Sustainable Intensification Practices Reduce Food Deficit for the Best- and Worst-Off Households in Ethiopia and Mozambique

An adequate food supply is widely recognized as a necessary condition for social development as well as a basic human right. Food deficits are especially common among semi-subsistence farming households in eastern and southern Africa and farm productivity is widely regarded as the locus for enhancing household food outcomes. However, knowledge gaps surrounding benefits associated with climate smart, productivity-enhancing technologies require attention. This study evaluates benefits associated with sustainable intensification farm management practices (crop residue retention, minimum tillage, manure application and use of herbicides, pesticides, fertilizer, and improved seeds) for household calorie and protein supplies and demonstrates their scope across households with high-, moderate- and low- likelihoods of calorie and protein deficits. Household-level calorie and protein deficits were estimated from survey data on food production, acquisition and consumption for households in Ethiopia and Mozambique. Multinomial logistic models were used to identify drivers of household food deficit status and logistic model trees established “rules of thumb” to classify households by food deficit status as low, moderate or high likelihood. In Ethiopia, especially wet seasons were associated with a high likelihood of a food deficit while especially dry seasons were associated with a high likelihood of food deficit in Mozambique. The practices associated with sustainable intensification and related technologies substantially enhanced food outcomes in groups with a high- and a low-likelihood of food deficit, and associated benefits were high for the best-off households. Benefits associated with sustainable intensification technologies were not observed for households with a moderate likelihood of a food deficit and some technologies even increased risk. The sustainable intensification practices assessed here were associated with improved food outcomes yet benefits were limited in scope for households of intermediate status. Thus, there is a need to expand the technical options available to reduce food deficit.

Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout

Objectives This study aimed to develop a virtual electronic health record (EHR) training and optimization program and evaluate the impact of the virtual model on provider and staff burnout and electronic health record (EHR) experience. Methods UCHealth created and supported a multidisciplinary EHR optimization and training program, known as the Epic Sprint Program. The Sprint Team conducted dozens of onsite Sprint events over the course of several years prior to the pandemic but transitioned to a fully virtual program and successfully “sprinted” 21 outpatient clinics from May to December 2020. Core program components of group and 1:1 training, workflow analysis, and new or adjusted EHR build were unchanged from the onsite model. Pre- and post-Sprint surveys provided detailed, objective data about EHR usability, EHR proficiency, job satisfaction, and burnout. Results The EHR Net Promoter Score (NPS), a likelihood to recommend metric, increased by 39 points (−3 pre and 36 post; p < 0.001) for providers and 29 points (8 pre and 37 post; p = 0.001) for staff post-Sprint. Positive provider (NPS = +53) and staff (NPS = +47) NPS scores indicated a high likelihood to recommend the Sprint Program. Post-Sprint surveys also reflect an increase in providers (10%; p = 0.04) and staff (9%; 0.13) who indicated “no burnout” or “did not feel burned out.” Discussion The UCHealth Sprint Team transitioned this comprehensive, enterprise level initiative from an onsite model to a fully virtual EHR training and optimization program during the first few months of the novel coronavirus disease (COVID-19) pandemic. Despite this change in program delivery, survey data clearly demonstrated improved EHR satisfaction, a high likelihood to recommend a sprint to a friend or colleague, and a trend toward burnout reduction in providers and staff. Conclusion Changing an existing on-site EHR optimization program to a purely virtual format can be successful, and this study showed improved provider and staff EHR satisfaction with reduced burnout.

Kept in the Family: Remarriage, Siblings, and Consanguinity in the Netherlands

Widowhood involves many practical challenges next to the emotional impact of bereavement. Remarriage to a blood relative of a deceased spouse can often help a bereaved spouse to solve issues related to inheritance, child care, and comfort in a stressful period. A study of 15,540 widowers and 18,837 widows in the Dutch province of Zeeland—of whom about 8,000 men and 5,000 women eventually remarried—which uses genealogical data about their partners and the links family-reconstitution database, finds that the relatively high likelihood of farmers’ widows remarrying and doing so with kin may have been a strategy to prevent property from falling into the hands of other families. Notwithstanding that the attractiveness of a widow or widower could also be a factor in opportunities to remarry, older widows and widows with many young children, whose chances on the remarriage market tended to be poor, did not usually have such recourse to kin in remarriage.

Acute GVHD: think before you treat

The treatment of acute graft-versus-host disease (aGVHD) has become more nuanced in recent years with the development of improved risk classification systems and a better understanding of its complex, multisystem pathophysiology. We review contemporary approaches to the risk stratification and initial treatment of aGVHD, including ongoing clinical trials. We summarize the findings that led to the first US Food and Drug Administration approval for steroid-refractory aGVHD (SR-aGVHD), ruxolitinib, as well as some of the challenges clinicians still face in treating SR-aGVHD. Finally, we discuss the evaluation and management of steroid-dependent aGVHD, which affects approximately one-third of patients who have long-term, waxing and waning symptoms distinct from chronic GVHD. Future clinical trials for aGVHD treatment may identify steroid-sparing approaches for patients who have a high likelihood of response and approaches to improve tissue repair and dysbiosis for those unlikely to respond to immunosuppression alone.

Preliminary Impact of a Social Connection Program on Older Adults

Background Research demonstrates social connections decrease loneliness and improves life satisfaction among older adults. Unfortunately, the COVID-19 pandemic has limited social connectedness, specifically for older adults. Thus, programs aiming to increase social connectedness among older adults are imperative. Purpose The primary objective of this study was to determine if the telephonic Peer-to-Peer (P2P) program can improve social connectedness and loneliness among older adults. A secondary objective was to determine whether additional improvements in life satisfaction and perception of aging were achieved. Methods Eligible older adults (age 65+) were recruited via outbound calls and/or a mailer. Participants were mailed a T1 survey, completed intervention training, and matched into a dyad. The matched dyad engaged in weekly telephone calls for 12 weeks. Post 12 weeks, participants completed a T2 survey, and a T3 four weeks later. Results Overall, 7,544 individuals were contacted to participate, and 759 expressed interest in participation. A total of 475 participants (62%) completed a T1, 372 (78%) completed training, and 348 (94%) were matched. Gender distribution was skewed towards females (74%), and most were 65-74 years old (53%). Preliminary results show significant differences between lonely and not lonely participants, with lonely participants reporting more negative health associations across all measures. Conclusion Once agreeing to participate, results showed a high likelihood of continuing in P2P, thus demonstrating a social connectedness opportunity for older adults. Delay in mailing and scheduling training may contribute to challenges in attrition. However, developing automated processes utilizing technology may decrease lag time for future phases.

Efficiency vs. Resilience: Lessons from COVID-19

Why was the world not ready for COVID-19, in spite of many warnings over the past 20 years of the high likelihood of a global pandemic? This chapter argues that the economic goal of efficiency, focused on short-term optimization, has distracted us from resilience, which is focused on long-term optimization. Computing also seems to have generally emphasized efficiency at the expense of resilience. But computing has discovered that resilience is enabled by redundancy and distributivity. These principles should be adopted by society in the “after-COVID” era.

Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis

Understanding the impact of preemptive interventions on development for those with a high likelihood for autism is a critical step in building a transdiagnostic model of optimized intervention. The purpose of this systematic review and meta-analysis is to examine the impact of preemptive autism interventions on parent outcomes and child developmental outcomes. A total of 345 unique records were assessed for eligibility yielding 13 unique studies with 715 total infant/toddlers with a high likelihood for autism. There was a significant association between the early interventions on parent implementation of intervention strategies immediately following the intervention. However, there was no significant association between the early interventions and child developmental outcomes. The studies reporting moderator and/or mediator analyses suggest a meaningful association between parent implementation and long-term child social communication outcomes. Taken together, these findings suggest that parent-mediated interventions are associated with improved parent use of strategies, and although these results do not translate into immediate or short-term child developmental outcomes, there is evidence that parents with the greatest implementation facilitate later improved communication outcomes for their children. There is an urgent need to develop a nuanced intervention approach during a time of ever-changing concern about child development. Lay abstract Interventions to address core symptoms for young children on the autism spectrum have a strong and growing evidence base. Adapting and delivering evidence-based interventions to infants and toddlers with a high likelihood for autism is a logical next step. This systematic review and meta-analysis summarize the association between infant and toddler interventions and developmental and family outcomes. Results indicate that these early interventions are effective for improving parent implementation of core strategies, yet the effects do not readily translate to child outcomes. However, key studies demonstrate conditional results that indicate that parent implementation is associated with child outcome. Implications for research and practice toward building adaptive interventions that respond to parent implementation and changing child characteristics are discussed.

Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations

Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARM). This study proposes sacral curvature (SC) as a new indicator to qualitatively assess the sacrum and hypothesizes that sacral development, both quantitatively and qualitatively, can be an indicator to predict the type of ARM. The study aims to investigate the difference of SR and SC between ARM types and the association with the type of ARM.Methods and Materials: This study was retrospectively conducted between August 2008 and April 2019. Male patients with ARMs were enrolled and divided into three groups based on the types of ARM: (1) rectoperineal fistulae, (2) rectourethral-bulbar fistulae, and (3) rectourethral-prostatic or rectobladder-neck fistulae. SC was measured in the sagittal views of an MRI or a lateral radiograph of the sacrum.Results: Included in the study were 316 male patients with ARMs. SRs were 0.73 ± 0.12, 0.65 ± 0.12, and 0.57 ± 0.12 in perineal, bulbar, and prostatic/bladderneck fistula, respectively (p &lt; 0.01). The SCs in perineal fistulae and bulbar fistulae were significantly higher than that in prostatic/bladderneck fistulae (0.25 ± 0.04, 0.22 ± 0.14, and 0.14 ± 0.18, p &lt; 0.01). When SR ≥ 0.779, there was an 89.9% of possibility that the child has a perineal fistula. When SR ≤ 0.490 and SC ≤ 0, the possibilities of the child having prostatic/bladderneck fistulae were 91.6 and 89.5%, respectively. SC &lt; 0 was also noted in 27 (27.8%), 19 (10.5%), and no (0%) patients of prostatic/bladderneck, bulbar, and perineal fistulae (p &lt; 0.01), respectively. Sacral defect was noted in 63% of patients with SC ≤ 0, compared to none with SC &gt; 0 (p &lt; 0.01).Conclusions: The higher the rectal level is in an ARM, the lower are the objective measurements of the sacrum. SC ≤ 0 is associated with sacral defects and implies a high likelihood of prostatic/bladderneck fistulae.