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Purpose: Volumetric arc therapy (VMAT) is a radiation therapy (RT) technique that spares normal tissues from high and intermediate RT doses but increases the volume of tissues receiving low doses of RT compared with 3-dimensional conformal RT (3DCRT). We hypothesized that palliative VMAT would reduce the detriment to patient quality of life (QOL) compared with palliative 3DCRT.Methods and Materials: This phase 2 trial randomized patients to palliative RT using VMAT or 3DCRT to 1 painful site of metastatic disease in the trunk. Treating physicians could choose 8 Gy in 1 fraction or 20 Gy in 5 fractions to stratify randomization. The primary endpoint was the change in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30) global health status QOL subscale at 1 week after RT. Repeated measures analysis of variance was used to assess the relationship of patient QOL over time with other factors.Results: From July 2014 to November 2017, 37 patients who underwent 3DCRT and 32 patients who underwent VMAT were randomized into the study. Median overall survival was 9 months. Overall pain responses to RT were equivalent (P = .53) between the techniques. Patient compliance in returning QOL questionnaires was 94%, 81%, and 69% at baseline, 1 week after RT, and 1 month after RT, respectively. At 1 week after RT, change in global QOL was not significantly (P = .31) different between VMAT versus 3DCRT. At 4 weeks after RT, VMAT induced significantly (P = .049) less global QOL deterioration than 3DCRT did. Patients who underwent VMAT maintained better physical (P = .012), role (P = .041), and social (P = .025) functioning, but they reported more diarrhea symptoms (P = .017) than in the 3DCRT group.Conclusions: Palliative VMAT and 3DCRT did not differ in their ability to control pain; however, palliative VMAT induced fewer QOL detriments than 3DCRT did at 4 weeks after RT. [ABSTRACT FROM AUTHOR]

Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin. In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18–65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14–21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of –10 percentage points. Safety endpoints were assessed before treatment, and at 2–3 h, 24 h, and 14–21 days after treatment. This trial is registered at ClinicalTrials.gov , NCT04056325 and NCT04848688. Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of –2·1 percentage points (95% CI –5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient. Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis. Swiss National Science Foundation. [ABSTRACT FROM AUTHOR]

Abstract: The Lao People''s Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries. [Copyright &y& Elsevier]

The Greater Mekong Subregion has been undergoing rapid agricultural transformation over the last decades, as traditional diverse subsistence-oriented agriculture is evolving towards intensified commercial production systems. Negative environmental impacts often include deforestation, nutrient pollution, and greenhouse gas (GHG) emissions. This study aims to explore the potential of crop-livestock integration to mitigate trade-offs between economic and environmental impacts of smallholder farming systems at different stages of agricultural transition and degrees of agricultural diversity across the Greater Mekong Subregion. We chose a 'middle ground' between detailed modeling of few, representative farming systems and modeling of large household populations. 24 low and high diversity farms were selected in Laos (Xieng Khouang province), Cambodia (Ratanakiri province) and Vietnam (Central Highlands) from a survey dataset of 1300 households. These farming systems were simulated with the whole-farm bio-economic and multi-objective optimization model FarmDESIGN, calculating operating profit, GHG emissions and nitrogen (N) balance. Two optimizations ('business as usual' vs. 'crop-livestock integration') were performed, generating 'solution spaces' or alternative configurations aiming to maximize profitability, keep farm N balanced and minimize GHG emissions. Agricultural systems across the sites differed in their production orientation and management practices, representing various stages of agricultural transition. Nitrogen balances varied between sites, being negative in Ratanakiri (average − 20.5 kg N ha−1 y−1) and Xieng Khouang (−36.5 kg N ha−1 y−1) and positive in the Central Highlands (73 kg N ha−1 y−1). Negative balances point to unsustainable mining of nutrients due to sale of cash crops without sufficient inputs, and positive balances to the risk of environmental contamination. Total GHG emissions ranged from 0.52–8.12 t CO 2 e ha−1 and were not significantly impacted by stage of agricultural transformation or agricultural diversity. GHG sources in Ratanakiri and Xieng Khouang were determined by crop residue burning while in Central Highlands fertilizer and livestock were main emitters. High diversity farms obtained higher operating profits (10,379 USD y−1) than low diversity farms (4584 USD y−1). Crop-livestock integration, a combination of measures including introduction of improved forages grasses, manure recycling and residue feeding, and reduction of residue burning, resulted in larger 'solution spaces', thus providing farmers with more options to mitigate agro-environmental trade-offs. These findings underline the potential of crop-livestock integration to support sustainable intensification pathways in the Greater Mekong region. Public and private investment in further research and extension is needed to develop and scale context-specific crop-livestock integration practices. [Display omitted] • The Greater Mekong Subregion is undergoing rapid agricultural transformation, accompanied by negative environmental impacts • This study explores the potential of crop-livestock integration to mitigate such agro-environmental trade-offs • Nitrogen balances and greenhouse gas emissions were partly determined by transition stage, but not agricultural diversity • Crop-livestock integration resulted in larger 'solution spaces' to mitigate trade-offs than business as usual • Investment in research and extension is needed to develop and scale context-specific crop-livestock integration practices [ABSTRACT FROM AUTHOR]

• The complexity index (CI) allows compressing historical land use data at multiple scales. • CI in the subsistence site was 4.4 times higher than in the market-oriented site. • Key drivers of land use change differed significantly along the transition gradient. • Households with higher food availability show less transition at the market-oriented site. • CI was significantly negatively correlated with poverty at the subsistence site. Agricultural systems in Southeast Asia are rapidly transitioning from subsistence-oriented to market-oriented agriculture. Driven by the highly complex and variable decision processes of individual farm households, these transitions have produced a diverse landscape mosaic across the region. Elucidation and characterization of underlying decision-making processes, and the factors that influence land use choices, are thus essential for sustainable land use planning. To enable a study that seeks to understand these linkages, data on plot-level 10-year land use history, management and farm performance indicators were collected from 163 households in the Northern Lao uplands and in the Central Highlands of Vietnam, areas chosen to represent two extremes of the transition gradient. The objectives of the study were (i) to describe plot-level sequence patterns of seasonal variation of land use over several years, (ii) to apply a sequence dissimilarity metric, the complexity index (CI), to measure land use transition in an agricultural system, and (iii) to identify the key drivers of land use change and their linkages with farm performance indicators and plot level characteristics through multi-dimensional analysis. CI allowed compressing historical land use data and quantifying land use complexity in a simple and efficient manner. Land use dynamics varied strongly between the two sites, with 66% of the land use types in the Laos site being completely replaced by others during the recall periods, compared to only 15% in the Vietnam site. Associated key drivers of land use change also differed significantly: while end use of agricultural products was the main driver behind land use changes in the Vietnam site, a more complex relationship between topography and management vs. land use change was evident in the Laos site. Likewise, land use complexity does not exhibit the same relationship with farm performance in the two sites: in the Central Highlands, households with higher food availability are half as likely to transition, while in the Lao uplands, land use complexity was significantly correlated with the Progress out of Poverty index. Multidisciplinary studies remain necessary to assess the impact of innovative sustainable intensification options on system performance and environmental sustainability, before policies are enacted to support their dissemination in Southeast Asian smallholder agricultural systems. Context-specific CI thresholds associated with system quality indicators could support this by informing decision-makers on the pace of agricultural transformation and its environmental impacts. [ABSTRACT FROM AUTHOR]

South East Asia's agricultural landscape is rapidly transitioning from subsistence to intensive and market-oriented production, often with negative impacts on soil fertility. Ensuring that this transition is conducted in a sustainable way is critical, especially for the poorest who rely exclusively on natural resources that are of limited quality and quantity. This study aims to evaluate sustainable intensification options for smallholder ethnic minority farmers of the Lao uplands. Following a systematic selection of case study crop-livestock farms with different degrees of diversification and market orientation, we adopted a detailed nutrient flow approach to quantify nitrogen (N) and phosphorus (P) balances at farm level using a whole farm modelling tool. This was then used to simulate alternative sustainable intensification options relative to the baseline and their impact on farm performance and N and P cycling. Irrespective of the intensification level, nutrient balances were negative on all farms, with net nutrient removal between −34 and −130 kg N ha−1y−1 and between −9 and −20 kg P ha−1y−1. The positive effect of the sustainable intensification options on selected system performance variables was up to 15 times higher when its baseline value was low, i.e. when potential for improvement was high. Compared to the baseline (rice and maize monocropping systems), fallow plots during the dry season and low level of residues recycling, all intensification options increased land productivity and N balance by at least 12% on each farm, whereas the P balances were negatively impacted. The positive effects on the N balances might not be sufficient to reverse nutrient depletion, and additional nutrient inputs would be necessary. Four management principles are key to ensure a smooth transition from subsistence to intensive production: no residue burning, stay diverse, integrate livestock and use small amounts of P mineral fertilizer. If combined with efficient and integrative agricultural extension, seed systems and market development, these basic principles could be the key success factor for a sustainable development of the Lao uplands. • Market orientation and diversity are the main drivers of variation in Lao upland farms. • Nutrient balances were negative for all farms, whether subsistence or intensive. • Farming system redesign is needed to avoid a decline of soil fertility and livelihoods. • Diversity, livestock, P fertilizer and no burning are key for sustainable intensification. [ABSTRACT FROM AUTHOR]

Over the past four decades, agricultural systems in the Greater Mekong Subregion (GMS) have largely evolved from a subsistence orientation toward commercial production, but the multi-faceted changes behind this evolution vary in substance and degree. Despite connoting economic progress, effects of these changes on household welfare indicators such as dietary diversity have been unclear. By taking a comprehensive view of the farm household, this study discerns the drivers of household dietary diversity in this transitional context by linking the Household Dietary Diversity Score (HDDS), as an indicator of dietary diversity, to key household characteristics, livelihood strategies and indicators of farm performance in three study sites in Cambodia, Laos and Vietnam. The Rural Household Multi-Indicator Survey (RHoMIS) tool, a combined survey and analysis platform, was employed to collect data from over 1300 farm households. HDDS is found to increase among the sites in a way that is roughly associated with their state of agricultural transition, though differing combinations of market orientation, specialisation, and intensification traits that describe such a transition suggest that the pathway to commercialisation, and dietary diversity, is not a linear one. Drivers of dietary diversity vary markedly between the sites. In the Laos site, HDDS is most closely correlated to a set of variables closely linked with agricultural transition, while in the Cambodia site it is associated more with other farm and household characteristics. In the Vietnam site, dietary diversity is correlated to the overall value of crop production. Findings point to the need to contextualise site-specific knowledge of linkages between dietary diversity and ongoing agricultural transition in the GMS, as well as policy and interventions seeking to improve dietary diversity in the face of such transition. • Market orientation, specialisation, and intensification describe agricultural transition. • These key agricultural transition aspects are linked to dietary diversity in the GMS. • The RHoMIS survey platform was applied to collect and analyse GMS household data. • Agricultural transition pathways in the GMS vary greatly and are multi-dimensional. • Site-specific knowledge is needed to enhance dietary diversity amidst transition. [ABSTRACT FROM AUTHOR]