Introduction and Objective: Randomized trials, such as the Diabetes Prevention Program (DPP), have demonstrated that intensive lifestyle interventions (ILIs) reduce the risk of developing type 2 diabetes (T2D) among high-risk adults. After nationwide implementation of DPP/ILIs, the REALITY Research Network was designed to assess their long-term impact among high-risk adults in real-world settings. Methods: Using a prospectively planned meta-analysis of 2014-2023 electronic health record (EHR), claims and cohort data from three diverse, multisite real-world systems, we evaluated the association between the number of DPP/ILI sessions attended and T2D onset. The Cox Proportional Hazards Model was used to estimate the impact of session attendance on incident T2D among all DPP-eligible adults, including enrollees and matched non-enrollees (0 sessions), adjusting for demographic, clinical, and area-level social factors. DPP eligibility was defined as having overweight or obesity with at least one additional T2D risk factor. Results: Pooled cohorts included 269,590 DPP/ILI enrollees and 541,458 matched non-enrollees. Meta-analysis showed that each additional session attended was associated with a 1% reduction in T2D risk (pooled hazard ratio: 0.99 [95% CI: 0.98-0.99], p<0.01 [I2=25%]). Completing a moderate (8 sessions) or a large (16 sessions) number of DPP/ILI sessions was associated with an estimated 7% and 13% reduction in T2D risk, respectively (pooled hazard ratios: 0.93 [95% CI: 0.88-0.98] and 0.87 [95% CI: 0.78-0.96], p<0.01 [I2=25%]). Conclusion: DPP/ILI participation was significantly associated with a reduced risk of T2D, and higher risk reduction was seen with each additional session attended. This REALITY Network study is addressing a gap in the translational evidence base for U.S. T2D prevention. T. Moin: None. N.J. Jackson: None. O. Duru: None. U. Chung: None. C.W. Jones: Consultant; Tula Health, Inc, Magellen Health, Inc. T. Belnap: None. W.H. Herman: Other Relationship; Merck Sharp & Dohme Corp, Rivus Pharmaceuticals Inc. L.N. McEwen: None. S. Kuo: None. C. Villatoro Santos: None. K. Joiner: None. H. Shao: None. P. Li: None. L.S. Phillips: Research Support; Janssen Pharmaceuticals, Inc, Boehringer-Ingelheim. Other Relationship; AbbVie Inc, ForaCare, Inc., Diasyst, Inc. Research Support; Kowa Pharmaceuticals America, Inc, Pfizer Inc. R.T. Ackermann: None. R. Kang: None. S. Jacobs: None. B.D. Tyndall: None. S. Neuwahl: None. P. Zhang: None. M.E. Pavkov: None. Center for Disease Control (U18DP006708-03-02)
In elite global soccer, professional clubs own and operate academy programs for talent identification and development purposes. The development of a youth player into an adult professional is a long-term process, requiring a combination of competitive match play and intensive training. Although developing maximum sprinting and acceleration are crucial, their physical development may be hindered by congested fixtures in youth soccer. Players compete for 40–50 games over 9 months of the in-season, including extremely dense/congested-schedule tournaments. Because of the different competition formats across the world, it is important to understand how youth players physically develop to reach from early development to the senior level and to maximize the efficacy of age-appropriate strength and conditioning programs. The purpose of the narrative review is to identify the physical performance in elite youth soccer players, spanning early to late stages of development and to discuss physical development plans aimed at supporting players transitioning from the youth to first team.
Sustainability, the continuation of a new program, is an ongoing challenge and a barrier to “sustaining” success. The American Heart Association (AHA) has completed the National Hypertension Control Initiative (NHCI), a 3-year demonstration project jointly funded by the United States Department of Health and Human Services’ Office of Minority Health and the Health Resources Services Administration (HRSA) to improve blood pressure (BP) control in 350 low-performing HRSA-funded community health centers (CHCs) with about 1.5 million persons with hypertension (HTN). Implementation strategies to improve BP control included accurate BP measurement, team-based care, standardized treatment protocols, culturally and linguistically appropriate services, and use of self-measured BP (SMBP) monitoring. Sustainability strategies for NHCI include the standardization and protocolization of care processes; adoption of data-informed performance improvement; and continuation and reinforcement of BP control efforts through Target: BP™, a BP control initiative jointly developed and delivered by AHA and the American Medical Association, serving about 9 million persons with HTN. Eligibility for NHCI included BP control < 60%. In 2023, year 3, 55.5% of NHCI CHCs reported BP control ≥60%. They experienced a 9.6% improvement (18.8% relative change) in BP control from 2020-2023, compared to a 7.7% improvement (13.2% relative change) for all HRSA CHCs. In 2023, 89% of NHCI CHCs reported using a BP measurement protocol, 93% reported an SMBP protocol, and 77% reported a BP treatment algorithm. Implementation of protocols and BP improvement will be sustained by pursuing participation in Target: BP. In the 1st and 2nd years of NHCI, 33% and 35%, respectively, of 346 NHCI CHCs concurrently participated in Target: BP. Of those submitting data in 2023, 25% reported control rates ≥70% and 67% reported adoption of evidence-based practices. In 2024, 55% of all CHCs participated in Target: BP. AHA’s NHCI work can be sustained by 1) enrollment of all NHCI CHCs in Target: BP through efforts of AHA staff that supported NHCI activities, 2) leveraging Target: BP tools, resources, and quality improvement support, and 3) seeking extramural funding to support AHA BP control efforts. Sustainability of NHCI through Target: BP could be extended from 346 NHCI CHCs to all 1487 CHCs with over 31 million patients. AHA can ensure sustainability of NHCI efforts beyond the 3-year NHCI period through Target: BP.
Rapid advancements in artificial intelligence (AI) have enabled breakthroughs across many scientific disciplines. In organic chemistry, the challenge of planning complex multistep chemical syntheses should conceptually be well-suited for AI. Yet, the development of AI synthesis planners trained solely on reaction-example-data has stagnated and is not on par with the performance of "hybrid" algorithms combining AI with expert knowledge. This Perspective examines possible causes of these shortcomings, extending beyond the established reasoning of insufficient quantities of reaction data. Drawing attention to the intricacies and data biases that are specific to the domain of synthetic chemistry, we advocate augmenting the unique capabilities of AI with the knowledge base and the reasoning strategies of domain experts. By actively involving synthetic chemists, who are the end users of any synthesis planning software, into the development process, we envision to bridge the gap between computer algorithms and the intricate nature of chemical synthesis.
The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted.
