Pathways Behavioral Services

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity among US adults, including recurrent emergency department (ED) visits and unplanned hospital admissions. Despite this, the transition of care (TOC) from the inpatient to outpatient setting remains under-studied. The objectives of the Reduce Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting (Reduce REVISITS) study are to conduct contextual assessments to inform implementation plans for COPD TOC interventions, conduct a cluster randomized trial evaluating implementation over 1 year of COPD TOC bundles, and monitor sustainment of implementation over a 2-year period across 20 sites. This pragmatic, multisite study uses a hybrid type II effectiveness-implementation design to evaluate clinical and implementation outcomes of COPD TOC programs across 20 sites. Sites are cluster-randomized to 1 of 4 intervention groups, varying by program delivery method (in-person vs virtual) and implementation strategy (mentored implementation with or without co-design). Sites select evidence-based interventions they wish to incorporate into their COPD TOC program and are randomized to in-person or virtual delivery. During the 1-year active implementation period of the study, assigned mentors will meet monthly with sites (for a total of 12 sessions) to enable on-the-ground troubleshooting of site-specific difficulties with TOC interventions. The primary effectiveness outcome for this study will be COPD-specific acute health care use, defined as a composite of all ED visits and hospitalizations within 30 days of index hospitalization for a COPD exacerbation. The primary implementation outcome will be reach, defined as the proportion of patients receiving their assigned TOC interventions (the whole bundle). As of August 2025, 21 sites completed the contextual assessments and developed site-specific implementation plans. Publication of the qualitative data from this pre-implementation phase is anticipated in December 2025. Site randomization is complete; sites randomized to co-design have completed 3 sessions. Baseline data collection on use is complete. Implementation-year data collection on use is nearly complete. Year 1 and 2 post-implementation-phase data collection on use is ongoing. Quantitative data analyses of the baseline and implementation-phase reports are nearly complete. Manuscript submission for the primary implementation-phase manuscript is anticipated for December 2025. Manuscript submission for the implementation-sustainment analyses are anticipated for September 2026. Qualitative data collection for year 1 of the post-implementation phase is complete, and analysis is under way. Qualitative data collection for year 2 began in August 2025. The Reduce REVISITS study will use novel integrated implementation science and human-centered design methodology to investigate bundles of effective COPD TOC interventions with the goal of reducing COPD hospital revisits. The study will evaluate evidence-based programs for effectiveness and implementation across a wide variety of health care sites to ultimately improve outcomes in this high-risk patient population. ClinicalTrials.gov NCT05568043; https://clinicaltrials.gov/study/NCT05568043. DERR1-10.2196/82043.

HighlightsPublic health relevance—How does this work relate to a public health issue?This work reviews articles related to landfills in rural Alaska communities and may guide future research related to gaps identified in this review.Unlined landfills lacking leachate collection systems may impact public health.Public health significance—Why is this work of significance to public health?This work identifies several potential disease transmission and chemical exposure pathways associated with such landfills, which are primarily found in rural and tribal communities already facing significant health disparities.If harvested, birds, fish, other animals and plants living, growing, or feeding by open surface area landfills could present public health implications for Indigenous and other hunting populations via ingestion or contact with waste pathogens or chemicals.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?This review paper elucidates the need to continue to assess landfill contaminant transport, exposure pathways and risks and the unique challenges of solid waste management in rural Alaska and other Arctic environments.Future research directions regarding the risk to subsistence resources and the associated health implications for Alaska Native and other Arctic subsistence-based cultures should prioritize community-based, co-produced research that integrates Indigenous Knowledge with Western science. This approach is crucial for addressing the existing health disparities and unique environmental exposures faced by these communities.Landfill contaminants pose significant risks to environmental and human health, particularly in rural Alaska. These communities are predominantly Alaska Native and face unique challenges in solid waste management due to geography, climate, and limited infrastructure. This scoping review assessed published research on the impacts of landfill contaminants in the Arctic (Aim 1) and Alaska specifically (Aim 2). Seventy-one studies met the inclusion criteria, all of which were used to develop a conceptual model of contaminant transport pathways. Thirty-nine studies included Alaska-specific research: thirty-three focused on environmental impacts, and six addressed human health (e.g., birth outcomes, cancer). Key topics included waste burning, heat generation, carbon release, leachate characterization, and water or sediment contamination. Evidence specific to Alaska suggested landfill leachate may contaminate surface water and groundwater, and that microbes can migrate beyond the landfill site boundaries in communities using honeybuckets (plastic bag-lined buckets that collect human waste). Landfill contaminants also impacted wildlife through consumption of garbage, which may have human health implications for subsistence-based communities. Major research gaps remain in understanding individual-level exposures, the effects of emerging contaminants, and the mechanisms of contaminant transport pathways. Further research designed for causal inference is needed to support improvements to public and environmental health.

This best practice brief presents Component 6 of the Data-to-Deal (D2D) framework, which addresses how to strengthen the enabling environment for investment. This component focuses on the coherent policy, regulatory, and institutional reforms needed to reduce risk, create clear routes to market, and build investor confidence in clean energy and sustainable transport systems. Stable legal frameworks, predictable pricing and incentive structures, and transparent procurement processes are essential to mobilise capital at scale. Component 6 on successful enabling environments comprises three sub-components: (i) operationalising cross-cutting enablers; (ii) identifying and designing policy reforms; and (iii) developing an implementation plan to prioritise and sequence reforms. These sub-components are embedded across the D2D pipeline, linking political commitment, technical planning, and finance mobilisation into a coherent reform agenda. The brief draws on case studies from Zambia, South Africa, and the UK to illustrate how targeted reforms can expand renewable energy, reduce costs, and create investor-ready markets, while also highlighting the role of domestic capital market reforms in unlocking long-term sustainable financing. By operationalising this approach, countries can develop integrated, context-specific reform packages that advance development priorities, meet climate commitments, and strengthen resilience.

BackgroundDespite the widespread availability of multiple antidepressant treatments, depression remains a common and sometimes debilitating disorder. A significant proportion of patients with major depressive disorder fail two or more antidepressant treatments and are considered to have treatment-resistant depression (TRD). Recent attention has turned to psilocybin and other psychedelic compounds as potential rapidly acting and durable episodic treatments for psychiatric disorders including depression.Aims & ObjectivesTo explore the efficacy and safety of crystalline psilocybin in the treatment of TRDMethodCOMP 001 was the first large, multinational, randomized controlled trial to evaluate the investigational drug COMP360, a proprietary pharmaceutical-grade synthetic psilocybin formulation, optimized for stability and purity, developed by the sponsor COMPASS Pathfinder Ltd in patients with TRD.ResultsThis was a dose-ranging study that randomized 233 participants equally to 25mg or 10mg, or the 1mg control treatment. Participants down-tapered and washed out any previous antidepressant medications, and received a single administration of COMP360 as monotherapy, after which they were followed for 12 weeks. On the primary efficacy measure, large dose-dependent reductions from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) scores were evident starting from Day 2. Clinically meaningful differences in MADRS score improvements between the 25mg and 1mg doses were statistically significant through week 6 and remained numerically evident at week 12. Results of secondary and additional efficacy measures were consistent with MADRS results. The intensity of the psychedelic experience entailing boundlessness was associated with clinical outcome.Discussion & ConclusionsCOMP360 was generally well-tolerated; in both studies over 90% of adverse events were either mild or moderate in severity. Suicidality remains a concern in TRD studies. These results suggested that COMP360 has potential to become an important contribution to the treatment for TRD. Further clinical development of COMP360 in rigorous, large, randomized controlled studies is underway.