatric hospitalization because of acute risk for self-harm were randomly assigned to the VA BIC or standard care alone. Effect sizes (Hedges' g) for suicidal ideation (primary outcome), social connectedness (measured as thwarted belongingness and perceived burdensomeness), hopelessness, and engagement were calculated at 1 and 3 months. RESULTS: Patients were randomly assigned to the VA BIC (N=10) or standard care (N=9). The VA BIC had a medium or large effect on most measures at 1 month (suicidal ideation, g=0.45). Effects diminished at 3 months, except for thwarted belongingness (g=0.81). CONCLUSIONS: The VA BIC had meaningful effects on suicide-related outcomes. The largest effect was seen in the first month.

Perceptions and Behaviors of Indigenous Populations Regarding Illegal Use of Protected Area Resources in East Africa's Mountain Gorilla Landscape.

Illegal activities and use of park resources are the main challenges facing mountain gorilla (Gorilla beringei beringei) conservation and the protection of their habitats in the East Africa's Greater Virunga Transboundary Landscape (GVTL). Indigenous residents around GVTL are considered the primary illegal users of park resources. Despite this, there is limited understanding of the current and past perceptions of indigenous residents living in communities adjacent to two GVTL parks; Volcanoes National Park in Rwanda and Mgahinga Gorilla National Park in Uganda. Equally, there is also limited understanding regarding the actual incidences of illegal activities inside both parks. This paper addresses these gaps. Perception data were collected from indigenous residents living adjacent to both parks. Further, Ranger-based Monitoring (RbM) data from both parks were analyzed to determine actual numbers and types of illegal activities over the 9-year period. Interestingly, findings indicated that residents perceived the prevalence of illegal activities to be decreasing across GVTL. To the contrary, RbM findings indicated that the number of actual illegal activities was increasing significantly, particularly in Volcanoes National Park. The discrepancy found between the two perspectives provides for a discussion of the social biases potentially present in these data, and their implications for management. Results also illuminated the subsistence-related nature of most illegal behaviors and suggest that to reduce illegal activities and local dependency on park resources, park management must work with communities and support them in tapping into alternative livelihoods and finding ways to address community household subsistence needs.

Bringing forecasting into the future: Using Google to predict visitation in U.S. national parks.

In recent years, visitation to U.S. National Parks has been increasing, with the majority of this increase occurring in a subset of parks. As a result, managers in these parks must respond quickly to increasing visitor-related challenges. Improved visitation forecasting would allow managers to more proactively plan for such increases. In this study, we leverage internet search data that is freely available through Google Trends to create a forecasting model. We compare this Google Trends model to a traditional autoregressive forecasting model. Overall, our Google Trends model accurately predicted 97% of the total visitation variation to all parks one year in advance from 2013 to 2017 and outperformed the autoregressive model by all metrics. While our Google Trends model performs better overall, this was not the case for each park unit individually; the accuracy of this model varied significantly from park to park. We hypothesized that park attributes related to trip planning would correlate with the accuracy of our Google Trends model, but none of the variables tested produced overly compelling results. Future research can continue exploring the utility of Google Trends to forecast visitor use in protected areas, or use methods demonstrated in this paper to explore alternative data sources to improve visitation forecasting in U.S. National Parks.

Shared Medical Appointments in Preoperative Joint Replacement: Assessing Patient and Healthcare Member Satisfaction.

BACKGROUND: Shared medical appointments (SMAs) have proven to be effective in improving patient access and education while augmenting productivity. In shifting from a traditional visit model, patient and interdisciplinary healthcare team (IHCT) member satisfaction is imperative. Predominantly seen in primary care, SMA use in orthopedics is limited. After identification of access and productivity concerns, the SMA was implemented as a quality improvement project in a rural clinic. The lower extremity joint replacement (LEJR) population was chosen because of multiple preoperative appointments and costs on the healthcare system. PURPOSE: To assess patients' and IHCT members' satisfaction levels in using an SMA for the preparation of LEJR. RELEVANCE TO HEALTHCARE QUALITY: The SMA is an effective model offering an efficient, cost-effective methodology aligning with the Institute for Healthcare Improvement's Triple Aim. RESULTS: Twenty SMAs were conducted. Sixty-three patients and 14 ICHT members participated. Mean (M) satisfaction rating for SMA patients (M = 4.90, SD 0.26) was significantly higher than mean for traditional patients (M = 4.03, SD 0.39). Interdisciplinary healthcare team members' attitudes toward SMAs revealed a mean score of 4.58. Incidentally, cycle times improved as did lengths of stay. CONCLUSIONS: Lower extremity joint replacement patients and IHCT members reported high satisfaction with SMAs.

Perampanel for the treatment of epilepsy; Longitudinal actuarial analysis and dose responses based on monthly outcomes.

PURPOSE: To explore the retention rates and the efficacy and tolerability of perampanel (PER) by using monthly real life data for a period of 12 months. METHODS: Longitudinal outcomes of (PER) usage were assessed using actuarial statistics in an observational nonrandomised multicentre study of 181 people with epilepsy (PWE) refractory to first and second line drugs. Graded seizure outcomes, toxicity and the dose of PER were recorded for each month. RESULTS: PWE were followed for a mean of 15.1 months. The total cumulative probability for retention on PER at 12 months was 61.7% and for ≥50% improvement was 38.2%. Most improvements in seizure control occurred soon after initiation of PER, 17% by one month, 32% by six months and 38% by twelve months, and mostly at low doses 53% on 2 mg and 90% up to 6 mg. Improvements, when they occurred, were sustained. The most common side effects were neuropsychiatric, occurring in 28%. The emergence of side effects did not appear to be dose related. Although people with intellectual disability (ID) were more likely to remain on PER they did not show improved seizure control and also reported more side effects. Patients treated with VNS and PER had a worse outcome. CONCLUSION: Overall around a third of people showed a useful, response to PER therapy. The response to PER is noted usually early in the treatment and for the majority of the patients for doses up to 8 mg.

Merging elaboration and the theory of planned behavior to understand bear spray behavior of day hikers in Yellowstone National Park.

This research empirically merges together two related theories: the elaboration likelihood model and the theory of planned behavior. A structural equation modeling approach is used to evaluate the relationship between the two theories and their collective impacts on behavioral intentions. The results suggest elaboration predicts the components of the theory of planned behavior (attitudes, subjective norms, and perceived behavior control), which in turn all predicted behavior intentions. Furthermore, results showed that the components of the theory of planned behavior partially meditated the relationship between elaboration and behavioral intentions, indicating that elaboration works mostly through the components of the theory of planned behavior to impact behavioral intentions. This study represents an improved understanding of the influence of communication techniques on visitor behaviors in sustainable tourism settings. Additionally, the discussion exemplifies how these techniques can be used to improve communications and evaluate communication strategies.

Effect of a Computerized Alert on Emergency Department Hepatitis A Vaccination in Homeless Patients During a Large Regional Outbreak.

BACKGROUND: While the overall incidence of hepatitis A has declined markedly since the introduction of a vaccine, sporadic cases and outbreaks of the disease continue to occur. OBJECTIVE: Our aim was to evaluate the effectiveness of an electronic health record (EHR) provider alert as part of an outbreak-control vaccination program implemented in the emergency department (ED). METHODS: We conducted a retrospective study assessing the impact of a Best Practice Alert (BPA) built into an EHR to prompt providers when a patient was homeless to consider hepatitis A vaccination in the ED. Data were collected over three 6-month time periods: a historical control period, a pre-intervention period, and an intervention period. RESULTS: There were no vaccinations given in the ED in the historical period, which increased to 465 after the implementation of the BPA. During the implementation period, there were 1,482 visits identified among 1,131 patients that met the inclusion criteria. Of these, there were 1,147 (77.5%) visits where the patient either received the vaccine in the ED, had already received the vaccine, or it was not indicated due to the current medical issue. There were also 333 (22.5%) visits where the BPA was active for potential vaccination eligibility, but did not receive it in the ED. CONCLUSIONS: We leveraged an informatics tool developed within our EHR to identify high-risk patients and remind providers of the availability of vaccination in the ED. Using these tools enabled providers to increase vaccination efforts within our ED to help control the community-wide outbreak.

Characterizing conflict between humans and big cats Panthera spp: A systematic review of research trends and management opportunities.

Conservation of big cats (Panthera spp.), a taxonomic group including tigers, lions, jaguars, leopards and snow leopards, is a daunting challenge. As expanding human populations across Panthera range countries exacerbate competition for land and prey, conflicts between humans and big cats are inevitable. Through a systematic review of the peer-reviewed literature published from 1991 to 2014 and indexed in Web of Science and Google Scholar (186 articles), our study explored the current state of knowledge regarding human-Panthera conflict and potential solutions, examining variables such as spatial and temporal distribution of research, methods used to study conflict, evaluation of interventions, and management recommendations. Our synthesis revealed several key data gaps and research needs. More studies could utilize diverse data collection approaches to focus on both the ecological and socio-cultural context for conflict. Additionally, only 21% of articles included in the review evaluated conflict mitigation interventions, and few of these yielded conclusive results. Success ratios suggest that compensation schemes and livestock management strategies were more effective tools for addressing conflict than either direct interventions (lethal removal or translocation of animals) or community interventions (e.g. education, ecotourism, local management). More studies should systematically evaluate the efficacy of conflict mitigation strategies, many of which are consistently recommended without empirical support. Results highlight trends and opportunities that can be used to inform future research and management efforts focused on human-Panthera conflict, ultimately enhancing the potential for coexistence between humans and carnivore species worldwide.

A dataset on tail risk of commodities markets.

This article contains the datasets related to the research article "The long and short of commodity tails and their relationship to Asian equity markets"(Powell et al., 2017) [1]. The datasets contain the daily prices (and price movements) of 24 different commodities decomposed from the S&P GSCI index and the daily prices (and price movements) of three share market indices including World, Asia, and South East Asia for the period 2004-2015. Then, the dataset is divided into annual periods, showing the worst 5% of price movements for each year. The datasets are convenient to examine the tail risk of different commodities as measured by Conditional Value at Risk (CVaR) as well as their changes over periods. The datasets can also be used to investigate the association between commodity markets and share markets.

Task-dependent cold stress during expeditions in Antarctic environments.

This study seeks to understand the degree of body cooling, cold perception and physical discomfort during Antarctic tour excursions. Eight experienced expedition leaders across three Antarctic cruise voyages were monitored during occupational tasks: kayaking, snorkelling and zodiac outings. Subjective cold perception and discomfort were recorded using a thermal comfort assessment and skin temperature was recorded using a portable data logger. Indoor cabin temperature and outdoor temperature with wind velocity were used as measures of environmental stress. Physical activity level and clothing insulation were estimated using previous literature. Tour leaders experienced a 6°C (2°C wind chill) environment for an average of 6 hours each day. Leaders involved in kayaking reported feeling colder and more uncomfortable than other leaders, but zodiac leaders showed greater skin temperature cooling. Occupational experience did not predict body cooling or cold stress perception. These findings indicate that occupational cold stress varies by activity and measurement methodology. The current study effectively used objective and subjective measures of cold-stress to identify factors which can contribute to risk in the Antarctic tourism industry. Results suggest that the type of activity may moderate risk of hypothermia, but not discomfort, potentially putting individuals at risk for cognitive related mistakes and cold injuries.

Improving coding accuracy in an academic practice.

Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. METHODS: Design: single group, pretest-posttest. SETTING: military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. MAIN OUTCOME MEASURES: overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. RESULTS: Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. CONCLUSIONS: Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.

Physical Activity Counseling by Diabetes Educators Delivering Diabetes Self-management Education and Support.

PURPOSE: The purpose of this study was to examine factors that influence physical activity counseling of diabetes educators delivering diabetes self-management/support (DSME/S). METHODS: Diabetes educators were surveyed about their DSME/S counseling at the American Association of Diabetes Educators Pennsylvania State Diabetes Conference to explore (1) time dedicated to physical activity counseling, (2) importance placed on physical activity as a treatment for diabetes, (3) knowledge of the 2008 Physical Activity Guidelines for Americans, (4) level of confidence with physical activity counseling, and (5) barriers associated with physical activity counseling. RESULTS: A sample of 119 diabetes educators with 13.0 ± 8.6 years of DSME/S experience participated in the survey (95.8% female; 94.1% white; 60.5% nurses; 73.9% Certified Diabetes Educators). Of 4 common DSME/S content areas (healthy eating, taking medications, monitoring blood glucose, and physical activity), physical activity was ranked as the third most important behind healthy eating and taking medications, with 14.5 ± 12.1 minutes per session spent counseling on physical activity. The proportion of educators acknowledging the current physical activity guidelines for moderate-intensity aerobic activity, vigorous-intensity aerobic activity, and resistance training was 74%, 20.5%, and 62.8%, respectively. Being "very confident" for counseling on physical activity was reported by 54.7%, while "inability to engage patients in physical activity" and "time allotted for DSME/S visits" were the most challenging personal and practice barriers reported, respectively. Physical activity is an important lifestyle behavior for the treatment of diabetes. CONCLUSIONS: Findings suggest that there are challenges to physical activity counseling within DSME/S. Strategies to improve physical activity counseling by diabetes educators warrant attention.

Influence of Patient-Centered Decision Making on Sustained Weight Loss and Risk Reduction Following Lifestyle Intervention Efforts in Rural Pennsylvania.

PURPOSE: The purpose of this study was to determine whether weight loss and cardiovascular disease risk factor reduction was maintained following a lifestyle intervention. METHODS: Five hundred fifty-five individuals without diabetes from 8 rural communities were screened for BMI ≥25 kg/m(2) and abdominal obesity (86.1% female, 95.1% white, 55.8% obese). Communities and eligible participants (n = 493; mean age, 51 years, 87.6% female, 94.1% Caucasian) were assigned to 4 study groups: face-to-face, DVD, Internet, and self-selection (SS) (n = 101). Self-selection participants chose the intervention modality (60% face-to-face, 40% Internet, 0% DVD). Outcomes included weight change and risk factor reduction at 18 months. RESULTS: All groups achieved maintenance of 5% weight loss in over half of participants. Self-selection participants had the largest proportion maintain (89.5%). Similarly, nearly 75% of participants sustained risk factor reduction. After multivariate adjustment, participants in SS were 2.3 times more likely to maintain 5% weight loss compared to the other groups, but not risk factor reduction. CONCLUSION: Despite the modality, lifestyle intervention was effective at maintaining weight loss and risk reduction. However, SS participants were twice as likely to sustain improvements compared to other groups. The importance of patient-centered decision making in health care is paramount.