Pediatric Gartland type III-IV extension-type supracondylar humeral fractures are associated with a risk of iatrogenic ulnar nerve injury during medial percutaneous pin insertion. The optimal technique for medial pin placement during crossed pin fixation remains debated. A retrospective case-control study was conducted involving 80 pediatric patients treated between September 2020 and September 2025. All patients had isolated closed extension-type Gartland III-IV supracondylar humeral fractures treated with two lateral and one medial crossed K-wires, with a minimum follow-up of 6 months. Patients were divided into the K-Hammer group, in which medial pinning was performed using a non-rotational K-Hammer-assisted technique with the elbow in 30°-60° extension, and the Freehand group, in which medial pinning was performed using conventional low-speed drilling with the elbow flexed at 90°. The primary outcome was symptomatic iatrogenic ulnar nerve injury within 2 weeks postoperatively. Secondary outcomes included medial pin attempts, operative time, radiographic alignment, elbow range of motion, Flynn functional grade, and postoperative complications. The K-Hammer group had significantly fewer medial pin attempts [1.0 (IQR: 1.0-1.0) vs. 2.0 (IQR: 1.0-2.0), P < 0.001] and shorter operative time (32.8 ± 6.9 vs. 37.9 ± 9.2 min, P = 0.006). Intraoperative pink pulseless hand rates were comparable (10.5% vs. 4.8%, P = 0.416), and all patients recovered radial pulse postoperatively. Iatrogenic ulnar nerve injury occurred in 0% (0/38) of the K-Hammer group vs. 11.9% (5/42) of the Freehand group (P = 0.056), corresponding to an exploratory absolute risk reduction (ARR) of 11.9% and a number needed to treat (NNT) of approximately 8.4. No secondary displacement or reoperation occurred in either group. Pinsite infection and myositis ossificans rates were low and similar. At a median follow-up of 7.5 months (IQR: 6.2-11.8; range: 6-36 months), radiographic and functional were comparable between groups. The K-Hammer technique improves operative efficiency, reduces pin insertion attempts, and demonstrates a favorable trend toward reduction in iatrogenic ulnar nerve injury risk (ARR 11.9%, NNT = 8.4), without compromising radiographic or functional outcomes. Although statistical significance was not reached (P = 0.056), likely due to limited sample size, these findings suggest it is a potential technical option for medial pin placement in severe pediatric supracondylar humeral fractures, warranting confirmation in larger prospective studies.
Postoperative cerebrospinal fluid (CSF) leakage remains one of the most challenging complications of transsphenoidal surgery (TSS). Numerous reconstruction techniques have been proposed, but none has been established as the gold standard. To address this issue, we standardized rigid sellar floor reconstruction using a hard buttress, based on the concept of counteracting the water-hammer effect of pulsatile CSF pressure. We retrospectively analyzed 1,168 consecutive TSS procedures for sellar lesions performed by a single surgeon between October 2004 and March 2024. Routine rigid reconstruction was implemented from January 2009 (Group B, n = 856) and compared with an earlier cohort without routine buttressing (Group A, n = 312). Reconstruction materials included autologous bone grafts, calcium phosphate cement, titanium mesh, and resorbable plates. Rigid reconstruction was performed in 885 cases, most commonly with autologous bone (n = 781), which proved most reliable. Calcium phosphate cement occasionally caused inflammatory change or graft dislodgement, and titanium mesh complicated reoperations. Postoperative CSF leakage requiring reoperation was significantly reduced from 2.88% in Group A to 0.47% in Group B (P = 0.002), despite a higher intraoperative leak rate in Group B (76.5% vs. 54.2%, P < 0.0001), particularly grade 3 leaks (30.4% vs. 11.2%, P < 0.0001). All postoperative leaks in Group B were attributable to inadequate buttressing. Rigid sellar floor reconstruction is a fundamental strategy-together with dural suturing and vascularized mucosal flaps-for safer and more extensive resections in modern TSS, supported by a physiological rationale based on the water-hammer effect.
Immunotherapy for pancreatic cancer remains a formidable challenge due to the highly immunosuppressive tumor microenvironment (TME), characterized by dense stromal barriers and acidic niches that collectively restrict drug delivery and antitumor immunity. Here, we propose an "Alkaline-Hammer" strategy that combines pH modulation with alkaliptosis induction to overcome these obstacles. We engineered alkalizing sodium bicarbonate nanoparticles (JTC801-NaHCO3@TPGS NPs) using a thin-film hydration method. Upon delivery, these nanoparticles neutralize the acidic TME through sustained NaHCO3 release, while JTC801, a selective opioid receptor-like 1 (ORL1) antagonist, activates the NF-κB pathway to downregulate carbonic anhydrase IX (CA9). This dual action synergistically enhances intracellular alkalinization and induces alkaliptosis. Furthermore, we developed a laparoscopic intratumoral injection system to achieve precise delivery of JTC801-NaHCO3@TPGS NPs in orthotopic pancreatic tumor models. This strategy increased CD8+ T cells infiltration, reduced immunosuppressive populations (Tregs, MDSCs, and M2 macrophages), and elicited immunological memory, thereby converting immunologically "cold" tumors into "hot" ones without evident systemic toxicity. These findings underscore the potential of localized alkaliptosis induction as a promising immunotherapeutic approach for pancreatic cancer.
Hypothenar hammer syndrome (HHS) is characterized by ischemic symptoms of the hand related to a stenotic or occluded ulnar artery. The disease is considered rare, although there is evidence of underdiagnosis. Digital subtraction angiography (DSA) is the primary diagnostic tool, although staging is typically based on the Kaji classification, which captures most abnormalities, though some may be overlooked. This study proposes an all-encompassing angiographic classification system for HHS. In this multicenter retrospective case series, electronic medical records were searched for patients with HHS based on vascular abnormalities and clinical symptoms in three hospitals. Among all HHS cases, clinical symptoms and DSAs were collected and classified using the Kaji classification system. This system only encompasses the pathology of the ulnar artery. We propose to augment the system with aneurysmatic deformation and radial artery disease. A total of 80 patients with 91 affected hands were included. Most cases had stenotic and occlusive deformities, whereas 7 cases had an aneurysm in the ulnar artery. Three cases had concomitant occlusion of the radial artery. Overall, no significant associations were found between the type of stenosis and most prevalent symptoms, except for numbness (p = 0.009). A non-significant trend was observed of a higher prevalence of severe symptoms, such as necrosis, in patients with HHS with concomitant radial artery occlusion. Expanding the Kaji classification with aneurysmatic deformation and concomitant radial artery disease offers a more accurate and comprehensive classification system for HHS.
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Erosion and fracture caused by repeated water-droplet impacts are often attributed to splash-mediated material removal, high-pressure impulsive loading, or cavitation. Yet, the mechanical response during the earliest instant of impact remains difficult to capture. Using a high-temporal-resolution polyvinylidene fluoride (PVDF) piezoelectric sensor combined with high-speed imaging, we directly measure substrate-coupled mechanical transients during a single water-droplet impact. A strong impulsive strain response appears within the first 2 ms after contact, followed by coherent 100-500 Hz oscillations at the water-solid interface during the first 20 ms, before any rebound occurs. The oscillation frequency is modulated by an effective interfacial stiffness, whereas the impulsive peak-to-peak response scales with droplet size and impact velocity. The experimentally captured signals provide direct experimental evidence of ultrafast substrate-coupled mechanical transients during droplet impact and establish a minimal inertial-capillary framework for understanding mechanical signatures that may contribute to low- to moderate-speed droplet-induced erosion and fatigue.
This study aimed to assess the evaluation accuracy of an artificial intelligence (AI) algorithm using the hammering sound to assess initial press-fit fixation in cementless total hip arthroplasty (THA). The acoustic features of the hammering sounds during a press-fit cup fixation were recorded and analysed. 81 hips of 79 patients undergoing primary THA using the Trident HA acetabular system (Stryker, Kalamazoo, MI, USA) for treatment of osteoarthritis and osteonecrosis of the femoral head were included. After the fast Fourier transform analysis was performed on the hammering sound, 24 sound pressure (SP) features across 23 frequency bands were extracted and applied to binary classification. Support vector machine algorithms were used to classify the data using 2 models: Model A - SP only; Model B - SP + patient characteristics. Among the 81 hips in 79 patients, the hammering sound of 348 impacts of 70 successful press-fit of 1st attempts in 70 hips and 80 impacts of 16 failed attempts in 11hips were analysed. The area under the curve for the test data was 0.9554 in Model A and 1.0 in Model B. The accuracy (accuracy/sensitivity/specificity/positive predictive value/negative predictive value) of each model in the test data was as follows: Model A, 0.849/1.000/0.188/0.843/1.000 and Model B, 0.965/1.000/0.813/0.959/1.000. The accuracy of an AI algorithm using hammering sounds to judge the success of initial press-fit fixation in cementless cup in THA was relatively high. Our results imply the possibility of a practical application for such a system to assist surgeons during the procedure.
Radiofrequency-powered and inductively coupled semi-implanted pacemakers offered an early alternative to battery-powered implantable pulse generators by transferring energy across intact skin to a small, implanted receiver. This review summarizes key clinical and engineering developments from the first reported radiofrequency-powered pacing in 1959 through subsequent refinements and commercial implementations, including the Cutler-Hammer and Cordis Transicor RF systems, and it places these efforts alongside the Abrams/Lightwood inductively coupled device commercialized by Joseph Lucas Ltd. These systems reduced implanted size and allowed external servicing, but they imposed major human factors and safety constraints because pacing depended on correct placement and continuous operation of external hardware. As implantable-grade batteries, hermetic packaging, and lead technology improved, fully implantable pacemakers became clinically dominant. The historical experience nonetheless established durable principles of transcutaneous energy transfer that continue to inform modern externally powered implantable therapies where brief interruptions are clinically tolerable.
Foot alterations have been identified in the literature as a significant risk factor for falls in older adults. However, the contribution of specific types of alterations, such as digital deformities and skin alterations, has not been studied in detail. These findings highlight the importance of improving understanding of podiatric factors that contribute to fall risk. This study aimed to identify which podiatric alterations, such as hyperkeratosis, corns, reduced plantar fat pad, onychomycosis, heel xerosis, and digital deformities, including hallux valgus (HAV), claw toes, supraductus toes, infraductus toes, hammer toes, and quintus varus, are most predictive of fall risk in older adults, both with and without diabetes mellitus. An analytical, cross-sectional, retrospective study was conducted on 85 individuals over 60 years of age. Foot deformities and dermatological alterations were recorded, and fall risk was assessed using the Tinetti balance and gait scale. Statistical analyses included bivariate tests and binary logistic regression to identify predictors of fall risk. The mean age of participants was 71 years; 66% were women, and 46% had type 2 diabetes mellitus. Overall, 66% of participants had a moderate-to-high risk of falling, and a significant association was observed between fall risk and the presence of diabetes (p = 0.048). Logistic regression analysis revealed that reduced plantar fat pad (p = 0.007) and heel xerosis (p = 0.038) were significantly associated with fall risk, irrespective of the presence of diabetes. Podiatric alterations, particularly reduced plantar fat pad and heel xerosis, are strong predictors of fall risk in older adults, irrespective of the presence of diabetes. Foot health assessment should be considered a core component of multidisciplinary fall prevention programmes, reinforcing the crucial role of podiatrists in geriatric care to reduce fall risk.
Disturbance events and subsequent management practices significantly shape the ecological legacies of affected sites. This study evaluated the impacts of a 2022 derecho and the subsequent forest management on forest structure and arthropod diversity by comparing affected forests at Fogwell Forest Nature Preserve and Fox Island County Park with control forests at Blue Cast Springs and Hammer Wald Nature Preserves. Arthropod communities were sampled using pitfall traps, while forest structure was assessed through detailed surveys of understory, midstory, and overstory vegetation. Results indicated a decrease in overall arthropod diversity across all sites since 2016, variably attributed to forest maturation, climatic variability, and the 2022 disturbance, with some taxa showing declines, such as Formicidae and Curculionidae. Fogwell exhibited a significant decline in arthropod diversity, likely linked to the derecho, while Fox Island's diversity aligned more closely with undisturbed control sites. Notable midstory reductions were observed across sites over time, especially at Fox Island, due to harvest and storm impacts. Meanwhile, overstory diversity varied between properties. Regression modeling revealed that forest management practices at Fox Island may have mitigated the disturbance's effects, aiding arthropod recovery. All in all, these findings highlight the importance of forest management strategies in influencing biodiversity and ecological recovery post-disturbance.
Hydraulic transients in drag-based in-pipe turbines during sudden operational changes can induce pressure pulsations, water hammer, cavitation, and column separation in pipeline components located both upstream and downstream of the turbine. Additionally, the torque imposed on turbine blades is a critical concern, as frequent operational changes can accelerate blade fatigue and potentially lead to structural failure. This study integrates the Method of Characteristics (MOC) and Computational Fluid Dynamics (CFD) to model transient phenomena resulting from the abrupt stoppage of a hydrodynamic in-pipe turbine. The analysis evaluates how varying deceleration rates influence pressure surges, pressure pulsations, and torque amplification on blades across different blade counts. The results demonstrate that stoppage time significantly affects torque escalation and confirm that turbine blade count strongly influences the magnitude of pressure surges during transient events. Detailed scenario analyses further reveal that specific configurations exhibit greater susceptibility to extreme pressure fluctuations, thereby creating substantial operational and reliability challenges.
The application of shear thickening electrolytes (STEs) in batteries is hindered by the conventional trade-off, in which enhanced impact resistance comes at the cost of reduced ionic conductivity. Here, we overcome this barrier by introducing lithium sulfonate-functionalized mesoporous silica (M-SiO2-SO3Li) as a multifunctional filler. Unlike conventional fillers that impede ion transport, M-SiO2-SO3Li simultaneously induces shear thickening and enhances conductivity. At 15 wt.% loading, the electrolyte achieves a remarkable ionic conductivity of 10.73 mS cm-1, higher than that of filler-free traditional electrolytes (TE), by anchoring anions via the -SO3Li groups to increase the Li+ transference number. This synergy enables exceptional battery performance: Li||LFP cells demonstrate 97.0% capacity retention after 500 cycles, and LFP||Gr pouch full cells maintain 83.8% capacity after 200 cycles at 0.5 C. In impact tests, the robustness of this design is evident as the M-SiO2-SO3Li-based pouch cell withstands hammer drops that cause immediate failure in standard TE cells. Thus, this design strategy overcomes the performance trade-off, integrating high conductivity, long cycling life, and impact resistance, and provides a pathway for application across the liquid-based electrolyte family.
High-performance fiber materials, poly(p-phenylene-benzimidazole-terephthalamide) (PBIA) fibers, exhibit exceptional mechanical properties, and they are finding critical use in aerospace, ballistic protection, and other civilian areas. However, the insufficient orientation and weak lateral interactions of PBIA polymer chains limit their impact-resistant applications. In this work, we report a strategy that significantly enhances the dynamic mechanical properties of heterocyclic aramid fibers via in situ polymerization of graphene oxide (GO) and wet spinning, achieving an ultrahigh dynamic strength of 10.63 GPa, which exceeds that of PBIA fibers by 47.23%. To simultaneously enhance the strength and toughness of PBIA, an ether-group component was polymerized with GO, the dynamic toughness can reach 277.25 MJ m-3, which is 85.3% higher than that of PBIA fibers. The dynamic performance is attributed to improvements in contact area and interfacial energy. In laser-induced microparticle impact tests, the composite fiber exhibits a markedly higher specific energy dissipation power than other high-performance fibers. Importantly, large-scale and flexible fabrics were woven and exhibit superior impact resistance, highlighting the practical potential of these fibers, which showed a 40.46% higher load than PBIA fabrics in drop-hammer impact tests. This study presents a straightforward yet effective approach to enhancing the dynamic strength and toughness of PBIA fibers.
In our daily lives we encounter a myriad of things with which we interact when navigating our environment. Mental representations of these things are computed and stored in our brains to be manipulated in support of cognition. Several proposals have been put forth on how such representations are organized in the brain - and specifically within ventral temporal cortex (VTC), which is thought to support object recognition. Some propose that the organization of mental representations tracks the animacy status of target stimuli in a continuous way: high-animacy stimuli (e.g., chimps) are represented farther from artifacts (e.g., hammers) than low-animacy stimuli (e.g., lobsters). Others emphasize the role of different dimensions in the organization of mental representations, including real-object size, shape, texture and material properties, and graspability. Here we used functional magnetic resonance imaging (fMRI) and multivariate approaches to test the role of these dimensions as organizing principles of object information in VTC. We show that pattern discriminability between different categories of objects does not seem to follow differences in animacy status in any continuous way. Moreover, graspability and haptic texture properties are better predictors of representational content within VTC than animacy and real-object size. Our results align with evidence that object processing depends on bidirectional functional coupling between parietal regions involved in manipulation and grasping and VTC regions involved in material/texture processing. This supports a multidimensional account of object representations in VTC, where action-relevant and haptic/material properties contribute strongly to representational structure, potentially through interactions with distal regions involved in object-directed action.
One in four older adults report experiencing current anxiety or depression, yet fewer than 20% access formal mental health care services. To better understand this treatment gap, the present study investigated the influence of sociocultural factors (e.g., close others stigma, self-stigma, internalized ageism, emotional control, self-reliance, provider cultural humility, logistical barriers, psychological distress, social support) on professional mental health help-seeking intention among older adults (age ≥ 55) in the United States, using the Integrated Behavioral Model of Mental Health Help-Seeking. Structural equation modeling was used to determine which of these sociocultural factors demonstrated an independent indirect effect on intention, as well as the Integrated Behavioral Model of Mental Health Help-Seeking mechanisms (attitude, perceived norm, personal agency) that mediate these indirect effects. Self-stigma of seeking help, perceived provider cultural humility, and psychological distress demonstrated the clearest connection with intention via the mediators of attitude and/or perceived norm. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Sleep disturbance is a well-established risk factor for suicide, though few studies to date have examined whether sleep disturbance contributes to suicide risk among individuals at clinical high risk for psychosis (CHR). The current study addressed this gap in the literature. We hypothesized that sleep disturbance would have a unique relationship with suicidal ideation/attempts when accounting for other variables in the model. We also hypothesized that the interaction between sleep disturbance/attenuated positive symptoms and sleep disturbance/stress would be related to suicidal ideation/attempts in CHR. The current study used data generated by the Accelerating Medicines Partnership® Schizophrenia Observational Study. The total sample included 1,048 participants (827 CHR and 221 community controls). Participants completed measures of suicidal ideation/attempts, attenuated positive symptoms, depressive symptoms, perceived stress, and sleep disturbance. Results supported a relationship between sleep disturbance and suicidal ideation/attempts in CHR, with participants who had lifetime ideation and attempts experiencing more sleep disturbance than those with no ideation or attempts. We also found small, but significant positive correlations between sleep disturbance and suicide risk in CHR. When accounting for other variables in the model, the effect of sleep disturbance remained significant for past month ideation, but not lifetime ideation or attempts. Both interaction models were non-significant. Our findings highlight the potential value of sleep measures in early identification and treatment of suicide risk in CHR. Further research in this area is warranted.
The Indiana University Brain Health Program was developed to support safe implementation of amyloid-targeting therapies (ATTs) for early Alzheimer's disease (AD). We established Neurology Brain Health Navigators (neuroBHNs) to extend our Brain Health Navigator model into specialty care. NeuroBHNs pre-screen patients for ATT eligibility, coordinate biomarker and imaging evaluation, provide structured education, and guide treatment initiation and monitoring. The program includes a dedicated social worker and insurance pre-authorization specialist to streamline infusion access. Blood pressure is monitored at each visit, and infusions are deferred if readings exceed 140/90 mmHg. Through December 16, 2025, 243 patients initiated lecanemab therapy. Apolipoprotein E (APOE) ε4 homozygotes were not excluded; 74% of treated patients carried at least one Apoε4 allele. The ARIA rate was 13.2%, and 40% of patients experienced infusion-related reactions. A navigator-centered model can efficiently deliver ATT while supporting structured education, screening, and safety monitoring, potentially contributing to favorable safety outcomes.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(4):25f04175. Author affiliations are listed at the end of this article.
The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved. This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer. This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023. Hierarchical multilevel logistic regression models quantified associations between the urgency of surgery (elective versus emergency) and surgical quality, measured by margin-positive resection, adjusting for patient, disease, and health system factors. Bootstrap multivariable simulations evaluated effect modification by country income level, cancer stage, and location. Of the 45 699 patients registered, 13 101 across 95 countries were included in this analysis. Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001). In adjusted multilevel models, emergency surgery was associated with increased odds of margin-positive resections (adjusted odds ratio 2.45, 95% confidence interval (c.i.) 1.86 to 3.22), consistent across all country income groups and robust to alternative health system indicators. Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i. 10.2 to 15.7) in high-income countries, 19.0% (95% c.i. 13.6 to 23.9) in upper middle-income countries, and 14.1% (95% c.i. 10.9 to 16.5) in lower middle- and low-income countries. Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality. Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice. These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage. For patients presenting as an emergency with potentially curative resection, enhanced decision-making around resectability, ensuring specialist surgeon availability, and developing bridge-to-surgery pathways represent immediate, low-cost strategies to improve global cancer outcomes.
Nutrition insecurity is a major driver of poor cardiovascular health in Indigenous communities. Medically tailored meals that reclaim traditional foods may improve heart failure outcomes and quality of life. Community-based participatory methods were used to design Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure (MUTTON-HF), a culturally and medically tailored meal program incorporating traditional Navajo foods and recipes. To determine the efficacy of a culturally and medically tailored meal program on the incidence of hospitalizations and emergency department visits. This pragmatic, open-label randomized clinical trial was conducted from May to November 2025 at 2 Indian Health Service sites in rural Navajo Nation. Eligible patients were adults with heart failure who were receiving care at the study sites and had a hospitalization or emergency department visit during the last 12 months. All patients were followed for 12 weeks for outcomes, death, and adverse events. The data were analyzed from December 2025 to February 2026. Patients were randomized in a 1:1 ratio to 8 weeks of a culturally and medically tailored meal program or usual dietary advice. The primary end point was the proportion of patients with an all-cause hospitalization or emergency department visit within 90 days. Secondary outcomes included hospitalizations or emergency department visits separately, and for heart failure specifically, and change in Kansas City Cardiomyopathy Questionnaire scores, food insecurity, financial strain, blood pressure, and weight from enrollment to 8 weeks. A total of 206 patients (mean [SD] age, 65.8 [14.2] years; 87 female individuals [42%] and 119 male individuals [58%]; 203 American Indian individuals [99%], 2 American Indian or Alaskan Native and White individuals [0.97%], and 1 White individual [0.03%]; ejection fraction, 48%) were randomized. The primary outcome was significantly less frequent in the intervention arm (43 [40.6%] vs 57 [57.0%]; relative risk, 0.72; 95% CI, 0.54-0.96; P = .02), which was driven mainly by reduced hospitalizations (13 [12.3%] vs 26 [26.0%]). There was a lower incidence of heart failure hospitalizations specifically (4 [3.8%] vs 13 [13.0%]). The Kansas City Cardiomyopathy Questionnaire score and food security measures had significantly greater increases in the intervention arm while measures of financial strain, weight, and blood pressure significantly decreased in the intervention arm. Adverse events were uncommon. In this randomized clinical trial, an Indigenous Food is Medicine intervention reduced the incidence of hospitalization and emergency department visits among patients with heart failure. Community-based interventions that leverage protective assets of Native communities are needed to advance Indigenous health. ClinicalTrials.gov Identifier: NCT06549699.