Up to 70% of Veterans experience challenges with community reintegration. Volunteerism is associated with increased community connection, improved mental health, and lower suicide rates. However, volunteer opportunities are sometimes limited in rural areas. The Rural WAVE (Wellness and Veteran Engagement) Initiative was developed for the Department of Veterans Affairs (VA) Center for Development & Civic Engagement (CDCE) and aims to connect Veterans in rural areas to volunteer activities in local communities. This brief report describes Rural WAVE and the main findings from its evaluation.

A mixed-methods evaluation of Rural WAVE was informed by the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework and includes event and volunteer activity administrative data, volunteer (civilian and Veteran) and VA staff interviews, and site visits.

Since launching in 2021, 17 Veteran Health Administration (VHA) facilities have adopted Rural WAVE. As of October 2025, outcomes included 223 activities/events, 111 volunteers, 2944 volunteer hours, and 3388 rural Veteran contacts. Rural Veteran volunteers reported improved mental health, a sense of purpose and meaning, and opportunities for camaraderie with other Veterans. CDCE staff reported improved accountability and motivation fostered by regular meetings with other sites, which promoted progress, idea sharing, and improved morale. Project site visits facilitated evaluation, strengthened relationships, and increased the Initiative's visibility among VA leadership.

Rural WAVE positively impacts Veteran and civilian volunteers and site staff. CDCE adopted Rural WAVE as part of their national programming in October 2025, achieving a sustainable future and new opportunities for growth.

Access to clean water is increasingly threatened by rapid industrialization, population growth, and the discharge of heavy metals into aquatic systems, posing serious risks to human health and ecological balance. The development of advanced materials with high adsorption efficiency and multifunctionality is therefore essential for sustainable water treatment. In this study, a novel tantalum-based metal-organic framework (Ta-MOF) was synthesized via conventional and ultrasound-assisted methods and evaluated for the removal of cadmium (Cd), arsenic (As), and molybdenum (Mo) from aqueous solutions. The ultrasound-assisted route produced materials with improved crystallinity, particle dispersion, and structural uniformity, as confirmed by FTIR, SEM, EDS, XRD, and BET analyses. The adsorption process was systematically optimized using Response Surface Methodology (RSM), considering key operational parameters including pH, initial metal concentration, adsorbent dosage, and contact time. Maximum removal efficiencies of 89.76% (As), 94.32% (Mo), and 88.94% (Cd) were achieved under optimized conditions, with pH values around neutral and contact times of 39.77-46.25 min. Kinetic studies followed the pseudo-second-order model, indicating that the adsorption rate is strongly dependent on active site availability and suggesting a surface interaction-controlled process. Isotherm analyses showed good agreement with the Langmuir model, indicating monolayer adsorption on a relatively homogeneous surface. In addition, Ta-MOF exhibited moderate antibacterial activity against Escherichia coli and Staphylococcus aureus. Overall, the findings highlight the potential of Ta-MOF as a dual-functional material for heavy metal removal and microbial control, offering a promising approach for integrated water treatment in contaminated environments.

Obstructive sleep apnoea (OSA) is underdiagnosed and undertreated in low-resource settings. This study aimed to comprehensively assess the availability, accessibility, and affordability of diagnostic and therapeutic resources for OSA across 15 francophone sub-Saharan African (FSSA) countries.

A cross-sectional survey was conducted from October to December 2025 under the coordination of the Société Africaine de Pneumologie de Langue Française (SAPLF). National experts from 15 countries were purposefully selected through the SAPLF network and completed a standardized questionnaire covering infrastructure, costs, workforce, insurance coverage, and perceived barriers. Quantitative data were analyzed descriptively; qualitative responses were analyzed thematically.

Polysomnography (PSG) was available in 6/15 countries (40%) and respiratory polygraphy (RP) in 13/15 (86.7%), primarily concentrated in capital cities and private centers. Diagnostic costs were prohibitive: PSG ranged from €221-686 and RP from €69-259, often exceeding the statutory monthly minimum wage (SMW). Continuous positive airway pressure (CPAP) devices were available in 8/15 countries (53.3%) and mandibular advancement devices (MAD) in 5/15 (33.3%), with costs ranging from €381-3,812 and €38-305, respectively. Insurance coverage for CPAP was partial and reported in only three countries. The density of trained practitioners was critically low, with most countries reporting fewer than two per million inhabitants.

OSA care in francophone sub-Saharan Africa is constrained by centralised diagnostic capacity, prohibitive costs, and a shortage of trained providers. Strengthening training, reducing financial barriers, and integrating sleep medicine into non-communicable disease strategies may improve equity in access.

Type 1 diabetes can be predicted through the presence of multiple circulating islet autoantibodies in the blood. However, although more than half of type 1 diabetes cases are diagnosed in adults, natural history and prediction studies to date have focused on children. This protocol describes the first type 1 diabetes natural history study in adults, both general population and relatives for screening with longitudinal monitoring.

The study launched on 14 November 2023 and the planned end date is 31 May 2027. The recruitment target is 20 000 adults. Participants are consented online and posted capillary blood kits for remote self-sampling. Serum, isolated from samples returned to the laboratory by mail, is tested for islet autoantibodies in a two-step process. Samples are initially screened for autoantibodies to truncated (t)glutamate decarboxylase 65, insulinoma-associated antigen-2 and zinc transporter 8 using a multiplex luciferase immunoprecipitation system (LIPS) screening assay. Positive samples are retested in individual LIPS assays. Autoantibodies to insulin are measured by radiobinding assay. Individuals positive for one or more islet autoantibody are recontacted and a remote confirmation sample is requested.Once positivity is confirmed, positive participants are provided education about the symptoms of type 1 diabetes and invited to annual monitoring to allow risk of future type 1 diabetes to be accurately measured. The confirmation sample is also tested for autoantibody characteristics including affinity and positivity by a second platform to allow a tiered approach to future follow-up.

The study protocol was submitted to Liverpool Central Research Ethics Committee and received a favourable opinion on 26 October 2023. Results are disseminated through conference presentations, peer-reviewed journals and will be shared openly.

. The prevalence of diabetes mellitus in French Guiana (11.6%) is marked by a significant proportion of type 2 diabetes (T2D). The high level of poverty and ethnic diversity of the French Guiana population may limit access to care, delay diabetes management and increase the risk of complications. Diabetes Self-Management Education (DSME) teams have been implemented since 2017 to improve diabetes care in the region. This study aimed to evaluate the effect of DSME on glycemic control in patients living with type 2 diabetes (T2D) in French Guiana.

. - This cross-sectional study analyzed inclusion data from patients living with T2D who participated in the French Amazon Diabetes Cohort Study (CODIAM) conducted between April 2019 and June 2021. The main outcome was the achievement of the patient's individual HbA1c target. Associations between the main outcome and DMSE were investigated with simple and multiple regression analysis.

. - Among the 796 included participants, 51.3% were women with a median age of 58 years. Individualized HbA1c targets were achieved by 35.3% of participants, and 38% had attended at least one DSME session. Participation in DSME was associated with higher odds of achieving the HbA1c target. Participants with better glycemic control were more likely to be older, more likely to have been born in France, in a relationship, not working, and had better French-language proficiency. Clinically, these participants more frequently had comorbidities and a longer duration of disease. No association was found between glycemic control and gender or education level.

. - These results suggest that DSME may improve glycemic control in patients living with T2D in French Guiana, in the context of a multicultural population with high precarity levels and low health literacy. Improving and guaranteeing the access to DSME to all is thus critical, in particular for the most vulnerable.

Diabetic ulcer (DU) remains a major health problem with high morbidity and treatment cost. Effective, rapid, and affordable treatment is essential for its management. Topical polypeptide gel has regenerative, angiogenic, and anti-inflammatory properties that may accelerate wound healing. However, clinical evidence regarding effectiveness is limited.

A double-blinded randomized controlled trial was conducted involving 26 subjects with DU, randomly allocated into an intervention group that received 7% topical polypeptide and a control group that received hydrocolloid gel. Wound healing was assessed by measuring ulcer surface area reduction on days 7, 14, and 21 compared to baseline.

The polypeptide gel group demonstrated significantly greater absolute ulcer size reduction on day 7 (p = 0.002) and day 14 (p = 0.004), whereas the difference in absolute area did not reach statistical significance on day 21 (p = 0.106). When healing was expressed as the percentage of wound reduction from baseline, the polypeptide gel group showed significantly greater wound closure at all three time points, including day 21 (day 7: 66.4% vs. 16.8%, p < 0.001; day 14: 83.3% vs. 27.8%, p < 0.001; day 21: 92.7% vs. 41.5%, p = 0.002), with large effect sizes.

Topical 7% polypeptide gel was associated with significantly greater reduction in diabetic ulcer surface area compared with hydrocolloid gel. Although the difference in absolute area reduction did not reach statistical significance at day 21, the relative reduction from baseline remained significantly greater in the polypeptide gel group at all three time points, indicating a sustained healing advantage.

To quantify community care consultations for patients with newly diagnosed diabetic foot ulcers (DFUs), identify associated patient- and facility-level characteristics, and measure time to specialty care within and outside the Veterans Health Administration (VHA).

A retrospective cohort study.

This study included patients 65 years and older with newly diagnosed DFUs who received specialty care between 2019 and 2023. Data were sourced from the VHA Corporate Data Warehouse and linked Medicare data. Community care consultation was defined as receiving specialized consultations (ie, podiatry, vascular surgery, infectious disease, endocrinology) at a community health care system within 1 year of DFU diagnosis. Patient demographics, comorbidities, and facility characteristics were analyzed with multivariable mixed-effects logistic regression models to assess factors associated with community care consultation while controlling for facility-level clustering.

A total of 60,121 patients with a new diagnosis of DFU were included. Of these, 29.2% had a community care consultation. Those receiving community care were more often older, White, living in a rural area, and cared for in lower-complexity facilities. Patients were more frequently referred to community care for vascular surgery, infectious disease, and endocrinology consultations than for podiatry. For all specialties, the time to a new consultation was longer for community care than for a consultation within the VHA.

Community care consultations for patients with DFUs in the VHA system were substantial but varied significantly across facilities. Rural and lower-complexity facilities relied more on community care, particularly for vascular surgery, infectious disease, and endocrinology. Future research should explore the impact of community care on DFU outcomes and strategies to enhance multidisciplinary care coordination.

Interventions to reduce cost-related medication nonadherence have focused on reducing out-of-pocket (OOP) prescription drug costs. However, little is known about the impact of OOP medical costs on adherence. This study examines the relationship between patient all-cause OOP medical costs and medication adherence.

A retrospective study was conducted using July 2017 to December 2018 Medicare Advantage data from the Optum Clinformatics Data Mart deidentified database. Inclusion criteria were adapted from the specifications of 3 medication adherence measures used in the Medicare Part D Star Ratings program: diabetes, renin-angiotensin system antagonists (RASAs), and statins.

Multivariable logistic regression models were used to assess the relationship between OOP medical costs and medication adherence across 4 mutually exclusive cohorts-diabetes only, RASA only, statins only, and diabetes-RASA-statins-after adjusting for covariates.

A total of 47,091, 443,831, 510,394, and 284,137 individuals were included in the diabetes-only, RASA-only, statins-only, and diabetes-RASA-statins cohorts, respectively. OOP medical costs were associated with a significant decrease in medication adherence across all cohorts. A $1000 increase in patient all-cause OOP medical costs reduced the odds of adherence by 7.3% (OR, 0.927; 95% CI, 0.919-0.935; P  < .001) for statins, 7.4% (OR, 0.926; 95% CI, 0.903-0.949; P  < .001) for diabetes medications, and 11.6% (OR, 0.884; 95% CI, 0.876-0.892; P  < .001) for RASAs. The negative impact of OOP medical costs on adherence was greatest in the diabetes-RASA-statins cohort.

Interventions aimed at improving medication adherence should focus on patient OOP prescription drug costs but should also consider the potential impact on adherence of total patient OOP costs incurred for all medical services.

Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations.

SGLT2 inhibitor new-user retrospective cohort study using a 25% random sample of IQVIA PharMetrics Plus for Academics US health plan claims, 2014 to 2022.

We included new users of SGLT2 inhibitors who had type 2 diabetes with prior cardiovascular disease or risk factors. Group-based trajectory modeling identified SGLT2 inhibitor adherence subgroups using monthly proportions of days covered over the 12 months post SGLT2 inhibitor initiation. Cox proportional hazards models, adjusted for baseline covariates, estimated the HRs for diabetes-related hospitalizations/emergency department (ED) visits in the year following 12-month treatment with SGLT2 inhibitors.

We classified 5051 new SGLT2 inhibitor users into 5 SGLT2 inhibitor adherence trajectory groups: nonadherent (14.7%), early decline (13.5%), late decline (10.5%), dynamic adherence (13.0%), and adherent (48.3%). A diabetes-related hospitalization/ED visit occurred in 2.3% of the overall cohort, with a median (IQR) time to event of 151.5 (76-263) days. In the adjusted Cox proportional hazards model, the late decline group (HR, 2.52; 95% CI, 1.38-4.60) and the dynamic adherence group (HR, 2.42; 95% CI, 1.52-3.86) had a statistically significantly greater risk of diabetes-related hospitalizations/ED visits than the adherent group.

These findings suggest that variable adherence to SGLT2 inhibitors can negatively impact diabetes-related outcomes.

Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations.

Glucagon-like peptide-1 receptor agonists (GLP-1RA) and other second-line glucose-lowering agents are increasingly used among women of reproductive age. Data on the safety of these medications in pregnancy are limited. We aimed to assess the comparative safety of first-trimester exposure to second-line glucose-lowering agents on the risk of organ-specific congenital malformations among pregnancies affected by type 2 diabetes mellitus that was pharmacologically treated.

We conducted a population-based cohort study using the French National Health Data System including singleton infants born after pregnancies lasting more than 22 weeks, in women aged 18 to 50 years with pregestational, pharmacologically treated type 2 diabetes from January 2011 to August 2024. We defined first-trimester exposure to glucose-lowering agents as having at least one prescription filled from 30 days before through to 91 days after conception. All glucose-lowering agents were considered: insulin, metformin, GLP-1RA, sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), sulfonylureas and other glucose-lowering agents. The primary reference group was the use of insulin alone, but the use of metformin, with and without insulin, and non-use of glucose-lowering agents were also comparators in additional analyses to facilitate comparison with previous studies. Analysed outcomes were major congenital malformations during the delivery stay and up to 1 year after birth to consider delayed identification, using ICD-10 codes as per EUROCAT (European surveillance of congenital anomalies) guidelines. Adjusted RRs and 95% CIs were estimated using Poisson regressions with generalised estimating equations. Values of BMI and HbA_1c were unavailable in the database; proxies of diabetes severity were used instead for confounding adjustment.

Among 19,092 eligible pregnancies, 17.5% were exposed to insulin alone, 34.7% to at least one second-line glucose-lowering agent and 10.4% were unexposed to any glucose-lowering agent during the first trimester. Compared with insulin-only use, first-trimester exposure to second-line glucose-lowering agents was not associated with an increased risk of overall or organ-specific major congenital malformations. Sensitivity analyses using stricter exposure definitions suggested a possible small increased risk of cardiac malformations following first-trimester exposure to GLP-1 RA and sulfonylureas.

In this largest study to date on the use of glucose-lowering agents in pregnancy, first-trimester exposure to second-line glucose-lowering agents was not associated with an increased risk of major congenital malformations when compared with insulin-only use. However, a small increased risk of cardiac defects associated with first-trimester exposure to GLP-1RA and sulfonylureas is possible, and thus teratogenicity cannot be excluded.