The role of livelihood, social capital, and market organization in shaping rural-urban interactions (post-print)

This chapter starts from the premise that economic actions can only be understood if looked upon as embedded in social structure. Therefore, it elaborates the concept of (sustainable) livelihood, which is taken to emanate from the interactions of actors with vital capitals. It argues that, in the context of globalization, livelihood becomes increasingly multidimensional and multilocal, spanning rural and urban areas at the same time. The chapter focuses on changing rural-urban linkages in West Africa, notably on the trade in maize, yam, and cattle in Benin. Expanding flows between rural areas and urban outlets are analysed against the background of the livelihood strategies of traders, paying special attention to trade organization, networks, entry modes, and accumulation paths. Emphasis is placed on the role of social capital in these interactions

Cross-border cattle marketing in Sub-Saharan Africa since 1990: geographical patterns and government induced change

This chapter aims to study the impact of government policies on cross-border cattle marketing in Africa. It analyses the extent to which this type of cross-border trade has been created, diverted or contracted as a result of government policies. The chapter portrays the geographical patterns of cattle trade in the pre-colonial, colonial and post-colonial periods. It examines the main reasons for the increase, decline or diversion of cross-border cattle trade and it specifically pays attention to trade and other policies. The volume of cross-border cattle trade in Sub-Saharan Africa, which is often long distance trade, became significant when the colonial economy developed. Population growth, export production and increased incomes triggered demand for meat in newly emerging consumption areas. Whereas colonial trade policies contributed little to this expansion in West Africa, government interventions in East and Southern Africa had more impact. However, despite the stronger grip of the state on cattle marketing in East and Southern Africa, much of the cross-border cattle trade in these regions was in the hands of private traders like in West Africa. In the post-colonial era, government interventions increased through the creation of cattle and meat marketing boards. However, in West Africa many of these boards never functioned properly. In East and Southern Africa their impact was substantial, still most of them were dismantled under structural adjustment programs. The chapter concludes that mainly changes in supply caused by (civil) wars and droughts, and changes in demand caused by rising and falling economic prosperity have had significant impact on cross-border cattle trade, which was accordingly created, diverted or contracted. Notwithstanding differences between West Africa on the one hand and East and Southern Africa on the other, government policies aiming at intervention in cattle marketing only temporarily and to a smaller extent affected cross-border trade. Slightly more important are general economic policies resulting for example in currency fluctuations. Private cattle traders are acknowledged for their remarkable responsiveness to both short and long term opportunities cross-border cattle trade, legal or illicit, offer to them

Uptake of HIV testing among adolescents and associated adolescent-friendly services

Abstract Background HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. Methods The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents' uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. Results Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. Conclusions We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence

Imaging biomarker roadmap for cancer studies.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.Development of this roadmap received support from Cancer Research UK and the Engineering and Physical Sciences Research Council (grant references A/15267, A/16463, A/16464, A/16465, A/16466 and A/18097), the EORTC Cancer Research Fund, and the Innovative Medicines Initiative Joint Undertaking (grant agreement number 115151), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution

The Prospective Dutch Colorectal Cancer (PLCRC) cohort: real-world data facilitating research and clinical care

Real-world data (RWD) sources are important to advance clinical oncology research and evaluate treatments in daily practice. Since 2013, the Prospective Dutch Colorectal Cancer (PLCRC) cohort, linked to the Netherlands Cancer Registry, serves as an infrastructure for scientific research collecting additional patient-reported outcomes (PRO) and biospecimens. Here we report on cohort developments and investigate to what extent PLCRC reflects the “real-world”. Clinical and demographic characteristics of PLCRC participants were compared with the general Dutch CRC population (n = 74,692, Dutch-ref). To study representativeness, standardized differences between PLCRC and Dutch-ref were calculated, and logistic regression models were evaluated on their ability to distinguish cohort participants from the Dutch-ref (AU-ROC 0.5 = preferred, implying participation independent of patient characteristics). Stratified analyses by stage and time-period (2013–2016 and 2017–Aug 2019) were performed to study the evolution towards RWD. In August 2019, 5744 patients were enrolled. Enrollment increased steeply, from 129 participants (1 hospital) in 2013 to 2136 (50 of 75 Dutch hospitals) in 2018. Low AU-ROC (0.65, 95% CI: 0.64–0.65) indicates limited ability to distinguish cohort participants from the Dutch-ref. Characteristics that remained imbalanced in the period 2017–Aug’19 compared with the Dutch-ref were age (65.0 years in PLCRC, 69.3 in the Dutch-ref) and tumor stage (40% stage-III in PLCRC, 30% in the Dutch-ref). PLCRC approaches to represent the Dutch CRC population and will ultimately meet the current demand for high-quality RWD. Efforts are ongoing to improve multidisciplinary recruitment which will further enhance PLCRC’s representativeness and its contribution to a learning healthcare system

Disclosing the Uncertainty Associated with Prognostic Estimates in Breast Cancer

Treatment decision making is often guided by evidence-based probabilities, which may be presented to patients during consultations. These probabilities are intrinsically imperfect and embody 2 types of uncertainties: aleatory uncertainty arising from the unpredictability of future events and epistemic uncertainty arising from limitations in the reliability and accuracy of probability estimates. Risk communication experts have recommended disclosing uncertainty. We examined whether uncertainty was discussed during cancer consultations and whether and how patients perceived uncertainty. Consecutive patient consultations with medical oncologists discussing adjuvant treatment in early-stage breast cancer were audiotaped, transcribed, and coded. Patients were interviewed after the consultation to gain insight into their perceptions of uncertainty. In total, 198 patients were included by 27 oncologists. Uncertainty was disclosed in 49% (97/197) of consultations. In those 97 consultations, 23 allusions to epistemic uncertainty were made and 84 allusions to aleatory uncertainty. Overall, the allusions to the precision of the probabilities were somewhat ambiguous. Interviewed patients mainly referred to aleatory uncertainty if not prompted about epistemic uncertainty. Even when specifically asked about epistemic uncertainty, 1 in 4 utterances referred to aleatory uncertainty. When talking about epistemic uncertainty, many patients contradicted themselves. In addition, 1 in 10 patients seemed not to realize that the probabilities communicated during the consultation are imperfect. Uncertainty is conveyed in only half of patient consultations. When uncertainty is communicated, oncologists mainly refer to aleatory uncertainty. This is also the type of uncertainty that most patients perceive and seem comfortable discussing. Given that it is increasingly common for clinicians to discuss outcome probabilities with their patients, guidance on whether and how to best communicate uncertainty is urgently neede

Disclosing the uncertainty associated with prognostic estimates in breast cancer.

BACKGROUND: Treatment decision making is often guided by evidence-based probabilities, which may be presented to patients during consultations. These probabilities are intrinsically imperfect and embody 2 types of uncertainties: aleatory uncertainty arising from the unpredictability of future events and epistemic uncertainty arising from limitations in the reliability and accuracy of probability estimates. Risk communication experts have recommended disclosing uncertainty. We examined whether uncertainty was discussed during cancer consultations and whether and how patients perceived uncertainty. METHODS: Consecutive patient consultations with medical oncologists discussing adjuvant treatment in early-stage breast cancer were audiotaped, transcribed, and coded. Patients were interviewed after the consultation to gain insight into their perceptions of uncertainty. RESULTS: In total, 198 patients were included by 27 oncologists. Uncertainty was disclosed in 49% (97/197) of consultations. In those 97 consultations, 23 allusions to epistemic uncertainty were made and 84 allusions to aleatory uncertainty. Overall, the allusions to the precision of the probabilities were somewhat ambiguous. Interviewed patients mainly referred to aleatory uncertainty if not prompted about epistemic uncertainty. Even when specifically asked about epistemic uncertainty, 1 in 4 utterances referred to aleatory uncertainty. When talking about epistemic uncertainty, many patients contradicted themselves. In addition, 1 in 10 patients seemed not to realize that the probabilities communicated during the consultation are imperfect. CONCLUSIONS: Uncertainty is conveyed in only half of patient consultations. When uncertainty is communicated, oncologists mainly refer to aleatory uncertainty. This is also the type of uncertainty that most patients perceive and seem comfortable discussing. Given that it is increasingly common for clinicians to discuss outcome probabilities with their patients, guidance on whether and how to best communicate uncertainty is urgently needed

Tectonic uplift mechanism of the Goodenough and Fergusson Island gneiss domes, eastern Papua New Guinea: Constraints from seismic reflection and well data

The D'Entrecasteaux Island (DEI) gneiss domes are fault‐bounded domes with ∼2.5 km of relief exposing ultrahigh‐pressure (UHP) and high‐pressure (HP) metamorphic gneisses and migmatites exhumed in an Oligocene‐Miocene arc‐continent collision and subduction zone subject to Late Miocene to Recent continental extension. To study the style of continental extension accompanying exhumation of the DEI gneiss domes, a grid of 1518 km of 2‐D multichannel seismic (MCS) reflection data and well data is interpreted from the offshore areas surrounding the DEI, including the Trobriand basin and the Goodenough basin. The offshore study is combined with onshore geologic information to constrain the Oligocene to Recent tectonic evolution of the basins. MCS and well data are consistent with the Trobriand basin forming as a forearc basin caused by southward Miocene subduction at the Trobriand trench. At ∼8 Ma, the margin transitioned to an extensional tectonic environment. Since then, the Trobriand basin has subsided 1–2.5 km with few normal faults deforming the basin fill. South of the DEI, the Goodenough rift basin developed after extension began (∼8 Ma) with the hanging wall of the north‐dipping Owen‐Stanley normal fault bounding the southern margin of the basin. The lack of evidence of upper crustal extension accompanying subsidence in the Trobriand and Goodenough basins suggests depth‐dependent lithospheric extension from 8 to 0 Ma has accompanied uplift of the DEI gneiss domes and supports schematic model of uplift of the DEI domes involving vertical exhumation of buoyant, postorogenic lower crust, far‐field extension from slab rollback, and an inverted two‐layer crustal density structure