Propensity Score Matching Model Research Articles

Effectiveness and Safety of Lianhua Qingwen Capsules for COVID-19: A Propensity-Score Matched Cohort Study.

As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group.

Oil extraction and gender equality for social equity: The role of corporate social responsibility in Nigeria's coastal communities

We examine the impact of multinational oil companies' (MOCs) corporate social responsibility (CSR) on gender equality for social equity using a combined propensity score matching and logit model. The result indicates a significant relationship between CSR and gender equality for social equity in coastal communities of Nigeria's oil producing region. This implies that CSR of MOCs is a critical factor for promoting equal opportunity, equal access, equal treatment, equal sharing and division of resources. The finding suggest for improved CSR investment of MOCs on empowering the women in coastal communities in taking up alternative livelihoods from conservation and marine resources.

Abstract TP106: Outcomes Following Off-label Glyburide In Large Hemispheric Infarction: A Single-center Experience

Background: One in 10 ischemic strokes are large hemispheric infarctions (LHI), half of which cause cerebral edema that can lead to significant mortality. Our center implemented a protocol using acute glyburide in patients with LHI to determine its safety and efficacy in reducing formation of cerebral edema. Methods: Consecutive adult patients at our center (10/2019-08/2021) with LHI who met criteria for the CHARM trial were treated with glyburide per an institutional protocol (2.5mg per nasogastric tube twice daily for 3 days) with multi-disciplinary oversight. Unadjusted logistic regression was used to estimate odds of a favorable shift in 90-day modified Rankin Scale (mRS), with adjustment for age, pre-stroke mRS, National Institutes of Health Stroke Scale (NIHSS) and large vessel occlusion (LVO). Propensity-score matching was used to model shift in 90-day mRS. Safety events were also assessed. Results: Of 1684 stroke patients treated at our center, 95 met criteria for CHARM and were included, among whom 21 completed the glyburide protocol (28 attempted) and 67 received standard-of-care (SOC); 34 patients were propensity-matched (nglyburide=17). Compared to SOC (n=67), patients treated with glyburide (n=21) had similar pre-stroke mRS, NIHSS, and LVOs, but were younger (median 61y vs. 67y, p&lt;0.01). Glyburide was not associated with a favorable shift in 90-day mRS in unadjusted (OR 1.40, 95%CI 0.51-3.88) or adjusted regression (OR 0.71, 95%CI 0.17-2.94), or following propensity score matching (OR 1.39, 95%CI 0.32-6.07). There was no significant reduction in midline shift in unadjusted, adjusted, or propensity score-matched models (p&gt;0.05). Two patients required D50 rescue, and 1 did not complete the protocol due to recurrent hypoglycemia. Conclusions: In this single center analysis, glyburide was found to have a low risk of hypoglycemic events. Despite the small sample size, there was no signal of better clinical or imaging outcomes in treated patients.

Real-world impact of empagliflozin on total cost of care in adults with type 2 diabetes: Results from an outcomes-based agreement.

BACKGROUND: Value-based health care is expanding through payment models such as outcomes-based agreements between manufacturers and payers. OBJECTIVE: To describe the total-cost-of-care outcomes of an outcomes-based agreement evaluating the real-world impact of empagliflozin vs other type 2 diabetes mellitus (T2DM) drugs among all patients with T2DM, with and without cardiovascular disease (within and beyond the requirement of the agreement). METHODS: In this prospective real-world analysis, members from the health plan of an integrated health care delivery system from the commercial and Medicare Advantage lines of business, who qualify under the confines of the contract, were included for analysis. Thus, members aged 18 years and older who were continuously enrolled in the identification (January 1, 2018, to December 31, 2018) and measurement periods (≤1 year post-index) with a T2DM diagnosis were retained. Patients using empagliflozin and empagliflozin-combination drugs constituted the empagliflozin group; those using all other antihyperglycemics, the nonempagliflozin group. Patients with type 1 diabetes, or those using metformin or insulin monotherapy, at index were excluded. Eligible members were followed for up to the earliest occurrence of disenrollment date, discontinuation (60-day medication fill gap allowed) of empagliflozin (or nonempagliflozin containing) medication, or the end of the measurement period. We compared, using Student's t-test and summary statistics (for reporting the outcomes agreement) and a propensity-matched difference-in-difference model (for the followup evaluation beyond the requirement of the agreement), the mean all-cause total cost of care (pharmacy plus medical) per patient per month (PPPM) between the 2 groups, including a subgroup of members with a baseline cardiovascular disease diagnosis. RESULTS: There were 4,577 (3,069 and 1,508 in the commercial and Medicare) and 33,712 (15,571 and 18,141 in the commercial and Medicare) in the empagliflozin and nonempagliflozin groups, respectively. The difference in mean total cost PPPM was $75 lower for empagliflozin vs nonempagliflozin groups, driven mainly by lower medical costs in the empagliflozin group (-$465 PPPM). However, the difference was not statistically significant in the propensity score-matched model. CONCLUSIONS: Although empagliflozin had higher pharmacy costs, the total cost of care for patients with T2DM and with established cardiovascular disease were comparable to the group of patients with all other T2DM, driven mainly by lower medical costs. DISCLOSURES: The authors report no conflicts of interest beyond being employees of the 2 organizations involved in this outcomes-based agreement. Ms. Palli is a former employee of Boehringer Ingelheim Pharmaceuticals, Inc., who was affiliated at the time of study conduct.

Impact of adopting the climate-smart crop varieties on food security in southwestern Ethiopia

Climate-smart crop varieties (CSV) are vital in improving food security by enhancing productivity while reducing problems of climate change. However, there is a low adoption of these varieties by the farmers in the study area due to lack of awareness of their impact on food security. Therefore, this study was designed to analyze their impact on food security in southwestern Ethiopia. The data were collected from 385 randomly selected sample households using a semi-structured questionnaire. Both descriptive and econometric analyses were used to analyze the data. The propensity score matching (PSM) model was used to evaluate the impact of climate-smart crop varieties on food security. Descriptive analysis showed that about 59.74% of the respondents were adopters of climate-smart crop varieties. The PSM analysis result revealed that the adoption of climate-smart crop varieties had a significant positive impact on food security. This implies that the likelihood of being food secure would increase by a factor of 0.8 if the climate-smart crop varieties were adopted. Therefore, developing and disseminating the climate-smart crop varieties at the right time through educational improvement (strengthening collaboration) and allocating land for their development is suggested for policymakers to improve food security.

Comparison of lymph node metastasis pattern from esophagogastric junction adenocarcinoma versus very low thoracic esophageal squamous cancer: a propensity-matched analysis.

The anatomical locations of esophagogastric junction adenocarcinoma (AEG) and very low thoracic esophageal squamous cell carcinoma (ESCC) are similar. This study aimed to evaluate the difference in lymph node metastasis (LNM) distribution between AEG and very low thoracic ESCC. Data from 156 Siewert I-II AEG patients and 120 ESCC patients with proximal edges located within 5 cm of the esophagogastric junction (EGJ) and underwent curative surgery from 2010 to 2015 were retrospectively analyzed using propensity score matching (PSM). Five or six baseline variables were included in PSM separately. All patients underwent curative transthoracic surgery and systematic lymphadenectomy. After PSM, LNM rates of major stations were compared using the chi-squared test or Fisher's exact test. After PSM was performed with covariates (age, sex, T stage, grade, tumor length), 60 pairs of patients were included. The lower mediastinal and total thoracic LNM rates of ESCC were significantly higher than those of AEG (18.3% vs. 3.3%, P=0.019; 25% vs. 3.3%, P=0.002). After further addition of the N stage as a variant to the previous PSM model, we found that the paracardial LNM distribution was significantly different between ESCC and AEG patients (36.1% vs. 19.7%, P=0.043). Among all tumor characteristics, only the T stage was positively correlated with paracardial LNM in ESCC (P=0.010), but not in AEG. In AEG, the median survival was poor for patients with thoracic LNM. Patients with very low thoracic ESCC exhibit stronger metastatic ability in the lower mediastinal and paracardial nodes than Siewert I-II AEG. However, the pathological metastasis of AEG in thoracic nodes was associated with poor survival outcomes.

Allopurinol and the Risk of Diabetic Macular Edema among U.S. Veterans with Type 2 Diabetes

ABSTRACT Background By inhibiting xanthine oxidase, subsequent inflammatory cytokine release and the resulting breakdown of the blood–retina barrier, allopurinol may limit the inflammation-driving diabetic macular edema (DME). Methods We examined the relationship between allopurinol and DME among type 2 diabetic United States veterans using a retrospective cohort study. We used propensity score matching and Cox hazard models to estimate the risk of DME. Results Propensity score-matched Cox models revealed allopurinol was associated with a 24.6% reduction in the risk of DME (HR = 0.754; 95% CI = (0.684–0.831)). Conclusion Allopurinol could reduce the risk of DME, one of the major causes of visual disturbance among diabetic patients. Further research into the effects of allopurinol on DME is warranted.

Preoperative Cannabis Use Did Not Increase Opioid Utilization After Primary Total Knee Arthroplasty in a Propensity Score–Matched Model

Background: Recreational and medicinal cannabis use is becoming increasingly popular, but there are little data on its effect on postoperative pain and opioid consumption after primary total knee arthroplasty (TKA). Purpose: We sought to evaluate the relationship between self-reported preoperative cannabis use and postoperative opioid consumption and post-discharge opioid prescriptions following elective primary TKA. Methods: We identified all patients who underwent unilateral, primary TKA for a diagnosis of osteoarthritis at a single institution between February 1, 2019, and April 30, 2021, and subdivided them into current cannabis users and non-users based on self-reported data. Regular users were propensity score-matched 1:6 with non-users using logistic regression on age, sex, body mass index (BMI), history of chronic pain, smoking status, history of anxiety/depression, American Society of Anesthesiology (ASA) classification, and type of anesthesia. Outcomes of interest included median inpatient (total, daily, and hourly) morphine milligram equivalents (MMEs), discharge MMEs, and outpatient MMEs within 90 days after surgery. Results: A cohort of 70 current cannabis users was matched with 420 non-users. There were no significant differences in opioid use in inpatient MMEs (hourly, daily, or total), discharge MMEs, or outpatient MMEs between cohorts. Also, there was no significant difference in hospital stay between cohorts. Conclusion: In this retrospective propensity score–matched model, preoperative cannabis use did not independently increase opioid use post-TKA in the inpatient or outpatient setting when compared with non-use. More rigorous, prospective study is warranted.

Examining the Impact of the Separation of Ownership from Management on the Performance of Small and Medium Poultry Agribusinesses in Ghana

ABSTRACT This study aimed to examine the relationship between the Separation of Ownership and Management (SOM) and the performance of poultry farms in Ghana. Binary Probit regression was used to examine the factors influencing SOM and the owner’s willingness to separate management from ownership. The Propensity Score Matching (PSM) model and Instrumental Variable Tobit Regression were used to analyze the impact of SOM on financial and non-financial performances. The results revealed that most farms studied had separate ownership and management roles, but owners still exerted the same amount of control over farm operations. SOM was determined to significantly impact the financial performance variable of total assets but did not impact total sales revenue and non-financial performance variables of employee satisfaction or corporate social responsibility. Owner’s demographics, perception and control variables, and farm characteristics have varying influences on the separation of ownership and management and the willingness to undertake the same.

Impact of Soil and Water Conservation on Household Income in East Shoa Zone of Oromia

This study was conducted to assess the impact of Soil and Water Conservation (SWC) intervention on the livelihood of smallholder farm households in terms household income and productivity. To meet this objective primary data was gathered in 2010 from 120 sample respondents (50 SWC program participants and 70 non-participants). Descriptive and inferential statistics (Logistic regression) and propensity score matching (PSM) models were used to address the stated objectives. The analysis of mean difference in outcome variables before matching result indicated that the mean total crop yield for SWC practiced respondent households is 29.10 and 27.80 quintal/ha having 1.30 quintal difference in the study. In the meantime total annual crop income of households who participated in SWC program was 33,903 and 33,808.40 birr. Except sex of the household, Market information, amount of land cultivated, Education and farm experience influenced the probability of HH participation in SWC positively and significantly at 10% expect land cultivated at 5% level. Nominal results of analysis of treatment effects indicate that there was a sign of positive impact on both of the variables considered due to SWC program. However, the changes in crop productivity and gross household income could not be statistically justified as there was no statistically significant difference between the two groups in terms of these variables. The possible reason could be that SWC programs are not short-term nature and impacts are to be realized gradually with increased adoption and intensification of activities.

Uptake of postplacental intrauterine device placement at cesarean delivery

Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.

The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery.

Due to radioresistance, some HER2+ patients may gain limited benefit from radiotherapy (RT) after breast-conserving surgery (BCS). This study aimed to develop an individualized nomogram to identify early-stage HER2+ patients who could omit RT after BCS. The data of HER2+ patients with T0-2N0M0 breast cancer after BCS between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER). Based on the independent prognostic factors determined by the Cox analysis in patients without RT after propensity score matching (PSM), the nomogram and risk stratification model were constructed, and then the prognosis of patients with and without RT was compared in each stratified group. A total of 10799 early-stage HER2+ patients after BCS were included. Baseline characteristics were similar between groups after PSM. Multivariate Cox analysis indicated that RT could improve overall survival (OS) (HR: 0.45, P<0.001) and breast cancer-specific survival (BCSS) (HR: 0.53, P<0.001). Age, marital status, tumor location, tumor size, and chemotherapy were identified by multivariate Cox analysis in patients without RT and were incorporated into a well-validated nomogram. The risk stratification model based on the nomogram indicated that RT was associated with improved OS (HR 0.40, P< 0.001) and BCSS (HR 0.39, P< 0.001) in the high-risk group but not in the low-risk group [OS: HR 1.04, P = 0.94; BCSS: HR 1.06, P = 0.93]. RT could significantly improve the OS and BCSS of HER2+ early-stage breast cancer patients after BCS on the whole. For high-risk patients, RT is an essential component of cancer therapy. However, the omission of radiotherapy may be considered for low-risk HER2+ early-stage patients. Further validation and improvement of the nomogram by prospective study or randomized controlled trials are warranted.

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model.

The management of severe COVID-19-induced acute respiratory distress syndrome (C-ARDS) often involves deep sedation. This study evaluated the efficacy of sevoflurane, a volatile anesthetic, as an alternative to traditional intravenous sedation in this patient population. This single-center, retrospective cohort study enrolled 112 patients with C-ARDS requiring invasive mechanical ventilation. A propensity score matching model was utilized to pair 56 patients receiving sevoflurane sedation with 56 patients receiving intravenous sedation. The primary outcome was mortality, with secondary outcomes being changes in oxygenation (PaO2/FiO2 ratio), pulmonary compliance, and levels of D-Dimer, CRP, and creatinine. The use of sevoflurane was associated with a statistically significant reduction in mortality (OR 0.40, 95% CI 0.18-0.87, beta = -0.9, p = 0.02). In terms of secondary outcomes, an increase in the PaO2/FiO2 ratio and pulmonary static compliance was observed, although the results were not statistically significant. No significant differences were noted in the levels of D-Dimer, CRP, and creatinine between the two groups. Our findings suggest an association between the use of sevoflurane and improved outcomes in C-ARDS patients requiring invasive mechanical ventilation. However, due to the single-center, retrospective design of the study, caution should be taken in interpreting these results, and further research is needed to corroborate these findings. The study offers promising insights into potential alternative sedation strategies in the management of severe C-ARDS.

Association between early vasopressor administration and in-hospital mortality in critically ill patients with acute pancreatitis: A cohort study from the MIMIC-IV database.

This study aims to explore the association between early administration of vasopressors and in-hospital mortality in acute pancreatitis (AP) patients admitted to the ICU. The MIMIC-IV database was used to identify AP patients who had and had not received vasopressors. Univariate and multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used for statistical analysis. A total of 894 AP patients admitted to the ICU were included in the study. Among them, AP patients who received vasopressors were associated with an increased risk of in-hospital mortality in the unadjusted model (OR: 7.77, 95% CI 4.92-12.61, p<0.001), multivariable-adjusted model (OR: 2.51,95% CI 1.1-5.76, p<0.05), PSM model (OR: 2.58, 95% CI 1.03-6.85, p<0.05) and IPTW model (OR: 1.82, 95% CI 1.06-3.15, p<0.05) compared with patients who did not receive vasopressors. In the subgroup analysis, age (≥ 65 years old: OR: 2.5, 95% CI 0.82-7.91; <65 years old: OR: 4.63, 95% CI 0.84-26.41), male (OR: 1.19, 95% CI 0.35-4.03), ethnicity (white: OR: 2.49, 95% CI 0.81-7.62; non-white: OR: 4.28, 95% CI 0.85-23.7), usage of norepinephrine (OR: 2.29, 95% CI 0.91-5.78), and single-use of vasopressor (OR: 1.48, 95% CI 0.43-4.95) were not associated with in-hospital mortality in patients with AP, whereas vasopressin (OR: 4.27, 95% CI 1.24-15.13; p<0.05) and phenylephrine usage (OR: 4.75, 95% CI 1.66-13.95; p<0.05), combined vasopressor usage (OR: 4.41, 95% CI 1.55-12.96; p<0.01), and female usage (OR: 7.89, 95% CI 2.03-34.2; p<0.01) were associated with in-hospital mortality. Early vasopressor use is significantly associated with increased in-hospital mortality among critically ill AP patients. This association might be greater in females, vasopressin, phenylephrine, and combined vasopressor users. Our results may benefit clinicians as they can guide the rational use of vasopressors in critically ill AP patients admitted to the ICU.

Why does knee flexion in the standing position occur? Spinal deformity or knee osteoarthritis.

Background: The interaction between knee osteoarthritis and spinal deformity and knee flexion (KF) remains unclear. We aimed to clarify the relationship between KF in the standing position and the severity of spinal deformity and knee osteoarthritis. Methods: We analyzed older volunteers aged over 60 years who participated in the musculoskeletal screening program. The participant's characteristics and standing radiographic parameters were assessed. After a preliminary analysis, a propensity score-matched model was established with adjustments for age, sex, and body mass index (BMI). Cases were divided into KF (knee angle [KA] ≥10°) and non-KF (KA <10°) groups. Results: In a preliminary analysis of 252 cases (42KF and 210 non-KF), there were significant differences in age and BMI between the KF and non-KF groups (all p < 0.05). Using a one-to-one propensity score-matched analysis, 38 pairs of cases were selected. There were significantly higher values of C7 sagittal vertical axis, T1 pelvic angle, pelvic tilt, pelvic incidence minus lumbar lordosis, KA, ankle angle, and pelvic shift in the KF group than in the non-KF group (all p < 0.05). In the KF group, 71.1% of the cases had severe spinal deformity (defined as marked deformity by the SRS-Schwab classification), and 31.6% had severe knee osteoarthritis (defined as a Kellgren Lawrence grade ≥3). Of the 31.6%, 7.9% were attributable to knee osteoarthritis alone, and 23.7% to both knee osteoarthritis and spinal deformity. Conclusions: This study clarified that compensatory changes due to spinopelvic malalignment, not due to knee osteoarthritis alone, mainly affected KF in the standing position.

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

ObjectiveTo find out the effect of different oral anticoagulation therapies (OAC) on mortality rate in patients with acute kidney injury (AKI) and atrial fibrillation (AF).DesignA retrospective study.SettingThis study was conducted...

Farmers′ use of climate change adaptation strategies and their impacts on food security in Kenya

Climate change threatens the sustainability of food production among farmers in Kenya who depend on rain‐fed agriculture. To minimize the negative impacts of climate change, farmers have sought to adopt different adaptation strategies. This study investigates factors influencing farmers’ choice of climate change adaptation strategies and associated effects on their food security in Kenya using data collected from 540 farmers from six counties. A multivariate probit, censored least absolute deviation (CLAD), and propensity score matching (PSM) models were employed to identify the determinants in the farmers’ choice of climate change adaptation strategies, the number of adaptation strategies adopted, and the effect of climate change adaptation strategies on their food security, respectively. Results show that planting drought-tolerant crop varieties (55%), growing diversified crops (34%), growing early maturing crops (22%), and diversifying the sources of household income (18%) were the four major adaptation strategies used by the farmers in the study area. Younger farmers and those with higher education levels are more likely to use these climate change adaptation practices. The number of adaptation strategies used was positively associated with male farmers, education level, family size, land size, farm income, extension contact, training, and information access. The farmers who adopt one adaptation strategy have higher food security status (approximately 7–11%) than those who do not. If they adopt two adaptation strategies, their food security status increases by approximately 11–14%; if they adopt three adaptation strategies, their food security status increases by nearly 12–15%; and if they adopt four adaptation practices, their food security status increases by about 14–18%, compared to those who do not adopt any strategy. Thus, the farmers’ climate change adaptation practices have positive food security effects in Kenya according to the number of adaptation strategies adopted.

Impact of collective marketing participation on farmers' income: Evidence from smallholder avocado farmers of Murang'a County, Kenya

Avocado (Persea Americana) is a major crop in Kenya but its potential to generate income is limited by challenges associated with production and marketing. The objective of this study was to assess the impact of participation in collective marketing on the incomes of smallholder avocado farmers in Kigumo Sub-County, Murang'a County, Kenya. Data was collected from 300 randomly selected households comprising of 150 participants and 150 non-participants of collective marketing. Data collected included demographic characteristics, socio-economic and institutional factors, farmers' income, and market information. Propensity Score Matching (PSM) models were employed to estimate the impact of participation in collective marketing on incomes. Results showed that farmers who participated in collective marketing benefitted from increased production and better sales. Participation in avocado collective marketing increased farmers' incomes by an average of 32.95% during the three consecutive years considered (2018, 2019, and 2020). Participants produced significantly higher avocado fruits (1251.3 kg) compared to non-participants (889.7 kg) in 2020. Participants also fetched better prices of 7.5Ksh per fruit compared to non-participants who sold their fruits at 5Ksh. Based on our findings, we recommend that farmers should participate more in collective marketing so as to improve the incomes from their avocado production. Policymakers should also promote a collective marketing strategy through interventions such as improving access to avocado collection centers and provision of market infrastructures.

Routine nasogastric tube placement in patients with small esophageal perforation after endoscopic foreign body removal may be unnecessary: a propensity score matching analysis.

Nasogastric tube (NGT) placement is part of the post-operative management of upper gastrointestinal perforation, but its routine use in esophageal perforation (EP) caused by foreign bodies remains unclear. The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal. A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study. Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed. The perforation healing rate, post-operative adverse events, hospital stay, and death rate were analysed using a 1:1 propensity score matching model. Before matching, there were 263 patients in the NGT group and 60 patients in the non-NGT group. There were significant differences in the time to treatment, infection, albumin, and types of endoscopy between the two groups, while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group. After 1:1 propensity score matching, 48 pairs of patients were matched between the two groups. The perforation healing rate, post-operative adverse events, length of hospital stay, and death rate did not show significant differences between the two groups. For patients with small EP caused by foreign bodies, routine NGT placement after endoscopic foreign body removal may be unnecessary.

The Impact of the Belt and Road Initiative on Corporate Excessive Debt Mechanism: Evidence from Difference-in-Difference Equation Model

This paper uses the difference in difference (DID) model to explore the impact of the “Belt and Road” Initiative (BRI) on the level of corporate debt and its mechanism based on quasi-natural experiment of the promulgation and implementation. The results indicate that the excessive debt level of enterprises has a hump trend after the implementation of the BRI. The excessive debt level of enterprises shows a hump trend—that is, although the excessive debt level of enterprises in the initial stage of the implementation of the BRI increases to a certain extent, showing a significant downward trend in the middle and later stages. By using the placebo test and DID propensity score matching model to alleviate the possible endogeneity problem, the above conclusion is still robust. The mechanism analysis shows that: during the implementation of the BRI, the government, and financial institutions have increased tax support for companies participating in the BRI, expanded corporate financing sources, reduce corporate financing costs, and increase companies’ demand for funds. As a result, the level of corporate debt has been increases. The conclusions of this paper not only provide micro-evidence for the interaction between the BRI and the micro-behavior of enterprises, but also have certain implications for evaluating the implementation effect of the BRI and subsequent reforms and refuting the “debt trap” of the “Belt and Road” construction from a microscopic perspective.