Deconstructing Indian cotton: weather, yields, and suicides

n/

Beyond the gene horizon: sustaining agricultural productivity and enhancing livelihoods through optimization of crop and crop-associated biodiversity with emphasis on semi-arid tropical agroecosystems

Increasing international attention is being given to the role and productive value of biological diversity in agriculture. Recognizing the potential of agricultural biodiversity and the services it provides will be key to meeting future food needs while maintaining and enhancing other goods and services, such as clean air and clean water, provided by agricultural ecosystems. FAO and ICRISAT are joining forces to further the understanding of the contribution of crop and crop-associated biodiversity (C-CAB) in sustainable agriculture in the semi-arid tropics (SAT). In order to address some of the key components of C-CAB, FAO and ICRISAT organized a joint workshop in late September 2002. The meeting was intended to generate animated exchanges between experts from different disciplines. Its outputs aim to provide a first step, not only in further understanding the role and value of main components of C-CAB for sustainable agriculture production intensification and livelihoods benefits, but also in identifying linkages and synergies between components of C-CAB in production systems for strategic interventions

I’ll make a “Patient” out of you: An Update to “Physicians as ‘Patients’”- Design, Implementation, and Challenges of Novel Immersive Simulated Patient Experiences to Foster Physician Empathy and Compassion

Title: I’ll make a “Patient” out of you: An Update to “Physicians as ‘Patients’”- Design, Implementation, and Challenges of Novel Immersive Simulated Patient Experiences to Foster Physician Empathy and Compassion Author: Aaron M. Lee, DO, MS (Internal Medicine, Chief Resident) Co-Authors and Specialty Program Affiliations:  Khanh Hoang Nicholas Le, MD (Internal Medicine, PGY-1), Preetham Suresh, MD (Anesthesia, faculty), Ricardo Wood (UCSD Simulation Center), Sean Kenmore, MD (Internal Medicine, faculty)  Issues Addressed/ Background The importance of fostering physician empathy and compassion has become increasingly recognized as a critical aspect of physician training, with the ACGME and AAMC both acknowledging empathy as a key component of professionalism, with recommendations to incorporate empathy education into core medical education goals. The challenge remains how best to teach physician empathy and compassion in medical education, and to create long term effective educational interventions. Empathy curriculum in graduate medical education remains limited, as there are few standardized methodologies for teaching empathy.  Herein lies an opportunity for growth and development of novel and new methodologies to deliver patient-centered and empathy/compassion education to physicians in training. We hypothesize that lack of appreciation or understanding of the patient experience is much to blame in the deficits in teaching physician empathy and compassion. To address this void, we propose a set of novel immersive simulation exercises to place resident physicians in the role of a patient with space for guided reflection. We propose that a standardized longitudinal curriculum based on high-fidelity immersive simulation exercises throughout medical training will improve physician empathy and compassion, and the delivery of this form of education can be effective, easily disseminated, cost effective, and enjoyable to the learner, ultimately leading to better patient-centered and high-value care.This project was previously presented at PSQI 2022 in an earlier iteration, wherein the simulations were less immersive and in smaller sample size. The updated model presented here utilizes the UCSD patient room simulation labs to create high-fidelity fully immersive role-reversal simulation experiences.  Description of project/protocol/innovation Study design and measuring empathyThis project was funded via a generous seed grant award from the Sanford Institute for Empathy and Compassion, Center for Empathy and Compassion Training in Medical Education. This study is being performed in the UCSD Internal Medicine residency program, which consists of 143 resident physicians at varying training levels. Simulations are based off national VA patient survey data and reflect aspects of the patient experience that are painful or common. Our first simulation session, which will occur April 14, 2023, will encompass 20 residents in several high-fidelity immersive simulations at the UC San Diego simulation labs, with the help of the UCSD Simulation team. We also have plans to have a separate simulation session to include another 10-20 residents in early May 2023.This study utilizes standardized survey data (Jefferson Scale of Empathy) to evaluate the effectiveness of role-reversal simulation didactics in fostering physician empathy. Baseline survey data has been collected from the entire residency, and additional survey data will be collected after interventions have been complete. An intervention group will include those residents who are randomly assigned to the simulation group, while the remainder of the cohort will make up the control group. Statistical analysis will be performed by the Jefferson Scale of Empathy team comparing the two cohorts. All results and responses are de-identified to the primary researchers.The intervention/simulationsSeveral original simulations have been designed, each representing several aspects of the patient experience. Each resident is intended to rotate through each of the simulations in the role of the patient, which in total equals 30-40 minutes of simulation time. A debrief exercise is held afterwards for 30 minutes as well. During this debrief time, participants also will experience several forms of patient’s foods supplied by UCSD Health Dining, which will add another sensory component to the patient experience. Simulation A: a patient on the commode in a shared room is unable to reach their nurse to help them get back to bedSimulation B: ED patient boarding in a busy hallway is given bad news, physician leaves partway through without finishing the newsSimulation C: patient undergoing central line procedure, being done by a novice resident who is visibly nervous, and accosted by a circulating nurseSimulation D:  patient interacts with a physician who speaks only a foreign language, who brokenly obtains consent for a procedure  Lessons Learned/expected outcomes These novel simulations will be performed on April 14, 2023 over a 2 hour session, and an additional session in May 2023. Preliminary results from a prior iteration of this simulation idea suggested a positive signal between role-reversal simulations leading to increased empathy and compassion. We anticipate that these higher fidelity simulations and sensory immersion are powerful tools towards fostering greater appreciation of the inpatient patient experience, and will be effective towards increasing physician empathy and compassion.We recognize several challenges with building this form of curriculum. These simulations require resources, including equipment and simulation space, actors who can play roles of physicians (which most standardized actors are not trained to do), and dedicated educational time, all of which can prove challenging to obtain.    Recommendations/ Next steps While the development and implementation of these simulation activities is not without its own challenges, we believe these exercises may truly revolutionize how we approach empathy education in medical training. Current versions of standardized encounters do not take into consideration the patient experience, which we feel to be a crucial aspect of building empathy. These simulations are relatively easy to reproduce, and in a world where simulation has become more commonplace, should be easily adopted into curricula. As such, we feel that the next steps for this exercise are to build more robust simulations and disseminate this information to other academic institutions. We have produced an educational packet for these simulation exercises, which will serve as a distribution tool so that other academic institutions may adopt this novel teaching modality. Within this educational packet includes the background and evidence supporting these interventions, a toolkit which includes a supplies list, the simulations and scripts, and generally provides the overall structure to recreate these simulations

Integrated Pest Management for Sustainable Intensification of Agriculture in Asia and Africa

Integrated Pest Management (IPM) is a leading complement and alternative to synthetic pesticides and a form of sustainable intensification with particular importance for tropical smallholders. Global pesticide use has grown over the past 20 years to 3.5 billion kg/year, amounting to a global market worth $45 billion. The external costs of pesticides are$4-$19 (€3-15) per kg of active ingredient applied, suggesting that IPM approaches that result in lower pesticide use will benefit, not only farmers, but also wider environments and human health. Evidence for IPM’s impacts on pesticide use and yields remains patchy. We contribute an evaluation using data from 85 IPM projects from 24 countries of Asia and Africa implemented over the past twenty years. Analysing outcomes on productivity and reliance on pesticides, we find a mean yield increase across projects and crops of 40.9% (SD 72.3), combined with a decline in pesticide use to 30.7% (SD 34.9) compared with baseline. A total of 35 of 115 (30%) crop combinations resulted in a transition to zero pesticide use. We assess successes in four types of IPM projects, and find that at least 50% of pesticide use is not needed in most agroecosystems. Nonetheless, policy support for IPM is relatively rare, counter-interventions from pesticide industry common, and the IPM challenge never done as pests, diseases and weeds evolve and move

Shaping agricultural innovation systems responsive to food insecurity and climate change

Climate change and variability present new challenges for agriculture, particularly for smallholder farmers who continue to be the mainstay of food production in developing countries. Recent global food crises have exposed the structural vulnerability of globalized agri-food systems, highlighting climate change as just one of a complex set of environmental, demographic, social and economic drivers generating instability and food insecurity, the impacts of which disproportionately affect poorer groups in marginal environments. Rather than search for single causes, there is a need to understand these changes at a systemic level. Improved understanding of and engagement with the adaptive strategies and innovations of communities living in conditions of rapid change provides an appropriate starting point for those seeking to shape agricultural innovation systems responsive to food insecurity and climate change. This paper draws lessons from selected country experiences of adaptation and innovation in pursuit of food security goals. It reviews three cases of systems of innovation operating in contrasting regional, socio-economic and agro-ecological contexts, in terms of four features of innovation systems more likely to build, sustain or enhance food security in situations of rapid change: (i) recognition of the multifunctionality of agriculture and opportunities to realize multiple benefits; (ii) access to diversity as the basis for flexibility and resilience; (iii) concern for enhancing capacity of decision makers at all levels; and (iv) continuity of effort aimed at securing the well-being of those who depend on agriculture. Finally, implications for policymakers and other stakeholders in agricultural innovation systems are presented