RESUMO
BACKGROUND: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. METHODS: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. FINDINGS: Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08). INTERPRETATION: Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.
RESUMO
Insecticide drenches were applied to postharvest field-grown nursery plants harvested as 60-cm-diameter balled and burlapped (B&B) root balls for controlling third instars of Japanese beetle, Popillia japonica Newman (Coleoptera: Scarabaeidae). Bifenthrin, chlorpyrifos, lambda-cyhalothrin, and thiamethoxam were drench-applied in fall and spring tests at volumes of runoff (1X; approximately equal 2.57 liters per drench per root ball) or twice runoff (2X). Tests also examined consecutive drenches (two, four, or six) and B&B rotation between drenches. Fall-applied drenches did not meet the Domestic Japanese Beetle Harmonization Plan (DJHP) standards of < or =1 grub and ranged from 0 to 90% control. However, most fall-applied drenches significantly reduced grub numbers relative to the untreated root balls. Spring-applied drenches were more effective than fall drenches: chlorpyrifos treatments gave 94-100% control, whereas other spring-applied treatments were less consistent, including thiamethoxam (83-100% control) and bifenthrin (61-100% control). Lambda-cyhalothrin was not effective. A higher drench volume (2X) did not significantly improve treatment efficacy; however, grub numbers decreased as the number of drenches increased for fall-applied chlorpyrifos and thiamethoxam and spring-applied bifenthrin. Rotation of root balls significantly reduced grub numbers compared with nonrotated treatments for fall-applied chlorpyrifos (six drenches) and bifenthrin (two or six drenches), but these treatments did not meet DJHP standards. The study indicates chlorpyrifos, bifenthrin, and thiamethoxam drenches can control Japanese beetle in the spring and may provide a new postharvest option to certify B&B plants for Japanese beetle.
Assuntos
Clorpirifos/administração & dosagem , Besouros , Controle de Insetos/métodos , Inseticidas/administração & dosagem , Raízes de Plantas/parasitologia , Animais , Formigas , Larva , ÁguaRESUMO
This study examined chlorpyrifos immersion of balled and burlapped (B&B) nursery trees for elimination of third instars of Japanese beetle, Popillia japonica Newman (Coleoptera: Scarabaeidae), and for phytotoxicity on red maple, Acer rubrum L. Trees were harvested as 45- and 60-cm-diameter B&B and immersed in chlorpyrifos at U.S. Domestic Japanese Beetle Harmonization Plan rate (0.24 kg active ingredient [AI/100 liters) or lower rates of 0.015, 0.03, 0.06, and 0.12 kg (AI)/100 liters. The 0.03, 0.06, and 0.24 kg (AI) rates provided 100% control of Japanese beetle grubs in both 45- and 60-cm B&B. The 0.015 and 0.12 kg (AI) chlorpyrifos rates were 100% effective in three tests. However, in another test, 0.015 and 0.12 kg (AI) chlorpyrifos treatments had four (93% control) and one (98% control) grubs recovered, respectively. Root ball soils consisted of loam, silt loam, or clay loam texture classifications. Trunk diameter and internode growth of red maple harvested as 45-cm B&B decreased linearly with increasing chlorpyrifos dip rate during the first year, but effects were unapparent in the second year. Chlorpyrifos rates had no measurable impact on growth of red maples harvested as 60-cm B&B. No visual phytotoxicity symptoms were detected for chlorpyrifos rate or root ball size treatments. In conclusion, results support lowering the U.S. Domestic Japanese Beetle Harmonization Plan chlorpyrifos dip rate for category 2 states to at least 0.03 kg (AI) for B&B diameters < or =60 cm. Chlorpyrifos rates < 0.24 kg (AI) will lower cost, reduce worker exposure, and lessen potential environmental contamination.
Assuntos
Acer/efeitos dos fármacos , Clorpirifos , Besouros , Inseticidas , Acer/anatomia & histologia , Acer/crescimento & desenvolvimento , Animais , Controle de Insetos/economia , Controle de Insetos/métodos , Inseticidas/farmacologia , Árvores/anatomia & histologia , Árvores/efeitos dos fármacos , Árvores/crescimento & desenvolvimentoRESUMO
More than 30,000 mosquitoes in 22 species or species groups were collected from the Florida Keys, Monroe County, FL, USA, in dry ice-baited light and gravid traps. Dry ice-baited traps collected more mosquitoes than did gravid traps. West Nile virus was detected in pools of Anopheles atropos Dyar & Knab, Deinocerites cancer Theobald, and Ochlerotatus taeniorhynchus (Wiedemann).