Treatment Effect Model Research Articles

Abstract 12779: Serial High-Sensitivity Troponin I and Long-Term Risk of Death in Subjects With Suspected Acute Coronary Syndrome

Introduction: Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome (ACS) are unknown. Hypothesis: To determine mortality according to high-sensitivity troponin I (TnI) concentrations and their changes from baseline, in patients with suspected ACS. Methods: Using Danish registries, we identified individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity TnI (Siemens TnI Flex® Reagent, 99 th percentile 45 ng/l) measurements during the same hospitalization. Prognostic implications of serial sampling were examined stratifying subjects for normal and elevated concentrations, and for relative changes of 20% and 50%. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling. Results: Of the 20,609 individuals included, 2.3% had died at 30 days, while 4.7% of 30-day-survivors died between days 31-365. The standardized risk of death at both 0-30 and 31-365 days was highest among subjects with two elevated TnI concentrations (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal TnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative changes between measurements clearly affect mortality. Nevertheless, among persons who went from a normal to an elevated TnI concentration, 30-day mortality was highest in those with a >50% rise versus subjects with a less pronounced rise (2.2% vs. <0.1%). The Figure shows the standardized absolute risk of death from any cause from days 31-365. Conclusions: Among individuals with suspected ACS, those with two elevated TnI concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal TnI values.

Abstract 9438: Serial Troponin T and Long-Term Risks of Myocardial Infarction and Revascularization in Patients With Suspected Acute Coronary Syndrome

Introduction: Long-term prognostic implications of serial high-sensitivity troponin concentrations in patients with suspected myocardial infarction (MI) are unknown. Hypothesis: To determine short- and long-term risks of MI and revascularization (PCI or CABG) according to high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome. Methods: Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged them with records of two serial hsTnT measurements obtained 1-7 hours apart. Absolute risks of MI and revascularization were calculated through multivariable logistic regression with average treatment effect modeling (G-formula), with patients stratified in groups according to normal and elevated concentrations and relative changes of 20% and 50% from baseline. Results: Complete data were available in 28,902 individuals (median age [25 th -75 th percentile] 65.2 [53.4-75.4] years, 11,632 [40.2%] women). The standardized risk of MI was highest in individuals with two elevated hsTnT concentrations (0-30 days: 54.1%, 31-365 days: 9.7%) and lowest in those with two normal values (0-30 days: 2.5%, 31-365 days: 0.4%). In the latter group, the risk of MI did not appear to depend on the relative hsTnT change between samples while in persons with two elevated hsTnT concentrations, the risks at both 0-30 days and 31-365 days increased in a stepwise fashion with more pronounced hsTnT rises. Individuals with a >20% to 50% fall also had a higher risk of MI than those with a less pronounced change while results were not significant for those with a >50% fall. Finally, individuals who went from a normal to an elevated hsTnT level and had a concomitant >50% rise had a significantly higher risk of MI at days 0-30 than those with a less pronounced rise. The standardized likelihood of undergoing coronary revascularization according to serial hsTnT concentrations followed the same pattern. Conclusions: Serial hsTnT measurements identify patients at long-term risk for both MI and revascularization.

Exposure to family planning messages and contraceptive use among women of reproductive age in sub-Saharan Africa: a cross-sectional program impact evaluation study

Many women of reproductive age in sub Saharan Africa are not utilizing any contraceptive method which is contributing to the high burden of maternal mortality. This study determined the prevalence, trends, and the impact of exposure to family planning messages (FPM) on contraceptive use (CU) among women of reproductive age in sub-Saharan Africa (SSA). We utilized the most recent data from demographic and health surveys across 26 SSA countries between 2013 and 2019. We assessed the prevalence and trends and quantified the impact of exposure to FPM on contraceptive use using augmented inverse probability weighting with regression adjustment. Sensitivity analysis of the impact estimate was conducted using endogenous treatment effect models, inverse probability weighting, and propensity score with nearest-neighbor matching techniques. The study involved 328,386 women of reproductive age. The overall prevalence of CU and the percentage of women of reproductive age in SSA exposed to FPM were 31.1% (95% CI 30.6–31.5) and 38.9% (95% CI 38.8–39.4) respectively. Exposure to FPM increased CU by 7.1 percentage points (pp) (95% CI 6.7, 7.4; p < 0.001) among women of reproductive age in SSA. The impact of FPM on CU was highest in Central Africa (6.7 pp; 95% CI 5.7–7.7; p < 0.001) and lowest in Southern Africa (2.2 pp; 95% CI [1.3–3.0; p < 0.001). There was a marginal decline in the impact estimate among adolescents (estimate = 6.0 pp; 95% CI 5.0, 8.0; p < 0.001). Exposure to FPM has contributed to an increase in CU among women of reproductive age. Programs that are geared towards intensifying exposure to FPM through traditional media in addition to exploring avenues for promoting the appropriate use of family planning method using electronic media remain critical.

Farmers’ Participation in Modern Supply Chains: The Case of Mandarin Profitability in Punjab-Pakistan

In developing countries, supply chains are rapidly transforming. However, smallholder farmers, in particular, have experienced mixed impacts in inclusion and exclusion from modern supply chains (MSC). Therefore, by taking Pakistan’s mandarin industry as a case, this study aims to analyze the farmers’ efficiency and inclusiveness in modern supply chains and compare them across the farm size categories, i.e., small, medium, and large. For that purpose, cross-sectional data from 300 farmers were collected to test the posit objectives. The empirical investigation was made using the endogenous treatment effect model and the propensity score matching approach. Findings show that large farmers prefer to participate in MSC, driven by contractors, processors or exporters. Conversely, the smallholders are more inclined to participate in the traditional supply chains (TSCs), driven by village vendors, local retailers/consumers, middlemen, and traditional fruit and vegetable markets. The results also revealed a positive connection between efficiency and farmers’ inclusion in the MSC. Orchard size, education, off-farm income, and extension services positively impact profitability. In terms of an increase in farmers’ profitability, the efficiency improvement can benefit the resource-poor smallholders who make up 74% of the total farmers in the sample. Therefore, these results are noteworthy for devising policy actions to facilitate smallholder inclusion in the modern agri-food supply chains to alleviate rural poverty and ensure farmers’ wellbeing.

Serial troponin-T and long-term outcomes in suspected acute coronary syndrome.

Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome are unknown. Individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity troponin-T (hsTnT) measurements 1-7 h apart were identified through Danish national registries. Absolute and relative risks for death at days 0-30 and 31-365, stratified for whether subjects had normal or elevated hsTnT concentrations, and whether these concentrations changed by <20%, > 20 to 50%, or >50% in either direction from first to second measurement, were calculated through multivariable logistic regression with average treatment effect modeling. Of the 28 902 individuals included, 2.8% had died at 30 days, whereas 4.9% of those who had survived the first 30 days died between days 31-365. The standardized risk of death was highest among subjects with two elevated hsTnT concentrations (0-30 days: 4.3%, 31-365 days: 7.2%). In this group, mortality was significantly higher in those with a > 20 to 50% or >50% rise from first to second measurement, though only at 30 days. The risk of death was very low in subjects with two normal hsTnT concentrations (0-30 days: 0.1%, 31-365 days: 0.9%) and did not depend on relative or absolute changes between measurements. Individuals with suspected acute coronary syndrome and two consecutively elevated hsTnT concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal hsTnT concentrations, irrespective of changes between measurements.

Evaluating the Heterogeneous Impacts of Adoption of Climate-Smart Agricultural Technologies on Rural Households’ Welfare in Mali

Climate change is negatively affecting agricultural production in the Sahel region. Climate-Smart Agricultural Technologies (CSATs) are disseminated to reduce these negative effects, and particularly those on resource-poor farm households. This article investigates the distributional impacts of the adoption of CSAT on-farm households’ welfare using a dataset that covers four regions, 32 communes, 320 villages, and 2240 households in Mali. Using an instrumental variable quantile treatment effects model, the paper addresses the potential endogeneity arising from the selection bias and the heterogeneity of the effect across the quantiles of the outcome variables’ distribution. The results show that the adoption of CSAT is positively associated with improved households’ welfare. The farmers’ decision to adopt any CSAT is influenced by access to credit, contact with extension agents, participation in training, access to information through the television, and being a member of any organization such as a cooperative society. Moreover, the effect of the adoption of CSAT on household welfare varies across the different households. In particular, the results show that the impact of the adoption of CSAT on households’ welfare is generally higher for the poorest (farmers located at the bottom tail of the distribution) end of the welfare distribution. The findings, therefore, highlight the pro-poor impact of the adoption of CSAT in the rural Malian context, as well as the need to tailor the CSAT interventions toward specific socio-economic segments of the rural population in Mali.

Striving to be resilient: the role of crop-poultry integrated system as a climate change adaptation strategy in semiarid eastern Kenya

Climate change continues to pose significant challenges to food security and livelihoods of smallholder farmers specifically in semi-arid regions. One approach that holds prospects for climate risk management is climate-smart agriculture (CSA). CSA has concentrated on crop practices with little attention to livestock especially indigenous (village) chickens as a potential practice that can be combined with crop agriculture. This study considers the adoption of three CSA practices: improved maize seeds (IS), soil management (SM), indigenous chicken (IC) enterprise and their various combinations. Using survey data collected from 300 farming households in semiarid Kenya, we estimate the impact of integrated crop-poultry system adoption on food security and farm income using multinomial endogenous treatment effect models. Robustness checks are conducted using alternative identification strategies. Results show that, generally, the adoption of IS, SM, IC and their combinations reduces the number of months without enough food and increases farm income. When we consider the magnitude of the impacts, interesting results emerge when a combination of the CSA practices are considered. The highest impact is observed with the joint adoption of SM & IC and IS &IC. Broadly, the empirical findings suggest that integrated systems (in our case crop-poultry integration), deserve both policy and research attention as they provide synergistic benefits that improve climate resilience and household welfare.

Comprehensive assessment of neurocognitive function, inflammation markers, and adiposity in treated HIV and control.

To compare the neurocognitive scores between persons living with human immunodeficiency virus (PLWH) and persons without human immunodeficiency virus (HIV) and assess the relationship between neurocognition, HIV status and variables, inflammation, and body composition measures. Cross-sectional study involving 225 participants (126 PLWH on antiretroviral therapy [ART] and 99 persons without HIV). For the first time in HIV, we used Cognivue®, an food and drug administration (FDA)-approved computer-based test to assess cognitive function. The test was calibrated to individuals’ unique cognitive ability and measured 6 cognitive domains and 2 performance parameters. Markers of inflammation, immune activation, insulin resistance, and body fat composition (using dual-energy X-ray absorptiometry scan) were collected. Classical t tests, chi-square tests, and spearman correlations were used to compare and explore relationships between variables. Inverse probability weighting adjusted average treatment effect models were performed to evaluate the differences between PLWH and persons without HIV, adjusting for age, race, sex, and heroin use. Overall, 64% were male, 46% were Black, with a mean age of 43 years. Among PLWH, 83% had an undetectable HIV-1 RNA level (≤20 copies/mL). Compared persons without HIV, PLWH performed poorer across 4 domains: visuospatial (P = .035), executive function (P = .029), naming/language (P = .027), and abstraction (P = .018). In addition, PLWH had a significantly longer processing speed time compared to controls (1686.0 ms vs 1606.0 ms [P = .007]). In PLWH, lower cognitive testing domain scores were associated with higher inflammatory markers (high sensitivity C-reactive protein [hsCRP]) and with higher total fat and visceral adipose tissue (P < .05). Neurocognitive impairment (NCI) in HIV is associated with inflammation and total and central adiposity.

Drug Treatment Effect Model Based on MODWT and Hawkes Self-Exciting Point Process.

In precision medicine, especially in the pharmacodynamic area, the lack of an adequate long-term drug effect monitoring model leads to a quite low robustness to the instant drug treatment. Modelling the effect of drug based on the monitoring variables is essential to measure the drug benefit and its side effect preciously. In order to model the complex drug behavior in the context of time series, a sin function is selected to describe the basic trend of heart rate variable that is medically monitored. A Hawkes self-exciting point process model is chosen to describe the effect caused by multiple and sequential drug usage at different time points. The model considers the time lag between the drug given time and the drug effect during the whole drug emission period. A cumulative Gamma distribution is employed to describe the time lag effect. Simulation results demonstrate the established model effectively when describing the baseline trend and the drug effect with low noise levels, where the maximal overlap discrete wavelet transformation is utilized for the information decomposition in the frequency zone. The real data of the variables heart rate and drug liquemin from a medical database is analyzed. Instead of the original time series, scale variable s4 is selected according to the Granger cointegration test. The results show that the model accurately characterizes the cumulative drug effect with the Pearson correlation test value as 0.22, which is more significant for the value under 0.1. In the future, the model can be extended to more complicated scenarios through taking into account multiple monitoring variables and different kinds of drugs.

Does enterprise risk management benefit manufacturing firms? Evidence from China

It is observed that Enterprise risk management (ERM) framework has been adopted by some manufacturing firms in China in the past years. To investigate the effectiveness of ERM, data of A-share listed manufacturing firms in Shanghai and Shenzhen stock exchange during 2010-2019 are adopted from Wind database and CSMAR database, two large domestic databases, to examine the impact of ERM on value of manufacturing firms. Treatment effects model and genenralised method of moments (GMM) are employed to derive the empirical results. Our results show that adoption of ERM can add value to the firms, and firms benefit more from high-quality ERM program. Furthermore, the impact of ERM seems to be more significant among the manufacturing firms with smaller scale, or stronger institutional shareholding, or international business. Our findings encourage the manufacturing firms to implement ERM program and improve the program to achieve its targets.

Serial high-sensitivity troponin T concentrations and long-term outcomes in patients with suspected acute coronary syndrome

Abstract Background High-sensitivity troponin assays allow for accurate and rapid rule-in or rule-out of myocardial infarction (MI) among patients with acute-onset chest pain. However, prognostic implications of serial high-sensitivity troponin concentrations are unknown. Purpose To determine short- and long-term prognostic implications of high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome. Methods Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged these individuals with all records of two serial hsTnT measurements obtained ≤7 hours apart during the same hospitalization. The primary outcome was death at days 0–30 and 31–365. Prognostic implications of serial hsTnT were examined in accordance with the 2012 ESC algorithm stratifying patients for normal baseline concentrations and relative changes of 20% and 50% from baseline. In case of a normal baseline concentration, 20% and 50% of the upper reference level (14 ng/l) were used as thresholds instead, i.e., 3 ng/l and 7 ng/l, respectively. Absolute risks were calculated through multivariable logistic regression with average treatment effect modeling (G-formula). Results Complete data were available in 28,902 individuals (median age [25th-75th percentile] 65.2 [53.4–75.4] years, 11,632 [40.2%] women). Of these, 11,116 (38.5%) had a final diagnosis of MI, 1518 (5.3%) of unstable angina, and 16,268 (56.3%) of either suspected MI or chest pain. Median baseline hsTnT was 18 ng/l (25th-75th percentile, 10–69), second hsTnT 21 ng/l (25th-75th percentile, 10–248), relative hsTnT change 3.6% (25th-75th percentile, 0–66.7), and time between samples 4.0 hours (25th-75th percentile, 3.2–5.4). Most patients had either two normal hsTnT concentrations (9483, 32.8%) or two elevated hsTnT concentrations (18,235, 63.1%). At 30 days, 796 (2.8%) individuals had died, while an additional 1287 (4.6% of 30-day survivors) died between days 31–365. Baseline hsTnT and the relative hsTnT change both displayed a significant, non-linear association with death and interacted with each other (P&amp;lt;0.001). Tables 1 and 2 show the standardized, absolute risks of death (with 95% confidence intervals) from days 0–30 and from days 31–365, respectively. Patients with two normal hsTnT concentrations had very low mortality rates, irrespective of the magnitude of relative change. Conversely, patients with two elevated hsTnT concentrations consistently had high mortality rates. Conclusions This is the first study to assess both short- and long-term outcomes as a function of both baseline hsTnT and its change from first to second measurement. In general, patients with two normal hsTnT concentrations have an excellent prognosis while those with two elevated concentrations require scrutiny. Funding Acknowledgement Type of funding sources: None.

Testing rank similarity in the local average treatment effects model

This paper develops a test for the rank similarity condition of the nonseparable instrumental variable quantile regression model using the local average treatment effect model. When the instrument takes more than two values or multiple binary instruments are available, there exist multiple complier groups for which the marginal distributions of potential outcomes are identified. A testable implication is obtained by comparing the distributions of ranks across complier groups. We propose a test procedure in a semiparametric quantile regression specification. We establish the weak convergence of the test statistic and the validity of the bootstrap critical value. We illustrate the test with an empirical example of the effects of fertility on women’s labor supply.

Treatment outcomes of advanced hepatocellular carcinoma in real-life practice: Chemotherapy versus multikinase inhibitors.

Multikinase inhibitors (MKIs) represent the main treatment options for advanced hepatocellular carcinoma (aHCC). However, accessibility in developing countries is limited. A chemotherapy, Fluorouracil and Oxaliplatin (FOLFOX), offers a less expensive treatment. Therefore, this study sought to compare the clinical effectiveness of FOLFOX with Sorafenib as a first-line treatment for aHCC in real-life practice. A retrospective aHCC cohort from four Thai hospitals was investigated for patients who received FOLFOX or Sorafenib between 2013-2019. Multiple imputation by chained equations addressed missing covariate data in a treatment effect model using Weight-adjusted-censoring inverse-probability-weighted regression adjustment; overall survival (OS) and progression-free survival (PFS) were estimated. A total of 504 patients were included, (Sorafenib [n=382] and FOLFOX [n=122]). The treatment effect model estimated a median OS for Sorafenib and FOLFOX of 11.38 and 8.22 months, representing a significantly shorter OS (95% confidence interval) of -3.16 (-6.21, -0.11) months for FOLFOX, p=0.042. A significant shorter median PFS of FOLFOX to Sorafenib of -2.13 (-3.03, -1.24) months, p < 0.001, was reported. Despite significantly shorter median OS and PFS than Sorafenib, FOLFOX still extended OS by 8.22 months. This evidence may offer clinical utility to physicians considering treatment options for aHCC in low resource settings.

Measuring Racial Discrimination in Bail Decisions

We develop new quasi-experimental tools to measure disparate impact, regardless of its source, in the context of bail decisions. We show that omitted variables bias in pretrial release rate comparisons can be purged by using the quasi-random assignment of judges to estimate average pretrial misconduct risk by race. We find that two-thirds of the release rate disparity between White and Black defendants in New York City is due to the disparate impact of release decisions. We then develop a hierarchical marginal treatment effect model to study the drivers of disparate impact, finding evidence of both racial bias and statistical discrimination. (JEL J15, K42)

Can the Participation in Quality Certification of Agricultural Products Drive the Green Production Transition?

The green production transition in agriculture is all about the quality of agricultural products at the source of production. Whether the product quality certification can accelerate the green production transition in agriculture is an issue of concern. We have measured the degree of green production transition of kiwifruit growers using a finite mixture model in this paper, and use research data from the main kiwifruit production areas in Shaanxi and Sichuan provinces to verify the impact of conducting product quality certification on the green production transition of kiwifruit growers. Besides, we use a multi-valued treatment effects model to verify the differences in the degree of green production transition among kiwifruit growers in the face of different certification types. Our findings are mainly as follows: the degree of green production transition among kiwifruit growers is not high, with an average of only 36.3%. Product quality certification can significantly promote the green production transition of kiwifruit growers, and the promotion effect of different certification methods in green production transition of kiwifruit growers significantly varies. The promotion effect of organic certification is greater than that of green certification and pollution-free certification. Further, the mechanism test analysis reveals that product quality certification can influence the green production transition of kiwifruit growers through three mechanisms: quality monitoring, market premium, and market access threshold. Based on this, this paper proposes policy recommendations to advance quality certification and green production transition among kiwifruit growers to increase the certification, enhance the willingness to green transition, and boost the differentiated certification system.

The STAGED-PKD 2-Stage Adaptive Study With a Patient Enrichment Strategy and Treatment Effect Modeling for Improved Study Design Efficiency in Patients With ADPKD

Rationale & ObjectiveVenglustat, a glucosylceramide synthase inhibitor, inhibits cyst growth and reduces kidney failure in mouse models of autosomal dominant polycystic kidney disease (ADPKD). STAGED-PKD aims to determine the safety and efficacy of venglustat and was designed using patient enrichment for progression to end-stage kidney disease and modeling from prior ADPKD trials.Study DesignSTAGED-PKD is a 2-stage, international, double-blind, randomized, placebo-controlled trial in adults with ADPKD (Mayo Class 1C-1E) and estimated glomerular filtration rate (eGFR) 45-<90 mL/min/1.73 m2 at risk of rapidly progressive disease. Enrichment for rapidly progressing patients was identified based on retrospective analysis of total kidney volume (TKV) and eGFR slope from the combined Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease and HALT Progression of Polycystic Kidney Disease A studies.Setting & ParticipantsTarget enrollment in stages 1 and 2 was 240 and 320 patients, respectively.InterventionsStage 1 randomizes patients 1:1:1 to venglustat 8 mg or 15 mg once daily or placebo. Stage 2 randomizes patients 1:1 to placebo or venglustat, with the preferred dose based on stage 1 safety data.OutcomesPrimary endpoints are TKV growth rate over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary endpoints include: annualized rate of change in eGFR from baseline to 18 months (stage 1); annualized rate of change in TKV based on magnetic resonance imaging from baseline to 18 months (stage 2); and safety, tolerability, pain, and fatigue (stages 1 and 2).LimitationsIf stage 1 is unsuccessful, patients enrolled in the trial may develop drug-related adverse events that can have long-lasting effects.ConclusionsModeling allows the design and powering of a 2-stage combined study to assess venglustat’s impact on TKV growth and eGFR slope. Stage 1 TKV assessment via a nested approach allows early evaluation of efficacy and increased efficiency of the trial design by reducing patient numbers and trial duration.FundingThis study was funded by Sanofi.Trial registrationSTAGED-PKD has been registered at ClinicalTrials.gov with study number NCT03523728.

Climate information pathways and farmers’ adaptive capacity: insights from South Africa

Access to meaningful climate information is required to meet the adaptation demands of Africa's smallholder farmers. However, there is inadequate evidence to demonstrate how access to climate information impacts farmers' adaptive capacity (measured in this study as the number of adaptation strategies adopted). Using cross-sectional data obtained from farming households in South Africa, the study used multivariate probit and an endogenous Poisson treatment effect models to make three significant contributions: 1) explore the determinants of farmers' choice of climate information pathways, 2) identify the drivers of the intensity of adaptation strategies, and 3) analyze the impact of access to climate information on farmers' adaptive capacity. The findings indicated that the key sources of information pathways: television, radio, agricultural extension agents and farmer-to-farmer extension services are complementary. Thus, the choice of an information pathway is conditioned on other sources. The results further showed that some socioeconomic characteristics have a significant influence on both climate information access and farmers' adaptive capacity. After controlling for observed and unobserved differences in household characteristics, access to climate information was predicted to have a significant and positive impact on farmers' adaptive capacity, with farmers who had access to climate information using three more adaptation strategies than they would have used otherwise. As a result, the study suggests that rural agricultural information systems be established in order to ensure that useful and appropriate information is both accessible and useable, hence improving farmers' adaptive capacity. Diversifying farming households' income to include nonfarm employment may become increasingly significant as a way of mitigating climate risks and strengthening overall resilience.

The Impact of Climate-Smart Agriculture Technology on Productivity: Does Row Planting Matter? Evidence from Southern Ethiopia.

The impact of climate-friendly agricultural practices on rural household productivity is not well understood, and the available evidence is mainly qualitative. Therefore, this study investigated the impact of the introduction of Climate-Smart Agriculture Practices (CSA, i.e., row planting) on the productivity of improved wheat producers of rural farmer households in Misha Woreda, the southern region of Ethiopia. For this study, we used the data collected from 202 randomly selected wheat producers through a structured questionnaire. The data were analyzed using propensity score matching (PSM) and the generalized Roy model of the semiparametric local instrument variable (LIV) method. The results of the PSM estimation showed that wheat row planting has a positive and significant impact on productivity. The study found that farmers who sowed wheat in a row produced 1368 kg of wheat per hectare compared to the counterfactual scenario. To further validate whether this result is a pure effect of the row planting technique, we performed a covariate balance test that confirmed the insensitivity of the treatment effect estimates to unobserved selection bias. In addition, the Marginal Treatment Effect (MTE) model also showed that the marginal utility of row planting adoption increases the propensity of farmers to adapt climate-smart agriculture technologies. Therefore, by increasing the productivity of farm households, the expansion of technology will significantly contribute to farmers' resilience to the harmful effects of climate change and welfare.

Effectiveness and safety of P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a nationwide registry-based study.

To compare the effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Nationwide, registry-based study of STEMI patients treated with primary PCI (2011-17) and subsequently with aspirin and a P2Y12 inhibitor. The effectiveness outcome was major adverse cardiovascular events (MACE) defined as a composite of recurrent myocardial infarction, repeat revascularization, stroke, or cardiovascular death at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate absolute and relative risks for outcomes standardized to the distributions of demographic characteristics of all included subjects. We included 10 832 patients; 1 697 were treated with clopidogrel, 7 508 with ticagrelor, and 1,627 with prasugrel. Median ages were 66, 63, and 59 years (P < 0.001). Standardized relative risks of MACE were 0.75 for ticagrelor vs. clopidogrel (95% confidence interval [CI], 0.64-0.83), 0.84 for prasugrel vs. clopidogrel (95% CI, 0.73-0.94), and 1.12 for prasugrel vs. ticagrelor (95% CI, 1.00-1.24). Standardized relative risks of bleeding were 0.77 for ticagrelor vs. clopidogrel (95% CI, 0.59-0.93), 0.89 for prasugrel vs. clopidogrel (95% CI, 0.64-1.15), and 1.17 for prasugrel vs. ticagrelor (95% CI, 0.89-1.45). Ticagrelor and prasugrel were associated with lower risks of MACE after STEMI than clopidogrel, and ticagrelor was associated with a marginal reduction compared with prasugrel. The risk of bleeding was lower with ticagrelor compared with clopidogrel, but did not significantly differ between ticagrelor and prasugrel.

English

Agricultural advisory services play a key role in disseminating agricultural information and technology to farmers. This study aims to assess the impact of agricultural advisory on improving agricultural productivity in Benin. The study uses cross-sectional data collected from randomly selected maize and cotton farmers located in the cotton basin of northern Benin.&nbsp; A total of 809 cotton and maize farmers (with access to farm advisory services or not) from 81 villages in the study area were selected. To overcome selection bias and the problem of endogeneity associated with the impact assessment, regression with endogenous treatment effect model was used. Besides assessing the effect of the farm advisory on productivity, this model also has the advantage of highlighting the main factors determining farmers&rsquo; access to advisory services. The results show that access to advisory services has a positive and significant impact on farm productivity. Maize and cotton farmers with access to the advisory services have a higher yield (yield improvement of 552.3 kg/ha and 668 kg/ha for maize and cotton, respectively) compared to their counterparts without access. In addition to access to agricultural advice, education, membership of farmers&rsquo; group, use of tractor, quantity of mineral fertiliser, use of cover crops, access to credit and the number of cattle have a positive effect on productivity. On the other hand, age, household size, and use of improved varieties have the opposite effect. Furthermore, the main factors influencing farmers&#39; access to extension services are age, gender, membership of a cooperative and distance between village and the municipal town. Strengthening the capacity of extension services is therefore essential for improving agricultural productivity. Key words: Agriculture, advisory services, maize productivity, cotton, North Benin.