Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)

INTRODUCTION In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income). METHODS AND ANALYSIS Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation. ETHICS AND DISSEMINATION Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer's Disease International, and via ongoing engagement with key policymakers

Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

To grip or to slip : smallholder inclusion in sustainable palm oil certifications in Riau, Indonesia

Increasing global focus on sustainable palm oil (SPO) initiatives has led to discussions of smallholder integration at the bottom of the supply chain. In 2019, the Roundtable on Sustainable Palm Oil (RSPO) introduced a new standard for independent smallholders. Meanwhile, through Presidential Regulation no. 44 of 2020, the President of Indonesia recently made Indonesian Sustainable Palm Oil (ISPO) mandatory for smallholders by 2025. While both certifications aim to improve smallholder inclusion, millions of palm oil independent smallholders face difficulties in attaining certification. This study examines the barriers that these smallholders face in pursuing the regulatory process prior to certification process and how they affect smallholder inclusion in sustainable palm oil initiatives. Through semi-structured interviews and focus group discussions, it analyses the perspectives of four independent smallholder groups pursuing RSPO, an ISPO certified independent smallholder group, and a non-certified independent smallholder community in Riau Province in Indonesia. It also assesses the perspectives of various decision-making stakeholders including certification standard-setters both RSPO and ISPO, and provincial- and local-level government. Walker’s (2012) notion of procedural justice, which includes access to information, access to facilitation and support, access to legal process, and participation in decision-making, is used to analyse the findings. The study finds that limited access to information regarding SPO certifications, a lack of understanding of regulations concerning land, and limited financial support may hinder independent smallholders from pursuing regulatory compliance. Facilitation can help farmers in addressing these issues; however, at the local level, access to facilitation is unequal. The findings show that the inequality is influenced by three factors, namely local institutional arrangement, land status and legality, and practicalities, must thus be concerned when attempting to improve facilitation opportunity. Furthermore, the current centralised licensing system that has been adopted at the local level limits smallholders’ ability to engage with the legal process; this is mainly due to technical and practical issues that arise in navigating convoluted regulations and bureaucracies. A lengthy bureaucratic chain indicates a structural problem due to a lack of coordination among government institutions and lack of clarity in regulations. Furthermore, farmers are facing environmental challenges to differing degrees, which prevents independent smallholder groups from being able to fulfil pre-certification requirements. Thus, from a practical point of view, procedural justice required to incorporate independent smallholders into sustainable palm oil initiatives has not yet been achieved.Meningkatnya fokus global terhadap inisiatif kelapa sawit berkelanjutan memantik integrasi pekebun swadaya dalam sertifikasi kelapa sawit berkelanjutan. Pada tahun 2019, Roundtable on Sustainable Palm Oil (RSPO) memperkenalkan standar baru untuk pekebun swadaya. Sementara itu, melalui Peraturan Presiden no. 44 tahun 2020, Presiden Indonesia menetapkan kewajiban sertifikasi Indonesian Sustainable Palm Oil (ISPO) bagi pekebun pada tahun 2025. Ketika kedua sertifikasi tersebut berupaya meningkatkan inklusivitas pekebun, jutaan pekebun menghadapi kesulitan untuk memperoleh sertifikasi. Studi ini mengkaji hambatan yang dihadapi pekebun untuk memenuhi standar kepatuhan regulasi sebelum memasuki proses sertifikasi dan bagaimana hambatan tersebut memengaruhi inklusivitas pekebun dalam inisiatif kelapa sawit berkelanjutan. Melalui wawancara semi terstruktur dan diskusi kelompok terfokus, penelitian ini menganalisis perspektif empat kelompok pekebun swadaya anggota RSPO, kelompok pekebun swadaya bersertifikasi ISPO, dan komunitas petani swadaya yang tidak bersertifikasi di Provinsi Riau di Indonesia. Lebih lanjut, studi ini juga mengkaji perspektif berbagai pemangku kepentingan termasuk pembuat standar RSPO dan ISPO, dan pemerintah tingkat provinsi dan kabupaten/kota. Gagasan Walker (2012) tentang keadilan procedural, termasuk akses terhadap informasi, fasilitasi dan dukungan finansial, proses hukum, dan partisipasi dalam pengambilan keputusan, digunakan untuk menganalisis temuan. Studi ini menemukan bahwa keterbatasan akses terhadap informasi mengenai sertifikasi SPO, minimnya pemahaman tentang peraturan dan legalitas lahan, dan dukungan finansial yang terbatas dapat menghambat pekebun swadaya untuk memenuhi kepatuhan regulasi. Fasilitasi dapat membantu pekebun dalam mengatasi masalah ini; namun, di tingkat lokal, akses untuk medapatkan fasilitasi tidak merata. Temuan menunjukkan bahwa ketidaksetaraan akses fasilitasi dipengaruhi oleh tiga faktor, yaitu kelembagaan, legalitas lahan, dan aspek praktik, yang harus diperhatikan untuk peningkatan peluang fasilitasi. Selain itu, sistem perizinan terpusat yang berlaku di tingkat lokal membatasi kemampuan pekebun untuk terlibat dalam proses perizinan; masalah teknis dan praktis kerap muncul ketika dihadapkan dengan peraturan dan birokrasi yang berbelit-belit. Rantai birokrasi yang panjang mengindikasikan masalah struktural karena kurangnya koordinasi antar lembaga pemerintah dan kepastian peraturan. Terlebih, pekebun menghadapi tantangan lingkungan yang berbeda-beda, yang mencegah kelompok pekebun swadaya untuk dapat memenuhi persyaratan pra-sertifikasi. Dengan demikian, dari sudut pandang praktis, keadilan prosedural yang diperlukan untuk mengintegrasikan petani swadaya ke dalam inisiatif kelapa sawit berkelanjutan belum tercapai

EFFECT OF COMPANY AGE, AUDIT QUALITY, LEVERAGE AND PROFITABILITY ON EARNINGS MANAGEMENT

This research aims to test the impact of Company Age, Audit Quality, Leverage and Profitability on Earnings management on Indonesian Stock Exchange-listed Retail and Wholesale Trading Companies for the years 2016-2020. The study used data obtained from financial statements. The trade sector, which is listed on the Indonesia Stock Exchange, is the focus population for this study. The sample selection technique used is purposive sampling with several criteria that have been determined, the sample data obtained by 18 companies with the period 2016-2020. SPSS version 25 was utilized for data analysis, and the traditional assumption test of heteroskedasticity multicollinierity, normality test, correlation and determination coefficient test, simultaneous test, and partial test were used. This research showed that company age had a significant positive impact on earnings management, audit quality had a significant negative impact on earnings management, leverage had no significant impact on earnings management and profitability had a positive impact on earnings management

Assessing Drivers of Forest Conservation in Simancuang Village Forest, West Sumatra

This study empirically assessed Social Forestry program implementation in Simancuang Village Forest or locally known as Hutan Nagari (HN) Simancuang in West Sumatra, Indonesia. We performed two analyses using primary and secondary data, namely propensity score matching to estimate the effects of the enactment of HN Simancuang in 2012 on forest cover loss and ordinal logistic regression (OLR) to predict the determinants of conservation awareness. The results of the forest cover analysis showed that forest cover loss in HN Simancuang between 2012 and 2019 was 0.038 percentage point lower than the adjacent protection forest. The relatively small impact was meaningful because although HN Simancuang is located much closer to settlements which increases the pressure on the forest, it could still maintain lower tree cover losses than the adjacent protection forest. This result indicated a certain degree of conservation awareness among HN Simancuang members, which prompted us to conduct a survey to 111 individuals from different households. To do this, we used the Ecosystem Services framework to conceptualise conservation awareness in HN Simancuang. Our OLR results showed that regulating and provisioning services of forests are the strong determinants of conservation awareness among the individuals in our sample. Our study indicates the need to implement social forestry program monitoring and evaluation, improve access to facilitation, and enhance agroforestry practice as the means to increase conservation awareness among forest-dwelling communities.ISSN:1873-7617ISSN:1873-785

#97 : Can Platelet Rich Plasma (PRP) Improve Human Ejaculated Sperm Quality? A Systematic Review and Meta Analysis

Background and Aims: Males are found contribute to 50% of infertility cases overall. Abnormal sperm parameters, such as low concentration, low motility, or abnormally morphology is thought to play a major role in male infertility. In many recent studies, Platelet Rich Plasma (PRP) was reported to have potential therapeutic effect. PRP with its rich growth factor composition, has already proven beneficial in regenerative therapy. PRP can improve the structural and functional impairment of the testis, thereby improve the sperm quality as its product. This study aims to identify the improvement of ejaculated sperm concentration, motility, morphology after treatment with PRP. Methods: A systematic search was conducted in PubMed, Cochrane and Google Scholar databases up to November 2022. We used Prisma’s checklist 2020 as a guideline for writing this. To be included in this meta-analysis, eligible studies had to be a clinical trial comparing ejaculated sperm with PRP treatment and no PRP addition. We conducted both quantitative and qualitative analysis of the assessed outcomes. Results: A total of 91 studies were retrieved. After excluding ineligible publication, 5 studies were finally included in the present meta-analysis (n=331). Among them, varied methods of PRP intervention, but all of them had using PRP 2%. By using a random effect model, there is an improvement of the progressive sperm in group with PRP treatment (MD 15,00, 95%-CI 6,71-23,29). Quantitative analysis (meta-analysis) was not carried out for sperm concentration and morphology, but was explained descriptively, that sperm concentration and morphology increased after PRP treatment. The articles included in the analysis have a low risk of bias. Conclusions: There is an improvement in sperm progressivity after treatment with PRP, that also means there is an improvement in human ejaculated sperm quality. Although found beneficial enhancing the sperm progressivity, but still needed strong evidence for further research

How well does the implementation of corporate zero-deforestation commitments in Indonesia align with aims to halt deforestation and include smallholders?

In response to growing scrutiny surrounding commodity-driven deforestation, companies have introduced zero-deforestation commitments (ZDCs) with ambitious environmental and social targets. However, such initiatives may not effectively reduce deforestation if they are not aligned with the spatial extent of remaining forests at risk. They may also fail to avert socio-economic risks if ZDCs do not consider smallholder farmers’ needs. We assess the spatial and functional fit of ZDCs by mapping commodity-driven deforestation and socio-economic risks, and comparing them to the spatial coverage and implementation of ZDCs in the Indonesian palm oil sector. Our study finds that companies’ ZDCs often underperform in four areas: traceability, compliance support for high-risk palm oil mills, transparency, and smallholder inclusion. In 2020, only one-third of companies sourcing from their own mills, and just 6% of those sourcing from external suppliers, achieved full traceability to plantations. Comparing the reach of ZDCs adopted by downstream buyers with those adopted by mill owners located further upstream, we find that high-quality ZDCs from buyers covered 62% of forests at risk, while mill owners’ ZDCs only covered 23% of forests at risk within the mill supply base. In Kalimantan and Papua, the current and future deforestation frontiers, the forests most at risk of conversion were predominantly covered by weak ZDCs lacking in policy comprehensiveness and implementation. Additionally, we find that only 46% of independent smallholder oil palm plots are in mill supply sheds whose owners offer programs and support for independent smallholders, indicating that smallholder inclusion is a significant challenge for ZDC companies. These results highlight the lack of spatial and functional alignment between supply chain policies and their local context as a significant gap in ZDC implementation and a challenge that the EU Deforestation Regulation will face.ISSN:1748-9326ISSN:1748-931

How well does the implementation of corporate zero-deforestation commitments in Indonesia align with aims to halt deforestation and include smallholders?

In response to growing scrutiny surrounding commodity-driven deforestation, companies have introduced zero-deforestation commitments (ZDCs) with ambitious environmental and social targets. However, such initiatives may not effectively reduce deforestation if they are not aligned with the spatial extent of remaining forests at risk. They may also fail to avert socio-economic risks if ZDCs do not consider smallholder farmers’ needs. We assess the spatial and functional fit of ZDCs by mapping commodity-driven deforestation and socio-economic risks, and comparing them to the spatial coverage and implementation of ZDCs in the Indonesian palm oil sector. Our study finds that companies’ ZDCs often underperform in four areas: traceability, compliance support for high-risk palm oil mills, transparency, and smallholder inclusion. In 2020, only one-third of companies sourcing from their own mills, and just 6% of those sourcing from external suppliers, achieved full traceability to plantations. Comparing the reach of ZDCs adopted by downstream buyers with those adopted by mill owners located further upstream, we find that high-quality ZDCs from buyers covered 62% of forests at risk, while mill owners’ ZDCs only covered 23% of forests at risk within the mill supply base. In Kalimantan and Papua, the current and future deforestation frontiers, the forests most at risk of conversion were predominantly covered by weak ZDCs lacking in policy comprehensiveness and implementation. Additionally, we find that only 46% of independent smallholder oil palm plots are in mill supply sheds whose owners offer programs and support for independent smallholders, indicating that smallholder inclusion is a significant challenge for ZDC companies. These results highlight the lack of spatial and functional alignment between supply chain policies and their local context as a significant gap in ZDC implementation and a challenge that the EU Deforestation Regulation will face

How well does the implementation of corporate zero-deforestation commitments in Indonesia align with aims to halt deforestation and include smallholders?

In response to growing scrutiny surrounding commodity-driven deforestation, companies have introduced zero-deforestation commitments (ZDCs) with ambitious environmental and social targets. However, such initiatives may not effectively reduce deforestation if they are not aligned with the spatial extent of remaining forests at risk. They may also fail to avert socio-economic risks if ZDCs do not consider smallholder farmers’ needs. We assess the spatial and functional fit of ZDCs by mapping commodity-driven deforestation and socio-economic risks, and comparing them to the spatial coverage and implementation of ZDCs in the Indonesian palm oil sector. Our study finds that companies’ ZDCs often underperform in four areas: traceability, compliance support for high-risk palm oil mills, transparency, and smallholder inclusion. In 2020, only one-third of companies sourcing from their own mills, and just 6% of those sourcing from external suppliers, achieved full traceability to plantations. Comparing the reach of ZDCs adopted by downstream buyers with those adopted by mill owners located further upstream, we find that high-quality ZDCs from buyers covered 62% of forests at risk, while mill owners’ ZDCs only covered 23% of forests at risk within the mill supply base. In Kalimantan and Papua, the current and future deforestation frontiers, the forests most at risk of conversion were predominantly covered by weak ZDCs lacking in policy comprehensiveness and implementation. Additionally, we find that only 46% of independent smallholder oil palm plots are in mill supply sheds whose owners offer programs and support for independent smallholders, indicating that smallholder inclusion is a significant challenge for ZDC companies. These results highlight the lack of spatial and functional alignment between supply chain policies and their local context as a significant gap in ZDC implementation and a challenge that the EU Deforestation Regulation will face

A field experiment to reduce deforestation while benefiting the livelihoods of Indonesian smallholder oil palm farmers

We will implement a randomised field experiment to test whether a new training intervention delivered to independent smallholder oil palm farmers as part of a palm oil company’s “No Deforestation, No Peat, No Exploitation” (NDPE) policy can reduce deforestation in Sumatra, Indonesia. The objective is to identify how NDPE policies can be improved to enhance: 1) their effectiveness in terms of reducing deforestation; 2) farmers’ perceptions of the fairness of NDPE policies; and 3) NDPE policies’ equity in terms of having no negative impact on, or ideally improving, farmers’ market access and prices received for palm oil production. The trial is being conducted in partnership with Musim Mas (MM), an Indonesian palm oil company. The participants will be smallholder oil palm farmers in 87 villages in Aceh Selatan and Aceh Singkil, two regencies (Kabupaten) in the Province of Aceh in Sumatra. The study consists of a common intervention offered to all villages in the sample and an experimental treatment layered on top and randomly assigned to half of the villages. The common intervention comprises a standard training package on Good Agricultural Practices (GAP) and Financial Literacy. The experimental treatment consists of training on MM’s NDPE policy with a norm-based framing. We will compare deforestation between villages that receive the baseline intervention and villages that additionally receive the experimental treatment. We will also compare perceived social norms for nature conservation and beliefs about environmentally- and socially-responsible farming behaviour between participants in treated and control villages. We expect a smaller annual reduction in forest cover, an improvement in perceived social importance of conservation, and improvement in beliefs about the importance of environmentally- and socially-responsible farming behaviour in treated villages that receive the norm-based NDPE training compared to control villages that receive the standard training package only