Adding rewards to regulation: The impacts of watershed conservation on land cover and household wellbeing in Moyobamba, Peru
Authors:
Javier Montoya-Zumaeta aff001; Eduardo Rojas aff003; Sven Wunder aff002
Authors place of work:
Crawford School of Public Policy, Australian National University, Canberra, Australia
aff001; Center for International Forestry Research (CIFOR), Bogor, Indonesia
aff002; Faculty of Geography and History, University of Barcelona, Barcelona, Spain
aff003; European Forest Institute (EFI), Barcelona, Spain
aff004
Published in the journal:
PLoS ONE 14(11)
Category:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0225367
Summary
We estimate the effects of Peru’s oldest watershed payments for environmental services (PES) initiative in Moyobamba (Andes–Amazon transition zone) and disentangle the complex intervention into its two main forest conservation treatments. First, a state-managed protected area (PA) was established, allowing sustainable use but drastically limiting de facto land use and land rights of households in the upper watershed through command-and-control interventions. Second, a subset of those environmentally regulated households also received incentives: PES-like voluntary contracts with conditional in-kind rewards, combined with access to participation in sustainable income-generating activities of the integrated conservation and development project (ICDP) type. To evaluate impacts, we perform matching procedures and adjustment regressions to obtain the average treatment effect on the treated (ATT) of each intervention. We investigate impacts on plot-level forest cover and household welfare for the period 2010–2016. We find that both treatments—command-and-control restrictions and the incentive package—modestly but significantly mitigated primary forest loss. Incentive-induced conservation gains came at elevated per-hectare implementation costs. We also find positive effects on incentive-treated households’ incomes and assets; however, their self-perceived wellbeing counterintuitively declined. We hypothesise that locally frustrated beneficiary expectations vis-a-vis the ambitiously designed PES-cum-ICDP intervention help explain this surprising finding. We finalise with some recommendations for watershed incentives and policy mix design in Moyobamba and beyond.
Keywords:
Water resources – Forests – Trees – Deforestation – Conservation science – Land use – Payment – Agroforests
Introduction
Learning processes regarding conservation incentives have often been based on anecdotal evidence [1, 2], rather than on rigorous impact assessments [3, 4]. Randomised control trials have been almost absent in testing conservation incentives, barring some recent exceptions [5]. Other rigorous empirical studies have also been scarce and, in the Southern Hemisphere, heavily concentrated on Costa Rica and Mexico [6–8]. However, the number of published quasi-experimental studies has recently expanded [9].
Peru is an illustrative case in point. Historically, the typical policy response to the deforestation and degradation of the Amazon rainforest has been to establish protected areas (PAs). About one-quarter of the Peruvian Amazon is under a state-managed protection regime [10]. Conservation incentives have been piloted only in a few cases, experimenting with design modalities [11]. Recent evidence suggests marginally positive conservation effects [12–14], including those from complementary policies such as communal land titling [15]. Policy impacts on local populations’ wellbeing remain even less clear [13].
Here we aim to contribute to filling the empirical gap regarding Peruvian conservation incentive programs by analysing one prominent conservation initiative, the Moyobamba Reward for Hydrological Ecosystem Services Mechanism—Peru’s pioneer watershed-based payment for environmental services (PES) initiative [16, 17]. Our objective is to quantify the effects of this initiative’s different treatment components on plot-level land cover changes, as well as the effect of conservation incentives on treated participant households’ wellbeing. We proceed as follows: in the next section, we review the literature using (experimental and quasi-experimental) robust methods to evaluate PES impacts in developing countries. Next, the Peruvian watershed intervention is discussed. After that, we describe in detail the study area and our analytical methods. We then present our results and finally consider them in a wider perspective.
Evidence on impacts of PES-like interventions
Direct payments conditioned on environmental performance of voluntarily contracted agents have recently been considered an appealing way to address threats to ecosystems and their services [18, 19]. Further, synergies between these type of interventions, widely known as PES, and wellbeing-related benefits have also been claimed (e.g., [20, 21]), thus making PES a particularly interesting possibility for adoption in developing countries.
Much of the PES debate so far has discussed concepts and provided qualitative descriptive analyses of limited cases [6]. Rigorous impact assessments are scarce, as in the field of conservation in general [7, 9, 22]. This is even more the case for socio-economic impacts [6]. We summarise findings from studies evaluating the environmental and socio-economic impacts of PES in S1 Table. Geographically, much analysis has been concentrated in Costa Rica [23–25], with the national PES program there being the first of its kind [26]. Follow-up nationwide PES programs in Mexico [27–32], China [33, 34], Ecuador [35, 36] and Peru [12] have also been impact evaluated.
Notably, some studies detected very low forest impacts in the early implementation phases of national programs [12, 23, 27], yet found higher impacts from the same programs in subsequent stages [24, 28, 29]. Arguably, the latter also used analytical techniques that better captured heterogeneous impacts and identified causal mechanisms more accurately [37].
Livelihood-oriented PES evaluations have come mostly from Asia. For instance, PES notably accelerated livelihood transitions among rural Chinese households [33, 38]. Clements and Milner-Gulland [39] demonstrated that PES in two Cambodian PAs significantly reduced poverty incidence, raised agriculture revenues and increased food security, allegedly due to synergies between conservation instruments (PES and PA); effectively excluding outsiders allowed resident households to sustainably use available forest and land resources to their own benefit. In Latin America, no significant wellbeing impacts on national-level PES participants were found from 1996 to 2005 in Costa Rica [25], nor from 2007 to 2013 in Mexico [32]. Nevertheless, a recent analysis found positive impacts of a local hydrological PES scheme on participant households’ assets enrolled through communal agreements in Chiapas, Mexico [40].
The case of Moyobamba
Construction of the interregional Carretera Marginal highway effectively promoted economic integration between the coastal and Amazonian regions of Peru but also triggered land clearing, forest loss and degradation through spontaneous settlements alongside the highway, mainly by colonists from neighbouring departments [41]. In the San Martin Department, one of the deforestation hotspots has been around Moyobamba. Therefore, in 2004, local authorities established a municipal conservation area, mainly to protect the city’s drinking water sources through traditional command-and-control measures [16].
The Moyobamba watershed protection initiative began in 2004, as part of the Cuencas Andinas Regional Project, which also features innovative, incentive-based models of integrated watershed management in several pilot sites across the Andean region [42]. The initiative achieved the participation of key stakeholders such as the Empresa Proveedora de Servicios de Saneamiento (EPS) Moyobamba (the public supplier of local drinking water) and the Proyecto Especial Alto Mayo (PEAM), a long-term state-funded program promoting productive entrepreneurship in the Alto Mayo watershed. From 2004 to 2006, hydrological assessments and PES feasibility studies were undertaken, including collating socio-economic diagnostics of the population settled in the upper watersheds and identifying Moyobamba drinking water users’ willingness to pay for improved watershed regulation services [43].
Subsequently, a PES-type intervention was designed, primarily to address increasing costs for EPS Moyobamba associated with an observed 20% acceleration of sediment loads between 2003 and 2005, which was being related to upstream land use changes [44]. Hydrological modelling identified the necessity to prioritise efforts in the Mishquiyacu and Rumiyacu micro-watersheds, maintaining remaining forest cover around water catchments and establishing agroforestry systems on already established coffee plots and treeless pasturelands to decrease soil erosion and stabilise dry season water flows [44, 45]. The third upper watershed, Almendra, was much less degraded, yet was included preventively [41]. By 2009, EPS Moyobamba had managed to raise modest PES funding from local water bills, adding a monthly PEN1.00 (approximately USD0.32) user fee. Simultaneously, a management committee was formed, representing EPS and other local organisations, to account for accumulated contributions collected through the water bills and to formulate and implement adequate investment projects. Fig 1 provides a timeline for the activities of the project since 2004, including also indicative amounts of resources invested into the initiative over time. Importantly, collected funds from water users have never sufficed to cover the envisaged investments: only PEN85,632 (USD25,793) were collected yearly [46]. This represents only about one-fifth of the average annual investments from 2009 to 2014. Hence, supplementary funding from public and private sources has continuously been required.
Aligned with the state norms for use of public funds, the management committee established that rewards to participant farmers should be in kind, rather than cash, allegedly so as not to compromise accountability [16]. Rather than handing over consumption goods, the idea was to provide distinct investments for farmers, which would allow them to improve their livelihoods, diversify income sources and simultaneously take actions for forest conservation, reforestation and sustainable use. This jointly would limit erosion (and thus sedimentation in water courses) while also stabilising dry season flows. The combined set of activities can best be described as an integrated conservation and development program (ICDP) [48, 49]. In practice, significant emphasis was placed on shifting traditional treeless coffee farming into shade-based agroforestry coffee systems, diversifying into new on-farm sustainable income sources and providing assets to raise living standards. In principle, the intervention was designed as a conditional ICDP, combined with conditional land rights; both support elements could, in principle, be discontinued in case of environmentally noncompliant actions.
Consequently, three type of investments emerged: 1) enhancing on-farm tree cover through agroforestry, reforestation and tree fences, 2) improving physical infrastructure (e.g., rain collector systems, ecological toilets, coffee post-harvest processing equipment) and 3) promoting new income-generating activities (e.g., apiculture, guinea pigs, handicrafts). These in-kind rewards, conditional upon conservation contract signature and continuous compliance, were customised to each household’s requirements [16]. From 2010 to 2012, 59 plots located in the priority area were enrolled in the initiative, after signing conservation agreements with their 49 land managers for conditional in-kind rewards funded by PEAM, stretching mostly over three years [50]. However, after this period, rewards became more irregular and subject to less available project funding, thus affecting successive renewals and contracting of new PES agreements. Seemingly, a new five-year public investment project formulated by EPS will be implemented soon.
Parallel to the design and execution of the PES-like scheme, since 2010, the Regional Government of San Martin (GORESAM) reinforced attempts to enforce land use restrictions in drinking water sources for Moyobamba, establishing the Rumialba Ecological Recovery and Conservation Zone (ZOCRE). This command-and-control measure was implemented to counteract risks of latent disordered occupation of the zone, including land trafficking [51]. The land was publicly registered as state property in 2013, but responsibility for its management was delegated to the Regional Environmental Authority, an office reporting directly to the GORESAM [52]. However, the ZOCRE could not yet be included in the nationwide PA system, which somewhat curbed enforcement potentials.
We ask the following question: how did the initiative’s implementers intend to achieve the desired conservation impacts on the ground? Summarising their variable actions into a theory of change (see Fig 2), we characterise two allegedly synergetic treatments for our analysis:
Treatment 1 (T1): command and control. This treatment involved the declaration of a state-managed conservation use area (ZOCRE Rumialba), limiting de facto land rights in plots fully or partially overlapping the ZOCRE Rumialba and its influence zone (as mapped below).
Treatment 2 (T2): PES–ICDP mix. This treatment involved the provision of incentives to households managing plots located in the prioritised upper watersheds, combining a) in-kind, allegedly conditional rewards delivered directly to voluntarily contracted households, b) granting of temporal land rights kept conditional on benign land uses and c) access to participation in sustainable economic activities.
From 2010 (our baseline year), approximately 140 plots were treated with T1, while 59 plots in total were treated with T2 [50]. The T2 treatment implied potential benefits to households but the stakes were also raised: monitoring would be more frequent, and in case of participants being caught in environmental noncompliance of contracts, sanctions would be harsher than for households in the ZOCRE that had received no incentives. We can, therefore, state that receiving incentives was accompanied by a greater threat of more severe command-and-control-induced sanctions, equalling a greater treatment intensity of the entire policy mix (T1 + T2).
Material and methods
The study area
The province of Moyobamba is located in the Department of San Martin, in north-western Peru, between the highland and Amazon regions (see Fig 3). The ZOCRE Rumialba covers 2396 ha, including the upper micro-watersheds of the Rumiyacu, Mishquiyacu and Almendra rivers. These provide drinking water to Moyobamba (about 50,000 inhabitants) [53]. Predominant natural land cover is premontane tropical forests, according to the Holdridge life zones system; temperatures fluctuate between 20° C and 24° C. Average annual precipitation is 1600 mm, with a marked rainy season between November and May and a drier season from June to August [16].
Moyobamba province received significant migratory influxes since the 1970s, with the construction of the Carretera Marginal; these have levelled off since 2007. From 1981 to 2002, however, annual population growth averaged 5.5%, mainly due to immigration from nearby departments such as Cajamarca, Amazonas, Piura and Lambayeque. Traditionally, the region produces dryland rice (in flat parts of the Alto Mayo river basin), cattle and coffee (on hillsides). Annual deforestation in the Alto Mayo region thus rose to 4.2% in the early 2000s [44]. Moyobamba has the most productive coffee lands in the San Martin Department [54–56]. The ZOCRE Rumialba is located at 6 km from central Moyobamba and is currently inhabited by around 200 migrant households of mostly Andean origin. Their cash income sources include crops (mainly coffee), livestock and off-farm employment [57].
Sampling and data collection
One of the first challenges we faced regarded identifying adequate control households or plots to compare with treatment groups; all comparable local upland areas were already or were in process of becoming state protected. We could, therefore, either opt for biophysically similar control plots (e.g., in terms of size, slope or altitude) from other regions but with different local development dynamics or for biophysically different plots from the same Moyobamba region. We adopted the second approach and then used statistical methods (further described below) to make the impact assessment possible.
Considering the above-mentioned challenge, our sampling procedure was performed in three steps. First, we merged cartographic shapes provided by PEAM, EPS Moyobamba and GORESAM to delimit the study area for the baseline year (2010). This allowed us to obtain a complete list of plots under treatments T1 and T2, respectively, and to identify non-treated control plots located in surrounding sectors of the ZOCRE.
Second, we conducted a total of 311 households surveys. Although we intended to include all 49 conservation agreement signatories (T2), we had to disregard seven of them: four were not households but instead were institutional representatives (e.g., a school or an non-governmental organisation) and thus not comparable, two households declined to participate in the study and one had a plot not located inside the prioritised area. We also surveyed 40 randomly selected households in the ZOCRE and its influence zone (T1), which accounts for 29% of all those available, given budget and time restrictions. For the non-treated control group, we selected 10 sectors with similar geographical and biophysical features, obtained lists of plots linked to these and then randomly selected and surveyed 229 households. This number exceeds the minimal sample size (estimated at 196 with 5% maximum allowable error for an identified population of 399 non-treated households in areas surrounding the ZOCRE). We restrict our analysis below to plots for which we could obtain both household surveys and remotely sensed land cover data (see Fig 3).
For our land cover analyses, we used geographic information system tools to estimate variables such as average slope, altitude, distance to Moyobamba and land cover changes at plot level, for which we used 2005, 2010 and 2016 Landsat imagery with a resolution of 30 m per pixel, respectively. The images allowed us to estimate, with relatively high precision, land cover changes in two periods: before treatment (from 2005 to 2010) and during the treatment period (2010–2016). RapidEye imagery with higher resolution (5 m per pixel), which was only available for the year 2011, was used complementarily to guide image interpretation. To classify plot-level land cover and its changes, we followed Potapov et al.’s [58] definition of forests as ‘areas with trees above 5m and tree canopy cover above 30% within Landsat 30m pixels’. We differentiated between primary and secondary forests, based on the visible signs of recent human alteration that are present in the latter.
This study met with the ethical standards established in the Latin American and Caribbean Environmental Economics Program’s (LACEEP) grant contract IDEA-186/2016. Our ethics protocols were approved by the Human Research Ethics Committee of the Australian National University (Human Ethics Protocol 438/2018), which included the explicitly documented free prior informed consent of all participants and measures to maintain the confidentiality of the data.
Household surveys were conducted in March and April 2017 by four previously trained enumerators and addressed questions about demographics, agricultural practices, assets and income. They also included a procedure to record Universal Transverse Mercator (UTM) coordinates in plots to validate our cartographic information. As in similar studies (e.g., [25, 32, 40]), we used recall questions to establish pre-intervention covariates, given the unavailability of information at this disaggregated level. The first author consulted regarding the content of the draft questionnaire with key institutional stakeholders (e.g., EPS Moyobamba, the management committee, PEAM, German Cooperation-GIZ, GORESAM) and then piloted the revised questionnaire in two rounds (15 and 30 surveys, respectively) in two nearby districts (Jepelacio and San José de Sisa) before finalising the survey instrument.
Subsequently, we built two datasets (see Fig 4). First, the plot-level land cover dataset (A) contains geographical and biophysical data of treated and non-treated plots. Second, the household-level dataset (B) contains biophysical, demographic and socio-economic information for all the households managing sampled plots in (A).
Empirical strategy
For 2010 to 2016, we evaluate the effects of both treatment components (command and control and the PES–ICDP mix) of the Moyobamba initiative on primary and secondary forest cover at the plot level. Likewise, we also estimate the simultaneous effects on the following wellbeing outputs:
Household yearly incomes—aggregated self-reported agricultural, environmental and off-farm incomes for the years 2010 and 2016 from the survey.
Household asset holding—a 0–11 scaled index based on the sum of self-reported assets, indicating a status of material wellbeing (e.g., vehicles, motorcycles, cell phones, cattle, gas stove) for the years 2010 and 2016.
Quality of life: households’ self-reported answers to the survey question: do you consider that the quality of life of your family compared with 2010 is the same, has improved or worsened?
For each indicator, we again estimated the average treatment effect on the treated (ATT) observations:
This first so-called naïve comparison between unmatched treatments and control plot reveals significant differences in terms of practically all covariates; the same conclusion arises from the comparison between households in the treatment (T1, T2) and control groups. This is unsurprising, since T1, at least, had been focused on the entire drinking water watershed sources of Moyobamba city, an area featuring geographically and biophysically different characteristics, such as greater altitude and slope, compared with the surrounding landscape (see Table 1). Further, plots under both treatments are larger, had larger forest coverage in the baseline year (2010) and also demonstrated a higher pre-treatment increase in secondary forests (2005–2010).
In addition to these biophysical differences, treated households initially had less income and fewer assets (see Table 2), in line with claims that incentives were mainly being targeted at poorer households.
To reduce these significant differences between groups, we first implemented statistical matching techniques, as used in other conservation impact evaluations [37]. We identified and matched observations in the control group that were similar to treated observations in terms of their baseline covariates. Matched observations comprised the subgroup that served as reference to estimate the effect of the treatment on outcomes and constituted the counterfactual (i.e., the scenario that hypothetically would have happened had the intervention not been implemented) [25].
We performed three matching algorithms: 1) 1-to-2 nearest neighbours (NN) with replacement using the Mahalanobis distance (M2NN), 2) kernel propensity score (K-PS) matching using 0.05 caliper and 3) radius propensity score (R-PS) matching, also with 0.05 caliper. To measure the effectiveness of each algorithm to reduce bias, we used as criterium the standardised percentage difference between means (%St.Dif.=X-T-X-c(ST2+SC2)2, where T and C represent treated and control groups, respectively) for each covariate, considering the usual rule of > 25% to determine presence of persistent bias [60]. All three matching algorithms significantly reduced bias in covariates, but the two propensity score–matching algorithms achieved much more balanced panels (see S2 Table), at the expense of dropping off some treated observations that fell outside the propensity score’s common support level. In the case of K-PS, the matching procedure discarded 15 (36%) plots and 21 (53%) households from the T1 group, and 13 (25%) plots and 17 (40%) households from the T2 group. Likewise, R-PS matching discarded 16 (38%) plots and 24 (60%) households from the T1 group, and 13 (25%) plots and 17 (40%) households from the T2 group. We used the user-written package psmatch2, available for Stata 14.0 [61], to perform all described matching procedures. After each matching, we ran multivariate regressions with resulting matched samples to minimise remaining bias and estimate the adjusted treatment effect [62].
We also reported Rosenbaum bounds (Γ) after each post-matching mean comparison between treatment and control groups, to assess unobserved heterogeneity that could potentially undermine the statistical significance of the evaluated treatment, as in other impact evaluation studies [13, 24, 36]. We repeated this for all environmental and wellbeing effects that presented statistic differences of 10% or greater [63]. Additionally, we estimated the intracluster correlation for all the outcomes, considering sectors as the cluster unit to measure potential spillover effects [64]. These results are shown in S3 Table.
Finally, our reading of the literature does not identify any of the three matching methods as superior in absolute terms; each has pros and cons. As such, we report their results simultaneously, also displaying transparently some sensitivity of the impact evaluation results vis-a-vis the adopted method and the size of the included sample. While these factors do not call into question the overall direction of our conclusions, the size and statistical significance of a few results is clearly sensitive; therefore, it is preferable to present them using ranges, rather than point estimates.
Results
Effects on plot-level land cover
We started our analysis comparing plots under T1 (command-and-control measures) versus controls plots. The comparison in Table 2 shows that plots under this treatment were on larger than average controls, thus holding more primary and secondary forests. The matching techniques allowed us to significantly reduce these biases for the land cover analysis (see S2 Table). We summarise the estimated land use effects of both treatments in Table 3. For T1, both K-PS and R-PS matching algorithms yielded significant results, while the M2NN did not, failing to produce balanced covariates vis-a-vis the aforementioned biases. We thereby confirmed significant (5% level) positive effects of T1 on mitigating primary forest loss, ranging from 0.11 (after R-PS matching) to 0.14 ha/plot (after K-PS matching); for M2NN, the coefficient is positive yet insignificant at 10% (p = 0.106). Treatment effects on secondary forests were all insignificant.
Treatment 2 (PES–ICDP mix added to command and control) significantly amplified the mitigating effect on primary forest loss; on average, it contributed to conserving somewhere between 0.13 ha (M2NN) and 0.2 ha (K-PS) of primary forest that otherwise would have been lost during the period from 2010 to 2016. All marginal treatment effects were larger and gained significance (1–5%) compared to T1. However, the K-PS and R-PS results indicated that secondary forest loss may also have risen slightly, yet the parameters were only significant at the 10% level. In conclusion, we reconfirm small but significant conservation effects from command-and-control measures (T1) on primary forests, which are further incrementally increased from the PES–ICDP mix treatment (T2).
Effects on household wellbeing
Next, we estimated the effect of each treatment on household wellbeing indicators for the same period (2010–2016) (see Table 4). For household incomes, PS-K and PS-R estimates for the command-and-control treatment (T1) were, as expected, negative but insignificant; for M2NN they were positive. All asset effects of T1 were insignificant. T1-treated households reported significantly less improvement in their quality of life than controls; the estimates’ significance varies from 1% to 5% across matching methods.
Regarding T2 (PES–ICDP mix), we found evidence of significantly positive effects on both income and assets (5% significance for K-PS and R-PS). The annual household incomes were PEN989–1022 (USD300–310) higher in this subgroup compared to controls, and asset values grew by 0.8 index points more than controls, using the estimated marginal effects after K-PS and R-PS matching (presenting best covariate balances). Conversely, there was a strongly negative impact on households’ perceived wellbeing: incentive-receiving households were statistically significantly (1% level) less likely to state that their wellbeing had improved by a probability ranging from 44% to 50% (using K-PS and R-PS algorithms).
Discussion and concluding remarks
Land cover effects
In Moyobamba, a set of interventions to protect strategic micro-watersheds for municipal water supply has been undertaken over the last decade, with the aim of reducing erosive sedimentation and enhancing dry season flows. Designed as a complex hybrid between PES, ICDP, protected sustainable use areas and conditional land rights, the initiative aimed to halt deforestation and promote sustainable agriculture, including agroforestry, while also improving livelihoods for upstream farmers. Sizeable investments were made, principally through various waves of sustainable development projects heavily subsidised by external donors, given that water user fees were never enough to cover the costs.
We now investigate the results emerging from the impact evaluation above (see Table 3). Splitting the complex intervention mix analytically into a ‘sticks only’ (T1: protected-area establishment, implicitly including conditional land rights) and ‘sticks and carrots’ treatment (T2: PA and PES-like conditional ICDP incentives), we find that the two treatments, separately and jointly, mitigated primary forest clearing in the expected reinforcing way. There were approximately equal quantitative contributions from both treatment components, but for T1, only the two propensity score methods yielded significant positive estimates (0–0.13 ha), while for T2 (0.13–0.20 ha), all three methods demonstrated a significant positive effect.
However, the evaluated land cover impacts of the initiative were, in absolute terms, quite small. We can calculate impacts as ranges obtained from the marginal parameters in the T1 and T2 sample quantifications and then scale them up to the entire population that was affected by the two treatments. From T1, multiplying the K-PS and R-PS estimators with the number of sampled plots provides a range of 2.91 ha to 3.83 ha. Assuming these estimates are extrapolable to the entire number of plots in the ZOCRE that did not receive rewards would yield a range of 10.04 ha to 13.22 ha of additional primary forest. This represents the estimated number of hectares that would counterfactually have been deforested, absent the declaration of the ZOCRE (T1). Similarly, for T2, the in-sample effect is 6.97 ha to 7.96 ha. This, upscaled to the total number of contractees, yields 7.91 ha to 9.03 ha that additionally would have been deforested by PES recipients, had they counterfactually not received any rewards. Hence, the combined, accumulated and upscaled impact of the two interventions over six years (2010–2016) was in the range of 7.91 ha to 22.25 ha of primary forest saved.
In response to this, we ask: why are we finding these arguably low land cover impacts from the implemented initiative? A partial answer is that the deforestation pressure in the entire area was not too large from the outset of the intervention. This seems at least in part related to the outbreak of the coffee plant plague known locally as la roya amarilla (Puccinia striiformis), which hit the region particularly between 2011 and 2016, thereby greatly reducing the attractiveness of converting forest to coffee plantations—previously the prime driver of deforestation [44].
A second internal, though minor, reason is that the initiative did not manage to entirely stop deforestation in the target zone, as might have been expected from the joint application of the ZOCRE and PES contract rules. This has to do with the monitoring and sanctioning mechanisms, together making up the principle of (enforced) conditionality. This is frequently referred to as the principal innovation of PES schemes [65, 66] but, in practice, often proves ill enforced [67]. While a protocol to monitor conservation agreements was established locally [68], few of the indicators were defined at plot level (i.e., at a sufficiently fine scale to capture potential violations). Notably, some clearings of secondary forest were, at pressure from farmers, also being allowed to establish ‘eco-friendly agricultural practices’ such as coffee agroforestry systems. However, posterior adoption was not properly ground-monitored and more traditional coffee farming was brought in, rather than agroforestry practices (e.g., use of shadow trees, fences). The official monitoring guide of the initiative [68] relies as protocol on self-reported information from interviews, rather than independent verification. The progress reports we reviewed during fieldwork also mainly monitored the delivery of benefits to signatory households, rather than their environmental compliance.
In prolongation, benefit delivery was also not consistently conditional upon land use compliance. Interviews with various stakeholders revealed that some in-kind rewards, such as seedlings or training, were not delivered exclusively to signatory households but instead to all ZOCRE-settled households, to give the initiative greater legitimacy. Furthermore, the payments were also discontinued; the last conservation agreements expired in 2015 due to shortage of funds. While some households still maintain hopes for further rounds of benefits, their patience has been tested over the last few years. Obviously, they likely still benefit from past ICDP investments in apiculture, handicraft, tourism and shade-grown coffee production.
Regarding sanctions, the initiative does not belong to those types of PES schemes that never punished any noncompliance—not only has it been known to cut off future incentives, but it has also enacted retroactive punishment. We collected testimonies of at least one emblematic case of a PES contract signatory who went to jail, having grossly violated the forest clearing rules on his plot. Therefore, problem of conditionality in Moyobamba seems more related to imprecise environmental monitoring at plot level than to detected but unsanctioned noncompliance.
Livelihood effects
Our results show that households receiving sticks only treatment (T1) suffered, as expected, some setbacks in self-perceived livelihood indicators, while income and asset effects were mostly insignificant. Unsurprisingly, households receiving both sticks and carrots (T2) were well compensated, and registered, on average, an income increase eight times larger than the controls (naïvely compared in Table 2). Although variance was large, a significant increase in annual incomes (USD300–310 per household) and assets persisted after matching. There are good reasons for this. As documented in the project timeline (see Fig 1), several cumulative waves of sizeable project investments favoured the relatively small group of PES-contracted households. The seeming paradox is, therefore, that the same group of T2 households that celebrated significant advances in material welfare exhibited a strongly negative self-perception of how their wellbeing developed over the same time period (see Table 4). In part, this probably has to do with perception of increased land tenure insecurity, which affects the entire population in the ZOCRE sustainable-use area (see the section dedicated to land rights below); both groups were less likely to state improvements in self-perceived wellbeing than control households.
However, for T1, the size and significance of this effect was not as marked and consistent over matching methods as for T2. Moreover, T2 households were also significantly more likely to state outright decreases in wellbeing than controls; this was not the case for T1. This raises the question: why is the most income - and asset-expanding group of households, the amply incentive-treated T2, clearly voicing the greatest dissatisfaction?
We suggest that this likely relates to the fact that large incentives were given and so became embodied into beneficiaries’ future expectations, but then benefit flows were discontinued in 2015. For a minimum of three years (for some, considerably more), PES contractees have become frustrated by not receiving any (new) payments or rewards, nor having clear prospects for benefit flows to be reinitiated any time soon. It is common, especially in ICDPs that tend to create paternalistic expectations on both sides, that beneficiaries voice strong dissatisfaction with spending-intensive projects when these, for whatever reason, have to cut back on their investments [48]. The Noel Kempff project in Bolivia is one such prominent example in Latin America [69]. This negative expression of trends in wellbeing should likely be understood predominantly as a vote of protest.
Land rights
A distinct feature of the Moyobamba initiative is that settlers in the protected sustainable-use area (ZOCRE) hold land rights that are conditional upon their environmentally benign stewardship; settlers could be expelled or put into prison in the case of blatant legal noncompliance, and at least one such demonstrative case exists (see section dedicated to land cover effects). Notably, local obligations also include communally organised monitoring vis-a-vis prospective land occupation from outside [70]. The case resembles others in the PES literature in which withdrawable land rights are being used as part of environmental conditionality (e.g., [66, 71]), though only a few Asian cases were specifically being formally reported (e.g., in Indonesia [72] and Cambodia [39]).
Currently, the regional government has announced plans to outsource management of the ZOCRE (e.g., to an environmental non-governmental organisation or another government agency), citing the high costs of self-administration as its main motive. Our interviews revealed that the resulting insecurity about future rules and conditions heavily influenced the negative household self-perceived wellbeing responses received from ZOCRE residents, especially as this decision seemingly was made without local consultation [70].
Cost-efficiency
As noted in the project timeline above (see Fig 1), sizeable investments have been made in the project. Using the information available at the Pre Registro Nacional de Mecanismos de Servicios Ecosistémicos [73], we can estimate the per-area amount invested in the frame of the Moyobamba initiative and compare it with other national experiences that present similar advances in their implementation. We find that Moyobamba is the single most spending-intense initiative. In total, USD353/ha have been spent so far, compared to an average of USD17/ha among four other similar, though admittedly shorter-lived, initiatives (in Cumbaza, Chira, Tilachancha and Quanda). In times when PESs were generally considered novel and promising, Moyobamba became a Peruvian ‘donor darling’ that was an attractive investment in terms of piloting watershed management incentives.
We can compare the scheme’s spending intensity not only with respect to the area enrolled, but also regarding its environmental additionality—that is, the number of hectares of forests that the initiative has saved from clearing, according to our above calculations. Combining the spending numbers previously mentioned (for the incentive component) with the impact ranges discussed above, we find that the initiative, with its cumulative investments, has had a high cost of USD24,900/ha–USD70,041/ha of forest saved. Given the impossibility of separating T1 and T2 costs, we divided the inflation-adjusted total updated costs of the initiative—USD554,024 (S3 Table)—by our estimated primary forest saved by T1 plus T2, estimated in the range between 7.91 ha and 22.25 ha. This amount is equivalent to an average annual cost between USD2075/ha and USD5837/ha for the period from 2004 to 2016.
A second bottom line of the project relates to human wellbeing impacts. Table 4 illustrates that T2 (PES–ICDP mix) caused incremental household annual incomes between USD300 and USD310 per household. Dividing the total spending of the project on the incentive component (PEN224,963/USD68,171 [74]) by the 42 sampled households treated by T2, the average project incentive spending (T2) per contractually participating household was USD1623—more than five times the average rise in 2016 household annual income. It remains to be observed to what extent the sunk ICDP investments will continue to yield extra household incomes in the future, now that technical assistance has been reduced. These results also lead to speculation regarding the extent to which ICDP investments were an efficient vehicle in terms of welfare, or whether direct cash payments to households could potentially have boosted livelihoods more efficiently.
These results paint a somewhat sobering picture about the cost-effectiveness of the initiative; each hectare saved and Soles (PEN) of incremental household income created came at high cost. Some unpredictable factors influenced environmental outcomes, such as the coffee disease–led downturn in local ‘baseline’ deforestation pressures, resulting in the low measured additionality. Overall, Moyobamba was the first ever PES project in Peru; pilots are to be experimental in nature and are seldom particularly cost-efficient. By our interpretation, the project should be given ample margin.
Perspectives and policy recommendations
Recently, direct conservation incentives have been considered promising ways to deal with threats to ecosystem services, including in watersheds [75, 76]. PES, the most emblematic of these policies, should bring about environmental outcomes in a more effective and cost-efficient way [19, 77, 78], while simultaneously alleviating poverty [21, 79].
Moyobamba is Peru’s pioneer and flagship PES case, used for replication in other watersheds [17]. A comparable PES-cum-ICDP intervention mix has also been applied by the Ministry of Environment’s National Programme for Forest Conservation (PNCB), which in Amazonian communities is using conditional incentives combined with investments in productive alternatives to promote forest conservation [11]; however, it is reportedly yielding equally modest environmental outcomes [12]. Since it is the most influential PES pilot in Peru, it is important to understand the Moyobamba project’s impacts to date, drawing adequate lessons for similar future initiatives.
First, we suggest that performance might have been better had the initiative been allowed invest more in the PES component and less in the ICDP component. As demonstrated, the ICDP investments proved to have little cost-efficiency regarding both environmental and income-generating goals. In retrospect, the optimistic pre-analysis of productive alternatives (e.g., [44]) perhaps underestimated the costs, obstacles and (plant disease) risks of a transition to perennial agroforestry. Project investments proved too ambitious to be covered by water user fees throughout, relying instead on punctual donor hyper-injections that raised the bar of beneficiary expectations but were eventually disrupted, contributing to the negative wellbeing perceptions among service providers.
Second, and relatedly, the initiative did not monitor compliance reliably at the farm scale and may have allowed for some secondary forest clearing for the establishment of (supposedly) shade-grown coffee systems. This feature compromised conditionality and is critical to many PES initiatives [67, 80]. Eventually, slack conditionality was not in the interest of focused ecosystem service provision, thereby also jeopardising environmental performance. Nevertheless, the conditional land tenure element seemed to have worked well across the ZOCRE as an alternative element of environmental conditionality; however, as a regulatory ‘stick’, it also negatively affected land users’ perceptions of wellbeing.
In this respect, Moyobamba exhibits some commonalities with other PES-like initiatives in the Amazon, such as Brazil’s Proambiente program [81], Bolsa Floresta in Brazil’s Amazonas state [82], the Transamazon project in Pará, also in Brazil [59], Peru’s aforementioned national PNCB program [11, 12] and Ecuador’s Socio Bosque [83]. For a variety of reasons, all implementers placed significantly more faith in the ICDP-type model of directed productive change—of allegedly ‘solving the problem’ permanently—than in the power of conditional payments. In these schemes, PES became part of highly complex intervention mixes, with other components sometimes having larger attributive roles in shaping on-the-ground impacts. Needless to say, these complex implementation designs also limit the options for evaluating the extent to which PES was genuinely working towards the intended environmental and livelihoods objectives.
Finally, we have only examined land cover proxy effects, not hydrological service end delivery, which sometimes might lead to erroneous conclusions [84, 85]. In Moyobamba, detailed socio-hydrological pre-analysis based on soil and water assessment tool models had neatly identified eight hydrological response units within the Mishquiyacu micro-watershed as being highly critical to erosion costs of the EPS Moyobamba [44]. However, the eventual implementation of the rewards mechanism was much less spatially targeted and, perhaps, more aligned with a broad development project logic whereby, typically, from an equity perspective, nobody should be left out.
Given this evaluation, we make the following recommendations regarding the Moyobamba initiative. More modest, continuous and truly conditional payments, aligned closer with the (equally continuous) water user payments, and less donor spree–dependent investments, may provide for a more sustainable future pathway. If cash payments to landowners remain politically infeasible, in-kind transfers for current consumption could still be an alternative, rather than forced investment projects resulting in high transaction costs, risks and expectations. If budgets are tight, highest spatial priority should go to payments in the pre-identified, most erosion-prone areas, which leverage by far the highest environmental service. Reducing add-on ICDP features and moving the Moyobamba initiative more towards a proper, spatially well-targeted PES intervention might eventually improve both its environmental and livelihoods impacts.
Supporting information
S1 Table [docx]
Relevant impacts evaluation of PES.
S2 Table [docx]
Covariate balance for land-cover and wellbeing analysis.
S3 Table [docx]
Additional estimations.
S1 Dataset [zip]
Stata archives (dta and do files) required to replicate findings reported in this paper are available as supporting information file.
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- Management of locally advanced non-small cell lung cancer in the modern era: A national Italian survey on diagnosis, treatment and multidisciplinary approach
- Foraging strategies are maintained despite workforce reduction: A multidisciplinary survey on the pollen collected by a social pollinator
- Incidence of colorectal cancer in Eritrea: Data from the National Health Laboratory, 2011-2017
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- Evolutionarily conserved susceptibility of the mitochondrial respiratory chain to SDHI pesticides and its consequence on the impact of SDHIs on human cultured cells
- Statistical determination of synergy based on Bliss definition of drugs independence
- The association between sleep problems and academic performance in primary school-aged children: Findings from a Norwegian longitudinal population-based study
- Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan
- Assessing reliability of intra-tumor heterogeneity estimates from single sample whole exome sequencing data
- Dispersion of Legionella bacteria in atmosphere: A practical source location estimation method
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- Why are undergraduate emerging adults anxious and avoidant in their romantic relationships? The role of family relationships
- Barriers to implementation of emergency obstetric and neonatal care in rural Pakistan
- Testosterone supplementation improves insulin responsiveness in HFD fed male T2DM mice and potentiates insulin signaling in the skeletal muscle and C2C12 myocyte cell line
- Ang-(1-7)/ MAS1 receptor axis inhibits allergic airway inflammation via blockade of Src-mediated EGFR transactivation in a murine model of asthma
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- Collembola laterally move biochar particles
- Decreased retinal thickness in patients with Alzheimer’s disease is correlated with disease severity
- Moving system with action sport cameras: 3D kinematics of the walking and running in a large volume
- Factors influencing subclinical atherosclerosis in patients with biopsy-proven nonalcoholic fatty liver disease
- Boundary violations and adolescent drinking: Observational evidence that symbolic boundaries moderate social influence
- Inadequate conflict of interest policies at most French teaching hospitals: A survey and website analysis
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- Lifetime prevalence of intimate partner violence against women in an urban Brazilian city: A cross-sectional survey
- The factors associated with being left-behind children in China: Multilevel analysis with nationally representative data
- High heat tolerance in plants from the Andean highlands: Implications for paramos in a warmer world
- Quantifying pediatric patient need for second- and third-line HIV treatment: A tool for decision-making in resource-limited settings
- Discovery of actionable genetic alterations with targeted panel sequencing in children with relapsed or refractory solid tumors
- Iodine status of non-pregnant women and availability of food vehicles for fortification with iodine in a remote community in Gulf province, Papua New Guinea
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- Integrated pan-cancer gene expression and drug sensitivity analysis reveals SLFN11 mRNA as a solid tumor biomarker predictive of sensitivity to DNA-damaging chemotherapy
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- Morphology, phylogeny, and taxonomy of two species of colonial volvocine green algae from Lake Victoria, Tanzania
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- Barriers to integration of bioinformatics into undergraduate life sciences education: A national study of US life sciences faculty uncover significant barriers to integrating bioinformatics into undergraduate instruction
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- Effect of community based health education on knowledge and attitude towards iron and folic acid supplementation among pregnant women in Kiambu County, Kenya: A quasi experimental study
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- The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul’s hospital Millennium Medical College and St. Peter’s specialized hospital, Addis Ababa, Ethiopia, 2018
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- Study on the damage characteristics of gas-bearing shale under different unloading stress paths
- EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America
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- Health impact of hepatic-venous-occlusive disease in a small town in Ethiopia—Case study from Tahtay koraro district in Tigray region, 2017
- Development of a novel automatable fabrication method based on electrospinning co electrospraying for rotator cuff augmentation patches
- Development of a quantitative PCR assay for the detection and enumeration of a potentially ciguatoxin-producing dinoflagellate, Gambierdiscus lapillus (Gonyaulacales, Dinophyceae)
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- Respiratory health and inflammatory markers - Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries
- Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria
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- An attempt to identify the issues underlying the lack of consistent conceptualisations in the field of student mathematics-related beliefs
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- Effects of light and nitrogen availability on photosynthetic efficiency and fatty acid content of three original benthic diatom strains
- Early signal detection of adverse events following influenza vaccination using proportional reporting ratio, Victoria, Australia
- Bioinformatic analysis of a novel Echinococcus granulosus nuclear receptor with two DNA binding domains
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- Hypoxia inhibits TNF-α-induced TSLP expression in keratinocytes
- Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications
- Elevated interleukin-25 and its association to Th2 cytokines in systemic lupus erythematosus with lupus nephritis
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- Involvement of extracellular vesicles in the macrophage-tumor cell communication in head and neck squamous cell carcinoma
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- Concurrent validity and discriminative ability of Dutch performance-based motor tests in 5 to 6 years old children
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- The clinicopathological significance of Thrombospondin-4 expression in the tumor microenvironment of gastric cancer
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- Association between ossification of the posterior longitudinal ligament and ossification of the nuchal ligament in the cervical spine
- Effects of Debaryomyces hansenii treatment on intestinal mucosa microecology in mice with antibiotic-associated diarrhea
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- Evolution of high tooth replacement rates in theropod dinosaurs
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- Investigating reindeer pastoralism and exploitation of high mountain zones in northern Mongolia through ice patch archaeology
- Diversity pattern of Plasmodium knowlesi merozoite surface protein 4 (MSP4) in natural population of Malaysia
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- Streptococcal phosphotransferase system imports unsaturated hyaluronan disaccharide derived from host extracellular matrices
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- Effects of an incremental theory of personality intervention on the reciprocity between bullying and cyberbullying victimization and perpetration in adolescents
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- Identifying resurrection genes through the differentially expressed genes between Selaginella tamariscina (Beauv.) spring and Selaginella moellendorffii Hieron under drought stress
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- Minimal effects of oyster aquaculture on local water quality: Examples from southern Chesapeake Bay
- Suboptimal infant and young child feeding practices in rural Boucle du Mouhoun, Burkina Faso: Findings from a cross-sectional population-based survey
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- From waste to food: Optimising the breakdown of oil palm waste to provide substrate for insects farmed as animal feed
- Quantitative assessment of interstitial lung disease in Sjögren’s syndrome
- Comparative efficacy of tenofovir and entecavir in nucleos(t)ide analogue-naive chronic hepatitis B: A systematic review and meta-analysis
- Reference ranges for ultrasonographic renal dimensions as functions of age and body indices: A retrospective observational study in Taiwan
- Finding phrases: On the role of co-verbal facial information in learning word order in infancy
- Mathematical modeling reveals the factors involved in the phenomena of cancer stem cells stabilization
- Effects of forest management and roe deer impact on a mountain forest development in the Italian Apennines: A modelling approach using LANDIS-II
- Evaluation of comprehensive improvement for mild and moderate soil salinization in arid zone
- Efficacy, acceptability and feasibility of daily text-messaging in promoting glycaemic control and other clinical outcomes in a low-resource setting of South Africa: A randomised controlled trial
- Magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, west Ethiopia, 2019: A community-based study
- Comparison of continuous wave and cold lateral condensation filling techniques in 3D printed simulated C-shape canals instrumented with Reciproc Blue or Hyflex EDM
- Effect of caffeine on neuromuscular function following eccentric-based exercise
- AtUBL5 regulates growth and development through pre-mRNA splicing in Arabidopsis thaliana
- The gut microbiome of freshwater Unionidae mussels is determined by host species and is selectively retained from filtered seston
- Alcohol consumption and survival after breast cancer diagnosis in Japanese women: A prospective patient cohort study
- Selection of reference genes for normalization of cranberry (Vaccinium macrocarpon Ait.) gene expression under different experimental conditions
- The household economic costs associated with depression symptoms: A cross-sectional household study conducted in the North West province of South Africa
- Increased cell size, structural complexity and migration of cancer cells acquiring fibroblast organelles by cell-projection pumping
- Acute low- compared to high-load resistance training to failure results in greater energy expenditure during exercise in healthy young men
- Impact of body mass index and metabolically unhealthy status on mortality in the Japanese general population: The JMS cohort study
- Characterization of two thermophilic cellulases from Talaromyces leycettanus JCM12802 and their synergistic action on cellulose hydrolysis
- Ecohydrology of urban trees under passive and active irrigation in a semiarid city
- Cyclosporine A eyedrops with self-nanoemulsifying drug delivery systems have improved physicochemical properties and efficacy against dry eye disease in a murine dry eye model
- LFastqC: A lossless non-reference-based FASTQ compressor
- Highly accurate prediction of flammability limits of chemical compounds using novel integrated hybrid models
- Nonsteroidal anti-inflammatory drugs and acetaminophen ameliorate muscular mechanical hyperalgesia developed after lengthening contractions via cyclooxygenase-2 independent mechanisms in rats
- A popular Indian clove-based mosquito repellent is less effective against Culex quinquefasciatus and Aedes aegypti than DEET
- Yeasts affect tolerance of Drosophila melanogaster to food substrate with high NaCl concentration
- The effect of climate change on cholera disease: The road ahead using artificial neural network
- Grit (effortful persistence) can be measured with a short scale, shows little variation across socio-demographic subgroups, and is associated with career success and career engagement
- Micro-dislodgement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis
- Improving the antimicrobial efficacy against resistant Staphylococcus aureus by a combined use of conjugated oligoelectrolytes
- Kin discrimination and outer membrane exchange in Myxococcus xanthus: Experimental analysis of a natural population
- Inflammatory cell infiltrates, hypoxia, vascularization, pentraxin 3 and osteoprotegerin in abdominal aortic aneurysms – A quantitative histological study
- Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review
- Serum miR-33a is associated with steatosis and inflammation in patients with non-alcoholic fatty liver disease after liver transplantation
- Association between housing tenure and self-rated health in Japan: Findings from a nationwide cross-sectional survey
- Investigation of biochemical and physiological parameters of the newborn Saiga antelope (Saiga tatarica) in Gansu Province, China
- One-year follow-up of changes in refraction and aberrations induced by corneal incision
- Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients
- An assessment of the Dutch experience with health insurers acting as healthcare advisors
- Perception of potential harm and benefits of HIV vaccine trial participation: A qualitative study from urban Tanzania
- Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise
- Deep brain stimulation restores the glutamatergic and GABAergic synaptic transmission and plasticity to normal levels in kindled rats
- Metformin strongly affects transcriptome of peripheral blood cells in healthy individuals
- Cranberry extracts promote growth of Bacteroidaceae and decrease abundance of Enterobacteriaceae in a human gut simulator model
- Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
- Histochemical quantification of collagen content in articular cartilage
- Optogenetically transduced human ES cell-derived neural progenitors and their neuronal progenies: Phenotypic characterization and responses to optical stimulation
- Ion torrent high throughput mitochondrial genome sequencing (HTMGS)
- Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data
- Acute Influenza A virus outbreak in an enzootic infected sow herd: Impact on viral dynamics, genetic and antigenic variability and effect of maternally derived antibodies and vaccination
- Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon
- Home-cage monitoring ascertains signatures of ictal and interictal behavior in mouse models of generalized seizures
- CRISPR/Cas9 gene editing in the West Nile Virus vector, Culex quinquefasciatus Say
- Genetic susceptibility to angiotensin-converting enzyme-inhibitor induced angioedema: A systematic review and evaluation of methodological approaches
- Proton pump inhibitor use increases the risk of peritonitis in peritoneal dialysis patients
- Comparative distribution of extended-spectrum beta-lactamase–producing Escherichia coli from urine infections and environmental waters
- Sex differences in thigh muscle volumes, sprint performance and mechanical properties in national-level sprinters
- Maternal serum and cord blood leptin concentrations at delivery
- Winter nitrification in ice-covered lakes
- Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies
- Monitoring exercise-induced muscle damage indicators and myoelectric activity during two weeks of knee extensor exercise training in young and old men
- Can adoption of pollution prevention techniques reduce pollution substitution?
- The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes
- Poly-arginine-18 peptides do not exacerbate bleeding, or improve functional outcomes following collagenase-induced intracerebral hemorrhage in the rat
- Affective disorders in the elderly in different European countries: Results from the MentDis_ICF65+ study
- Evaluation of forearm vascular resistance during orthostatic stress: Velocity is proportional to flow and size doesn’t matter
- Proton pencil minibeam irradiation of an in-vivo mouse ear model spares healthy tissue dependent on beam size
- Maternal stress in Shank3ex4-9 mice increases pup-directed care and alters brain white matter in male offspring
- Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax
- Exploiting open source 3D printer architecture for laboratory robotics to automate high-throughput time-lapse imaging for analytical microbiology
- Long non-coding RNAs and latent HIV – A search for novel targets for latency reversal
- Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children's hospital in the last 10 years
- Effects of neuromuscular electrical stimulation training on muscle size in collegiate track and field athletes
- Adaptive fuzzy flow rate control considering multifractal traffic modeling and 5G communications
- Evaluation of four commercial tests for detecting ceftiofur in waste milk bulk tank samples
- A smart tele-cytology point-of-care platform for oral cancer screening
- Vasopressin SNP pain factors and stress in sickle cell disease
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- Microbial metabolisms in an abyssal ferromanganese crust from the Takuyo-Daigo Seamount as revealed by metagenomics
- Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017
- The impact of short-term machine perfusion on the risk of cancer recurrence after rat liver transplantation with donors after circulatory death
- Proteomic profiling of the thrombin-activated canine platelet secretome (CAPS)
- Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011–2012
- The effects of prolonged single night session of videogaming on sleep and declarative memory
- Diversity, distribution and dynamics of large trees across an old-growth lowland tropical rain forest landscape
- Mapping developmental QTL for plant height in soybean [Glycine max (L.) Merr.] using a four-way recombinant inbred line population
- Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis
- UM171 induces a homeostatic inflammatory-detoxification response supporting human HSC self-renewal
- Positive selection and precipitation effects on the mitochondrial NADH dehydrogenase subunit 6 gene in brown hares (Lepus europaeus) under a phylogeographic perspective
- Evaluation of Minimum Inhibitory Concentrations for 154 Mycoplasma synoviae isolates from Italy collected during 2012-2017
- Enhancement of antibiotics antimicrobial activity due to the silver nanoparticles impact on the cell membrane
- Correction: Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored
- Correction: Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa
- Knowledge-based best of breed approach for automated detection of clinical events based on German free text digital hospital discharge letters
- Importance of thorough tissue and cellular level characterization of targeted drugs in the evaluation of pharmacodynamic effects
- Integrated value-chain and risk assessment of Pig-Related Zoonoses in Ghana
- Failed sperm retrieval from severely oligospermic or non-obstructive azoospermic patients on oocyte retrieval day: Emergent oocyte cryopreservation is a feasible strategy
- Cassava yield traits predicted by genomic selection methods
- Verification of hub genes in the expression profile of aortic dissection
- Pig farmers’ willingness to pay for management strategies to reduce aggression between pigs
- Metabolomic response of Euglena gracilis and its bleached mutant strain to light
- Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis
- Newly educated care managers’ experiences of providing care for persons with stress-related mental disorders in the clinical primary care context
- Real-time telemetry monitoring of oxygen in the central complex of freely-walking Gromphadorhina portentosa
- Qualification programmes for immigrant health professionals: A systematic review
- An analytical model to minimize the latency in healthcare internet-of-things in fog computing environment
- Grain filling of early-season rice cultivars grown under mechanical transplanting
- Intercalation of small molecules into DNA in chromatin is primarily controlled by superhelical constraint
- Correlative evidence for co-regulation of phosphorus and carbon exchanges with symbiotic fungus in the arbuscular mycorrhizal Medicago truncatula
- How to design a dose-finding study on combined agents: Choice of design and development of R functions
- Altered expression of Notch1 in Alzheimer's disease
- The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women
- Trunk velocity-dependent Light Touch reduces postural sway during standing
- Evaluation of cytological diagnostic accuracy for canine splenic neoplasms: An investigation in 78 cases using STARD guidelines
- Trade-offs in motivating volunteer effort: Experimental evidence on voluntary contributions to science
- Does caching strategy vary with microclimate in endangered Mt. Graham red squirrels?
- Assessment of energy expenditure during high intensity cycling and running using a heart rate and activity monitor in young active adults
- Evaluating rectal swab collection method for gut microbiome analysis in the common marmoset (Callithrix jacchus)
- Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study
- Can the CalproQuest predict a positive Calprotectin test? A prospective diagnostic study
- The calcium sensor OsCBL1 modulates nitrate signaling to regulate seedling growth in rice
- Acceptability of and treatment preferences for recurrent bacterial vaginosis—Topical lactic acid gel or oral metronidazole antibiotic: Qualitative findings from the VITA trial
- Mathematical determination of the HIV-1 matrix shell structure and its impact on the biology of HIV-1
- Contingent negative variation during a modified cueing task in simulated driving
- CAMDI interacts with the human memory-associated protein KIBRA and regulates AMPAR cell surface expression and cognition
- Effect of feeding patterns on growth and nutritional status of children aged 0-24 months: A Chinese cohort study
- A fecal sequel: Testing the limits of a genetic assay for bat species identification
- Measuring the impact of chronic conditions and associated multimorbidity on health-related quality of life in the general population in Hong Kong SAR, China: A cross-sectional study
- Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial
- Vaccine cold chain in general practices: A prospective study in 75 refrigerators (Keep Cool study)
- Brazilian norms for the Bank of Standardized Stimuli (BOSS)
- Distinct varieties of aesthetic chills in response to multimedia
- Interaction between apolipoprotein E genotype and hypertension on cognitive function in older women in the Nurses’ Health Study
- Correction: Resistance profile of the HIV-1 maturation inhibitor GSK3532795 in vitro and in a clinical study
- New formulation of the Gompertz equation to describe the kinetics of untreated tumors
- Development of visual perception of others’ actions: Children’s judgment of lifted weight
- Retrospective comparative analysis of intraocular lens calculation formulas after hyperopic refractive surgery
- Human vitreous concentrations of citicoline following topical application of citicoline 2% ophthalmic solution
- Development and validation of exhaled breath condensate microRNAs to identify and endotype asthma in children
- Arthroscopic release for frozen shoulder: Does the timing of intervention and diabetes affect outcome?
- Risk factors affecting dairy cattle protective grouping behavior, commonly known as bunching, against Stomoxys calcitrans (L.) on California dairies
- Acceleration of chemical shift encoding-based water fat MRI for liver proton density fat fraction and T2* mapping using compressed sensing
- Characterisation and microbial community analysis of lipid utilising microorganisms for biogas formation
- Sexuality in male partners of women with fibromyalgia syndrome: A qualitative study
- Exploring optimization strategies for improving explicit water models: Rigid n-point model and polarizable model based on Drude oscillator
- Artificial insemination with fresh, liquid stored and frozen thawed semen in dromedary camels
- Moving into an urban drug scene among people who use drugs in Vancouver, Canada: Latent class growth analysis
- Numerical study on the start and unstart phenomena in a scramjet inlet-isolator model
- Effects of dietary supplementation with apple peel powder on the growth, blood and liver parameters, and transcriptome of genetically improved farmed tilapia (GIFT, Oreochromis niloticus)
- Urban growth simulation in different scenarios using the SLEUTH model: A case study of Hefei, East China
- Chronic bronchitis without airflow obstruction, asthma and rhinitis are differently associated with cardiovascular risk factors and diseases
- Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study
- Mammary microbiome of lactating organic dairy cows varies by time, tissue site, and infection status
- Force field generalization and the internal representation of motor learning
- Polyphenism of visual and chemical secondary sexually-selected wing traits in the butterfly Bicyclus anynana: How different is the intermediate phenotype?
- Minimal genetic differentiation of the malaria vector Nyssorhynchus darlingi associated with forest cover level in Amazonian Brazil
- The impact of leisure activities on older adults’ cognitive function, physical function, and mental health
- scafSLICR: A MATLAB-based slicing algorithm to enable 3D-printing of tissue engineering scaffolds with heterogeneous porous microarchitecture
- Association of serum leptin and adiponectin concentrations with echocardiographic parameters and pathophysiological states in patients with cardiovascular disease receiving cardiovascular surgery
- Operation of cognitive memory inhibition in adults with Down syndrome: Effects of maintenance load and material
- Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals
- Post-treatment Lyme disease symptoms score: Developing a new tool for research
- Expression of Concern: The Role of the RACK1 Ortholog Cpc2p in Modulating Pheromone-Induced Cell Cycle Arrest in Fission Yeast
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- Investigating cooperation with robotic peers
- Synthesis, purification and crystallization of a putative critical bulge of HAR1 RNA
- Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review
- A case study of the use of verbal reports for talent identification purposes in soccer: A Messi affair!
- Transgenerational deep sequencing revealed hypermethylation of hippocampal mGluR1 gene with altered mRNA expression of mGluR5 and mGluR3 associated with behavioral changes in Sprague Dawley rats with history of prolonged febrile seizure
- Obesity is associated with an impaired survival in lymphoma patients undergoing autologous stem cell transplantation
- Periodontal disease: Repercussions in pregnant woman and newborn health—A cohort study
- Origins of Chinese reindeer (Rangifer tarandus) based on mitochondrial DNA analyses
- Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis
- How effective are films in inducing positive and negative emotional states? A meta-analysis
- 3D nanostructural characterisation of grain boundaries in atom probe data utilising machine learning methods
- An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors
- Initial clinical radiological findings and staging to predict prognosis of primary hepatic angiosarcoma: A retrospective analysis
- A new early Eocene deperetellid tapiroid illuminates the origin of Deperetellidae and the pattern of premolar molarization in Perissodactyla
- Longevity and marginal bone loss of narrow-diameter implants supporting single crowns: A systematic review
- Impact of UVC-sustained recirculating air filtration on airborne bacteria and dust in a pig facility
- Cold-related Florida manatee mortality in relation to air and water temperatures
- Conceptual fluency in inductive reasoning
- Clinical outcomes and treatment patterns among Medicare patients with nonvalvular atrial fibrillation (NVAF) and chronic kidney disease
- Improvements in the learnability of smartphone haptic interfaces for visually impaired users
- Role of the malic enzyme in metabolism of the halotolerant methanotroph Methylotuvimicrobium alcaliphilum 20Z
- Cyclic loading test study on a new cast-in-situ insulated sandwich concrete wall
- Natural compounds as angiogenic enzyme thymidine phosphorylase inhibitors: In vitro biochemical inhibition, mechanistic, and in silico modeling studies
- Analysis of virulence potential of Escherichia coli O145 isolated from cattle feces and hide samples based on whole genome sequencing
- Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching
- Prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients
- Determinants of preterm birth among mothers who gave birth at public hospitals in the Amhara region, Ethiopia: A case-control study
- Real-world evidence of the effectiveness of ombitasvir-paritaprevir/r ± dasabuvir ± ribavirin in patients monoinfected with chronic hepatitis C or coinfected with human immunodeficiency virus-1 in Spain
- Unique transcriptomic landscapes identified in idiopathic spontaneous and infection related preterm births compared to normal term births
- Restrained expansion of the recall germinal center response as biomarker of protection for influenza vaccination in mice
- Arabidopsis TRM5 encodes a nuclear-localised bifunctional tRNA guanine and inosine-N1-methyltransferase that is important for growth
- Achievement of weight loss in patients with overweight during dietetic treatment in primary health care
- Autophagy deficiency exacerbates colitis through excessive oxidative stress and MAPK signaling pathway activation
- The impacts of parity on lung function data (LFD) of healthy females aged 40 years and more issued from an upper middle income country (Algeria): A comparative study
- Reorganization of spatial configurations in visual working memory: A matter of set size?
- Unravelling travellers’ route choice behaviour at full-scale urban network by focusing on representative OD pairs in computer experiments
- Evaluating the higher-order structure of the Profile of Emotional Competence (PEC): Confirmatory factor analysis and Bayesian structural equation modeling
- HIV prevalence and correlated factors among male clients of female sex workers in a border region of China
- Next generation sequencing and RNA-seq characterization of adipose tissue in the Nile crocodile (Crocodylus niloticus) in South Africa: Possible mechanism(s) of pathogenesis and pathophysiology of pansteatitis
- Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population
- Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians
- Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project
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- Comparison of the fecal, cecal, and mucus microbiome in male and female mice after TNBS-induced colitis
- Identifying candidate diagnostic markers for early stage of non-small cell lung cancer
- Complex alternative splicing of human Endonuclease V mRNA, but evidence for only a single protein isoform
- Correction: KML001 Induces Apoptosis and Autophagic Cell Death in Prostate Cancer Cells via Oxidative Stress Pathway
- Unique developmental trajectories of risk behaviors in adolescence and associated outcomes in young adulthood
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- Overexpression of Saussurea involucrata dehydrin gene SiDHN promotes cold and drought tolerance in transgenic tomato plants
- Foxtail millet (Setaria italica (L.) P. Beauv) CIPKs are responsive to ABA and abiotic stresses
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- Frequency cluster formation and slow oscillations in neural populations with plasticity
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- Diagnostic accuracy of SOX11 immunohistochemistry in mantle cell lymphoma: A meta-analysis
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- Spatiotemporally random and diverse grid cell spike patterns contribute to the transformation of grid cell to place cell in a neural network model
- Empathic concern and personal distress depend on situational but not dispositional factors
- Who is more susceptible to job stressors and resources? Sensory-processing sensitivity as a personal resource and vulnerability factor
- Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
- A substitution mutation in a conserved domain of mammalian acetate-dependent acetyl CoA synthetase 2 results in destabilized protein and impaired HIF-2 signaling
- One step at a time: Physical activity is linked to positive interpretations of ambiguity
- Calreticulin regulates vascular endothelial growth factor-A mRNA stability in gastric cancer cells
- Evaluation of various methods of selection of B. subtilis strains capable of secreting surface-active compounds
- Association between US Pharmacopeia (USP) monograph standards, generic entry and prescription drug costs
- Molecular characterisation of the synovial fluid microbiome in rheumatoid arthritis patients and healthy control subjects
- On sorption hysteresis in wood: Separating hysteresis in cell wall water and capillary water in the full moisture range
- Inbreeding, Allee effects and stochasticity might be sufficient to account for Neanderthal extinction
- Reliability and construct validity of the stepping-forward affordance perception test for fall risk assessment in community-dwelling older adults
- Socioeconomic determinants of nutritional status among ‘Baiga’ tribal children In Balaghat district of Madhya Pradesh: A qualitative study
- Study on characteristics of fire plume in building facade window under lateral blow
- ‘When you talk to someone in a bad way or always put her under pressure, it is actually worse than beating her’: Conceptions and experiences of emotional intimate partner violence in Rwanda and South Africa
- Effects of 6-mercaptopurine in pressure overload induced right heart failure
- The association between haemoglobin levels in the first 20 weeks of pregnancy and pregnancy outcomes
- Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study
- Factors associated with persistently high-cost health care utilization for musculoskeletal pain
- Nitrogen and chlorophyll status determination in durum wheat as influenced by fertilization and soil management: Preliminary results
- Effect of repeated in vivo microCT imaging on the properties of the mouse tibia
- Coupling environment and physiology to predict effects of climate change on the taxonomic and functional diversity of fish assemblages in the Murray-Darling Basin, Australia
- Hematology and plasma biochemistries in the Blanding’s turtle (Emydoidea blandingii) in Lake County, Illinois
- CRISPR-Cas influences the acquisition of antibiotic resistance in Klebsiella pneumoniae
- Phosphorylation-dependent activity-based conformational changes in P21-activated kinase family members and screening of novel ATP competitive inhibitors
- Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis
- Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study
- Imported severe malaria and risk factors for intensive care: A single-centre retrospective analysis
- Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes
- Low-latency single channel real-time neural spike sorting system based on template matching
- Quantifying the scale effect in geospatial big data using semi-variograms
- Paper-and-pencil versus computerized administration mode: Comparison of data quality and risk behavior prevalence estimates in the European school Survey Project on Alcohol and other Drugs (ESPAD)
- Regression adjusted colocalisation colour mapping (RACC): A novel biological visual analysis method for qualitative colocalisation analysis of 3D fluorescence micrographs
- Ostrich eggshell bead diameter in the Holocene: Regional variation with the spread of herding in eastern and southern Africa
- Spatial and temporal variations in female size at maturity of a Southern Rock Lobster (Jasus edwardsii) population: A likely response to climate change
- Inactive USP14 and inactive UCHL5 cause accumulation of distinct ubiquitinated proteins in mammalian cells
- Training rhesus macaques to take daily oral antiretroviral therapy for preclinical evaluation of HIV prevention and treatment strategies
- Left ventricular structural and functional changes in Friedreich ataxia – Relationship with body size, sex, age and genetic severity
- Magnitude and factors associated with anemia among pregnant women attending antenatal care in Bench Maji, Keffa and Sheka zones of public hospitals, Southwest, Ethiopia, 2018: A cross -sectional study
- Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review
- Hydrogen sulphide-induced hypometabolism in human-sized porcine kidneys
- Correction: Comparison of the molecular properties of retinitis pigmentosa P23H and N15S amino acid replacements in rhodopsin
- Retraction: Regulation of gastric smooth muscle contraction via Ca2+-dependent and Ca2+-independent actin polymerization
- Evaluation of neutral oral contrast agents for assessment of the small bowel at abdominal staging CT
- Blood type and breed-associated differences in cell marker expression on equine bone marrow-derived mesenchymal stem cells including major histocompatibility complex class II antigen expression
- Induced abortion and future use of IVF treatment; A nationwide register study
- Psychosocial determinants of sustained maternal functional impairment: Longitudinal findings from a pregnancy-birth cohort study in rural Pakistan
- Measurement of finger joint angle using stretchable carbon nanotube strain sensor
- Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria
- Drugs modulating stochastic gene expression affect the erythroid differentiation process
- Efficacy of UB0316, a multi-strain probiotic formulation in patients with type 2 diabetes mellitus: A double blind, randomized, placebo controlled study
- Prognostic value of des-γ-carboxy prothrombin in patients with hepatocellular carcinoma treated with transarterial chemotherapy: A systematic review and meta-analysis
- Avermectin induces the oxidative stress, genotoxicity, and immunological responses in the Chinese Mitten Crab, Eriocheir sinensis
- Antibiotic use in mandarin production (Citrus reticulata Blanco) in major mandarin-producing areas in Thailand: A survey assessment
- Application of CPI cutoff value based on parentage testing of duos and trios typed by four autosomal kits
- Correction: Good and Bad in the Hands of Politicians: Spontaneous Gestures during Positive and Negative Speech
- Adolescents with worse levels of oral health literacy have more cavitated carious lesions
- Effective methods for the inactivation of Francisella tularensis
- Detection of early-stage Alzheimer’s pathology using blood-based autoantibody biomarkers in elderly hip fracture repair patients
- Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease
- Analysis of HER2 genomic binding in breast cancer cells identifies a global role in direct gene regulation
- Population productivity of shovelnose rays: Inferring the potential for recovery
- Correction: Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era
- Effects of tetracycline on myocardial infarct size in obese rats with chemically-induced colitis
- Mineral absorption is an enriched pathway in a brain region of restless legs syndrome patients with reduced MEIS1 expression
- Changes in weight and body composition across five years at university: A prospective observational study
- Adeno-associated virus-mediated expression of human butyrylcholinesterase to treat organophosphate poisoning
- Effects of insulin signaling on mouse taste cell proliferation
- Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya
- TAP: A static analysis model for PHP vulnerabilities based on token and deep learning technology
- Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of Latent Tuberculosis Infection in primary health care workers in Brazil
- Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial
- Changes over time in creatinine clearance and comparison of emergent adverse events for HIV-positive adults receiving standard doses (300 mg/day) of lamivudine-containing antiretroviral therapy with baseline creatinine clearance of 30–49 vs ≥50 mL/min
- Population dynamics of foxes during restricted-area culling in Britain: Advancing understanding through state-space modelling of culling records
- Impacts of experimental advisory exit speed sign on traffic speeds for freeway exit ramp
- In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium
- Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia
- Delivering genes across the blood-brain barrier: LY6A, a novel cellular receptor for AAV-PHP.B capsids
- Correction: Using remote sensing to detect whale strandings in remote areas: The case of sei whales mass mortality in Chilean Patagonia
- Comparison of the inoculum size effects of antibiotics on IMP-6 β-lactamase-producing Enterobacteriaceae co-harboring plasmid-mediated quinolone resistance genes
- Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma
- Non-invasive in vivo imaging of UCP1 expression in live mice via near-infrared fluorescent protein iRFP720
- Overexpression of pink1 or parkin in indirect flight muscles promotes mitochondrial proteostasis and extends lifespan in Drosophila melanogaster
- Fiber stiffness, pore size and adhesion control migratory phenotype of MDA-MB-231 cells in collagen gels
- Comparison of two experimental ARDS models in pigs using electrical impedance tomography
- Are primary school children attending full-day school still engaged in sports clubs?
- Stroke risks in women with dysmenorrhea by age and stroke subtype
- Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: A joinpoint analysis
- In vitro modeling of Batrachochytrium dendrobatidis infection of the amphibian skin
- Development and validation of LC-MS/MS method for imatinib and norimatinib monitoring by finger-prick DBS in gastrointestinal stromal tumor patients
- Correction: Habitat disturbance and the organization of bacterial communities in Neotropical hematophagous arthropods
- Characterisation of early metazoan secretion through associated signal peptidase complex subunits, prohormone convertases and carboxypeptidases of the marine sponge (Amphimedon queenslandica)
- Time trends between 2002 and 2017 in correlates of self-reported sitting time in European adults
- Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis
- Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
- Correction: Antimicrobial resistance genotypes and phenotypes of Campylobacter jejuni isolated in Italy from humans, birds from wild and urban habitats, and poultry
- Correction: Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum
- Correction: Establishing an infrastructure for collaboration in primate cognition research
- Correction: The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review
- Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting
- Comparison of potential drug-drug interactions with metabolic syndrome medications detected by two databases
- The Polish version of the Cultural Intelligence Scale: Assessment of its reliability and validity among healthcare professionals and medical faculty students
- Selection of optimal reference genes for qRT-PCR analysis of shoot development and graviresponse in prostrate and erect chrysanthemums
- Metastasis risk prediction model in osteosarcoma using metabolic imaging phenotypes: A multivariable radiomics model
- Defining hospital community benefit activities using Delphi technique: A comparison between China and the United States
- Establishment of the experimental procedure for prediction of conjugation capacity in mutant UGT1A1
- A robust multi-objective optimization framework to capture both cellular and intercellular properties in cardiac cellular model tuning: Analyzing different regions of membrane resistance profile in parameter fitting
- Sea star wasting disease demography and etiology in the brooding sea star Leptasterias spp.
- Diagnostic plasma miRNA-profiles for ovarian cancer in patients with pelvic mass
- Genetic diversity and drug resistance of HIV-1 among infected pregnant women newly diagnosed in Luanda, Angola
- I’ve been robbed! – Can changes in floral traits discourage bee pollination?
- Visualising statistical models using dynamic nomograms
- Assessing the capacity of Malawi’s district and central hospitals to manage traumatic diaphyseal femoral fractures in adults
- Diagnostic performance of basal cortisol level at 0900-1300h in adrenal insufficiency
- The Mastery Rubric for Bioinformatics: A tool to support design and evaluation of career-spanning education and training
- Microdissection and whole chromosome painting confirm karyotype transformation in cryptic species of the Lariophagus distinguendus (Förster, 1841) complex (Hymenoptera: Pteromalidae)
- Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice
- Gemcitabine potentiates the anti-tumour effect of radiation on medullary thyroid cancer
- iTRAQ-based high-throughput proteomics analysis reveals alterations of plasma proteins in patients infected with human bocavirus
- The detection of a non-anemophilous plant species using airborne eDNA
- Perception and control of low cable operation forces in voluntary closing body-powered upper-limb prostheses
- Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis
- Randomized methods to characterize large-scale vortical flow networks
- Disentangling the coexistence strategies of mud-daubing wasp species through trophic analysis in oases of Baja California peninsula
- Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers
- Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support
- Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill
- DOC export is exceeded by C fixation in May Creek: A late-successional watershed of the Copper River Basin, Alaska
- Behavioral observation of prosocial behavior and social initiative is related to preschoolers’ psychopathological symptoms
- Evaluating the impact of citations of articles based on knowledge flow patterns hidden in the citations
- Correction: Economic sanctions and academia: Overlooked impact and long-term consequences
- Correction: A novel association between relaxin receptor polymorphism and hematopoietic stem cell yield after mobilization
- Expression of Concern: Cooperativity of Oncogenic K-Ras and Downregulated p16/INK4A in Human Pancreatic Tumorigenesis
- Price dispersion of generic medications
- Sex differences in body composition but not neuromuscular function following long-term, doxycycline-induced reduction in circulating levels of myostatin in mice
- The emotion regulation effect of cognitive control is related to depressive state through the mediation of rumination: An ERP study
- Comparison of SMS-EPI and 3D-EPI at 7T in an fMRI localizer study with matched spatiotemporal resolution and homogenized excitation profiles
- Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method
- Correction: Combining biophysical parameters, spectral indices and multivariate hyperspectral models for estimating yield and water productivity of spring wheat across different agronomic practices
- Correction: Flowers as viral hot spots: Honey bees (Apis mellifera) unevenly deposit viruses across plant species
- 'Small small quarrels bring about happiness or love in the relationships’: Exploring community perceptions and gendered norms contributing to male perpetrated intimate partner violence in the Central Region of Ghana
- The performance of practitioners conducting facial comparisons on images of children across age
- Increased amounts and stability of telomeric repeat-containing RNA (TERRA) following DNA damage induced by etoposide
- Patients with limitation or withdrawal of life supporting care admitted in a medico-surgical intermediate care unit: Prevalence, description and outcome over a six-month period
- Correction: Diverse radiofrequency sensitivity and radiofrequency effects of mobile or cordless phone near fields exposure in Drosophila melanogaster
- Predicting the performance of TV series through textual and network analysis: The case of Big Bang Theory
- Risk of temperature, humidity and concentrations of air pollutants on the hospitalization of AECOPD
- Mixed methods grant applications in the health sciences: An analysis of reviewer comments
- Renal abnormalities among children with sickle cell conditions in highly resource-limited setting in Ghana
- Size matters: How reaching and vergence movements are influenced by the familiar size of stereoscopically presented objects
- Willingness to receive institutional and community-based eldercare among the rural elderly in China
- An improved deep learning method for predicting DNA-binding proteins based on contextual features in amino acid sequences
- Beyond executive functions, creativity skills benefit academic outcomes: Insights from Montessori education
- A LAMP assay for the rapid and robust assessment of Wolbachia infection in Aedes aegypti under field and laboratory conditions
- Nonarteritic anterior ischemic optic neuropathy is associated with cerebral small vessel disease
- Fiber-tract localized diffusion coefficients highlight patterns of white matter disruption induced by proximity to glioma
- The fight against polio through the NO-DO newsreels during the Francoism period in Spain
- Ocean sound levels in the northeast Pacific recorded from an autonomous underwater glider
- Cost-consequence analysis of influenza vaccination among the staff of a large teaching hospital in Rome, Italy: A pilot study
- The relationship among the progression of inflammation in umbilical cord, fetal inflammatory response, early-onset neonatal sepsis, and chorioamnionitis
- How medical professional students view older people with dementia: Implications for education and practice
- An enhanced nonparametric EWMA sign control chart using sequential mechanism
- Land use change, carbon stocks and tree species diversity in green spaces of a secondary city in Myanmar, Pyin Oo Lwin
- Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services
- Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort
- Adsorption of oxytetracycline on kaolinite
- Interdisciplinary stratified care for low back pain: A qualitative study on the acceptability, potential facilitators and barriers to implementation
- The role of resource transfer in positive, non-additive litter decomposition
- The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study
- Quantum dots reveal heterogeneous membrane diffusivity and dynamic surface density polarization of dopamine transporter
- Genomic analysis of Shiga toxin-producing Escherichia coli from patients and asymptomatic food handlers in Japan
- The heavy metals lead and cadmium are cytotoxic to human bone osteoblasts via induction of redox stress
- Anatomical, taxonomic, and phylogenetic reappraisal of a poorly known ghost knifefish, Tembeassu marauna (Ostariophysi: Gymnotiformes), using X-ray microcomputed tomography
- Matrix-assisted laser desorption/ionization time of flight mass spectrometry identification of Vibrio (Listonella) anguillarum isolated from sea bass and sea bream
- Recommendations of older adults on how to use the PROM ‘TOPICS-MDS’ in healthcare conversations: A Delphi study
- The winner takes it all—Competitiveness of single nodes in globalized supply networks
- Hamsters in the city: A study on the behaviour of a population of common hamsters (Cricetus cricetus) in urban environment
- Correction: Liquid biopsies for omics-based analysis in sentinel mussels
- Size matters! Association between journal size and longitudinal variability of the Journal Impact Factor
- Drug resistance and epidemiology characteristics of multidrug-resistant tuberculosis patients in 17 provinces of China
- A model-based framework for chronic hepatitis C prevalence estimation
- Adding rewards to regulation: The impacts of watershed conservation on land cover and household wellbeing in Moyobamba, Peru
- Clinical determinants of social media use in individuals with schizophrenia
- Arsenic and nutrient absorption characteristics and antioxidant response in different leaves of two ryegrass (Lolium perenne) species under arsenic stress
- An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi
- A single plasmid based CRISPR interference in Synechocystis 6803 – A proof of concept
- Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia’s Puerto Rican inner-city
- Temporal trends in intracerebral hemorrhage: Evidence from the Austrian Stroke Unit Registry
- Prevalence and risk factors for multi-drug resistant Escherichia coli among poultry workers in the Federal Capital Territory, Abuja, Nigeria
- Prediction of disease-related metabolites using bi-random walks
- Clinical use, efficacy, and durability of maraviroc for antiretroviral therapy in routine care: A European survey
- Biomarker discovery in inflammatory bowel diseases using network-based feature selection
- The Cinderella Complex: Word embeddings reveal gender stereotypes in movies and books
- Exoproteome profiling of Trypanosoma cruzi during amastigogenesis early stages
- Reproducible phenotype alteration due to prolonged cooling of the pupae of Polyommatus icarus butterflies
- Nutritional treatment with an immune-modulating enteral formula alleviates 5-fluorouracil-induced adverse effects in rats
- Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands
- Systematic review of the accuracy of plasma preparation tubes for HIV viral load testing
- Circadian clock regulates the shape and content of dendritic spines in mouse barrel cortex
- “Anybody can make kids; it takes a real man to look after your kids”: Aboriginal men’s discourse on parenting
- Correction: A 1D computer model of the arterial circulation in horses: An important resource for studying global interactions between heart and vessels under normal and pathological conditions
- Maternal interpregnancy weight change and premature birth: Findings from an English population-based cohort study
- Correction: Identifying performance benchmarks and determinants for reproductive performance and calf survival using a longitudinal field study of cow-calf herds in western Canada
- Prognostic value of the model for end-stage liver disease excluding INR score (MELD-XI) in patients with adult congenital heart disease
- Treatment of Urethral Pain Syndrome (UPS) in Sweden
- Migration and political polarization in the U.S.: An analysis of the county-level migration network
- Epidemiology and complications of late-onset sepsis: an Italian area-based study
- The relationship between women’s experience of intimate partner violence and other socio-demographic factors, and under-5 children’s health in South Africa
- Association between trunk and gluteus muscle size and long jump performance
- Multimorbidity and complex multimorbidity in Brazilian rural workers
- Correction: Interspecific Phylogenic Relationships within Genus Melilotus Based on Nuclear and Chloroplast DNA
- Insulin-like growth factor (IGF)-II- mediated fibrosis in pathogenic lung conditions
- Wolf diet and prey selection in the South-Eastern Carpathian Mountains, Romania
- In vitro activity of aryl-thiazole derivatives against Schistosoma mansoni schistosomula and adult worms
- Sample size issues in multilevel logistic regression models
- Seed germination ecology of Ageratum houstonianum: A major invasive weed in Nepal
- Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting
- Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?
- The association between cigarette smoking and serum thyroid stimulating hormone, thyroid peroxidase antibodies and thyroglobulin antibodies levels in Chinese residents: A cross-sectional study in 10 cities
- Mouse movement measures enhance the stop-signal task in adult ADHD assessment
- Ecosystem functioning in urban grasslands: The role of biodiversity, plant invasions and urbanization
- Correction: KETOS: Clinical decision support and machine learning as a service – A training and deployment platform based on Docker, OMOP-CDM, and FHIR Web Services
- Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany
- Hyperconnectivity during screen-based stories listening is associated with lower narrative comprehension in preschool children exposed to screens vs dialogic reading: An EEG study
- Weight loss is associated with improved quality of life among rural women completers of a web-based lifestyle intervention
- Long-term high-grain diet altered the ruminal pH, fermentation, and composition and functions of the rumen bacterial community, leading to enhanced lactic acid production in Japanese Black beef cattle during fattening
- Beyond detoxification: Pleiotropic functions of multiple glutathione S-transferase isoforms protect mice against a toxic electrophile
- Golgi reassembly and stacking protein 65 downregulation is required for the anti-cancer effect of dihydromyricetin on human ovarian cancer cells
- SSR marker development in Clerodendrum trichotomum using transcriptome sequencing
- Risk factors for the carriage of Streptococcus infantarius subspecies infantarius isolated from African fermented dairy products
- Development of an intervention tool for precision oral self-care: Personalized and evidence-based practice for patients with periodontal disease
- Personal values in adolescence and psychological distress in adults: A cross-sectional study based on a retrospective recall
- Overactive bladder and bladder pain syndrome/interstitial cystitis in primary Sjögren’s syndrome patients: A nationwide population-based study
- Clinical utility of combined preimplantation genetic testing methods in couples at risk of passing on beta thalassemia/hemoglobin E disease: A retrospective review from a single center
- Hip stress distribution - Predictor of dislocation in hip arthroplasties. A retrospective study of 149 arthroplasties
- Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services
- Pup mortality in New Zealand sea lions (Phocarctos hookeri) at Enderby Island, Auckland Islands, 2013-18
- In vitro endothelial cell migration from limbal edge-modified Quarter-DMEK grafts
- Liquid Chromatography/Mass Spectrometry based serum metabolomics study on recurrent abortion women with antiphospholipid syndrome
- Gut carriage of antimicrobial resistance genes among young children in urban Maputo, Mozambique: Associations with enteric pathogen carriage and environmental risk factors
- Prepubertal nutrition alters Leydig cell functional capacity and timing of puberty
- Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist’s attitudes to implementation of evidence-based practice
- Mitochondrial alarmins are tissue mediators of ventilator-induced lung injury and ARDS
- Complete Chloroplast Genomes of Vachellia nilotica and Senegalia senegal: Comparative Genomics and Phylogenomic Placement in a New Generic System
- Retraction: Over-Expression of Superoxide Dismutase Ameliorates Cr(VI) Induced Adverse Effects via Modulating Cellular Immune System of Drosophila melanogaster
- Effect of pre-season training phase on anthropometric, hormonal and fitness parameters in young soccer players
- Exosomes from conditioned media of bone marrow-derived mesenchymal stem cells promote bone regeneration by enhancing angiogenesis
- Outcome of patients with heart failure after transcatheter aortic valve implantation
- Fatty acid profile of Romanian’s common bean (Phaseolus vulgaris L.) lipid fractions and their complexation ability by β-cyclodextrin
- Appropriate empirical antibiotic therapy and mortality: Conflicting data explained by residual confounding
- Treatment of corneal endothelial damage in a rabbit model with a bioengineered graft using human decellularized corneal lamina and cultured human corneal endothelium
- Telbivudine on IgG-associated hypergammaglobulinemia and TGF-β1 hyperactivity in hepatitis B virus-related liver cirrhosis
- Correction: Axial variation of deoxyhemoglobin density as a source of the low-frequency time lag structure in blood oxygenation level-dependent signals
- Correction: Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study
- Retraction: Placental expression of CD100, CD72 and CD45 is dysregulated in human miscarriage
- Correction: Use of IoT sensing and occupant surveys for determining the resilience of buildings to forest fire generated PM2.5
- Correction: The modulation of facial mimicry by attachment tendencies and their underlying affiliation motives in 3-year-olds: An EMG study
- Correction: Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors
- Discovering novel disease comorbidities using electronic medical records
- Glutathione contributes to efficient post-Golgi trafficking of incoming HPV16 genome
- Epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolates colonizing pigs with different exposure to antibiotics
- Social information use in adolescents: The impact of adults, peers and household composition
- Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members
- Effects of Topper Training on psychosocial problems, self-esteem, and peer victimisation in Dutch children: A randomised trial
- Comparative studies of two generations of NanoString nCounter System
- General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study
- Can altered magnetic field affect the foraging behaviour of ants?
- Parasitic infections and medical expenses according to Health Insurance Review Assessment claims data in South Korea, 2011–2018
- A prospective observational study of on-treatment plasma homocysteine levels as a biomarker of toxicity, depression and vitamin supplementation lead-in time pre pemetrexed, in patients with non-small cell lung cancer and malignant mesothelioma
- A strategy to identify protein-N-myristoylation-dependent phosphorylation reactions of cellular proteins by using Phos-tag SDS-PAGE
- Expression profile of sonic hedgehog signaling-related molecules in basal cell carcinoma
- Seasonal alternation of the ontogenetic development of the moon jellyfish Aurelia coerulea in Maizuru Bay, Japan
- Reliability of measurement of active trunk movement in wheelchair basketball players
- Chinese SLE Treatment and Research group (CSTAR) registry: Clinical significance of thrombocytopenia in Chinese patients with systemic lupus erythematosus
- Does source credibility matter for point-of-decision prompts? A quasi-experimental field study to increase stair use
- Male-pattern baldness and incident coronary heart disease and risk factors in the Heinz Nixdorf Recall Study
- Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites
- Determining an optimal pool size for testing beef herds for Johne’s disease in Australia
- Correction: Change in larval fish assemblage in a USA east coast estuary estimated from twenty-six years of fixed weekly sampling
- APOE-knockout in rabbits causes loss of cells in nucleus pulposus and enhances the levels of inflammatory catabolic cytokines damaging the intervertebral disc matrix
- Testing Species Assignments in Extant Terebratulide Brachiopods: A Three-dimensional Geometric Morphometric Analysis of Long-Looped Brachidia
- A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations
- Improved chemotherapy modeling with RAG-based immune deficient mice
- Effect of tracheal antimicrobial peptide on the development of Mannheimia haemolytica pneumonia in cattle
- The internal realities of individuals with type 2 diabetes – a functional framework of self-management practices via Grounded Theory approach
- Role of platelet parameters in early detection and prediction of severity of preeclampsia: A comparative cross-sectional study at Ayder comprehensive specialized and Mekelle general hospitals, Mekelle, Tigray, Ethiopia
- eIF4E and 4EBP1 are prognostic markers of head and neck squamous cell carcinoma recurrence after definitive surgery and adjuvant radiotherapy
- Smoking and other determinants of bone turnover
- Oxygen delivery, oxygen consumption and decreased kidney function after cardiopulmonary bypass
- School engagement of children in early grades: Psychometric, and gender comparisons
- Correction: A review of the elusive bicolored iris Snouted Treefrogs (Anura: Hylidae:Scinax uruguayus group)
- Perceived attractiveness of Czech faces across 10 cultures: Associations with sexual shape dimorphism, averageness, fluctuating asymmetry, and eye color
- Discovery of stable and prognostic CT-based radiomic features independent of contrast administration and dimensionality in oesophageal cancer
- Correction: Population-based dementia prediction model using Korean public health examination data: A cohort study
- Location, location, location: Close ties among older continuing care retirement community residents
- Correction: ISED: Constructing a high-resolution elevation road dataset from massive, low-quality in-situ observations derived from geosocial fitness tracking data
- Correction: Use of validated objective methods of locomotion characteristics and weight distribution for evaluating the efficacy of ketoprofen for alleviating pain in cows with limb pathologies
- Monitoring fine root growth to identify optimal fertilization timing in a forest plantation: A case study in Northeast Vietnam
- Metabolic costs of spontaneous swimming in Sprattus sprattus L., at different water temperatures
- Enterovirus 71 vaccine acceptance among parents of children < 5 years old and their knowledge of hand, foot and mouth disease, Chongqing, China, 2017
- Correction: Transcriptome profiling of mouse brain and lung under Dip2a regulation using RNA-sequencing
- Genetic diversity and antiretroviral resistance-associated mutation profile of treated and naive HIV-1 infected patients from the Northwest and Southwest regions of Cameroon
- Maximum parsimony interpretation of chromatin capture experiments
- Multiple innate antibacterial immune defense elements are correlated in diverse ungulate species
- Incidence and characteristics of ventricular tachycardia in patients after percutaneous coronary revascularization of chronic total occlusions
- Estimating measures of latent variables from m-alternative forced choice responses
- Clade F AAVHSCs cross the blood brain barrier and transduce the central nervous system in addition to peripheral tissues following intravenous administration in nonhuman primates
- First evidence of hepatitis E virus infection in a small mammal (yellow-necked mouse) from Croatia
- The inhibitory effects of polypyrrole on the biofilm formation of Streptococcus mutans
- Self-reported adverse drug effects and associated factors among H. pylori infected patients on standard triple therapy: Prospective follow up study
- Upregulation of ERK phosphorylation in rat dorsal root ganglion neurons contributes to oxaliplatin-induced chronic neuropathic pain
- Characterization of the relationship between neutron production and thermal load on a target material in an accelerator-based boron neutron capture therapy system employing a solid-state Li target
- Remote heart rate monitoring - Assessment of the Facereader rPPg by Noldus
- Seroprevalence of rubella virus antibodies among pregnant women in the Center and South-West regions of Cameroon
- Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study
- Relevance of HTLV-1 proviral load in asymptomatic and symptomatic patients living in endemic and non-endemic areas of Argentina
- Ritualized aggressive behavior reveals distinct social structures in native and introduced range tawny crazy ants
- The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
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