Local Practices Research Articles

Stakeholder communication framework for successful implementation of community-based renewable energy projects

The implementation of community-based renewable energy projects demands effective stakeholder communication to ensure project sustainability, community acceptance, and overall success. This review proposes a strategic framework for communicating with diverse stakeholders, including local communities, government agencies, project developers, and non-governmental organizations. The framework emphasizes transparency, trust-building, and engagement as core principles to address the unique challenges and requirements of community-based renewable energy initiatives. Key components include identifying relevant stakeholders, establishing clear communication objectives, and selecting appropriate channels for tailored, ongoing dialogue. First, the framework outlines the identification process of key stakeholders, considering their roles, influence, and interests in the project. This involves categorizing stakeholders into primary (directly impacted) and secondary (indirectly impacted) groups, which enables targeted engagement efforts. Next, the framework recommends diverse communication channels, such as community meetings, social media platforms, local radio, and informational workshops. These channels are chosen based on accessibility, stakeholder preferences, and cultural appropriateness, ensuring messages reach all stakeholders effectively. The framework also includes strategic engagement tactics to enhance community participation, including participatory planning sessions, regular feedback loops, and transparent reporting on project milestones and impacts. By fostering continuous interaction, the project team can build and sustain trust, helping to alleviate concerns and gain community support. Moreover, the framework advocates for the inclusion of culturally relevant communication approaches that respect local values and practices, further strengthening stakeholder relationships. Implementing this communication framework is expected to enhance transparency, cultivate trust, and improve community buy-in, ultimately driving the success and long-term sustainability of community-based renewable energy projects. This approach aligns stakeholder interests, mitigates risks of opposition, and promotes shared ownership, facilitating smoother project execution. By engaging stakeholders meaningfully, community-based renewable energy initiatives can achieve greater resilience and acceptance, contributing to the broader goals of energy transition and environmental sustainability.

Islam, State, and Local Wisdom: An Examination of Widowhood Inheritance Law in Indonesia

This article highlights the urgency of applying the common property distribution approach prior to the distribution of inheritance in the Indonesian context, which is influenced by local wisdom practices. This research aims to emphasize the rights of wives as widows over joint property through the application of the Compilation of Islamic Law (KHI), so that widows can obtain a fairer share before the distribution of their inheritance rights in accordance with the principles of fiqh. The method used in this research is a normative-juridical approach, with document analysis of legal regulations and their application in the context of local wisdom in Indonesia. The findings show that the distribution of joint property, before the distribution of inheritance, is very important to protect the rights of women who are often marginalized in a society that prioritizes the tradition of male lineage. The affirmation of giving half of the joint property to the widow at the beginning of the distribution before the widow receives her inheritance rights can be equated with shirkah that in the context of marriage the wife also contributes to the collection of property. The discussion in this study emphasizes that the integration of fiqh principles and KHI provisions in the distribution of inheritance, by first recognizing the widow's right to joint property, then the widow receives her inheritance rights after the joint property is distributed, this form of model not only ensures that the widow receives a fair share, but also strengthens the position of women in inheritance issues for the welfare of her family.

Inventing with bacteriology: controversy over anti-cholera therapeutic serum and tensions between transnational science and local practice in Tokyo and Berlin (1890-1902).

The present article examines the material, epistemological, and social dimensions of late nineteenth-century anti-cholera serum controversies that unfolded in Tokyo and Berlin. It seeks to shed light on the conflicting values embedded in the construction of scientific evidence during the transnational exploration of bacteriology as an effective response to controlling epidemics. Driven by Japanese health authorities' initiatives, Japanese bacteriologist Kitasato Shibasaburo participated in the elaboration of bacteriological research oriented toward therapeutic application during his stay in Berlin. This work coincided with the rise of a controversy over anti-cholera serum in relation to the animal experiments conducted by Richard Pfeiffer, a German bacteriologist. After presenting a series of animal experiments and certain clinical cases conducted in Germany, France, and Egypt in the context of the controversies, the article analyzes a therapeutic trial conducted by Kitasato in Japan during an 1895 cholera epidemic. His strategy, bringing new data to the transnational debate through an intensive investment of resources in the trial, provoked criticism from his Japanese and German colleagues. These critics questioned Kitasato's method and pointed out the low social value of this experimental serum therapy, performed in highly equipped conditions. Through this case study, the present article highlights: a) a strong tension between transnational research interactions among bacteriologists and local medical practices during public health campaigns against epidemics at the turn of the twentieth century; b) the importance of analyzing the interconnected effects of local, national and transnational frameworks of medical science when examining the increasingly intertwined relationships between laboratory science and clinical medicine.

Between International Policy and Local Practice: Nepali Service Providers' Constructions of Domestic Violence in Context.

The conceptualization of social problems is an important site for examining the extent to which the knowledge and priorities of local practitioners are reflected in international policy. This study employed critical discourse analysis to examine the constructions of domestic violence (DV) used by service providers in Pokhara, Nepal, as compared with two major international women's human rights policy documents. Both constructed DV as a human rights issue that should be contextualized within patriarchal and intersecting oppressions. Service providers additionally emphasized the denial of rights and entitlements of family life as DV. This finding underscores the long-term risks that survivors navigate and suggests that international human rights policymakers should broaden conceptualizations of DV.

Shake table testing of a seismic isolation system for lightweight structures

AbstractThe implementation of seismic isolation in lightweight structures, such as houses, is limited, except for Japan, where nearly 5000 houses are seismically isolated with highly engineered systems. The use of such systems in countries of growing economies is prohibitive due to their cost, difficulties in locally fabricating components, and incompatibility with local construction practices. Previous studies on low‐cost isolation systems showed that isolation devices with rolling rather than sliding elements are more suitable for lightweight structures. A low‐cost isolation system based on a deformable rolling bearing developed at the University at Buffalo has simple components that can be easily manufactured, has a large displacement capacity, and features a fail‐safe mechanism. The bearing is composed of one flat and one concave concrete plate and a rubber rolling ball. This paper presents the results of shake table testing of half‐length scale versions of prototype houses and small bridges equipped with this deformable rolling isolation system in three‐directional seismic excitation. The results showed that deformable rolling bearings provide significant seismic protection of lightweight structures against strong ground motions, which in the testing reached a maximum peak ground velocity of 1.2 m/s in the test scale and a peak ground acceleration of 4 g in the horizontal direction and up to 1 g in the vertical direction. The isolation system was particularly effective in the horizontal direction, whereas it did not provide any vertical isolation. The tests included cases of extreme response, which included vertical impact within the bearing's components and uplift of the isolated structure.

Morbidity-free survival in extremely premature infants after changes of clinical practices according to evidence-based guidelines: a quality improvement uncontrolled before-after study in a neonatal intensive care unit.

The evolution of our clinical practices appears to have positive effects on global and SNM-free survival and seems to have reduced the incidence of nosocomial infections. • Using global survival and severe neonatal morbidity-free survival rates allows to compare inter- and intra-team critical care practices in neonatal intensive care units. • Major changes in clinical procedures, in accordance to recent guidelines, were implemented after the restructuration of the medical team in 2018, with the expected objective of improving morbidity and mortality of extremely premature infants (EPI) in our unit. • After the changes, EPI exhibit a lower composite endpoint of "death or severe neonatal morbidity (SNM)" and were more frequently free of any SNM indicators concomitantly with a shorter median duration of invasive ventilation and parenteral nutrition. • The evolution of local clinical practices may positively impact mortality and morbidity within a few years.

A COMPARATIVE ANALYSIS OF CORPORATE GOVERNANCE DISCLOSURE PRACTICES: EVIDENCE FROM INDIAN AND GCC NATIONS

This paper makes a cross-sectional comparison of corporate governance disclosure trends in India and the GCC (Gulf Cooperation Council) countries. Benchmarking measures which include board of directors’ responsibility, audit committee efficiency and transparency, the study encompasses varied growth trend based on region. Local practices of Indian firms are relatively higher than global counterparts due to structured regulatory environment and focus on conformance to the established rules and regulation as well as international standards. Still, Gulf countries companies present more variations in terms of board accountability that has to do with difference in regulatory environment due to differences in economic and culture. Nonetheless, both regions experienced stable audit practices, and this shows that both sides are equally serious about how the financial aspect of their enterprises is managed. This underlines the call for improved governance discloser to, appeal investment from international markets and improve stakeholder confidence. Thus, some suggestions for future research include longitudinal research that will focus on the dynamics of governance in the periods of time and investigations of the differences across the countries of the wider emerging markets. This research provides lessons that the policymakers, investors and corporate leaders should consider while enhancing governance standards of firms to be in parity with the best international practices. KEYWORDS: Corporate governance, disclosure practices, transparency, board accountability, audit committee, emerging markets, India, GCC, regulatory frameworks, stakeholder trust

EDI&S SO03 Replacing Single-use Chloraprep with Low Carbon Cost-effective Surgical Skin Preparation: A QI Project for Sustainability in Surgery

Abstract Background Operating theatre waste accounts for approximately 50% of all hospital waste produced in the NHS [1] and two-thirds of carbon contributions come from single-use items [2]. With a major goal of the NHS being net-zero, surgeons have a collective responsibility for reducing the carbon footprint through eliminating single-use equipment and plastic waste such as Chloraprep wands. The aim of this quality improvement project was to introduce the use of chlorhexidine solution poured into reusable gallipots and applied using reusable sponge-holders into local practice, which is more environmentally friendly, significantly cheaper and is the first-line skin preparation recommended by NICE [3]. Method Chloraprep use in consecutive operations performed by the trust in a month before and after the intervention was retrospectively collected and categorised based on specialties. The intervention was a series of local oral presentations, leaflets and posters to highlight the benefits of chlorhexidine solution over Chloraprep. The change in percentage of Chloraprep use in all cases completed in 1 month pre- and post-intervention was retrospectively collected and analysed. Further qualitative data was obtained through pre- and post-intervention surveys. Results There was a reduction in use of Chloraprep across all specialties targeted by the intervention, with 27% of cases pre-intervention and 24% of cases post-intervention using Chloraprep. The highest percentage reduction was seen by the local upper gastrointestinal surgery team (37%). The percentage reductions in the cases using Chloraprep 10 days post intervention were general surgery 9%, upper GI 3%, colorectal 1% and vascular 6%. The pre- and post-intervention surveys also showed a decrease in Chloraprep use from 94.1% to 80% and corresponding increased use of swabs and antiseptic solution. 100% of the responders agreed with using the sustainable option. Conclusion The educational intervention has proven to be effective in achieving the aims of this project. Critical analysis of the literature has shown no difference in surgical site infection rates between the two options [2]. However, there is a need for high quality trials that directly compare the clinical effectiveness of both methods of application. We hope to encourage surgeons and theatre staff to opt out of using Chloraprep and consider the use of swabs dipped in chlorhexidine alcohol solution. Thus, we recommend the re-usable low carbon low-cost alternative method and encourage efforts to promote sustainability in surgery.

BN SO17 - When cholecystectomies go wrong: A single-centre review of post-operative complications over a two year period

Abstract Background Laparoscopic cholecystectomy (LC) is the main treatment for symptomatic gallstone disease with around 70,000 performed in the UK each year. The majority of these are day case procedures and patients recover well, however, there will always be a risk of more serious complication which can have serious negative effects on patients. The Clavien-Dindo classification of surgical complications is the most recognised method of grading post-operative complications by severity. The aim of our study was to identify our rates and severity of post-operative complication and their management. Method All patients who had LC between 1st July 2020 and 30th June 2022 were identified. Patient and operative details were retrieved from their electronic record. A complication was defined as any deviation from the standard post-operative course and was graded according to the Clavien-Dindo classification. 30-day readmission data was collected via hospital episode statistics and outcomes were reviewed on the patient record. Results 974 patients underwent LC. 30-day morbidity = 8.9%, 30-day readmission = 4.8% and 30-day mortality = 0.31%. Clavien-Dindo grade of complication: Grade 1= 44.7%, Grade 2 = 22.4%, Grade 3A = 12.9%, Grade 3B = 11.8%, Grade 4A = 1.2%, Grade 4B = 1.2%; and Grade 5 = 3.5%. 11 patients (1.1%) returned to theatre; bile leak was the most common indication (73%). Two intra-operative bile duct injuries were observed (0.21%) with one managed locally and the other transferred to the regional HPB centre. 7 patients required post-operative ERCP (0.72%), 57% for CBD stones and 43% for persistent bile leak. Conclusion Our study showed that the majority of post-operative morbidity following LC is related to post-operative pain (2.9%) or simple wound infection (1.8%). 2.6% of patients who underwent LC during had a significant complication requiring surgical, endoscopic or radiological intervention or admission to intensive care (Clavien-Dindo > 2). We report a 0.21% risk of bile duct injury and a 0.92% risk of post-operative bile leak. Overall our findings are in keeping with other studies but provide an insight into our local practice and that an area of potential improvement would be better management of post-operative pain.

‘Social defence’ and the resilience of the domestic war on terror: A genealogy of social security, national security, and defence

Abstract Russia’s invasion of Ukraine has moved attention within International Security back to Great Power Politics and interstate war, and away from phenomena like ‘foreign terrorist fighters’ and lone actor terrorism. Is the War on Terror paradigm receding? This paper argues that counter-radicalisation imaginaries and counter-extremism programming will all remain stubbornly present despite the shift back to interstate war. The resilience of domestic War on Terror policies will stem from their integration within local municipality activity and social policy during the second decade of the 21st century. These policy areas and levels are detached from the international security community, meaning that shifts in attention at the global level will have little effect upon localised national security practices. The paper then interrogates how counterterrorism agendas have so successfully entered the world of social policy and local public administration, using genealogical methods to trace how social security and crime prevention were historically prefaced upon defence. The paper traces the policy paradigm of ‘social defence’ which dominated mid-20th century international organisations, targeting non-criminal juveniles with pre-emptive interventions to prevent ‘dangerous persons’ imperilling society. Effectively, this untold history of crime prevention in Europe demonstrates the profound interlocking of national security, social policy and defence across the 20th century, with implications for the resilience of this triad.

The ‘bad’ pasts of ‘good’ norms: explaining the opium ban through the postcolonial lens

The global proscription of the opium trade and its non-medical consumption took almost a century to evolve. Within International Relations, opium’s ban is explained as part of the normative order that culminated in the global anti-drugs prohibition regime of the 1900s. The conventional view presents the history of opium’s ban as a ‘bad’ imperial and local practice discontinued through the activism of ‘good’ transnational actors. However, seen through the postcolonial lens, this simplistic narrative is upended. By centering hierarchical power relations, the postcolonial lens demands a reflective interrogation into ‘global’ standards to expose parochial subjectivities that are otherwise couched in the universalistic language of modernity, rationality and progress. Though the ban on opium challenged an imperial practice, this article shows that it did so with the help of discourses that were themselves imperialistic. An analysis of the underlying evangelical, racial and scientific discourses illustrate how it was in the context of a specific worldview that opium came to be vilified. It also explains how the anti-opium views of the newly decolonized countries like India and China were suffused with the ethical visions of the anti-colonial and nation-building movements. A granular interrogation into opium’s history is necessary as we try and work our way toward a more nuanced and textured understanding of the international normative order while eschewing a one-dimensional, unproblematic, and simplified understanding of norms in IR.

Flattening Hierarchies and Encouraging Reflection: Systems Maps as a Local Literacy Practice

In this study, we explore systems thinking maps as a local literacy practice in a systems thinking professional development institute for PreK-8 teachers. Existing literature underscores the necessity of equipping teachers with a robust understanding of systems thinking; this study addresses a call in the research to find ways to do so. Rooted in the principles of systems thinking, professional development, and literacy practices, we analyze how the literacy practice of systems thinking mapping contributed to participant pedagogical reflection and systems thinking theory development. We employed a case study approach, allowing an in-depth investigation of the mapping literacy events within the professional development setting. We collected data throughout the four days of the professional development; the data set included observations and recordings of mapping sessions, reflections on mapping from 29 participants, and photographs of the systems maps created. Our results highlight the potential of systems thinking maps to foster collective understandings of systems thinking, deepen understandings via the co-construction of dynamic texts, and imagine pedagogical possibilities. The literacy practice not only strengthens participants’ grasp of systems but also creates a shared space for collaborative learning, flattening hierarchies and engaging teachers as co-learners. The implications extend to disrupting traditional professional structures, emphasizing the centrality of the learner while fostering hope, optimism, and agency. This study contributes valuable insights into literacy practices that promote collaborative learning among teachers, encouraging a shift toward more inclusive and transformative professional development.

Optimized agricultural management reduces global cropland nitrogen losses to air and water.

Nitrogen (N) losses from croplands substantially contribute to global N pollution. Assessing the reduction in N losses through improved N management practices is complex due to varying site conditions, such as land use, climate, soil properties and local farming methods. In this Article, we conducted a meta-analysis to evaluate the effects of improved practices on N loss reduction, analysing data from 1,065 studies with 6,753 pairs of observations comparing standard and optimized practices. Without considering site-specific conditions, optimized management practices can reduce N2O emissions by 3-39%, NH3 emissions by 15-68%, N run-off by 21-37% and N leaching by 19-52%. After considering local conditions and current practices, average reductions on a global scale were 31% for N2O, 23% for NH3, 18% for N run-off and 17% for N leaching. The effectiveness of N loss reduction was mainly influenced by optimized management practices and, to a lesser extent, site conditions. The results of this study underscore the importance of implementing optimized, site-specific management to effectively reduce N losses from global croplands.

Ethnomathematics: Learning Geometric Transformation Through the Formation of Lagosi Motif

The Lagosi motif, a prominent design in the traditional fabric of the Wajo district, is well-known but increasingly rare among local weavers. This motif, drawing inspiration from natural elements such as flowers and stems, holds significant philosophical and cultural meaning for the Wajo people, serving as a key element of their endangered cultural heritage. Despite its cultural importance, the motif has been minimally explored in the context of ethnomathematics. Consequently, this study investigates the mathematical concepts inherent in the design of Lagosi motifs, aiming to utilize them as educational tools for students and to support cultural preservation efforts. Employing a qualitative research methodology with an ethnographic approach, data were collected through observations, interviews, and documentation. The validity and reliability of the data were ensured through triangulation and confirmability. The study reveals that geometric transformations, specifically translation and reflection, play a central role in the creation of Lagosi motifs. These findings highlight the natural emergence of mathematical concepts within local cultural practices, offering potential for their integration into contextualized mathematics education. Furthermore, the results aim to instill a sense of cultural pride in students, thereby contributing to the preservation of Wajo's cultural heritage. The study also underscores the opportunity to leverage Lagosi motifs as culturally relevant educational tools and to foster interdisciplinary collaboration between mathematics and cultural studies.

Use of Prenatal Exome Sequencing: Opinion Statement of the French Federation of Human Genetics Working Group.

Prenatal whole exome sequencing (pES) is increasingly prescribed for fetuses with ultrasound anomalies. Starting from the local French prenatal medicine practice, healthcare system and legal landscape, we aimed to address the broad medical and ethical issues raised by the use of pES for women and couples as well as for prenatal care providers. The French Federation of Human Genetics established a working group composed of clinicians and biologists from all over France to discuss pES challenges. A literature review was also performed. We emphasize the importance of non-directive information that helps couples make a decision that is consistent with their personal values and ideas. We address the difficulty of obtaining informed consent that respects the couple's autonomy, despite the complexity of the information and regardless of their level of education and cultural background. We address whether variants of uncertain significance and unsolicited results should be reported. We emphasize the need for national harmonization of access to pES and the need for multidisciplinary meetings in complex situations. We point out that the specific French context of healthcare financing and the French law have a major influence on medical care organization and support for couples. The outcome of the working group is the development of 12 proposals. This opinion statement, dedicated to prenatal care providers worldwide although linked to the French context, will provide food for thought and assist them in understanding the complexity and implications of pES.

Promoting Good Governance Through Transnational Projects: A Study of Swedish Funding in Russia 1991–2005

ABSTRACTThis article explores how foreign funders may promote good governance in a country without a history of established democratic processes. It examines the travel of ideas of democracy and human rights from Sweden to Russia through transnational cooperation projects during the period 1991–2005. Considering these projects as forms of high‐stakes translations, the study finds that many of them engaged with Russian society only on a superficial level without embedding ideas in local organizational practices. Identifying the weaknesses often found in such translations, the study points to the difficulty of contributing to a democratic transformation of Russia by means of foreign‐funded projects lacking contextual anchorage.

BIOM-63. LONG-TERM SURVIVAL AND MOLECULAR CHARACTERIZATION OF IDH-WILDTYPE GLIOBLASTOMA IN AN ASIAN COHORT

Abstract BACKGROUND Glioblastoma (GB), the most aggressive form of brain tumor, presents a significant clinical challenge with a devastating prognosis. Globally, the median overall survival (OS) for GB is typically 12-15 months, largely due to its inherent resistance to chemotherapy and radiotherapy. However, some patients exhibit prolonged survival, and their specific demographic and genomic characteristics remain poorly defined. Understanding the clinical profile of these exceptional responders holds great promise for informing improved management strategies for GB. METHODS In a retrospective two-center study conducted in Hong Kong (IRB: UW 21-189), we recruited 80 patients diagnosed with IDH wildtype glioblastoma. All patients underwent next-generation sequencing as part of their treatment. Long-term survivor (LTS) was defined as >=36 months from diagnosis, while medium-term survivor (MTS) was defined as >=18 months, and <18 months as short-term survivors (STS). When appropriate, descriptive statistics were used to report frequency with percentage or median with range. Fisher’s exact test was employed to analyze categorical variables, while continuous variables were assessed using the Kruskal-Wallis test. All statistical analyses were conducted using R (version 4.2.3). Result: Among the cohort of 80 recruited patients, the median survival was 18.8 months (95% CI 17.2-24.8). Notably, 21% (n=17) were LTS, 31% (n=25) were MTS, and 48% (n=38) were STS. A statistically significant variation (p < 0.05) was evident across three groups: gender distribution, the number of resections performed, the proportion of patients receiving genomic-guided treatment, and their participation in clinical trials. However, no significant difference was observed in MGMT promoter status and ECOG score. CONCLUSION Identifying these clinical factors enhances the clinical management of GB. The implications of these findings underscore the potential importance of incorporating genomic-guided treatment in both local and global clinical practices in GB.

Innovative Strategies for Hosts in the Dissemination of China's Narrative System in the Age of Intelligent Media

In the report of the 20th National Congress of the Communist Party of China, the "second integration" emphasized the contemporary significance of excellent traditional Chinese culture, highlighting the construction of an independent narrative system based on the integration of traditional Chinese culture and local cultural practices. In today’s society, China faces challenges in the dissemination of its narrative system, such as the external shaping of cultural symbols and a relatively singular form of cultural communication. The integration of culture and tourism has become a popular topic in recent years, with tourism programs serving as a window to showcase Chinese culture. Although cultural programs and tourism programs have both seen substantial development, creating a comprehensive program that effectively integrates both remains a task requiring continuous reflection from hosts. Particularly, current tourism programs face challenges like weak cultural relevance, lack of distinctive hosting styles, and hollow content. These issues present new challenges to hosts and offer great development potential for related programs. The key topic of this paper is how hosts can leverage their expertise to expand the program’s reach or enhance its content dissemination. Through research, the paper identifies innovative approaches for hosts in cultural tourism programs, summarized into three phases: tasks to be completed in the pre-production, production, and post-production stages. The analysis covers the core content, the host’s positioning, and communication methods. The proposed innovative paths provide new perspectives and ideas for more effectively disseminating Chinese cultural symbols abroad.

Empowering Rural Women through Nutrition Education: Enhancing Dietary Quality with Mushroom-enriched Foods and Participation in Local Mushroom Production Systems

Ensuring quality nutrition for rural women remains a critical public health challenge, particularly in regions where dietary diversity is limited, and micronutrient deficiencies are prevalent. One potential solution is the incorporation of mushroom-enriched food into the daily diets of these women, combined with effective nutrition education and active participation in the mushroom production system. Mushrooms are a nutrient-dense food source, rich in essential vitamins such as vitamin D, and B vitamins, and minerals like zinc, selenium, and iron, which are often deficient in rural diets. Additionally, mushrooms provide a valuable source of protein and fiber, making them an ideal complement to traditional staples. Nutrition education programs focusing on the health benefits of mushrooms can help shift dietary patterns and empower rural women to make healthier food choices for themselves and their families. The integration of mushroom cultivation into local agricultural practices not only enhances food security but also provides an additional income source for women, supporting their economic empowerment. Moreover, the cultivation process is relatively low-cost and can be sustainably managed within small-scale farming systems, making it an accessible and feasible solution for rural communities. Training women to grow, harvest, and prepare mushroom-enriched foods can address both the supply and demand side of the nutrition equation, ensuring that nutrient-rich foods are both available and consumed regularly. The dual focus on nutrition education and production system participation also fosters a sense of ownership and self-reliance among rural women, leading to more sustainable long-term improvements in dietary quality. This approach has the potential to reduce gender disparities in agricultural participation by providing women with a specific and profitable area of expertise within their communities.

Evaluation of decision support to wean patients from mechanical ventilation in intensive care: a prospective study reporting clinical and physiological outcomes.

This study investigated the clinical and physiological response to use of the BEACON Caresystem, a bedside open-loop decision support system providing advice to guide clinicians when weaning patients from invasive mechanical ventilation. Multicenter prospective study conducted in five adult intensive care units in the UK. Following screening and assent, intubated patients mechanically ventilated for > 24 h were randomized to intervention or usual care. Intervention consisted of application of the BEACON Caresystem's advice on tidal volume/inspiratory pressure, inspired oxygen, respiratory rate and PEEP. Usual care was defined as local clinical practice. The primary outcome was duration of mechanical ventilation. Secondary outcomes quantified prolonged intubation and survival; adverse events; ventilator settings and physiological state; time spent in ventilator modes; links to other therapy; the frequency of advice utilization and time spent outside normal physiological limits. The study was terminated early with a total of 112 patients included. Fifty-four were randomised to the intervention arm and fifty-eight to usual care. The study was underpowered and no significant differences were seen in duration of mechanical ventilation (p = 0.773), prolonged intubation or survival. Intervention arm patients had lower rates of adverse events (p = 0.016), including fewer hypoxaemic events (p = 0.008) and lower values of PEEP (p = 0.030) and tidal volume (p = 0.042). Values of peak inspiratory pressure and pressure support were reduced but at the boarder of statistical significance (p = 0.104, p = 0.093, respectively). No differences were seen for time in ventilator mode or other therapy. Advice presented by the decision support system was applied at the beside an average of 88% of occasions, with a significantly increased number of changes only in inspired oxygen fraction. No significant differences were seen in time spent outside physiological limits. This study investigated the use of the BEACON Caresystem, an open loop clinical decision support system providing advice on ventilator settings. It was terminated early, with no significant difference shown in duration of mechanical ventilation, the primary outcome. Application of advice indicated potential for fewer adverse events and improved physiological status. (Trial registration ClinicalTrials.gov under NCT03249623. Registered 22nd June 2017).