In 2010, the World Health Organization changed its guidance on malaria case management, recommending parasitological confirmation of all suspected cases before treatment with an antimalarial. This ...recommendation was in large part as a result of the availability of quality assured malaria rapid diagnostic tests (RDTs) that made it possible for malaria diagnosis to be performed by laboratory staff in all health facilities irrespective of the facility's place in the tiered health system. Community health workers and other non-laboratory health workers who traditionally did not perform malaria testing due to the technical and logistic demands of smear microscopy were now able to test for malaria. The use of RDTs has led to substantial increases in testing rates, improved quality of case management, as well as more accurate reporting of malaria cases. Although current RDTs have limitations, they remain one of the most important tools in contemporary malaria control. Further improvements to existing products, such as increased sensitivity for non-falciparum tests, diversification of Plasmodium falciparum antigen targets, along with strengthened health system support for current RDTs will further enhance their utility in malaria control and prevention.
IMPORTANCE Diagnostic tests are often ordered by physicians in patients with a low pretest probability of disease to rule out conditions and reassure the patient. OBJECTIVE To study the effect of ...diagnostic tests on worry about illness, anxiety, symptom persistence, and subsequent use of health care resources in patients with a low pretest probability of serious illness. EVIDENCE ACQUISITION Systematic review and meta-analysis. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases through December 31, 2011, for eligible randomized controlled trials. We independently identified studies for inclusion and extracted the data. Disagreements were resolved by discussion. We performed meta-analysis if heterogeneity was low or moderate (I2 < 50%). RESULTS Fourteen randomized controlled trials that included 3828 patients met the inclusion criteria and were analyzed with outcomes categorized as short term (≤3 months) or long term (>3 months). Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio, 0.87 95% CI, 0.55-1.39), and 2 showed no effect on nonspecific anxiety (standardized mean difference, 0.06 −0.16 to 0.28). Ten trials showed no overall long-term effect on symptom persistence (odds ratio, 0.99 95% CI, 0.85-1.15). Eleven trials measured subsequent primary care visits. We observed a high level of heterogeneity among trials (I2 = 80%). Meta-analysis after exclusion of outliers suggested a small reduction in visits after investigation (odds ratio, 0.77 95% CI, 0.62-0.96). CONCLUSIONS AND RELEVANCE Diagnostic tests for symptoms with a low risk of serious illness do little to reassure patients, decrease their anxiety, or resolve their symptoms, although the tests may reduce further primary care visits. Further research is needed to maximize reassurance from medically necessary tests and to develop safe strategies for managing patients without testing when an abnormal result is unlikely.
The hospitality literature is quite deficient in insights on consumer behaviour towards food waste generation and its mitigation in out-of-home dining. The present study addresses this gap by ...undertaking a mixed-method study to examining a broad spectrum of diners’ behaviour, beginning from planning the meal and ending with bringing the leftovers home. To this end, it utilises the Stimulus-Organism-Response theory to conceptualise the association of planning routine, food-ordering routine, motives, attitude, and behaviour of taking away leftovers and throwing away leftovers. The results of analysis of the data collected from 276 diners in the United States confirm a positive association of food-ordering and planning routines with motives, which, in turn, are positively associated with attitude and the behaviour of taking away leftovers. Finally, attitude is not only negatively associated with throwing away leftovers but also partially mediates the association of motives with throwing leftovers away. Our findings provide useful inputs for businesses and researchers to motivate green consumer behaviour.
•Examines leftover takeaway attitude and behaviour through the stimulus-organism-response (SOR) paradigm.•Food-ordering and planning routines act as stimuli positively associated with motives for taking away leftovers.•Motives associate positively with attitude towards and behaviour of taking away leftovers in doggy bags.•Attitude as a response negatively associates with throwing away leftovers brought home.•Attitude partially mediates the association of motives with throwing away leftovers brought home.
We use evidence from a disruption of clinical documentation routines to propose a novel, predictive mechanism for routine dynamics based on path coherence. Path coherence refers to the continuity of ...situational attributes from one event to the next along a path, for example, a set of activities conducted by the same person has high actor coherence. Situational attributes include classic descriptors such as who, what, when, where, and why. To be recognized as a path, a minimal level of coherence is required, but path coherence can vary along a path. For example, in a medical clinic, typical paths flow from place to place (e.g., reception, waiting room, exam room) and involve different clinical staff (e.g., receptionist, nurse, physician). Using latent factor network models, we compare clinical documentation routines in five outpatient clinics before and after a technological disruption (an upgrade to the electronic health record system). We show that coherent paths are up to 14 times more likely to persist and up to 40 times more likely to form than less coherent paths. We use these findings to theorize about the role of path coherence in routine dynamics. Path coherence in narrative networks is like homophily in social networks, but with a completely different underlying mechanism. We discuss the implications of our findings for organizational path dependence, resilience, and inertia. Funding: This research was supported by the National Science Foundation Grants SES-1734237 and BCS-2120530. This research was also supported in part by the University of Rochester CTSA Grant UL1 TR002001 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).
The current conceptualization of dynamic capabilities entails a paradox, one that hampers the achievement of one of the framework’s main missions: While studies on dynamic capabilities claim to offer ...explanations of continuous, routine-based organizational change, their prevalent conceptualization of organizational routines is rather undynamic and less prone to change. Thus, we propose to draw on an alternative, practice-based understanding of organizational routines to unravel the “dynamics” of dynamic capabilities. The practice perspective captures and explains the internal dynamics of organizational routines and positions the performance of organizational routines as a source of both organizational stability and change. This perspective offers to deepen our understanding of the dynamics within dynamic capabilities as driver of routine-based organizational change. To foster a research agenda that advances our understanding of dynamic capabilities from a practice perspective on organizational routines, we provide onto-epistemological, theoretical, and methodological implications of such a “dynamic view” of dynamic capabilities.
Zusammenfassung
Hintergrund und Ziele
Aufgrund der steigenden Hautkrebsinzidenz wurde in Deutschland im Jahr 2008 ein bundesweites gesetzliches Hautkrebsscreening (gHKS) eingeführt. Die vorliegende ...Studie zielt darauf ab, (1) zu analysieren, welche patientenseitigen Faktoren mit der Teilnahme am gHKS in Deutschland assoziiert sind und (2) die Gründe für die Nichtteilnahme zu untersuchen.
Patienten und Methodik
Teilnehmer und Nichtteilnehmer von gHKS (≥ 35 Jahre) wurden im Rahmen der Routineversorgung in neun dermatologischen Ambulanzen rekrutiert. Es wurden Gründe für die (Nicht‐)Teilnahme, Wissen über Hautkrebs sowie klinische und sozioökonomische Daten erhoben. Nach Gruppen stratifiziert, wurden deskriptive Analysen und binäre logistische Regressionsanalysen für Zusammenhänge mit der Teilnahme durchgeführt.
Ergebnisse
Von den 294 gHKS‐Teilnehmern und 162 Nichtteilnehmern waren 46,5% männlich mit einem Durchschnittsalter von 54,5 ± 12,7 Jahren. Insgesamt hatten 87,1% der Teilnehmer in ihrer Kindheit einen Sonnenbrand und 47,1% hatten bereits Sonnenbanken benutzt. Höheres Alter, weibliches Geschlecht, frühere Nutzung von Sonnenbanken sowie die Sorge um und das Wissen über Hautkrebs standen in signifikantem Zusammenhang mit einer bisherigen Teilnahme an gHKS. Von den Nichtteilnehmern wussten 46% nichts von der Möglichkeit eines kostenlosen gHKS, und 40% begründeten ihre Nichtteilnahme mit dem Gefühl gesund zu sein.
Schlussfolgerungen
Die Gründe für die Nichtteilnahme an gHKS wie soziodemografische Merkmale und Risikoverhalten sollten bekannt sein, damit gHKS‐Programme optimiert werden können.
Isoprostanes are considered as being "gold standard" markers of lipid peroxidation although large differences have been observed in normal plasma reference values.
After blood collection on EDTA, ...plasma samples were purified through an original solid-liquid extraction protocol. After evaporation to dryness and reconstitution, samples were directly injected into an UHPLC/MS-MS system for 15-F2t-isoprostane analysis.
A population of 61 subjects aged between 18 and 60 years (29 men and 32 women) was selected in our study *. The mean value in plasma 15-F2t-isoprostane obtained was 260pg / mL with a standard deviation of 55pg / mL (minimum and maximum values of 294.7 and 403.3pg / mL). The normal distribution observed gave a reference interval between 151.96 and 368.16pg/mL. This observation was confirmed by the Shapiro-Wilk test result (p=0.1125). Interestingly, we have observed a moderate but significant positive correlation with the copper/zinc ratio (r=0.34; p=0.01) and a moderate but significant negative correlation with total glutathione (r=- 0.28; p=0.34), both markers being considered as reflecting the presence of in vivo oxidative stress.
Our study has allowed to measure plasma 15-F2t-isoprostane in a routine way.
Hospitals worldwide are facing an increasing incidence of hard-to-treat infections. Limiting infections and providing patients with optimal drug regimens require timely strain identification as well ...as virulence and drug-resistance profiling. Additionally, prophylactic interventions based on the identification of environmental sources of recurrent infections (e.g., contaminated sinks) and reconstruction of transmission chains (i.e., who infected whom) could help to reduce the incidence of nosocomial infections. WGS could hold the key to solving these issues. However, uptake in the clinic has been slow. Some major scientific and logistical challenges need to be solved before WGS fulfils its potential in clinical microbial diagnostics. In this review we identify major bottlenecks that need to be resolved for WGS to routinely inform clinical intervention and discuss possible solutions.
In principle, WGS can provide highly relevant information for clinical microbiology in near-real-time, from phenotype testing to tracking outbreaks.
However, despite this promise, the uptake of WGS in the clinic has been limited to date, and future implementation is likely to be a slow process.
The increasing information provided by WGS can cause conflict with traditional microbiological concepts and typing schemes.
Decreasing raw sequencing costs have not translated into decreasing total costs for bacterial genomes, which have stabilised.
Existing research pipelines are not suitable for the clinic, and bespoke clinical pipelines should be developed.
Recent advancements in next-generation sequencing (NGS) have provided the foundation for modern studies into the composition of microbial communities. The use of these NGS methods allows for the ...detection and identification of (‘difficult-to-culture’) microorganisms using a culture-independent strategy. In the field of routine clinical diagnostics however, the application of NGS is currently limited to microbial strain typing for epidemiological purposes only, even though the implementation of NGS for microbial community analysis may yield clinically important information. This lack of NGS implementation is due to many different factors, including issues relating to NGS method standardization and result reproducibility. In this review article, the authors provide a general introduction to the most widely used NGS methods currently available (i.e., targeted amplicon sequencing and shotgun metagenomics) and the strengths and weaknesses of each method is discussed. The focus of the publication then shifts toward 16S rRNA gene NGS methods, which are currently the most cost-effective and widely used NGS methods for research purposes, and are therefore more likely to be successfully implemented into routine clinical diagnostics in the short term. In this respect, the experimental pitfalls and biases created at each step of the 16S rRNA gene NGS workflow are explained, as well as their potential solutions. Finally, a novel diagnostic microbiota profiling platform (‘MYcrobiota’) is introduced, which was developed by the authors by taking into consideration the pitfalls, biases, and solutions explained in this article. The development of the MYcrobiota, and future NGS methodologies, will help pave the way toward the successful implementation of NGS methodologies into routine clinical diagnostics.
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