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There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group.
We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention.
A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield.
Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
Plant breeding makes genetic gains over years, so growing newer varieties generally provides greater benefits than growing older ones. However, in low-altitude districts of Nepal, a few rice varieties covered 75% of the rice area and were more than 20 years old (first paper in this series). We test here if this slow rate of adoption of new varieties could be accelerated using a participatory method, Informal Research and Development (IRD), where packets of seeds of new rice varieties are widely distributed to many farmers. From 2008 to 2011, over 117 000 IRD packets were distributed in 18 districts of the Nepal Terai, including over 70 000 of three released varieties from a client-oriented breeding (COB) programme in Nepal. The IRD significantly increased the adoption of the three COB varieties. The benefits obtained by farmers in a single growing season equal the costs of IRD, if for every 75 kits distributed an additional 1 ha is grown. This assumes that the new varieties produce a 10% increase in yield (lower than that evidenced in their release proposals). On an average, fewer than three IRD kits were distributed for each hectare of a new variety grown by farmers in 2011. Furthermore, the effectiveness of IRD could be increased 1.2 to 2.7 fold (depending on the COB variety) if the IRD distribution were to be restricted to the region where the variety was most accepted. The best comparison of IRD with extension by the conventional system was their popularity compared with similar-aged varieties that had been promoted in the two systems. The adoption of three COB varieties was about twicethat of three varieties from the National Rice Research Programme (NRRP) that were closest in release date to the COB varieties. Unlike cost effectiveness assessed by hectares grown per IRD kit distributed, this comparison can only indicate efficacy because, as well as extension method, many factors influenced the adoption rates of the COB and NRRP varieties. The costs of IRD are small, both relative to the cost of breeding new varieties and to the benefits gained; so it is one of the simplest and most cost-effective interventions to increase agricultural productivity.
Farmers who continue to grow old and obsolete varieties do not gain the benefits they could get from growing newer ones. Given the potential large scale of these foregone benefits, relatively few studies have examined the age of varieties that farmers grow. In three surveys, members of over 3300 households were interviewed to find the rice varieties they grew in 2008 and 2011 in 18 districts in the Terai, the low-altitude region of Nepal. This provided the first description of detailed geographical patterns of adoption of rice varieties and their ages that were repeated over time. There were large differences between district and individual varieties that showed specific geographical patterns of adoption. Such detailed knowledge on spatial diversity of varieties is invaluable for planning extension activities and developing breeding programmes, and cheaper ways than household surveys of collecting this information are discussed. Some of the factors considered important in determining this complex pattern of adoption were seed availability, growing environments that differed from east to west and the continued popularity of varieties once they had established markets. Rice diversity was low because a small number of rice varieties occupied large areas. In 2011, nine varieties covered at least 75% of the total rice area in western districts, just four in central districts and eight in eastern districts. Of these, most were released before 1995 resulting in a high average age of the predominant varieties – they always had an average age of over 20 years no matter which region or year was considered. Even though there were some large changes in varietal composition from 2008 to 2011, the average age of the predominant varieties remained almost the same. In a second paper in this series, we examine how these very low varietal replacement rates, that reduce yields and increase risk to farmers, can be accelerated using a participatory research for development approach called Informal Research and Development (IRD) (Joshi et al., 2012).
Background: To evaluate the myocardial protective effect of nicorandil when used as an adjuvant to cold hyperkalaemic cardioplegia in open-heart surgery. Methods: Patients who underwent surgery under cardiopulmonary bypass (CPB) for mitral valve replacement (MVR, 23 patients) or coronary artery bypass grafting (CABG, 24 patients) were entered in a double-blind study. The patients were randomized to a nicorandil Group (N) or placebo Group (P). Nicorandil 0.1 mg kg−1 (Group N), or normal saline (Group P), were administered at three time points: (1) after aortic cannulation, but prior to going on CPB, (2) 5 min before aortic cross-clamping and (3) 5 min before reperfusion. The following variables were studied: (a) time until electromechanical arrest after cardioplegia administration (Tarrest), (b) time until return of electromechanical activity after aortic cross-clamp removal (Trecovery), (c) incidence of postoperative myocardial infarction or low output syndromes (d) dysrhythmias requiring intervention after aortic cross-clamp removal and (e) haemodynamic changes after nicorandil administration. Results: The Tarrest after cardioplegia administration was significantly faster in nicorandil group in both MVR and CABG patients (P < 0.05), but Trecovery did not differ significantly. The incidence of postoperative serum CK-MB > 75 IU L−1 in MVR patients was significantly lower in the Group N than in placebo patients (P < 0.05). However, in CABG patients there was no such significant difference. The incidence of dysrhythmias requiring intervention after aortic cross-clamp removal was also less in Group N. Administration of 0.1 mg kg−1 boluses of nicorandil did not cause significant haemodynamic changes or precipitate dysrhythmias in any patient. Conclusion: Nicorandil enhances the myocardial protective effect of cold hyperkalaemic cardioplegia in cardiac surgery patients.
Background and objective: We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio ≥0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. Methods: Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. Results: Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 ± 29.5 mmHg, SaO2 = 98.1 ± 1.4%) than in supine (PaO2 = 111.0 ± 30.6 mmHg, SaO2 = 97.6 ± 2.2%) and left lateral positions (PaO2 = 109.7 ± 32.0 mmHg, SaO2 = 97.6 ± 1.7%; mean ± SD; P < 0.01). There was no significant difference in arterial oxygenation between left lateral and supine positions (P > 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). Conclusion: Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.