Addressing cost barriers to healthy eating with Eat Well, a prescription produce subsidy, for patients with diabetes and at risk for food insecurity: Study protocol for a type 1 hybrid effectiveness-implementation pragmatic randomized controlled trial.

Background: Patients with diabetes at risk of food insecurity face cost barriers to healthy eating and, as a result, poor health outcomes. Population health management strategies are needed to improve food security in real-world health system settings. We seek to test the effect of a prescription produce program, 'Eat Well' on cardiometabolic health and healthcare utilization.

Using the R package to assess the sustainability of offtake in birds.

The R package was designed to help assess the sustainability of offtake in birds when only limited demographic information is available. In this article, we describe some basics of harvest theory and then discuss several considerations when using the different approaches in to assess whether observed harvests are unsustainable. Throughout, we emphasize the importance of distinguishing between the scientific and policy aspects of managing offtake.

Residential Structural Racism and Prevalence of Chronic Health Conditions.

Importance: Studies elucidating determinants of residential neighborhood-level health inequities are needed.

Objective: To quantify associations of structural racism indicators with neighborhood prevalence of chronic kidney disease (CKD), diabetes, and hypertension.

Design, Setting, And Participants: This cross-sectional study used public data (2012-2018) and deidentified electronic health records (2017-2018) to describe the burden of structural racism and the prevalence of CKD, diabetes, and hypertension in 150 residential neighborhoods in Durham County, North Carolina, from US census block groups and quantified their associations using bayesian models accounting for spatial correlations and residents' age.

Community-based organizations' perspectives on piloting health and social care integration in North Carolina.

Background: Community-based organizations (CBOs) are key players in health and social care integration initiatives, yet little is known about CBO perspectives and experiences in these pilot programs. Understanding CBO perspectives is vital to identifying best practices for successful medical and social care integration.

Methods: From February 2021 to March 2021, we conducted surveys with 12 CBOs that participated in the North Carolina COVID-19 Social Support Program, a pre-pilot for North Carolina's Medicaid Sect.

Rapid formation of new migration route and breeding area by Arctic geese.

Many Arctic-breeding animals are at risk from local extirpation associated with habitat constriction and alterations in phenology in their Arctic environment as a result of rapid global warming. Migratory species face additional increasing anthropogenic pressures along their migratory routes such as habitat destruction, droughts, creation of barriers, and overexploitation. Such species can only persist if they adjust their migration, timing of breeding, and range.

The gut signals to AGRP-expressing cells of the pituitary to control glucose homeostasis.

Glucose homeostasis can be improved after bariatric surgery, which alters bile flow and stimulates gut hormone secretion, particularly FGF15/19. FGFR1 expression in AGRP-expressing cells is required for bile acids' ability to improve glucose control. We show that the mouse Agrp gene has 3 promoter/enhancer regions that direct transcription of each of their own AGRP transcripts.

Open removal models with temporary emigration and population dynamics to inform invasive animal management.

Removal sampling data are the primary source of monitoring information for many populations (e.g., invasive species, fisheries).

Evaluating the effect of expert elicitation techniques on population status assessment in the face of large uncertainty.

Population projection models are important tools for conservation and management. They are often used for population status assessments, for threat analyses, and to predict the consequences of conservation actions. Although conservation decisions should be informed by science, critical decisions are often made with very little information to support decision-making.

popharvest: An package to assess the sustainability of harvesting regimes of bird populations.

Bird harvest for recreational purposes or as a source for food is an important activity worldwide. Assessing or mitigating the impact of these additional sources of mortality on bird populations is therefore crucial issue. The sustainability of harvest levels is however rarely documented, because knowledge of their population dynamics remains rudimentary for many bird species.

Setting population-size targets for geese causing socio-economic conflicts.

Most European goose populations have increased exponentially, and this has increasingly brought them into conflict with human activities. To manage this conflict, we used multi-criteria decision analysis to help set population targets for a super-abundant population of greylag geese (Anser anser). We relied on expert elicitation to assess the consequences of varying goose abundance on nine ecological, economic, and societal objectives.

A Multiarmed Bandit Approach to Adaptive Water Quality Management.

Nonpoint source water quality management is challenged with allocating uncertain management actions and monitoring their performance in the absence of state-dependent decision making. This adaptive management context can be expressed as a multiarmed bandit problem. Multiarmed bandit strategies attempt to balance the exploitation of actions that appear to maximize performance with the exploration of uncertain, but potentially better, actions.

Incorporating uncertainty and risk into decision making to reduce nitrogen inputs to impaired waters.

This article aims to understand decision making under uncertainty and risk, with a case study on Cape Cod, Massachusetts. Decision makers need to consider imperfect information on the cost and effectiveness of advanced nitrogen-removing on-site wastewater treatment systems as options to mitigate water quality degradation. Research included modeling nitrogen load reduction to impaired coastal waters from seven treatment system technologies and eliciting expert knowledge on their costs.

Spatial conservation planning under uncertainty: adapting to climate change risks using modern portfolio theory.

Climate change and urban growth impact habitats, species, and ecosystem services. To buffer against global change, an established adaptation strategy is designing protected areas to increase representation and complementarity of biodiversity features. Uncertainty regarding the scale and magnitude of landscape change complicates reserve planning and exposes decision makers to the risk of failing to meet conservation goals.

Value of sample information in dynamic, structurally uncertain resource systems.

Few if any natural resource systems are completely understood and fully observed. Instead, there almost always is uncertainty about the way a system works and its status at any given time, which can limit effective management. A natural approach to uncertainty is to allocate time and effort to the collection of additional data, on the reasonable assumption that more information will facilitate better understanding and lead to better management.

Dynamic minimum set problem for reserve design: Heuristic solutions for large problems.

Conversion of wild habitats to human dominated landscape is a major cause of biodiversity loss. An approach to mitigate the impact of habitat loss consists of designating reserves where habitat is preserved and managed. Determining the most valuable areas to preserve in a landscape is called the reserve design problem.

Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention.

Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs.

Making do with less: must sparse data preclude informed harvest strategies for European waterbirds?

The demography of many European waterbirds is not well understood because most countries have conducted little monitoring and assessment, and coordination among countries on waterbird management has little precedent. Yet intergovernmental treaties now mandate the use of sustainable, adaptive harvest strategies, whose development is challenged by a paucity of demographic information. In this study, we explore how a combination of allometric relationships, fragmentary monitoring and research information, and expert judgment can be used to estimate the parameters of a theta-logistic population model, which in turn can be used in a Markov decision process to derive optimal harvesting strategies.

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.

Frequencies of decision making and monitoring in adaptive resource management.

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame.

Evaluation of harvest and information needs for North American sea ducks.

Wildlife managers routinely seek to establish sustainable limits of sport harvest or other regulated forms of take while confronted with considerable uncertainty. A growing body of ecological research focuses on methods to describe and account for uncertainty in management decision-making and to prioritize research and monitoring investments to reduce the most influential uncertainties. We used simulation methods incorporating measures of demographic uncertainty to evaluate risk of overharvest and prioritize information needs for North American sea ducks (Tribe Mergini).

Implementation of the first adaptive management plan for a European migratory waterbird population: The case of the Svalbard pink-footed goose Anser brachyrhynchus.

An International Species Management Plan for the Svalbard population of the pink-footed goose was adopted under the Agreement on the Conservation of African-Eurasian Migratory Waterbirds in 2012, the first case of adaptive management of a migratory waterbird population in Europe. An international working group (including statutory agencies, NGO representatives and experts) agreed on objectives and actions to maintain the population in favourable conservation status, while accounting for biodiversity, economic and recreational interests. Agreements include setting a population target to reduce agricultural conflicts and avoid tundra degradation, and using hunting in some range states to maintain stable population size.

Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.

Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible.

State-Dependent Resource Harvesting with Lagged Information about System States.

Markov decision processes (MDPs), which involve a temporal sequence of actions conditioned on the state of the managed system, are increasingly being applied in natural resource management. This study focuses on the modification of a traditional MDP to account for those cases in which an action must be chosen after a significant time lag in observing system state, but just prior to a new observation. In order to calculate an optimal decision policy under these conditions, possible actions must be conditioned on the previous observed system state and action taken.