Yield gap analysis and entry points for improving productivity on large oil palm plantations and smallholder farms in Ghana

Oil palm production must increase in Ghana to meet the increasing demand for palm oil and avoid costly imports. Although maximum fruit bunch (FB) yields of >20 t ha−1 yr−1 are achievable, average FB yields in Ghana are only 7 t ha−1 yr−1. Despite the pressing need to increase palm oil production and improve yields, knowledge of the underlying causes of poor yields in Ghana is lacking. Closing yield gaps in existing plantings in smallholdings and plantations offers great opportunities to increase oil production without area expansion, thus sparing land for other uses. This study sought to understand the magnitude and underlying causes of yield gaps in plantation and smallholder oil palm production systems in Ghana based on a detailed characterization of management practices and yield measurements over a two-year period. Using a boundary line analysis, the water-limited yield (Yw) over a planting cycle was defined as about 21 t ha−1 yr−1 FB, with yield gaps of 15.4 t ha−1 yr−1 FB at smallholder farms and 9.8 t ha−1 yr−1 FB at plantations. Poor management practices, including incomplete crop recovery (i.e., harvesting all suitable crop) and inadequate agronomic management were the main factors contributing to these yield gaps. Productivity losses were further exacerbated by low oil extraction rates by small-scale processors of 12% as compared to 21% by the large-scale processors. The potential losses in annual crude palm oil (CPO) during the crop plateau yield phase therefore exceed 5 and 3 t ha−1 yr−1 for small-scale and large-scale production systems respectively. Investment to reduce yield gaps by appropriate agronomic and yield recovery practices across all production systems, while improving access of smallholder producers to more efficient oil palm processing facilities, can make a significant contribution to closing the supply gap for palm oil in Ghana. The impact of such investments on large-scale plantations could result in a doubling of CPO production. Smallholder farmers could benefit the most with a fourteen-fold increase in CPO production and economic gains of >1 billion US$

A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder

Introduction: Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder. Methods: A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HRFI = 1.04 [95% CI: 1.02–1.06]). Results: Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HRFI = 0.98 [95% CI: 0.97–0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p <.001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time. Conclusions: The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late-life depression

Evaluating hospital websites in Kuwait to improve consumer engagement and access to health information:a cross-sectional analytical study

Abstract Background Current advances in information and communication technology have made accessing and obtaining health-related information easier than ever before. Today, many hospital websites use a patient-centric approach to promote engagement and encourage learning for better health-related decision making. However, little is known about the current state of hospital websites in the State of Kuwait. This study aims to evaluate hospital websites in Kuwait and offer recommendations to improve patient engagement and access to health information. Methods This study employs a cross-sectional analytical approach to evaluate hospital websites in Kuwait in 2017. The websites of hospitals that provide in-patient services were identified through a structured search. Only active websites that were available in either English or Arabic were considered. The evaluation of the websites involved a combination of automated and expert- based evaluation methods and was performed across four dimensions: Accessibility, Usability, Presence, and Content. Results Nine hospitals met the inclusion criteria. Most of the websites fell short in all four dimensions. None of the websites passed the accessibility guidelines. The usability of websites varied between hospitals. Overall, the majority of hospitals in Kuwait have rudimentary online presence and their websites require careful reassessment with respect to design, content, and user experience. The websites focus primarily on promoting services provided by the hospital rather than engaging and communicating with patients or providing evidence-based information. Conclusions Healthcare organization and website developers should follow best-practices to improve their websites taking into consideration the quality, readability, objectivity, coverage and currency of the information as well as the design of their websites. Hospitals should leverage social media to gain outreach and better engagement with consumers. The websites should be offered in additional languages commonly spoken by people living in Kuwait. Efforts should be made to ensure that health information on hospital websites are evidence-based and checked by healthcare professionals

A model with compression for estimating speech intelligibility in quiet and in noise

For speech reception thresholds (SRTs), measured in normally-hearing listeners using various types of stationary noise, the Speech Intelligibility Index (SII, ANSI S3.5-1997) model predicts a fairly constant speech proportion (of about 0.3) necessary for sentence intelligibility. For SRTs in quiet, the estimated speech proportions are often lower, and show a larger inter-subject variability, than found for speech in noise near normal speech levels. This might be related to the fact that cochlear compression is larger at normal speech levels than near the threshold for speech in quiet. The SII model does not take this into account. The present model attempts to alleviate this problem by including cochlear compression. It is based on a loudness model for normally-hearing and hearing-impaired listeners [ANSI S3.4-2007]. It estimates internal excitation levels of the speech, accounts for the compressed effective dynamic range of the internal speech signal, and calculates the proportion of speech above threshold using similar spectral weighting as used in the standard SII. The present model and the standard SII were used to predict SRTs in quiet and noise for both normally-hearing and hearing-impaired listeners. The present model predicted speech intelligibility with less variability than the standard SI