Equivalent Benefits Research Articles

Investigating the Feasibility of a Restaurant Delivery Service to Improve Food Security among College Students Experiencing Marginal Food Security, a Head-to-Head Trial with Grocery Store Gift Cards.

Restaurant delivery services have gained in popularity among college students; however, students participating in the Supplemental Nutrition Assistance Program (SNAP) are not allowed to redeem their benefits via restaurant delivery services. This mixed-methods head-to-head crossover trial assessed whether college students experiencing marginal food security prefer benefits via a grocery store gift card (as a proxy for traditional SNAP benefits) or via a restaurant delivery service gift card of equivalent value, and which type of benefit is more effective at improving food security status. Thirty college students experiencing marginal food security were recruited to receive $80 in cash equivalent benefits to spend over a two-month period in the form of grocery store gift cards and restaurant delivery service gift cards. Participants completed surveys and interviews to measure their food security status and share their experiences with each benefit type. After four months of benefits, 48.3% of participants improved their food security status. However, neither type of benefit was statistically better at improving food security status. Most participants preferred grocery store benefits (89.7%) over restaurant delivery service benefits (10.3%). However, more research is needed to explore whether allowing SNAP recipients to redeem their benefits with restaurant delivery services is a viable mechanism to address food challenges among college students experiencing marginal food security.

Spatial Management to Reduce Entanglement Risk to North Atlantic Right Whales in Fishing Gear: A Case Study of U.S. Northeast Lobster Fishery 2002–2009

Despite the use of gear requirements and access restrictions to manage lobster fishery interactions with north Atlantic right whales since 1997, the population is likely below 370 animals. The Dynamic Area Management (DAM) program (2002–2009) used “real-time” right whale sightings data to provide temporary protection using closures or whale-modified-gear to reduce entanglement. Our ex-post evaluation uses a flexible framework to identify strengths and weaknesses of the program. Biological and economic implications of the program are evaluated using a relative risk of entanglement index (RREI) calculated with spatially and temporally explicit data on density of right whales and fishing effort. An illustrative closure optimization model demonstrates the trade-offs between the non-monetary benefits of risk reduction and the opportunity cost of closures under alternative decision rules (benefit-ranking and cost-effectiveness). Annual aerial sampling to detect DAM areas was low (<3%), yet in some months’ the 17% of area covered by all northeast right whale management areas encompassed up to 70% of the region’s population. Despite their small spatial footprint, dynamic and static measures may have reduced total risk by 6.5% on average, and DAM zones may have created an indirect economic incentive for some fishers to adopt the whale-modified-gear. Similar RREI index values in some months with inverse levels of fishing effort and whale presence highlight the need to consider fishing and whales jointly to reduce risk. These temporal-spatial patterns are critical in policy instrument design. Further, optimization results illustrate how different decision rules can attain equivalent non-monetary benefits of risk reduction at different opportunity costs to industry; the implications of whale-modified-gear and compliance factors are explored. We recommend that DAMs be considered as part of a suite of policy instruments, and highlight how recent technological advances may support lower cost data collection and faster implementation given limited public sector budgets. This case study highlights the need for evaluation of past policy instruments with a lens beyond biological outcomes, and sets the stage for further empirical analysis to better understand harvester responses to management measures designed to protect right whales and the resulting private and public sector trade-offs.

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

Introduction: Prenatal closure of open spina bifida via open fetal surgery improves neurologic outcomes for infants in selected pregnancies. Fetoscopic techniques that are minimally invasive to the uterus aim to provide equivalent fetal benefits while minimizing maternal morbidities, but the optimal technique is undetermined. We describe the development, evolution, and feasibility of the laparotomy-assisted 2-port fetoscopic technique for prenatal closure of fetal spina bifida in a newly established program. Methods: We conducted a retrospective cohort study of women consented for laparotomy-assisted fetoscopic closure of isolated fetal spina bifida. Inclusion and exclusion criteria followed the Management of Myelomeningocele Study (MOMS). Team preparation involved observation at the originating center, protocol development, ancillary staff training, and surgical rehearsal using patient-matched models through simulation prior to program implementation. The primary outcome was the ability to complete the repair fetoscopically. Secondary maternal and fetal outcomes to assess performance of the technique were collected prospectively. Results: Of 57 women screened, 19 (33%) consented for laparotomy-assisted 2-port fetoscopy between February 2017 and December 2019. Fetoscopic closure was completed in 84% (16/19) cases. Over time, the technique was modified from a single- to a multilayer closure. In utero hindbrain herniation improved in 86% (12/14) of undelivered patients at 6 weeks postoperatively. Spontaneous rupture of membranes occurred in 31% (5/16) of fetoscopic cases. For completed cases, median gestational age at birth was 37 (range 27–39.6) weeks and 50% (8/16) of women delivered at term. Vaginal birth was achieved in 56% (9/16) of patients. One newborn had a cerebrospinal fluid leak that required postnatal surgical repair. Conclusion: Implementation of a laparotomy-assisted 2-port fetoscopic spina bifida closure program through rigorous preparation and multispecialty team training may accelerate the learning curve and demonstrates favorable obstetric and perinatal outcomes.

Diminishing potential for tropical reefs to function as coral diversity strongholds under climate change conditions

AbstractAimForecasting the influence of climate change on coral biodiversity and reef functioning is important for informing policy decisions. Dominance shifts, tropicalization and local extinctions are common responses of climate change, but uncertainty surrounds the reliability of predicted coral community transformations. Here, we use species distribution models (SDMs) to assess changes in suitable coral habitat and associated patterns in biodiversity across Western Australia (WA) under present‐day and future climate scenarios (RCP 2.6 and RCP 8.5).LocationCoral reef systems and communities in WA.MethodsWe developed SDMs with model prediction uncertainty analyses, using specimen‐based occurrence records of 188 hermatypic scleractinian coral species and seven variables to estimate present‐day and future changes to coral species distribution and biodiversity patterns in WA under climate change conditions.ResultsWe found that suitable habitat is predicted to increase across all regions in WA under , and scenarios with all tropical and subtropical regions remaining coral biodiversity strongholds. Under the extreme scenario, however, a clear tropicalization trend could be observed with coral species expanding their range to mid‐high latitude regions, while a substantial drop in coral species richness was predicted at low latitude tropical coral reefs, such as the inshore Kimberley and offshore NW reefs. Despite the predicted expansion south, we identified a net decline in coral biodiversity across the WA coastline.Main conclusionsResults from the models predicted higher net coral biodiversity loss at low latitude tropical regions compared with net gains at mid‐high latitude regions under . These results are likely to be representative of latitudinal trends across the Southern Hemisphere and highlight that increases in habitat suitability at higher latitudes may not lead to equivalent biodiversity benefits. Urgent action is needed to limit climate change to prevent spatial erosion of tropical coral communities, extinction events and loss of tropical ecosystem services.

A direct comparison of attentional orienting to spatial and temporal positions in visual working memory

Different visual attributes effectively guide attention to specific items in visual working memory (VWM), ensuring that particularly important memory contents are readily available. Predictable temporal structures contribute to this efficient use of VWM: items are prospectively prioritized when they are expected to be needed. Occasionally, however, visual events only gain relevance through their timing after they have passed. We investigated retrospective attentional orienting based on temporal position by directly comparing it with orienting to spatial locations, which is typically considered the most powerful selection mechanism. In a colour-change-detection task, in which items appeared sequentially at different locations, symbolic number cues validly indicated the temporal or spatial location of the upcoming probe item either before encoding (precues; Experiment 1) or during maintenance (retrocues; Experiments 1–3). Temporal and spatial cues were physically identical and only differed in their mapping onto either temporal or spatial positions. Predictive cues yielded cueing benefits (i.e., higher accuracy and shorter reaction times) as compared with neutral cues, with larger benefits for precues than for retrocues. Importantly, spatial and temporal cueing benefits did not differ. Equivalent retrocueing benefits were also observed across different cue-probe intervals and irrespective of whether spatial or temporal position was used as retrieval cue, indicating that items were directly bound to temporal position and not prioritized via a space-based mechanism. These findings show that spatial and temporal properties can be used equally well to flexibly prioritise representations held in VWM and they highlight the functional similarities of space and time in VWM.

Symmetrical and asymmetrical directional benefits are present for talkers at the front and side

Objective The purpose of the study was to examine the effects of symmetrical and asymmetrical directional microphone settings on speech recognition, localisation and microphone preference in listening conditions with on- and off-axis talkers. Design A within-subjects repeated-measure evaluation of three hearing aid microphone settings (bilateral omnidirectional, bilateral directional, asymmetrical directional) was completed in a moderately reverberant laboratory. An exploratory analysis of the potential relationship between microphone preference and unaided measures was also completed. Study Sample Twenty adult listeners with mild to moderately severe bilateral hearing loss participated. Results The directional and asymmetric microphone settings resulted in equivalent benefits for sentence recognition in noise, word recall, and localisation speed regardless of the speech loudspeaker location (on- or off-axis). However, localisation accuracy was significantly worse with the asymmetric fitting than the directional setting when speech was presented from the rear hemisphere. Listeners who always preferred directional microphones had significantly poorer unaided speech recognition than those who preferred the omnidirectional setting for one or more listening condition. Conclusions Benefits from directional and asymmetric processing were small in the current study, but generally similar to each other. Unaided speech recognition in noise performance may have utility as a clinical predictor of preference for directional processing.

Socioeconomic status, diabetes, and gestation length in Native American and White women.

"Diminishing returns" of socioeconomic status (SES) suggests that higher SES may not confer equivalent health benefits for ethnic minority individuals as compared to White individuals. Little research has tested whether diminishing returns also affects Native Americans. The objective of this study was to determine whether higher SES is associated with lower diabetes risk and longer gestational length in both Native American and White women, and whether SES predicts gestational length indirectly via diabetes risk. A sample of 674,014 Native American and White women was drawn from a population-based California cohort of singleton births (2007-2012). Education, public health insurance status, gestational length, and diabetes diagnosis were extracted from a state-maintained birth cohort database. Covariates were age, health behaviors, pregnancy variables, residence rurality, and prepregnancy body mass index. In logistic regression models, the race by SES interaction (both education and insurance status) was associated with diabetes risk. Compared to high-SES White women, high- and low-SES Native American women had highest and equivalent diabetes risk. In path analyses, the race by SES interaction indirectly predicted gestational length through diabetes, ps < .001. For White women, an indirect effect of diabetes was detected, ps < .001, such that higher SES was associated with reduced risk for diabetes and thus longer gestational length. For Native American women, no indirect effect was detected, ps > .067. Among Native American women, higher SES did not confer protection against diabetes or shorter gestational length. These findings are consistent with the diminishing returns of SES phenomenon. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of Audiovisual Presentations on Visual Localization Errors: One or Several MultisensoryMechanisms?

The present study examines the extent to which temporal and spatial properties of sound modulate visual motion processing in spatial localization tasks. Participants were asked to locate the place at which a moving visual target unexpectedly vanished. Across different tasks, accompanying sounds were factorially varied within subjects as to their onset and offset times and/or positions relative to visual motion. Sound onset had no effect on the localization error. Sound offset was shown to modulate the perceived visual offset location, both for temporal and spatial disparities. This modulation did not conform to attraction toward the timing or location of the sounds but, demonstrably in the case of temporal disparities, to bimodal enhancement instead. Favorable indications to a contextual effect of audiovisual presentations on interspersed visual-only trials were also found. The short sound-leading offset asynchrony had equivalent benefits to audiovisual offset synchrony, suggestive of the involvement of early-level mechanisms, constrained by a temporal window, at these conditions. Yet, we tentatively hypothesize that the whole of the results and how they compare with previous studies requires the contribution of additional mechanisms, including learning-detection of auditory-visual associations and cross-sensory spread of endogenous attention.

Equivalence Curves for Healthy Lifestyle Choices.

Understanding equivalence of time-use trade-offs may inform tailored lifestyle choices. We explored which time reallocations were associated with equivalent changes in children's health outcomes. Participants were from the cross-sectional Child Health CheckPoint Study (N = 1179; 11-12 years; 50% boys) nested within the population-based Longitudinal Study of Australian Children. Outcomes were adiposity (bioelectrical impedance analysis, BMI and waist girth), self-reported health-related quality of life (HRQoL; Pediatric Quality of Life Inventory), and academic achievement (standardized national tests). Participants' 24-hour time use (sleep, sedentary behavior, light physical activity, and moderate-to-vigorous physical activity [MVPA]) from 8-day 24-hour accelerometry was regressed against outcomes by using compositional log-ratio linear regression models. Children with lower adiposity and higher HRQoL had more MVPA (both P ≤ .001) and sleep (P = .001; P < .02), and less sedentary time (both P < .001) and light physical activity (adiposity only; P = .03), each relative to remaining activities. Children with better academic achievement had less light physical activity, relative to remaining activities (P = .003). A 0.1 standardized decrease in adiposity was associated with either 52 minutes more sleep, 56 minutes less sedentary time, 65 minutes less light physical activity, or 17 minutes more MVPA. A 0.1 standardized increase in HRQoL was associated with either 68 minutes more sleep, 54 minutes less sedentary time, or 35 minutes more MVPA. Equivalent differences in outcomes were associated with several time reallocations. On a minute-for-minute basis, MVPA was 2 to 6 times as potent as sleep or sedentary time.

Outcomes of semantic feature analysis treatment for aphasia with and without apraxia of speech.

To date, studies have not explored whether a dual diagnosis of aphasia plus apraxia of speech (AOS) versus aphasia alone (APH) affects the response to language-based naming treatments. To compare the effects of semantic feature analysis (SFA) treatment for individuals with APH versus aphasia plus AOS, and to test if the presence of AOS impacted the effects of treatment. A non-randomized experimental group study was conducted to explore the treatment, generalization and maintenance effects between the AOS and APH groups. Participants included nine individuals with aphasia and 11 with concomitant aphasia and AOS. Dependent measures included lexical accuracy, number of sound-level distortions, and lexical stress and syllable segmentation errors. Both groups showed significantly improved naming accuracy of trained items for up to 2 months post-treatment. Improvement on naming accuracy of untrained items post-treatment, both semantically related and unrelated to trained items, was lower in magnitude. That this may have been due to effects of repeated probing (which included target repetition) or regression to the mean cannot be excluded. There was a tendency for the AOS group to respond slightly better to treatment than the APH group overall, which was not correlated with aphasia severity. Also, measures of phonetic accuracy and fluency improved for both groups, with no main effect of group. Treatment effects did not generalize to formal measures of (untrained) picture naming or expression of correct information units in discourse in a story retelling task. Findings indicate that individuals with aphasia plus AOS can gain equivalent benefits in word retrieval and production from the language-based SFA treatment as individuals with aphasia alone. This may be, in part, due to the tendency for SFA to incorporate principles of practice that are known to support motor learning in AOS, such as high intensity, random stimulus presentation and variable practice. Findings provide further support for high-intensity practice and use of self-generated features to facilitate maintenance of effects. What this paper adds What is already known on the subject SFA treatment is the most common intervention for word-finding difficulties for individuals with aphasia. AOS is a common concomitant disorder to aphasia. However, it is not clear whether the effects of language-based SFA treatment are mitigated by the presence of AOS, which tends to respond well to treatments focused on articulatory-kinematic aspects of speech movement. What this paper adds to the existing knowledge This study compares the effects of SFA in a group of individuals with aphasia alone and a group with similar severity of aphasia but with concomitant AOS, ranging from mild to moderate-severe. Overall, AOS did not have a negative effect on response to the treatment. What are the potential or actual clinical implications of this work? Individuals with aphasia plus AOS can be expected to benefit to a similar degree from SFA as people with aphasia alone. It is likely that the use of practice principles of high intensity, random stimulus presentation and varied practice are important components of the protocol.

Health Impact Attributable to the Control of PM2.5 Pollution in China During 2013-2017

To evaluate the health benefits brought about by air environmental treatment and determine the main drivers of health risk, we calculated the health and economic benefits attributed to PM2.5 control in Eastern and Central China from 2013 to 2017 by combining PM2.5 concentrations with a human activity enhanced exposure-response model. The relative contributions of changes in four factors related to the PM2.5 health burden were also quantified, namely total population, population aging, baseline mortality rates, and ambient exposure. The results show that the population weighted PM2.5 concentration decreased by 28.73% and the proportion of the population exposed to annual PM2.5 concentrations lower than or equal to 35 μg·m-3 increased from 11.23% to 27.91% across the study area during this period. Avoided deaths were decreased to 14.43%, which equates to avoided economic losses of approximately 559 billion RMB. If PM2.5 concentration meets the Chinese Ambient Air Quality Standard Grade Ⅱ (35 μg·m-3) or Grade Ⅰ (15 μg·m-3), or the World Health Organization Air Quality Guidelines (AQG) standards (10 μg·m-3), a 8.22%, 55.05%, and 79.36% reduction in the total deaths could be achieved in the base year (2017) with equivalent total economic benefits of approximately 319, 2137, and 3081 billion RMB, respectively. Total population, population aging, baseline mortality rates, and PM2.5 concentrations contributed -2.69%, -12.38%, 1.66%, and 14.57% to PM2.5-related deaths. Overall, during the study period, the reduction in PM2.5 concentrations has been the main factor contributing to the reduction in the public health burden. China has implemented significant air pollution control measures; however, the health burden associated with high PM2.5 concentrations in densely populated areas is still extremely high, requiring an aggressive air pollution control strategy.

Strategic prioritisation enhances young and older adults' visual feature binding in working memory.

Visual working memory for features and bindings is susceptible to age-related decline. Two experiments were used to examine whether older adults are able to strategically prioritise more valuable information in working memory and whether this could reduce age-related impairments. Younger (18–33 years) and older (60–90 years) adults were presented with coloured shapes and, following a brief delay, asked to recall the feature that had accompanied the probe item. In Experiment 1, participants were either asked to prioritise a more valuable object in the array (serial position 1, 2, or 3) or to treat them all equally. Older adults exhibited worse overall memory performance but were as able as younger adults to prioritise objects. In both groups, this ability was particularly apparent at the middle serial position. Experiment 2 then explored whether younger and older adults’ prioritisation is affected by presentation time. Replicating Experiment 1, older adults were able to prioritise the more valuable object in working memory, showing equivalent benefits and costs as younger adults. However, processing speed, as indexed by presentation time, was shown not to limit strategic prioritisation in either age group. Taken together, these findings demonstrate that, although older adults have poorer visual working memory overall, the ability to strategically direct attention to more valuable items in working memory is preserved across ageing.

Rationale and Design of the Randomized Controlled Trial of New Oral Anticoagulants Versus Warfarin for Post Cardiac Surgery Atrial Fibrillation: The NEW-AF Trial.

This manuscript describes the rationale and design of a randomized, controlled trial comparing outcomes with Warfarin vs Novel Oral Anticoagulant (NOAC) therapy in patients with new onset atrial fibrillation after cardiac surgery. New onset atrial fibrillation commonly occurs after cardiac surgery and is associated with increased rates of stroke and mortality. in nonsurgical patients with atrial fibrillation, NOACs have been shown to confer equivalent benefits for stroke prevention with less bleeding risk and less tedious monitoring requirements compared with Warfarin. However, NOAC use has yet to be adopted widely in cardiac surgery patients. The NEW-AF study has been designed as a pragmatic, prospective, randomized controlled trial that will compare financial, convenience and safety outcomes for patients with new onset atrial fibrillation after cardiac surgery that are treated with NOACs versus Warfarin. Study results may contribute to optimizing the options for stroke prophylaxis in cardiac surgery patients and catalyze more widespread application of NOAC therapy in this patient population. The study is ongoing and actively enrolling at the time of the publication. The trial is registered with clinicaltrials.gov under registration number NCT03702582.

Overview of recent cases before the Court of Justice of the European Union (October 2019-January 2020)

During the period of reporting (1 October 2019-31 January 2020), six judgments are worth noting in the area of EU social security law. In Safeway, the Court had to decide whether Article 119 of the EC Treaty on equal treatment precluded a measure ending discrimination through the fixing, with retroactive effect, of a uniform normal pension age equal to that of the members within the previously disadvantaged category. In Bocero Torrico, the question related to the obligation on Member States, under Regulation 883/2004, to take into account equivalent benefits acquired in other Member States for the purpose of calculating an early retirement pension. WA concerned a discriminatory law that granted a pension supplement solely to women. UB was about a discriminatory law that granted additional benefits for sportspersons based on their citizenship. In ZP, the question concerned Article 62 of Regulation 883/2004 dealing with the calculation of unemployment benefits. Finally, in Pensions-Sicherungs-Verein, the Court had to interpret Article 8 of Directive 2008/94 in the context of a reduction of pension benefits following the insolvency of the employer.

Eosinophils in chronic obstructive pulmonary disease: are they just another biomarker?

Interest in blood eosinophils as a biomarker of responsiveness to therapy in chronic obstructive pulmonary disease (COPD) continues to grow, with recommendations regarding their adjunctive use incorporated into the GOLD 2019 treatment algorithm. The present review summarizes some key recent papers referencing differential treatment effects based on blood eosinophil counts. Post-hoc analyses of trials of inhaled corticosteroids in COPD have shown greater treatment responses in patients with higher blood eosinophil levels, with some exceptions. Eosinophil-directed treatment with oral corticosteroids showed equivalent benefits to noneosinophil-directed therapy, with reduced corticosteroid exposure. Prespecified analyses of recent prospective trials of therapies incorporating inhaled corticosteroids were generally supportive of previous findings, so evidence for the use of blood eosinophils as biomarkers is gathering. Nonetheless, the anti-interleukin (IL)-5 receptor antagonist benralizumab, which depletes blood eosinophils, showed no treatment benefit in patients with COPD selected for eosinophilic phenotype and treatment of COPD with the IL-5 antagonist, mepolizumab showed inconsistent results. The 2019 GOLD COPD Strategy document embraced the use of the blood eosinophil to guide ICS therapy in management of patients with stable COPD and frequent exacerbations. Although post-hoc and several prospective studies with prespecified subgroup analyses have supported this approach, questions still remain about how to incorporate this new assessment tool into real-life management of COPD and more research is required to validate its adoption into clinical practice. There is an absence of data to support the use of biologic therapy in patients with an eosinophilic COPD phenotype at this stage.

Using Cluster Analysis to Explore Engagement and e-Attainment as Emergent Behavior in Electronic Mental Health.

BackgroundIn most e-mental health (eMH) research to date, adherence is defined according to a trial protocol. However, adherence to a study protocol may not completely capture a key aspect of why participants engage with eMH tools, namely, to achieve personal mental health goals. As a consequence, trial attrition reported as non-adherence or dropout may reflect e-attainment, the discontinuation of eMH engagement after personal goals have been met. Clarifying engagement patterns, such as e-attainment, and how these align with mental health trajectories, may help optimize eMH design and implementation science.ObjectiveThis study aimed to use clustering techniques to identify real-world engagement profiles in a community of eMH users and examine if such engagement profiles are associated with different mental health outcomes. The novelty of this approach was our attempt to identify actual user engagement behaviors, as opposed to employing engagement benchmarks derived from a trial protocol. The potential of this approach is to link naturalistic behaviors to beneficial mental health outcomes, which would be especially informative when designing eMH programs for the general public.MethodsBetween May 2013 and June 2018, Australian adults (N=43,631) signed up to myCompass, a self-guided eMH program designed to help alleviate mild to moderate symptoms of depression, anxiety, and stress. Recorded usage data included number of logins, frequency of mood tracking, number of started and completed learning activities, and number of tracking reminders set. A subset of users (n=168) completed optional self-assessment mental health questionnaires (Patient Health Questionnaire-9 item, PHQ-9; Generalized Anxiety Disorder Questionnaire-7 item, GAD-7) at registration and at 28 and 56 days after sign-up. Another subset of users (n=861) completed the PHQ-9 and GAD-7 at registration and at 28 days.ResultsTwo-step cluster analyses revealed 3 distinct usage patterns across both subsamples: moderates, trackers, and super users, signifying differences both in the frequency of use as well as differences in preferences for program functionalities. For both subsamples, repeated measures analysis of variances showed significant decreases over time in PHQ-9 and GAD-7 scores. Time-by-cluster interactions, however, did not yield statistical significance in both subsamples, indicating that clusters did not predict symptom reduction over time. Interestingly, users who completed the self-assessment questionnaires twice had slightly but significantly lower depression and anxiety levels at sign-up compared with users who completed the questionnaires a third time at 56 days.ConclusionsFindings suggested that although users engaged with myCompass in different but measurable ways, those different usage patterns evoked equivalent mental health benefits. Furthermore, the randomized controlled trial paradigm may unintentionally limit the scope of eMH engagement research by mislabeling early mental health goal achievers as dropouts. More detailed and naturalistic approaches to study engagement with eMH technologies may improve program design and, ultimately, program effectiveness.

Can management of ‘thirsty’ alien trees improve water security in semi-arid India?

Arid and semi-arid regions of central India receive scarce and episodic precipitation during the short monsoon season, and also experience substantial evaporation. Traditional and innovative water harvesting and governance practices improve water stewardship, or abate some impacts of intensive mechanised water extraction. However, significant numbers of alien trees, in particular Eucalyptus species with high water demands, populate some regions practicing progressive water stewardship. The water demands of these trees can potentially undermine efforts to achieve water security. Through interviews with community leaders in Indian villages with differing eucalyptus tree densities, water loss through evapotranspiration compared with livelihood demands was approximated. Literature review of the water demands and ecosystem services provided respectively by alien eucalypts and native, culturally valued neem trees supports assessment of the likely benefits and acceptability of a replacement programme favouring native trees. Although data limitations mean that the findings of this study are necessarily uncertain, they nonetheless illustrate the likely scale of impact, substantiating the case for alien tree management as an important contribution to water security. Alien vegetation management practices as a contribution to water security are already firmly established in South Africa, and are likely to yield equivalent benefits if translated to dryland India.

Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants

Umbilical cord milking as an alternative to delayed umbilical cord clamping may provide equivalent benefits to preterm infants, but without delaying resuscitation. To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping. Noninferiority randomized clinical trial of preterm infants (born at 23-31 weeks' gestation) from 9 university and private medical centers in 4 countries were recruited and enrolled between June 2017 and September 2018. Planned enrollment was 750 per group. However, a safety signal comprising an imbalance in the number of severe intraventricular hemorrhage events by study group was observed at the first interim analysis; enrollment was stopped based on recommendations from the data and safety monitoring board. The planned noninferiority analysis could not be conducted and a post hoc comparison was performed instead. Final date of follow-up was December 2018. Participants were randomized to umbilical cord milking (n = 236) or delayed umbilical cord clamping (n = 238). The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin. Among 540 infants randomized, 474 (88%) were enrolled and completed the trial (mean gestational age of 28 weeks; 46% female). Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4% [95% CI, -2% to 9%]; P = .16). Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5% [95% CI, 1% to 9%]; P = .02). The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only (P = .003); among infants born at 23 to 27 weeks' gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16% [95% CI, 6% to 26%]; P = .002). In this post hoc analysis of a prematurely terminated randomized clinical trial of umbilical cord milking vs delayed umbilical cord clamping among preterm infants born at less than 32 weeks' gestation, there was no statistically significant difference in the rate of a composite outcome of death or severe intraventricular hemorrhage, but there was a statistically significantly higher rate of severe intraventricular hemorrhage in the umbilical cord milking group. The early study termination and resulting post hoc nature of the analyses preclude definitive conclusions. ClinicalTrials.gov Identifier: NCT03019367.

Successful patient-oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer - a systematic review.

Minimally invasive surgical approaches for cancer of the right colon have been well described with significant patient and equivalent oncological benefits. Robotic surgery has advanced in its ability to provide multi-quadrant abdominal access, leading the surgical community to widen its application outside of the pelvis to other abdominal compartments. Globally it is being realized that a patient's surgical episode of care is becoming the epicentre of cancer treatment. In order to establish the role of robotic surgery in a patient's episode of care, 'successful patient-oriented surgical' parameters in right hemicolectomy for malignancy were measured. The objective was to examine the rates of successful patient-oriented surgical outcomes in robotic right hemicolectomy (RRH) compared to laparoscopic right hemicolectomy (LRH) for cancer. A systematic search of MEDLINE (Ovid: 1946-present), PubMed (NCBI), Embase (Ovid: 1966-present) and Cochrane Library was conducted using PRISMA for parameters of successful patient-oriented surgical outcomes in RRH and LRH for malignancy alone. The parameters measured included postoperative ileus, anastomotic complication, surgical wound infection, length of stay (LOS), incisional hernia rate, conversion to open, margin status, lymph node harvest and overall morbidity and mortality. There were 15 studies which included 831 RRH patients and 3241 LRH patients, with a median age of 62-74years. No study analysed the concept of successful patient-oriented surgical outcomes. There was no significant difference in the incidence of postoperative ileus, with less time to first flatus in RRH (2.0-2.7days, compared with 2.5-4.0days, P<0.05). Anastomotic leak rate in one study reported a significant increase in LRH compared to RRH (P<0.05, 0% vs 8.3%). Significantly decreased LOS following RRH was outlined in six studies. One study reported a significantly higher rate of incisional hernias following LRH with extracorporeal anastomoses compared to RRH with intracorporeal anastomoses. Overall rates of conversion to open surgery were less with RRH (0%-3.9% vs 0%-18%, P<0.001, 0.05). One study outlined significantly higher rates of incomplete resection with an open right hemicolectomy compared with minimally invasive laparoscopic and robotic resections, with positive margin rates of 2.3%, 0.9% and 0% respectively (P<0.001). Two studies reported significantly higher lymph node harvest in RRH (P<0.05). Overall morbidity and 30-day mortality were comparable in both approaches. Thirty-day morbidity and mortality were comparable between the two approaches, with patients undergoing RRH having lower anastomotic complications, increased lymph node harvest, and reduced LOS, conversion to open and incisional hernia rates in a number of studies. There are limited data on surgical approach and impact on quality of life and what patients deem successful surgical outcomes. There is a further need for a randomized controlled trial examining successful patient-oriented outcomes in right hemicolectomy for malignancy.

Oral antibody to interleukin-10 receptor 2, but not interleukin-10 receptor 1, as an effective Eimeria species immunotherapy in broiler chickens.

Coccidiosis is a major gastrointestinal disease caused by several Eimeria species in floor raised chickens. Feeding an antibody to interleukin 10 (aIL-10) ameliorates the negative symptoms of coccidiosis in broilers, i.e., lack of weight gain, decreased feed conversion, and mortality. IL-10 signals by forming a ligand-receptor complex with IL-10 Receptor 1 (IL-10 R1) and IL-10 Receptor 2 (IL-10 R2). In this study, we hypothesize oral antibodies to the IL-10 receptors will neutralize the IL-10 signaling pathway equal to or better than aIL-10 to act as an oral anti-coccidiosis immunotherapy. A total of 5 sequential feed trials, set up as a 4 (diet antibody) × 2 (Eimeria challenge) factorial design, tested oral egg yolk antibodies to a total of 6 IL-10 R1 epitopes and 3 IL-10 R2 epitopes compared to a control antibody diet. A total of 10 pens of 5 chicks/pen/diet antibody/Eimeria challenge were housed for 21 d. On day 3 of age, chicks were either infected or not infected with a 10× dose of an Eimeria vaccine containing Eimeria acervulina, Eimeria tenella, and Eimeria maxima. Pen feed consumption and mean body weights were assessed weekly (d1, d7, d14, and d21); fecal oocyst shedding was assessed on day 10. Data were analyzed using a 2-way ANOVA. No significant interaction on chick weight was observed in chicks fed IL-10 R1 antibodies compared to chicks fed the control antibody was observed. In studies evaluating aIL-10 R2 oral antibodies, infected chicks fed aIL-10 R2: epitope 1 overcame the negative effects of Eimeria infection and had similar 21-d body weight to uninfected chicks (P4 = 0.07). We hypothesized that feeding oral antibodies to the IL-10 receptors would result in equivalent anti-coccidial benefits to aIL-10. However, none of the 6 antibodies to IL-10 R1 epitopes yielded any benefits during Eimeria infection compared to controls. A total of 2 oral antibodies to IL-10 R2 showed promising results equivalent to the aIL-10 immunotherapeutic. Immunofluorescence staining shows that the IL-10R2 significantly increases in abundance in response to Eimeria infection, whereas IL-10R1 does not.