The financial impact of an outbreak of FMD in 2010 on 62 smallholder cattle farmers in four villages in southern Cambodia was investigated by a financial impact survey questionnaire. Financial losses associated with FMD infection were severe with variation depending on whether the animal survived or died or was used for draft. The average post-FMD loss varied from USD 216.32, a 54% reduction from the pre-FMD value because of weight loss and treatment costs, to USD 370.54, a 92% reduction from pre-FMD values if the animal was treated, died and a rental draft replacement was required. Partial budget analysis identified a strongly positive incentive for cattle to be vaccinated biannually for FMD, providing USD 31.48 per animal for each animal owned. However low vaccination rates suggest that farmers are mostly unaware of the need or averse to the practice of vaccinating their cattle for FMD. This may be due to poor understanding of preventative disease strategies such as vaccination, unavailable disposable income for purchase of vaccines, and failure to recognize the full costs that are incurred when the disease occurs. Enhancing smallholder cattle productivity through the introduction of forage growing systems has been suggested as a pathway for alleviating rural poverty in the Mekong region. As our financial analysis identified a net benefit of vaccination for smallholder farmer enterprises in an endemic FMD area in Cambodia, it is considered important that farmer education strategies aimed at improving cattle productivity, also include both access to vaccine and training in preventative disease risk management and biosecurity practices in Cambodia.

In what percentage of married couples do wives outearn their husbands, and, moreover, how persistent are these patterns? This study systematically examined variation in point-in-time estimates across alternative measures of earnings, definitions of types of couples, and data sources and gauged the persistence of these patterns for a period of three calendar years using data from the 2000 Current Population Survey and the 1996-2000 Survey of Income and Program Participation. Among the findings are that in 19% to 30% of all married couples, wives have higher earnings than their husbands. In 60% of such couples, this arrangement persists over the three-year period; for the rest, this arrangement is transitory.

PURPOSE: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.

BackgroundGiven excellent survival outcomes in breast cancer, there is interest in de‐escalating the amount of chemotherapy delivered to patients. This approach may be of even greater importance in the setting of the COVID‐19 pandemic.MethodsThis concurrent mixed methods study included (1) interviews with patients and patient advocates and (2) a cross‐sectional survey of women with breast cancer served by a charitable nonprofit organization. Questions evaluated interest in de‐escalation trial participation, perceived barriers/facilitators to participation, and language describing de‐escalation.ResultsSixteen patient advocates and 24 patients were interviewed. Key barriers to de‐escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for focus on less treatment. Facilitators included trust in physician recommendation, toxicity avoidance, monitoring for progression, perception of good prognosis, and impact on daily life. Participants reported that the COVID‐19 pandemic made them more likely to avoid chemotherapy if possible. Of 91 survey respondents, many (43%) patients would have been unwilling to participation in a de‐escalation clinical trial. The most commonly reported barrier to participation was fear of recurrence (85%). Few patients (19%) considered clinical trials themselves as a barrier to de‐escalation trial participation. The most popular terminology describing chemotherapy de‐escalation was “lowest effective chemotherapy dose” (53%); no patients preferred the term “de‐escalation.”ConclusionsFear of recurrence is a common concern among breast cancer survivors and patient advocates, contributing to resistance to de‐escalation clinical trial participation. Additional research is needed to understand how to engage patients in de‐escalation trials.

Information about patterns of individual health insurance coverage is limited.Knowledge gaps include the extent to which individual insurance provides transitional versus long-term coverage, and participants' insurance status before and after being covered by an individual plan. In this study we use data from the 1996-2000 Survey of Income and Program Participation (SIPP) to examine how long the individually insured maintain their coverage; sources of coverage before and after enrolling in an individual health plan; and characteristics of those who rely on individual insurance coverage. Understanding the dynamics of this market will better inform federal and state insurance reform efforts. I n t h e fac e o f t h e g r ow i n g p r o b le m of uninsurance, U.S. policymakers have proposed using the individual insurance market to increase coverage. 1 However, policy discussions are hampered by limitations in empirical knowledge about the individual market and its participants.2 A limitation of prior research has been that the most readily available data sources, such as the Current Population Survey (CPS), are cross-sectional. This means that previous studies have been unable to explore patterns of individual insurance coverage over time.Little is known about the extent to which individual insurance provides transitional or longer-term coverage. We also do not know what types of insurance coverage people hold before purchasing or after leaving an individual plan. Experts observe that before making policy prescriptions, we need a clearer understanding of how people move between individual and other sources of coverage.3 Additionally, analysts believe that volatile enrollment and disenrollment patterns have undermined the effects of state and federal individual insurance reforms. 4 These patterns have been inferred from researchers' observations that many people hold both employer and individual insurance over the course of a year. D a t a W a t c h