Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

INTRODUCTION: There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. METHODS AND MATERIALS: We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. RESULTS: Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. DISCUSSION: Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

IntroductionThere is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation.Methods and materialsWe collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors.ResultsImplementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits.DiscussionPrograms need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The TolC-Like Protein of Neisseria meningitidis Is Required for Extracellular Production of the Repeats-in-Toxin Toxin FrpC but Not for Resistance to Antimicrobials Recognized by the Mtr Efflux Pump System▿

A 2.9-kilobase pair locus in Neisseria meningitidis was identified as containing transcriptionally linked open reading frames encoding TolC- and HlyD-like proteins. Although the meningococcal TolC protein was required for extracellular production of the repeats-in-toxin (RTX) FrpC toxin, it could not functionally replace the MtrE protein as the outer membrane protein channel for drug export by the MtrC-MtrD-MtrE efflux pump

Preliminary Study on the Effect of Nitrogen and Potassium Fertilization, and Evapotranspiration Replacement Interaction on Primary and Secondary Metabolites of Gynura procumbens Leaves

Despite progressive reports on pharmacological properties in Gynura procumbens, many are overlooking the importance of agronomic requirements for high yields and phytochemical content that vary due to environmental variations. The study was carried out to examine the effects of nitrogen (N), potassium (K), and evapotranspiration replacement (ER) on growth and phytochemical content. Treatments affected parameters significantly (p≤0.05) with a stronger effect on physiological and biochemical attributes (p≤0.0001). Highest and lowest yield of biomass and phytochemical content were observed under N0K30(70) and N90K0(25), respectively. Treatments interaction was highly significant (p≤0.0001) in Cond, TPrC, and TFC, (p≤0.05) in CF and PWP, and not significant (p>0.05) in Photo, TCC, and TPC. The 75% ER had significant (p≤0.05) output of biomass and phytochemical content. As ER decreased from 100 to 25%, the Photo and CF were reduced. Phytochemical content displayed a significant negative relationship with PWP. Caffeic acid, kaempferol, and ferulic acid demonstrated as lead compounds. Following this, there were correlations between phenolic biosynthesis-regulated gene and gene expressions such as PAL, CHS, and F3H primers

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Not AvailableBiotic stress factors have a major impact on plants and cause extensive losses to crop production. Plants possess a range of defenses that can be actively expressed in response to pathogens. The timely activation of these defense responses is important and determines whether plant is able to cope or succumb to the challenge of a pathogen. Plant defense mechanisms which are involved in biotic stress management are classified as innate and induced plant response. Systemic acquired resistance (SAR) and induced systemic resistance (ISR) are two forms of induced resistance; in both types of resistance, prior infection or treatment preconditions plant defenses leading to resistance (or tolerance) against further challenge by a pathogen. Identification of a number of biological and chemical elicitors has to a great extent helped in unraveling the understanding of the biochemical and physiological basis of ISRNot Availabl

Preliminary study on the effect of nitrogen and potassium fertilization, and evapotranspiration replacement interaction on primary and secondary metabolites of Gynura procumbens leaves

Despite progressive reports on pharmacological properties in Gynura procumbens, many are overlooking the importance of agronomic requirements for high yields and phytochemical content that vary due to environmental variations. The study was carried out to examine the effects of nitrogen (N), potassium (K), and evapotranspiration replacement (ER) on growth and phytochemical content. Treatments affected parameters significantly (p≤0.05) with a stronger effect on physiological and biochemical attributes (p≤0.0001). Highest and lowest yield of biomass and phytochemical content were observed under N0K30(70) and N90K0(25), respectively. Treatments interaction was highly significant (p≤0.0001) in Cond, TPrC, and TFC, (p≤0.05) in CF and PWP, and not significant (p>0.05) in Photo, TCC, and TPC. The 75% ER had significant (p≤0.05) output of biomass and phytochemical content. As ER decreased from 100 to 25%, the Photo and CF were reduced. Phytochemical content displayed a significant negative relationship with PWP. Caffeic acid, kaempferol, and ferulic acid demonstrated as lead compounds. Following this, there were correlations between phenolic biosynthesis-regulated gene and gene expressions such as PAL, CHS, and F3H primers

Not Available

Not AvailableBiotic stress factors have a major impact on plants and cause extensive losses to crop production. Plants possess a range of defenses that can be actively expressed in response to pathogens. The timely activation of these defense responses is important and determines whether plant is able to cope or succumb to the challenge of a pathogen. Plant defense mechanisms which are involved in biotic stress management are classified as innate and induced plant response. Systemic acquired resistance (SAR) and induced systemic resistance (ISR) are two forms of induced resistance; in both types of resistance, prior infection or treatment preconditions plant defenses leading to resistance (or tolerance) against further challenge by a pathogen. Identification of a number of biological and chemical elicitors has to a great extent helped in unraveling the understanding of the biochemical and physiological basis of ISR and SAR. Combining SAR and ISR can provide protection against a number of pathogens including the pathogens that resist through both pathways. The use of pesticides for the control of crop diseases and pests is however inefficient and not eco-friendly. Genetic engineering has enabled the cloning of genes and their insertion into the crop plants to make them resistant to different biotic stresses.Not Availabl

Analysis of Business Organising in Ornamental Plant Cooperatives

Namen diplomskega dela je bil raziskati pripravljenost pridelovalcev okrasnih rastlin za povezovanje v poslovno organiziranje zadružništvo. Za pridobitev informacij je bilo v maju in juniju 2017 anketiranih 17 pridelovalcev okrasnih rastlin iz severovzhodne Slovenije. Rezultati ankete so pokazali, da so pridelovalci v glavnem seznanjeni z obliko poslovnega organiziranja zadružništvo. Večina pridelovalcev (94 %) je mnenja, da bi bilo potrebno na območju SV Slovenije ustanoviti zadrugo pridelovalcev okrasnih rastlin. Ugotovili smo, da bi v primeru ustanovitve zadruge bila več kot polovica pridelovalcev pripravljena postati član zadruge, iz česar sledi, da so pripravljeni na povezovanje v zadrugo. V primeru ustanovitve zadruge pa pridelovalci ne bi bili pripravljeni zaposliti osebo, ki bi skrbela za nabavo repromateriala, trženje, promocijo in drugo. Raziskava je pokazala, da večina (69 %) pridelovalcev ni zadovoljna s sodelovanjem slovenskih vrtnarjev med seboj.The purpose of the degree was to investigate the willingness of producers of ornamental plants to join business organising cooperatives. To acquire information on the topic, a survey was carried out among 17 growers of ornamental plants from north-eastern Slovenia, and it was carried out in May and June 2017. The results of the survey showed that the growers are mostly familiar with the business organising cooperatives form. Most Growers’ (94%) opinion was that they would be beneficial for the north-eastern area of Slovenia and that Ornamental Plant Cooperatives should be established. We found that, in the event of the establishment of a cooperative, more than half of the growers would be willing to become members of the cooperative and are thus ready to join the cooperative. In case a cooperative should be established, growers would not be willing to employ people who would be responsible for the procurement of raw materials, marketing, promotion and more. The survey showed that a high percentage (69%) of growers are not satisfied with the cooperation of Slovenian gardens with each other