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Background: The physical, paper-based Georgia TB Reference Guide has served as the clinical reference handbook on tuberculosis (TB) diagnostic and treatment guidelines for the state of Georgia in the United States. Supported by the Georgia Department of Public Health, the production of the 112-page palm-sized booklet was previously led by a team of Georgia-based TB experts at Emory University and printed every three-five years with updates to clinical management guidelines and TB consult contact information. However, the costs associated with editorial printing combined with delays in updating a static printed booklet with revised guidance hampered the utility of the tool. Considering the barriers with paper-based production and based on the beneficial use of apps to support the dissemination of clinical management guidance in other settings, the booklet was converted into a mobile application. This paper describes the process of developing a mobile app version of the Georgia TB Reference Guide in an easy-to-update and readily available format. Methods: We employed a user-centered design approach to develop the app, including a series of qualitative interviews and quantitative surveys. Participants included a mix of state officials and local TB experts. First, initial foundational interviews were conducted to conceptualize current utilization practices of both the paper and PDF versions of the tool. Second, the findings from the initial interviews were organized thematically and informed the design of the app, which was then beta tested by a round of previously unsampled TB experts as well as a re-sample from the initial interviews. Third, the designs were coded into developmental phases and beta tested among users of the current Georgia TB Reference Guide. Fourth, the app was published and downloaded by a pre-selected group of local users who provided answers to a follow-up survey after using the app for one month. Fifth, user growth, self-reported demographics, and app usage between February and July 2022 were recorded through automatic data metrics built into the app. Results: The paper copy Georgia TB Reference Guide usage themes included commonly referenced content, navigation paths, and desired features and content. The themes were converted into features and designs such as prioritizing commonly reviewed topics and guide customization with bookmarks and notes. Iterations of the designs were driven by feedback from TB experts and included home page featured content, improving content readability, and improving the search feature. The follow-up survey revealed a 90% preference for the app over the paper version of the guide. In the six months following the app's release, the app was downloaded by 281 individuals in the United States. The majority of downloads were in Georgia and the app also expanded organically to 19 other states. Conclusion: The experience of converting the Georgia TB Reference Guide offers specific and effective steps to converting a medical reference guide into a mobile application tool that is readily available, easy to use, and easy to update. The organic dissemination of the app beyond the state of Georgia's borders within the first six months of app launch underscores desire among TB healthcare professionals for high-quality digital reference content outside the state. This experience offers clear outlines for replication in other contexts and demonstrates the utility of similar mobile medical reference tools. [ABSTRACT FROM AUTHOR]

Urban trees are at risk of stress due to heat island effects and the increased proportion of impervious areas surrounding them. Among pests of trees, insect borers such as bark beetles (Coleoptera: Curculionidae) and flatheaded borers (Coleoptera: Buprestidae) are some of the most devastating, frequently colonizing stressed trees. The objective of this study was to explore the effects of biotic and abiotic risk factors on borer attacks on trees in urban areas. In the summer of 2021 and 2022, this study was conducted in 50 urban sites in Atlanta and Augusta, Georgia (USA). Specific factors explored include overall tree health, differentially warmer maximum and minimum temperatures of sites compared to surrounding areas, tree species, and the percentage of impervious surface surrounding trees. Generalized linear models and zero-inflated models explored how these factors were related to damage from these borers. The number of borer attacks on trees increased with higher percentage impervious area. As the two most commonly encountered trees, Acer rubrum was found to be significantly more susceptible to attack from borers than Ulmus parvifolia. Unhealthy trees were more likely to experience more frequent and more severe borer attack. Trees with increased impervious cover around them as well as those with differentially warmer daily maximum and minimum temperatures relative to surrounding were more likely to be attacked. [ABSTRACT FROM AUTHOR]