Soil physical quality of citrus orchards under tillage, herbicide, and organic managements

Soil capacity to support life and to produce economic goods and services is strongly linked to the maintenance of good soil physical quality (SPQ). In this study, the SPQ of citrus orchards was assessed under three different soil managements, namely no-tillage using herbicides, tillage under chemical farming, and no-tillage under organic farming. Commonly used indicators, such as soil bulk density, organic carbon content, and structural stability index, were considered in conjunction with capacitive indicators estimated by the Beerkan estimation of soil transfer parameter (BEST) method. The measurements taken at the L'Alcoleja Experimental Station in Spain yielded optimal values for soil bulk density and organic carbon content in 100% and 70% of cases for organic farming. The values of structural stability index indicated that the soil was stable in 90% of cases. Differences between the soil management practices were particularly clear in terms of plant-available water capacity and saturated hydraulic conductivity. Under organic farming, the soil had the greatest ability to store and provide water to plant roots, and to quickly drain excess water and facilitate root proliferation. Management practices adopted under organic farming (such as vegetation cover between the trees, chipping after pruning, and spreading the chips on the soil surface) improved the SPQ. Conversely, the conventional management strategies unequivocally led to soil degradation owing to the loss of organic matter, soil compaction, and reduced structural stability. The results in this study show that organic farming has a clear positive impact on the SPQ, suggesting that tillage and herbicide treatments should be avoided

Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial.

BACKGROUND: Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. METHODS: A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed. FINDINGS: From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; pinteraction=0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated. INTERPRETATION: Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. FUNDING: US National Institutes of Health

Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting

<div><p>The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both <i>p</i> < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (<i>p</i> < 0.001 district; <i>p</i> = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings demonstrate that a smartphone-based tool can improve guideline adherence. This study should serve as a catalyst for a randomized controlled trial to expand on the findings and address limitations.</p></div

Rehydration calculator.

<p>(A) Home page with the Rehydration Calculator for decision-support (upper) and the data collection platform (lower). (B) Data input page. (C) WHO derived recommendations for medication and fluid administration; units can be changed by side-swiping. “i” represents a link to educational summaries and primary publications. (D) Outbreak Responder data collection and aggregation platform for the research team (aka ‘Response Team’). ‘QI’ is a portal for customized quality improvement questions intended to be used by researchers only.</p

Population characteristics during the pre-intervention and intervention periods.

<p>Population characteristics during the pre-intervention and intervention periods.</p

Antibiotic and zinc guideline adherence.

<p>(A and B) Percentages of patients for whom antibiotics were prescribed when azithromycin was recommended at the district and sub-district hospitals, respectively. (C) Percentages of zinc prescriptions for patients under 5 years (recommended). (D) Percentages of zinc prescriptions for patients over 5 years (not recommended). *<i>p</i><0.05, **<i>p</i><0.01, ***<i>p</i><0.001.</p

Weight estimation.

<p>(A and B) Measured weights for female (N = 120) and male patients (N = 216) less than 5 years, respectively. (C and D) Measured and estimated weights during the pre-intervention and intervention periods for older female and male patients, respectively. Data are presented as standard box plots; estimated weights used during the study are 42 kg for females 15–19 years; 45 kg for female 20+ years; 45 kg for males 15–19 years; 50 kg for males 20+ years.</p