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The research developed a circularity framework that can be adopted at Mtapa urban open market in Gweru, Zimbabwe. The market has experienced a significant increase in vendors since many smaller open markets were closed in 2020 during covid-19 pandemic in a bid to clean up the city. However, rapid development and overcrowding have led to challenges in waste management which pose health risks to vendors. To address these challenges, the research utilised a descriptive case-study design combining both qualitative and quantitative data collection and analysis methods. Data was collected using questionnaires, semi structured interviews and direct-field observation. Analysis was conducted using soft wares such as Microsoft Excel and Statistical Package for Social Sciences (SPSS). Content analysis was used to analyse qualitative data. A relationship between level of education and participation in circular initiatives was tested, yielding a chi-square p-value of 0.001. This indicates that a lack of knowledge among vendors is a significant barrier to the adoption of circularity practices. The lack of waste recycling infrastructure was also a major barrier for waste management and waste recycling at Mtapa Open Market. The study highlights the importance of implementing circularity through developing a framework which lays out measures that can be adopted to enhance sustainability and address waste management. Therefore, the study concludes that there is need for circularity at Mtapa Open Market, that has opportunity for market growth and revenue generation. The study recommends the need for waste utilisation, recycling and adoption of circular economy with involvement of major stakeholders such as the Gweru City Council, Environmental Management Agency and Mtapa Open Market vendors.

Objective: Clinical guidelines provide recommendations on the minimal blood vessel diameters required for arteriovenous fistula creation but the evidence for these recommendations is limited. We compared vascular access outcomes of fistulas created in agreement with the ESVS Clinical Practice Guidelines (i.e. arteries and veins >2 mm for forearm fistulas and >3 mm for upper arm fistulas) with fistulas created outside these recommendations.Methods: The multicenter Shunt Simulation Study cohort contains 211 hemodialysis patients who received a first radiocephalic, brachiocephalic, or brachiobasilic fistula before publication of the ESVS Clinical Practice Guidelines. All patients had preoperative duplex ultrasound measurements according to a standardized protocol. Outcomes included duplex ultrasound findings at 6 weeks after surgery, vascular access function, and intervention rates until 1 year after surgery.Results: In 55% of patients, fistulas were created in agreement with the ESVS Clinical Practice Guidelines recommendations on minimal blood vessel diameters. Concordance with the guideline recommendations was more frequent for forearm fistulas than for upper arm fistulas (65% vs 46%, p= 0.01). In the entire cohort, agreement with the guideline recommendations was not associated with an increased proportion of functional vascular accesses (70% vs 66% for fistulas created within and outside guideline recommendations, respectively; p= 0.61) or with decreased access-related intervention rates (1.45 vs 1.68 per patient-year, p= 0.20). In forearm fistulas, however, only 52% of arteriovenous fistulas created outside these recommendations developed into a timely functional vascular access.Conclusions: Whereas upper arm arteriovenous fistulas with preoperative blood vessel diameters <3 mm had similar vascular access function as fistulas created with larger blood vessels, forearm arteriovenous fistulas with preoperative blood vessel diameters <2 mm had poor clinical outcomes. These results support that clinical decision-making should be guided by an individual approach.

The inferior alveolar nerve block (IANB) is a dental anesthetic injection that is critical to the performance of many dental procedures. Dental students typically learn to administer an IANB through videos and practice on silicone molds and, in many dental schools, on other students. This causes significant stress for both the students and their early patients. To reduce discomfort and improve clinical outcomes, we created an anatomically informed virtual reality headset-based educational system for the IANB. It combines a layered 3D anatomical model, dynamic visual guidance for syringe position and orientation, and active force feedback to emulate syringe interaction with tissue. A companion mobile augmented reality application allows students to step through a visualization of the procedure on a phone or tablet. We conducted a user study to determine the advantages of preclinical training with our IANB simulator. We found that in comparison to dental students who were exposed only to traditional supplementary study materials, dental students who used our IANB simulator were more confident administering their first clinical injections, had less need for syringe readjustments, and had greater success in numbing patients.

Cyber-slacking interrupts classroom teaching and learning activities and is associated with poor academic performance. Based on the theory of planned behavior (TPB), this study aimed to investigate whether both cognitive (i.e., attitudes, perceived norms, and perceived behavioral control) and affective (i.e., fear of missing out [FoMO]) factors contribute to classroom cyber-slacking intention and behavior among Chinese university students. We recruited a convenience sample of 431 undergraduate students (M= 19.34, SD= 1.08; 66.4% female; 33.6% male) from mainland China who completed an online survey (i.e., items measured cognitive factors of cyber-slacking, cyber-slacking behavior, FoMO, and demographic information). The findings of correlational, hierarchical multiple regression, and path analysis with bootstrapping approach showed that both cognitive and affective factors were positive correlates of cyber-slacking intention and behavior and explained the variance in cyber-slacking intention. Moreover, attitudes, perceived norms, perceived behavioral control, and FoMO had statistically significant indirect effects (via intention) on cyber-slacking behaviors, whereas perceived behavioral control alone has a direct impact on cyber-slacking behaviors. The findings not only lend more credence to TPB, suggesting that cognitive factors are reliable correlates of both classroom cyber-slacking intention and behavior, but also showed affective factors, such as FoMO, can be used to reduce students’ cyber-slacking intention and, subsequently, their behavior. Based on these findings, interventions for reducing classroom cyber-slacking are discussed.

As the youth mental health crisis continues to worsen, there is a need for more evidence-based social-emotional interventions that can be applied in schools – the setting in which youth are most likely to seek and receive mental health treatment (Simon et al., 2015). Further, exploring ways to culturally adapt interventions for marginalized students is essential. The Ecological Validity Model (EVM; Bernal & Sáez-Santiago, 2006) guides the cultural adaptation process. This study examined the social validity of a promising school-based positive psychology intervention adapted using the EVM. A total of 98 middle school students with diverse backgrounds provided quantitative ratings of their perception of the adapted WBPP. Among those students, 70% participated in individual interviews providing qualitative information about their experiences with the adapted WBPP. Using a sequential explanatory mixed methods design, the findings indicated that participants believed the intervention content was appropriate, goals were significant, and outcomes were important. Participants requested more attention be given to their unique life experiences and adding interactive session activities. Given this initial evidence to support the acceptability of the adapted WBPP, future studies should explore the effectiveness of this program among students who reflect the diversity of public schools.

El presente artículo se centra en las plumas tapiragede los textiles miniatura con arte plumario hallados en el templo Huaca de la Luna del sitio Huacas de Moche (Valle de Moche, Perú), asociados a la ocupación Chimú (1000-1440 dC). El tapiragees una técnica de manipulación biológica, practicada por ciertos grupos amazónicos, que altera el color de las plumas de algunos psitácidos de los géneros Aray Amazona. Para confirmar la existencia de plumas tapirageen estos textiles, se realizó una identificación taxonómica macroscópica y microscópica de las plumas arqueológicas. Por último, se aplicaron análisis arqueométricos de microscopía de barrido electrónico (SEM) y microscopía digital para identificar los cambios en las microestructuras de las plumas, como también las especies de las plumas mismas. Los resultados muestran que las plumas de los textiles chimúes de Huaca de la Luna presentan plumas tapirage, lo que permite discutir sobre las relaciones de intercambio entre la costa norte peruana y la Amazonia, y avanzar en la interpretación de los significados de estas plumas en los rituales de la cultura Chimú, por su valor simbólico y capacidad de acceso a estas bienes por parte de estas comunidades costeras.

The European Commission has made grants available for supporting the collection of road safety performance indicators (called ‘KPIs’) within the EU. 18 EU Member States are participating in this project. For each of the eight KPIs considered, a common methodology for data collection and analysis has been developed by European experts; the methodological guidelines are available at the Baseline website (baseline.vias.be). Data collection and analysis is currently being finalized; the KPIs will be available in October 2022. They will constitute the basis for monitoring road safety progress at national and EU level, will facilitate the formulation of targets at European an national level, and will support decision makers on the most appropriate measures to be taken to improve road safety. Several EU countries have already integrated the monitoring of the KPIs in their road safety strategy.

The article narrates the interfaith marriage of a Jewish woman and her atheist husband, highlighting their journey of accommodating each other's beliefs and practices. It also discusses the evolution of their religious practices, their family's approach to Judaism, and their shared experiences in Israel.

IMPORTANCE: Feeding intolerance is a common condition among preterm infants owing to immaturity of the gastrointestinal tract. Enteral insulin appears to promote intestinal maturation. The insulin concentration in human milk declines rapidly post partum and insulin is absent in formula; therefore, recombinant human (rh) insulin for enteral administration as a supplement to human milk and formula may reduce feeding intolerance in preterm infants. OBJECTIVE: To assess the efficacy and safety of 2 different dosages of rh insulin as a supplement to both human milk and preterm formula. DESIGN, SETTING, AND PARTICIPANTS: The FIT-04 multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at 46 neonatal intensive care units throughout Europe, Israel, and the US. Preterm infants with a gestational age (GA) of 26 to 32 weeks and a birth weight of 500 g or more were enrolled between October 9, 2016, and April 25, 2018. Data were analyzed in January 2020. INTERVENTIONS: Preterm infants were randomly assigned to receive low-dose rh insulin (400-μIU/mL milk), high-dose rh insulin (2000-μIU/mL milk), or placebo for 28 days. MAIN OUTCOMES AND MEASURES: The primary outcome was time to achieve full enteral feeding (FEF) defined as an enteral intake of 150 mL/kg per day or more for 3 consecutive days. RESULTS: The final intention-to-treat analysis included 303 preterm infants (low-dose group: median [IQR] GA, 29.1 [28.1-30.4] weeks; 65 boys [59%]; median [IQR] birth weight, 1200 [976-1425] g; high-dose group: median [IQR] GA, 29.0 [27.7-30.5] weeks; 52 boys [55%]; median [IQR] birth weight, 1250 [1020-1445] g; placebo group: median [IQR] GA, 28.8 [27.6-30.4] weeks; 54 boys [55%]; median [IQR] birth weight, 1208 [1021-1430] g). The data safety monitoring board advised to discontinue the study early based on interim futility analysis (including the first 225 randomized infants), as the conditional power did not reach the prespecified threshold of 35% for both rh-insulin dosages. The study continued while the data safety monitoring board analyzed and discussed the data. In the final intention-to-treat analysis, the median (IQR) time to achieve FEF was significantly reduced in 94 infants receiving low-dose rh insulin (10.0 [7.0-21.8] days; P = .03) and in 82 infants receiving high-dose rh insulin (10.0 [6.0-15.0] days; P = .001) compared with 85 infants receiving placebo (14.0 [8.0-28.0] days). Compared with placebo, the difference in median (95% CI) time to FEF was 4.0 (1.0-8.0) days for the low-dose group and 4.0 (1.0-7.0) days for the high-dose group. Weight gain rates did not differ significantly between groups. Necrotizing enterocolitis (Bell stage 2 or 3) occurred in 7 of 108 infants (6%) in the low-dose group, 4 of 88 infants (5%) in the high-dose group, and 10 of 97 infants (10%) in the placebo group. None of the infants developed serum insulin antibodies. CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial revealed that enteral administration of 2 different rh-insulin dosages was safe and compared with placebo, significantly reduced time to FEF in preterm infants with a GA of 26 to 32 weeks. These findings support the use of rh insulin as a supplement to human milk and preterm formula. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02510560

Introduction: Nursing homes (NHs) are an ideal environment in which to implement interventions aimed at reducing inappropriate prescriptions. Quality indicators (QIs) may be useful to standardize practices, but it is unclear how they mediate change. In the framework of a quantitative study aimed at reducing the prescription of anticholinergic drugs among NH residents using QIs, we performed a qualitative study to describe the investigators’ perception of the utility of QIs. Methods: Qualitative study using focus group methodology. Focus groups were recorded and transcribed, and analyzed by thematic analysis. Participants were purposefully recruited from among the medical directors of the NHs in the quantitative study. Results: Five medical directors participated in two focus group meetings. The main themes to emerge were: (1) communication is key to introducing new practices and achieving lasting uptake; (2) improved coordination and communication provided useful information to help interpret the quantitative results observed: e.g., participants reported that they were able to obtain contextual and patient-specific information that explained why some prescribers had consistently, but justifiably “poor” performance on the quantitative indicators; (3) negative aspects reported included reluctance to change among prescribers and the tendency to shirk responsibility. Conclusion: From the point of view of medical directors of NHs participating in an interventional program to reduce inappropriate prescriptions of anticholinergic drugs, the main factor driving the success of the program was communication, which is key to achieving adherence. Improved communication provides useful insights into the reasons why no quantitative reduction is observed in objective quality indicators.

Supplemental digital content is available in the text.

Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA) < 37 weeks]; 10 at-term [GA = 37 weeks]) on = 4 time-points per day during the first five days, and once on the tenth day postpartum. The HM insulin concentration declined rapidly within the first three days postpartum (day 1: 516 [312–1058] pmol/L; day 3: 157 [87–299] pmol/L), after which the concentration remained relatively stable. The insulin concentrations were higher in HM from obese mothers than from non-obese mothers (P< 0.001). Preterm delivery did not significantly affect HM insulin concentrations when adjusted for maternal pre-pregnancy body mass index category (P= 0.270). Diurnal rhythm was characterized by an insulin concentration decline throughout the night (P= 0.001), followed by an increase in the morning (P= 0.001). The HM insulin concentration declines rapidly in the first three days postpartum, follows a diurnal rhythm, and is higher in obese mothers compared to non-obese mothers. HM insulin concentrations are not affected by preterm delivery.

Archaeological research in Lebanon often focuses on settlement from the Bronze Age to Roman periods, while surrounding landscapes, earlier and later periods are under-represented. Large datasets collecting information from all periods and site types, such as the Endangered Archaeology in the Middle East and North Africa (EAMENA) database, address this imbalance. EAMENA predominantly uses satellite imagery to identify archaeological sites and the threats posed to them, leading to the recognition of many previously unpublished sites, including abandoned buildings and agricultural terraces. Here we explore how such data can be used to trace patterns of settlement and landscape use. Transects running from coast to uplands in northern and southern Lebanon are compared: the results show profound differences between north and south, and between coastal and inland zones. The importance of large, holistic datasets for previously understudied site types and periods in piecing together past patterns of land use, subsistence economies, burial traditions and change over time are demonstrated.

This paper introduces the EAMENA database, from a user perspective, as a living document of archaeological datasets, assessing its utility for research and heritage management with respect to unfinished data collection and ongoing database development. An incomplete dataset of Crusader sites provides a useful case study of heritage places. First, through a simple analysis using the site function field, the paper demonstrates how users can query the database to identify areas or themes for future research. Second, it analyses condition assessments of Crusader sites in Lebanon to investigate whether these places are disproportionally affected by certain types of modern disturbance. Throughout, the paper discusses aspects of the EAMENA data recording process, highlighting several technical developments that the project has implemented since the public launch of its database in 2017. In doing so, it demonstrates the value of responsive database development to remain at the cutting edge of research technologies.

Background: There is a compelling need to prepare our societies and healthcare systems to deal with the oncoming wave of population ageing. The majority of older persons maintain a desire to be valued and useful members of society and of their social networks. Aims: We sought to investigate the perception of usefulness among persons aged 65 years and over in four European countries. Methods: We performed a cross-sectional survey with a representative sample of individuals aged 65 years or older from the population of retired persons (including recently retired persons and oldest-old individuals) from 4 European countries selected using quota sampling. In February 2016, an internet questionnaire was sent to all selected individuals. The characteristics used for the quota sampling method were sex, age, socio-professional category, region, city size, number of persons in household, autonomy, marital status, place of residence, income and educational status. The questionnaire contained 57 questions. Sociodemographic characteristics were recorded. Responses were analysed with principal components analysis (PCA). Results: A total of 4025 persons participated; 51% were males, and 70% were aged 65–75 years. PCA identified six classes of individuals, of which two classes (Classes 2 and 3) were characterized by more socially isolated individuals with little or no sense of usefulness, low self-esteem and a poor sense of well-being. These two classes accounted for almost 20% of the population. Younger and more autonomous classes reported a more salient sense of usefulness. Conclusions: The loss of the sense of usefulness is associated with dissatisfaction with life and a loss of pleasure, and persons with profiles corresponding to Classes 2 and 3 should, therefore, be targeted for interventions aimed at restoring social links.

The article focuses on the shift in the personal and emotional impact of the Israel-Hamas war on many Jews, highlighting the internal struggles, fears, and emotional toll caused by the conflict. Topics include the author's personal response to the events of October 7, concerns about Israeli governance, the rise of antisemitism, and a call for promoting projects that advance peaceful resolutions in the Israeli-Palestinian conflict.

The article focuses on the use of controversial terms like "apartheid," "racist," and "fascist" to describe Israel and how these words are increasingly being used in discussions about the country's policies. Topics include the historical context of these terms, evidence of actions by Israel that align with their definitions, and the growing concerns about Israel's direction under its current leadership.

To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. We report a prospective longitudinal trial comparing late first‐ and early second‐trimester US to traditional second‐trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P= .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2(UST1 [69%] versus UST2 [38%]; P= .001). Sixty‐two percent of patients with a body mass index of greater than 40 kg/m2required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. This study represents the largest prospective trial assessing early‐gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early‐gestation US to the 20‐ to 22‐week US substantially improves the visualization of fetal cardiac anatomy.

Few large projects have evaluated the factors that influence the HIV RNA concentrations (viral load) in cerebrospinal fluid (CSF) during antiretroviral therapy (ART) over time. We aimed to determine the correlates of HIV RNA in CSF in a large cohort.

The article discusses the evolving relationship between American Jews and the State of Israel. It highlights the traditional notion of "ahavat Yisrael" (love of one's fellow Jews) and how it has been extended to encompass support for the Jewish state. It portrays a shift in the relationship between American Jews and Israel, indicating that love for the Jewish state may have its limits.

Background:First-time NCLEX-RN pass rates are often used to evaluate the effectiveness of prelicensure nursing programs. Faced with pass rates that had declined from 85.71% to 64.86% over a period of 4 years, this baccalaureate-nursing program developed a postgraduation coaching intervention to assist graduates in developing an individualized plan as they prepared for their examination.Method:The intervention was designed to close the loop for graduates on NCLEX-RN preparedness. The intervention, led by the program's Tutor and Retention Coordinator, consisted of cognitive behavioral techniques, content reviews, and test-taking strategies.Results:The intervention has been successfully implemented for a period of 2 years and first-time pass rates rose to 87.66% in 2016 and 94.29% in 2017.Conclusion:Addressing first time NCLEX-RN pass rates requires a comprehensive approach. Students need to begin preparation for their NCLEX-RN examination early in their nursing program; however, this preparation needs to also continue after program completion. [Addressing first time NCLEX-RN pass rates requires a comprehensive approach. Students need to begin preparation for their NCLEX-RN examination early in their nursing program; however, this preparation needs to also continue after program completion. [J Nurs Educ.2018;57(9):561–565.]

This article is an essay about a mentor–mentee relationship that developed in an example of Boykin–Shoenhofer’s Theory of Nursing Caring. It is a demonstration of how caring for one another became caring for students, and caring for students leads to their enhanced self-efficacy and self-assurance, which led to greater success on the NCLEX-RN exam.

(Abstracted from J Ultrasound Med2019;38:2057–2063)The worldwide obesity epidemic has led to more than 1.9 billion adults 18 years of age or older classified as “obese.” As obesity is associated with greater risk of maternal and feto-neonatal complications, this study aimed to assess the utility of early gestational ultrasounds (USs) in cardiac screening for obese patients. This entailed performing both late first-trimester/early second-trimester transvaginal and transabdominal US, in comparison with the current national guideline-based second-trimester abdominal US for initial fetal cardiac screening in obese patients.

Variation in the density of archaeological evidence is caused by a multitude of interacting factors, some of which reinforce each other and some of which act to disguise genuine patterns of past practice. This paper initially presents a set of density models for England constructed by the members of the English Landscape and Identities (EngLaId) project and then goes on to discuss three possible explanations for the variation seen: modern affordance, variability in past usage of material culture, and past population density. The various members of the project team (with the aid of Andrew Lowerre) then provide their thoughts on the models and ideas presented from their own specific period specialist perspectives. The article is presented in this discursive format to reflect the differing opinions and approaches across an unusual multi-period project, in the spirit of multi-vocality and healthy debate.

Les mots sont à considérer comme les signes émergeants de valeurs, de normes sociales et de modèles culturels pensés et vécus par les individus de notre société. Notre ambition est ici d’explorer le lexique de « l’âge » qui soit plus juste, plus positif et surtout plus en phase avec la réalité actuelle liée au vocabulaire utilisé pour aborder ces thématiques. Notre objectif était d’identifier les grands champs lexicaux actuellement employés pour déterminer les représentations sociales associées aux personnes âgées, aux structures d’accueil, à la maladie et aux activités. La complexité de cette étude réside dans son ambition. En effet, pour déterminer les champs lexicaux actifs sur les sujets concernant les personnes âgées, il est nécessaire de concevoir un véritable « panorama » sémantique. Dans ce contexte, nous avons utilisé la sémiotique comme outil de classification et de structuration adapté à la complexité du sujet. Sa pratique nous a permis de classer les mots en fonction de leur appartenance signifiante, de les structurer en thèmes, d’en identifier les valeurs sous-jacentes (le sens) et de déterminer de nouveaux axes sémantiques potentiels. Cette recherche s’articule autour de 4 grandes étapes : une phase préalable de cadrage, la composition du corpus de données, l’analyse et le positionnement des différents items sous forme de cartographie. Les définitions du Domicile – en opposition à Maison de retraite – font émerger des attributs nouveaux. La notion du repère, du lieu de l’identité (chez soi), du lieu de l’intimité (mon lit), du lieu des habitudes (habitus, habitation), du lieu de la sécurité (un refuge) ou encore du lieu de la stabilité (une demeure) sont nécessaires lorsque l’on s’adresse à des structures d’accueil. De la même façon, pour parler des personnes âgées, de nombreux registres sémantiques sont possibles : on peut caractériser la personne sous l’angle de l’évolution des attributs physiques (personnes fragiles, être usé, être dépassé, les tempes grises, les silvers), sous l’angle de l’âge chronologique (les aïeux, les matures), de la sagesse (les anciens, les aînés), de l’expérience, de la bonification (l’âge d’or, les vermeils), sous l’angle du positivisme sportif (les vétérans, la réserve), ou de la joie de vivre affichée (les happy boomers, les jubilatoires, les flamboyants). Nos résultats identifient une réelle richesse et une grande diversité sémantique utilisée pour aborder ces quatre thématiques. Cette richesse nous indique de réelles possibilités quant à l’évolution de la sémantique vers une approche plus positive de ces thématiques.

IMPORTANCE: Infections and necrotizing enterocolitis, major causes of mortality and morbidity in preterm infants, are reduced in infants fed their own mother’s milk when compared with formula. When own mother’s milk is not available, human donor milk is considered a good alternative, albeit an expensive one. However, most infants at modern neonatal intensive care units are predominantly fed with own mother's milk. The benefits of add-on donor milk over formula are not clear. OBJECTIVE: To determine whether providing donor milk instead of formula as supplemental feeding whenever own mother’s milk is insufficiently available during the first 10 days of life reduces the incidence of serious infection, necrotizing enterocolitis, and mortality. DESIGN, SETTINGS, AND PARTICIPANTS: The Early Nutrition Study was a multicenter, double-blind randomized clinical trial in very low-birth-weight infants (birth weight &lt;1500 g) admitted to 1 of 6 neonatal intensive care units in the Netherlands from March 30, 2012, through August 17, 2014. Intent-to-treat analysis was performed. INTERVENTIONS: Infants received pasteurized donor milk or preterm formula during the first 10 days of life if own mother’s milk was not (sufficiently) available. MAIN OUTCOMES AND MEASURES: The primary end point was cumulative occurrence of serious infection (sepsis or meningitis), necrotizing enterocolitis, or mortality during the first 60 days of life. RESULTS: A total of 930 infants were screened for inclusion; 557 were excluded, resulting in 373 infants (183 receiving donor milk and 190 receiving formula) who were evaluated by intent-to-treat analysis (median birth weight, 1066 g; mean gestational age, 28.4 weeks). Own mother’s milk comprised 89.1% and 84.5% of total mean intake during the intervention period for the donor milk and formula groups, respectively. The incidence of the combined outcome was not different (85 [44.7%] [formula] vs 77 [42.1%] [donor milk]; mean difference, 2.6%; 95% CI, −12.7% to 7.4%). The adjusted hazard ratio was 0.87 (95% CI, 0.63-1.19; P = .37). CONCLUSIONS AND RELEVANCE: In the current study, pasteurized donor milk and preterm formula as supplemental feeding during the first 10 days of life yielded similar short-term outcomes in very low-birth-weight infants regarding safety and efficacy when own mother’s milk availability was insufficient. Future studies investigating longer duration of use of human donor milk on short-term and long-term outcomes are necessary. TRIAL REGISTRATION: trialregister.nl Identifier: NTR3225

•Lay people associate most globalization-related items with competence and lack of warmth.•Seeing symbols of two cultures simultaneously evokes categorical perceptions of culture.•Cultural identification and cultural threat increase resistance to inflow of foreign culture.•Foreign culture exposure improves creativity when culture is viewed as intellectual resource.