Within the nutritionism paradigm, in this article we critically review the marketization and medicalization logics which aim to address the pressing issue of malnutrition in low- and middle-income ...countries. Drawing from political economy and food system transformation discourses, we are using the popular intervention types of nutrition-sensitive value chains (marketization logic) and biofortification exemplified through orange-fleshed sweet potato (medicalization logic) to assess their outcomes and underlying logics. We demonstrate that there is insufficient evidence of the positive impact of these interventions on nutritional outcomes, and that their underlying theories of change and impact logics do not deal with the inherent complexity of nutritional challenges. We show that nutrition-sensitive value chain approaches are unable to leverage or enhance the functioning of value chains to improve nutritional outcomes, especially in light of the disproportionate power of some food companies. We further demonstrate that orange-fleshed sweet potato interventions and biofortification more broadly adopt a narrow approach to malnutrition, disregarding the interactions between food components and broader value chain and food system dynamics. We argue that both intervention types focus solely on increasing the intake of specific nutrients without incorporating their embeddedness in the wider food systems and the relevant political-economic and social relations that influence the production and consumption of food. We conclude that the systemic nature of malnutrition requires to be understood and addressed as part of the food system transformation challenge in order to move towards solving it. To do so, new evaluation frameworks along with new approaches to solutions are necessary that support multiple and diverse development pathways, which are able to acknowledge the social, political-economic, and environmental factors and drivers of malnutrition and poverty.
Starting from the observation that value chain research has informed much of agricultural development interventions in recent decades, this paper identifies five key challenges to current ...agricultural development policies in low- and middle-income countries (LMICs): access to finance, infrastructure, land tenure, local linkages and knowledge transfer. Based on this review, it is argued that recent theoretical advances in the global production network (GPN) approach can help to achieve a more holistic view of agricultural development policies than the more linear value chain research. In particular, three key concepts from the GPN approach are highlighted: mobilisation of regional assets, strategic coupling and territorial embeddedness. These key concepts are used to propose a framework called ‘insight-out strategic coupling for smallholder integration’, which builds on the concept of strategic coupling in GPN research and applies it as a development tool to agricultural production. Using an in-depth case study approach, the usefulness of this framework is tested by examining the experience of Malawi Mangoes, a company established to promote smallholder exports. Malawi Mangoes was initially funded by private equity, but despite a number of challenges along the way, was soon able to attract development funding and integrate smallholders from surrounding villages throughout-grower schemes. Analysis of the case shows both the usefulness of the framework and the lost potential in implementing agricultural development policy. The authors conclude that the framework is useful for linking current debates on agricultural development interventions, but that the findings of critical GPN research need to be taken into account when developing agricultural development interventions in order to respect the ‘do no harm’ principle.
A recent study found that adoption rates of improved chickpea varieties were above 90 per cent in Andhra Pradesh, India. In this paper, we use a novel perspective to reconstruct and attribute how ...this outcome came about. The accepted success narrative is that the public international agricultural research system developed some excellent new chickpea varieties, which were well suited to local agro-ecologies, farming systems and cropping patterns, and highly appreciated by farmers. We argue that this narrative is incomplete, because it constitutes only a partial explanation of the confluence of factors that led to the outcome. We reconstruct the success story using a recent conceptual framework that decomposes the technological change process into four aspects: propositions, encounters, dispositions and responses (PEDR). We show that many of the factors which contributed to the spread of modern chickpea varieties in Andhra Pradesh lay beyond the control of the international agricultural research system, and operated across large spatial and temporal scales. In conclusion, we argue that the success of improved chickpeas in Andhra Pradesh underscores the value of basic plant breeding and research, which aim to produce public goods. We relate our analysis to current discussions about the future strategic direction of international agricultural research organisations and the CGIAR. Our argument implies a criticism of the drive to develop new varieties which conform to product profiles that are based on predictions of current and near-term demand. While that approach makes sense for product developers seeking to serve commercial markets, basic research is needed to create and diversify technical options, which anticipate a range of future needs that are hard to predict in the present.
We present a new method for the stable reconstruction of a class of binary images from a small number of measurements. The images we consider are characteristic functions of algebraic domains, that ...is, domains defined as zero loci of bivariate polynomials, and we assume to know only a finite set of uniform samples for each image. The solution to such a problem can be set up in terms of linear equations associated to a set of image moments. However, the sensitivity of the moments to noise makes the numerical solution highly unstable. To derive a robust image recovery algorithm, we represent algebraic polynomials and the corresponding image moments in terms of bivariate Bernstein polynomials and apply polynomial-generating, refinable sampling kernels. This approach is robust to noise, computationally fast and simple to implement. We illustrate the performance of our reconstruction algorithm from noisy samples through extensive numerical experiments. Our code is released open source and freely available.
This paper investigates two important analytical properties of hyperbolic-polynomial penalized splines, HP-splines for short. HP-splines, obtained by combining a special type of difference penalty ...with hyperbolic-polynomial B-splines (HB-splines), were recently introduced by the authors as a generalization of P-splines. HB-splines are bell-shaped basis functions consisting of segments made of real exponentials eαx,e−αx and linear functions multiplied by these exponentials, xe+αx and xe−αx. Here, we show that these types of penalized splines reproduce functions in the space {e−αx,xe−αx}, that is they fit exponential data exactly. Moreover, we show that they conserve the first and second ‘exponential’ moments.
With the aim of generalizing P-splines, we here define a special type of penalized splines, called HP-splines, where polynomial splines are replaced by the richer class of hyperbolic-polynomial ...splines and a suitably tailored discrete penalty term is used. Hyperbolic-polynomial splines, important in several applications, are a natural generalization of polynomial splines consisting of piecewise-defined functions with segments spanned by ‘atoms’of type xreαx where r=0,…,ℓ and α∈R. HP-splines, that reduce to P-splines for α=0, are more suitable to data with an exponential trend which is frequent in applications.
During chronic kidney disease (CKD) progression, an increase in fibroblast growth factor (FGF23) is present. In stage 5, a positive correlation between FGF23 and omega-6 (n-6) polyunsaturated fatty ...acids (PUFAs) emerges. Hypothesizing that the rising positive correlation between monocyte chemoattractant protein 1 (MCP1) and n-6 in stage 4 could be the cause, we previously explored FGF23 and MCP1’s roles in dyslipidemia and cardiovascular risk in CKD. In the present paper, we retraced the study evaluating 40 kidney transplant patients (KTx), a cohort where several factors might modify the previous relationships found. An ELISA and gas chromatography assessed the MCP1, FGF23, and PUFA levels. Despite the FGF23 increase (p < 0.0001), low MCP1 levels were found. A decrease in the n-6/n-3 ratio (p = 0.042 CKD stage 4 vs. 5) lowered by the increase in both n-3 αlinolenic (p = 0.012) and docosapentaenoic acid (p = 0.049) was observed. A negative correlation between FGF23 and the n-6/n-3 ratio in CKD stage 4 (r2 −0.3 p = 0.043) and none with MCP1 appeared. According to our findings, different mechanisms in the relationship between FGF23, PUFAs, and MCP1 in CKD and KTx patients might be present, which is possibly related to the immunosuppressive status of the last. Future research will further clarify our hypothesis.
Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific ...community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps.
The primary end point of this pilot study is to evaluate patients' usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources-based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app).
This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named "PainRELife," which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701).
The recruitment process started in May 2022 and ended in October 2022.
The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP.
DERR1-10.2196/41216.
Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological ...health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway.
This pilot study aims to evaluate patients' experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data.
We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology.
The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057).
The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory.
RR2-10.2196/41216.
Abstract Current evidences show that recombinant human bone morphogenetic protein 7 (rhBMP-7, eptotermin alfa) can be considered an effective alternative to autologous bone graft (ABG) in the ...treatment of tibial nonunions. Few studies, so far, have analysed the costs of treating tibial nonunions with either rhBMP-7 or ABG and none of them has specifically considered the Italian situation. The aim of the present study was to capture, through observational retrospective methods, the direct medical costs associated with the treatment of tibial nonunions with rhBMP-7 or ABG in Italy and to compare the cost effectiveness of the two interventions. The secondary objective was to perform a cost-reimbursement analysis for hospitalisations associated with the two treatments. Data of 54 patients with indication for tibial nonunion were collected from existing data sources. Of these patients, 26 were treated with ABG and 28 with rhBMP-7. The study captured the direct medical costs for treating each tibial nonunion, considering both inpatient and outpatient care. The hospital reimbursement was calculated from discharge registries, based on diagnosis-related group (DRG) values. A subgroup of patients ( n = 30) was also interviewed to capture perceived health during the follow-up, and the quality-adjusted life years (QALYs) were subsequently computed. The two groups were similar for what concerns baseline characteristics. While the medical costs incurred during the hospitalisation associated with treatment were on average €3091.21 higher ( P < 0.001) in patients treated with rhBMP-7 (reflecting the product procurement costs), the costs incurred during the follow-up were on average €2344.45 higher ( P = 0.02) in patients treated with ABG. Considering all costs incurred from the treatment, there was a borderline statistical evidence ( P = 0.04) for a mean increase of €795.42, in the rhBMP-7 group. Furthermore, the study demonstrated that, without appropriate reimbursement, the hospital undergoes significant losses ( P = 0.003) when using rhBMP-7 instead of ABG. In contrast to these losses, in Italy, the average cost to achieve a successful outcome was €488.96 lower in patients treated with rhBMP-7 and, additionally, the cost per QALY gained was below the cost-utility threshold of $50,000.
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