Potential of the system of rice intensification for systemic improvement in rice production and water use: the case of Andhra Pradesh, India

As opportunities to enhance the irrigation base for raising food production in the country are dwindling, India needs a more concerted effort to increase the efficiency and productivity of its irrigation systems. This study, based on an analysis of experience from the state of Andhra Pradesh, addresses the potential of the System of Rice Intensification (SRI) to contribute to systemic corrections in present paddy cultivation, both with regard to agronomic productivity and irrigation water use efficiency. This study points to the considerable increase in rice productivity and farmer incomes, which is being achieved in Andhra Pradesh with substantial reduction in irrigation water application, labor, and seed costs through utilization of SRI methods. Potential public savings on water and power costs could be drawn upon not only for promoting SRI but also to effect systemic corrections in the irrigation sector, to mutual advantage

Potential of the system of rice intensification for systemic improvement in rice production and water use: the case of Andhra Pradesh, India

As opportunities to enhance the irrigation base for raising food production in the country are dwindling, India needs a more concerted effort to increase the efficiency and productivity of its irrigation systems. This study, based on an analysis of experience from the state of Andhra Pradesh, addresses the potential of the System of Rice Intensification (SRI) to contribute to systemic corrections in present paddy cultivation, both with regard to agronomic productivity and irrigation water use efficiency. This study points to the considerable increase in rice productivity and farmer incomes, which is being achieved in Andhra Pradesh with substantial reduction in irrigation water application, labor, and seed costs through utilization of SRI methods. Potential public savings on water and power costs could be drawn upon not only for promoting SRI but also to effect systemic corrections in the irrigation sector, to mutual advantage

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)