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Payments for Ecosystem Services (PES) provide conditional incentives for forest conservation. PES short-term effects on deforestation are well-documented, but we know less about program effectiveness when participation is sustained over time. Here, we assess the impact of consecutive renewals of PES contracts on deforestation and forest degradation in three municipalities of the Selva Lacandona (Chiapas, Mexico). PES reduced deforestation both after a single 5-year contract and after two consecutive contracts, but the impacts are only detectable in higher deforestation-risk parcels. Enrollment duration increases PES impact in these parcels, which suggests a positive cumulative effect over time. These findings suggest that improved spatial targeting and longer-term enrollment are key enabling factors to improve forest conservation outcomes in agricultural frontiers., (© 2023. The Author(s).)

Objectives: Some patients with rheumatoid arthritis develop interstitial lung disease (RA-ILD) that develops into progressive pulmonary fibrosis. We assessed the efficacy and safety of nintedanib versus placebo in patients with progressive RA-ILD in the INBUILD trial., Methods: The INBUILD trial enrolled patients with fibrosing ILD (reticular abnormality with traction bronchiectasis, with or without honeycombing) on high-resolution computed tomography of >10% extent. Patients had shown progression of pulmonary fibrosis within the prior 24 months, despite management in clinical practice. Subjects were randomised to receive nintedanib or placebo., Results: In the subgroup of 89 patients with RA-ILD, the rate of decline in FVC over 52 weeks was -82.6 mL/year in the nintedanib group versus -199.3 mL/year in the placebo group (difference 116.7 mL/year [95% CI 7.4, 226.1]; nominal p = 0.037). The most frequent adverse event was diarrhoea, which was reported in 61.9% and 27.7% of patients in the nintedanib and placebo groups, respectively, over the whole trial (median exposure: 17.4 months). Adverse events led to permanent discontinuation of trial drug in 23.8% and 17.0% of subjects in the nintedanib and placebo groups, respectively., Conclusions: In the INBUILD trial, nintedanib slowed the decline in FVC in patients with progressive fibrosing RA-ILD, with adverse events that were largely manageable. The efficacy and safety of nintedanib in these patients were consistent with the overall trial population. A graphical abstract is available at: https://www.globalmedcomms.com/respiratory/INBUILD_RA-ILD . Key Points • In patients with rheumatoid arthritis and progressive pulmonary fibrosis, nintedanib reduced the rate of decline in forced vital capacity (mL/year) over 52 weeks by 59% compared with placebo. • The adverse event profile of nintedanib was consistent with that previously observed in patients with pulmonary fibrosis, characterised mainly by diarrhoea. • The effect of nintedanib on slowing decline in forced vital capacity, and its safety profile, appeared to be consistent between patients who were taking DMARDs and/or glucocorticoids at baseline and the overall population of patients with rheumatoid arthritis and progressive pulmonary fibrosis., (© 2023. The Author(s).)

Context: We present a post-hoc approach to improve the recall of ICD classification., Method: The proposed method can use any classifier as a backbone and aims to calibrate the number of codes returned per document. We test our approach on a new stratified split of the MIMIC-III dataset., Results: When returning 18 codes on average per document we obtain a recall that is 20% better than a classic classification approach.

Introduction: Systemic sclerosis (SSc) is a rare condition that can be complicated by interstitial lung fibrosis (SSc-ILD)-a major cause of mortality. This study explored information and communication needs of patients with SSc-ILD and their carers to understand what they are and whether they are met., Methods: Qualitative research was performed, including in-depth individual interviews and observed conversations between pairs of patients, physicians and nurses, and between patients and physicians discussing experiences of SSc-ILD. The study was performed in Germany, Italy, Spain, the UK and the USA. Participants included 42 SSc-treating physicians, 21 patients with diagnosed SSc-ILD, 16 specialist nurses and five carers., Results: Prognosis and mortality were the main unspoken topics acknowledged by patients, carers and healthcare professionals. Patients and carers felt afraid to ask physicians about mortality, and most physicians reported avoiding the question because their duty was to give patients hope and avoid causing additional distress. Patients often felt unable to ask physicians about relationships, family and work because of time constraints or because they felt these were not topics physicians would be concerned about. Often, specialist nurses felt that they had insufficient knowledge to provide adequate support., Conclusion: Key topics, including mortality and prognosis, are rarely openly discussed, leaving patients uncertain and anxious about the future. By communicating about difficult but important topics, physicians and nurses could help patients and carers manage and plan their lives. This study shows that a multi-professional team-based communication approach is likely to better address patient needs and priorities., Key Points: • Key topics in SSc or SSc-ILD, such as mortality and prognosis, are rarely openly discussed in clinical consultations. • By communicating difficult but important topics, physicians and nurses could help patients manage their disease and plan their lives. • A multi-professional team-based communication approach is likely to better address patient needs and priorities and could be easily implemented without the need for significant additional resources.

Introduction Transparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS ® clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial. Summary We describe the establishment of a community advisory board (CAB): a transparent, multiyear collaboration between the scleroderma patient community and a CRS. We present shared learnings from the collaboration, which is split into three main areas: (1) the implementation and conduct of the clinical trial; (2) analysis and dissemination of the results; and (3) aspects of the collaboration not related to the trial.1. The scleroderma CAB reviewed and provided advice on trial conduct and reporting. This led to the improvement and optimisation of trial procedures; meaningful, patient-focused adaptations were made to address challenges relevant to scleroderma-associated interstitial lung disease patients.2. To ensure that results of the trial were accessible to lay audiences and patients, written lay summaries were developed by the trial sponsor with valuable input from the CAB to ensure that language and figures were understandable.3. The CAB and the CRS also collaborated to co-develop opening tools for medication blister packs and bottles. In addition, to raise disease awareness among physicians, patients and caregivers, educational materials to improve diagnosis and management of scleroderma were co-created and delivered by the CAB and CRS. Conclusions This collaboration between POs and a CRS, in a rare disease condition, led to meaningful improvements in patient safety, comfort and self-management and addressed information needs. This collaboration may serve as a template of best practice for future collaborations between POs, research sponsors and other healthcare stakeholders., Competing Interests: Competing interests: The authors have read and understood the BMJ policy on declaration of interests and have the following interests to declare:AR, MS, JW, RJR, ATK, IG, EB, CL, AGo, APPG, FH and RC did not receive any personal payments for their contributions to this article.AR, MS, JW, RJR, ATK, IG, EB, CL and APPG declare payments from Boehringer Ingelheim International GmbH to their respective POs (FESCA aisbl., Scleroderma Canada and Scleroderma Foundation, USA) for participation in community advisory board meetings and payment of travel expenses. AGo declares that Boehringer Ingelheim International GmbH paid for their travel expenses for participation in community advisory board meetings. AR, MS, JW and RJR declare that their POs (FESCA aisbl., Scleroderma Canada and Scleroderma Foundation, USA) received additional payments from Boehringer Ingelheim International GmbH for speaker and advisory services including payment of travel expenses. FH and RC declare that Boehringer Ingelheim International GmbH paid for their travel expenses for speaker and advisory services including one BI internal meeting and community advisory board meetings.RJR declares that the Scleroderma Foundation (USA) has received sponsorships in support of the annual scleroderma awareness raising campaign and the Scleroderma National Patient Education Conference from both Boehringer Ingelheim International GmbH and Boehringer Ingelheim Pharmaceuticals. FH and RC declare that EURORDIS-Rare Diseases Europe has received sponsorships from Boehringer Ingelheim International GmbH for the EURORDIS Round Table of Companies and the European Conference on Rare Diseases and Orphan Products. AR and ATK declare that FESCA aisbl. has received sponsorships in support of their annual scleroderma awareness raising campaign and World Scleroderma Conference from Boehringer Ingelheim International GmbH. MS declares that Scleroderma Canada has received sponsorships in support of their Scleroderma Canada Patient Conference from Boehringer Ingelheim International GmbH. These sponsorships are not related to this article. AGi has worked with the research sponsor (BI) as a paid consultant since September 2016. MG, LM, JLLF, FS, WS and HF are paid employees of the research sponsor (BI)., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Systemic sclerosis (SSc) is a rare, potentially life-threatening condition. The prognosis is difficult to predict, and treatment is complex. This can be difficult to understand or explain, posing challenges for effective physician-patient communication. Our study assessed communication between physicians and patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) to identify information gaps and needs., Methods: Twenty-three 20-min consultations between physicians (rheumatologists, pulmonologists) and patients (19 real, 4 actors) with diagnosed SSc-ILD across 6 countries were observed and recorded. Interactional sociolinguistic discourse analysis was used to understand the pattern and meaning of communication, whether the needs of both participants were met, and the level of understanding between participants., Results: In most consultations, patients were given little opportunity to explain their concerns or ask questions. Physicians used plain language but would revert to medical terminology for complex issues. Patients would also use medical terminology, despite not fully understanding the terms, which led to some physicians mistakenly believing that patients had a better understanding than they did. Differences in cognitive models between physicians and patients were often responsible for misunderstandings. However, during effective consultations, patients were invited to tell their story, and physicians used techniques to check and demonstrate understanding, express empathy and build rapport., Conclusions: Communication challenges between physicians and patients limit joint understanding of SSc-ILD and may result in both parties misunderstanding important information and patients being less aware of self-help management approaches. Strategies should be developed with physicians to facilitate effective communication and increase patient understanding and support. Key Points • Physicians and patients have different explanatory models for SSc-ILD. • The differences between the physician-constructed model of SSc-ILD and the personal model patients construct often result in misunderstandings. • Many patients with SSc have learned the medical terminology for their condition, but their often limited understanding may lead to missed opportunities for physicians to provide clear explanations and correct misperceptions. • The style of consultation determines the information patients share and the degree to which they feel supported by, and confident in, their physicians' care.

Nintedanib is a tyrosine kinase inhibitor used to treat idiopathic pulmonary fibrosis (IPF). We investigated the cardiovascular safety of nintedanib using pooled data from the TOMORROW and INPULSIS trials.Cardiovascular events were assessed post hoc in patients with a history of atherosclerotic cardiovascular disease (CVD) and/or one or more cardiovascular risk factors at baseline ("higher cardiovascular risk") and patients with no history of atherosclerotic CVD and no cardiovascular risk factors at baseline ("lower cardiovascular risk").Incidence rates were calculated for 1231 patients (n=723 nintedanib and n=508 placebo), of whom 89.9% had higher cardiovascular risk. Incidence rates of major adverse cardiovascular events were similar in the nintedanib and placebo groups in patients with higher cardiovascular risk (3.88 (95% CI 2.58-5.84) and 3.49 (95% CI 2.10-5.79) per 100 patient-years, respectively) and lower cardiovascular risk (4.78 (95% CI 1.54-14.82) and 5.37 (95% CI 1.73-16.65) per 100 patient-years, respectively). Incidence rates of myocardial infarction in the nintedanib and placebo groups, respectively, were 3.03 (95% CI 1.91-4.81) and 1.16 (95% CI 0.48-2.79) per 100 patient-years in patients with higher cardiovascular risk and 1.59 (95% CI 0.22-11.29) and 1.78 (95% CI 0.25-12.64) per 100 patient-years in patients with lower cardiovascular risk. Incidence rates of other ischaemic heart disease in the nintedanib and placebo groups, respectively, were 1.85 (95% CI 1.02-3.34) and 3.28 (95% CI 1.94-5.54) per 100 patient-years in patients with higher cardiovascular risk and 0 and 1.80 (95% CI 0.25-12.78) per 100 patient-years in patients with lower cardiovascular risk.These data help to establish the cardiovascular safety profile of nintedanib in IPF., Competing Interests: Conflict of interest: I. Noth reports personal fees for consultancy, lecturing, advisory board work and travel support from Boehringer Ingelheim and Roche/Genentech, personal fees for advisory board work from Sanofi and Global Blood Therapeutics, and personal fees for consultancy from Veracyte, outside the submitted work. Conflict of interest: M. Wijsenbeek reports grants and other from Boehringer Ingelheim and Roche, and other from Galapagos, outside the submitted work. Conflict of interest: M. Kolb reports grants from Canadian Pulmonary Fibrosis Foundation and Canadian Institute for Health Research, has acted as site principal investigator in industry-sponsored clinical trials for Roche, Sanofi and Boehringer Ingelheim, grants from and advisory board work for Pulmonary Fibrosis Foundation, personal fees for advisory board work from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Vertex, Genoa, Gilead, Prometic and Alkermes, and grants and personal fees for advisory board work from Roche Canada and Janssen, outside the submitted work. Conflict of interest: F. Bonella reports personal fees for consultancy, lecturing and travel support from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: L. Moros is an employee of Boehringer Ingelheim. Conflict of interest: D. Wachtlin is an employee of Boehringer Ingelheim. Conflict of interest: T.J. Corte reports grants and personal fees for travel, lecturing and advisory board compensation from Boehringer Ingelheim, grants and personal fees for travel, lecturing, steering committee work and advisory board compensation from Roche, grants from Gilead, Bayer, Intermune and BMS, and personal fees for advisory board compensation from AstraZeneca, during the conduct of the study., (Copyright ©ERS 2019.)

[This corrects the article DOI: 10.1371/journal.pone.0158878.].

Subjective insecurity is a key determinant of different forms of prosocial behavior. In Study 1, we used field experiments with farmers in Colombian villages exposed to different levels of violence to investigate how individual perceptions of insecurity affect cooperation, trust, reciprocity and altruism. To do so, we developed a cognitive-affective measure of subjective insecurity. We found that subjective insecurity has a negative effect on cooperation but influences trust and altruism positively. In Study 2, carried out three years after Study 1, we repeated the initial design with additional measures of victimization. Our goal was to relate subjective insecurity with actual victimization. The findings of Study 2 support the initial results, and are robust and consistent for cooperative behavior and trust when including victimization as a mediator. Different indicators of victimization are positively correlated with subjective insecurity and an aggregate index of victimization has a negative direct effect on cooperation and trust.

Since 1971 the efficacy of a combination chemotherapy, which included the nitrosoalkylurea derivative nitrosomethylurea, was tested in three clinical trials. The combination of vincristine (VCR), nitrosomethylurea (NMM) and actinomycin-D (Act.-D) showed an activity of 34.9% (10.9% CR + 24% PR) with a duration of remission from 2 to 30 months in 92 patients. The comparison of the combination VCR, NMM, Act.-D (group 1 = 44 pat.), VCR, NMM, Act.-D, DTIC (group 2 = 46 pat.) and VCR, Act.-D, CCNU, DTIC (group 3 = 48 pat.) showed an efficacy (CR + PR) of 29.6%; 28.3% and 18.8%. The duration of remission within all three groups is significantly longer in patients with a CR. In the first and second group the survival after 12, 18 and 24 months is significantly better than in the third group. The median survival time of patients reaching CR is in the first and second group (30.4 and 28.7 months) significantly better than in the third group (20.5 months). The comparison of a DTIC-monotherapy (group 1 = 56 pat.) and the combination VCR, NMM, Act.-D. (group 2 = 58 pat.) showed 7.1% CR and 16.0% PR, and 13.7% CR and 10.4% PR respectively. A cross over, when a progression occurred, was ineffective; survival time being 6.9 and 6.5 months did not differ.