Over-diagnosis of malaria is not a lost cause.

BACKGROUND: Recent studies have highlighted the over-diagnosis of malaria in clinical settings in Africa. This study assessed the impact of a training programme implemented as part of an intervention trial on diagnostic behaviour of clinicians in a rural district hospital in a low-moderate malaria transmission setting. METHODS: From the beginning of 2005, a randomized controlled trial (RCT) of intermittent preventive treatment for malaria in infants (IPTi) has been conducted at the study hospital. As part of the RCT, the study team offered laboratory quality assurance, and supervision and training of paediatric ward staff using information on malaria epidemiology in the community. Data on clinical and blood slide confirmed cases of malaria from 2001 to 2005 were extracted from the hospital records. RESULTS: The proportion of blood slides positive for malaria parasites had decreased from 21% in 2001 to 7% in 2005 (p < .01). The proportion of outpatient and inpatient cases diagnosed as malaria ranged between 34% and 28% from 2001 to 2004 and this decreased substantially to 17% after the introduction of the package of training and support in 2005 (p < .01). There was no clear trend in the ratio of blood slide examined versus total diagnosis of malaria. CONCLUSION: It may be possible to change the diagnostic behaviour of clinicians by rigorous training using local malaria epidemiology data and supportive supervision

Toward a Spectrum of Moral Harm: A New Paradigm

Moral harm is the pain, anguish, or trauma experienced as a result of violations to one’s value system. Researchers have analyzed the experience of moral harm through the lenses of moral injury among military personnel, and moral distress among helping professionals. Although both fields of research share similar frames of reference, the current project is the first known work to conceptualize moral injury and moral distress within the same theoretical model. The authors posit that moral injury and moral distress are experiences along a spectrum; both struggle and recovery can be understood within this context. Implications for ethical practice and future research are discussed

Gordon McKelvie, Bastard Feudalism, English Society and the Law: the Statutes of Livery, 1390-1520, Boydell & Brewer, Woodbridge 2020., 261 str.

Prikaz knjige

Church, State, and Reformation: the use and interpretation of praemunire from its creation to the English break with Rome

This thesis examines the use and interpretation of praemunire from its fourteenth-century creation to the English break with Rome. Although much has been written on praemunire in the Tudor period, when Henry VIII and Thomas Wolsey used the offence to intimidate their rivals in the years preceding the break with Rome, little work has been done on the offence in the century-and-a-half before this date. The central point of this thesis is to connect the creation of the offence of praemunire in the fourteenth century to this sixteenth-century use, to see how it changed from an offence designed to protect both the ecclesiastical and temporal spheres in England from an encroaching papacy, to one that could bring low the mightiest of England’s churchmen. As this thesis deals primarily with how the offence changed over time, the chapters follow a broadly chronological structure. Chapters one to three look at the fourteenth-century creation of the writ of praemunire facias, the Statutes of Praemunire, and the offence of praemunire that they created. Chapters four and five look at the spiritual responses to the offence in the fifteenth century. Chapter four looks at the papal reactions to praemunire and the ostensibly similar provisors legislation. Chapter five looks at the contemporary records of convocation to measure English ecclesiastical opinion of praemunire in the fifteenth century. Chapter six look at the legal interpretation of the offence, from the deposition of Richard II to the accession of Henry VII, to see how the offence was confirmed as one that could be used against the English ecclesiastical courts. Finally, chapters seven and eight examine the use of praemunire in the Tudor period, and reassess the high-profile events in the sixteenth century based on this new understanding of praemunire

3D printing the future: scenarios for supply chains reviewed

Purpose: The aim of this paper is to evaluate existing scenarios for 3D Printing in order to identify the “white space” where future opportunities have not been proposed or developed to date. Based around aspects of order penetration points, geographical scope and type of manufacturing, these gaps are identified. Design/methodology/approach: A structured literature review has been carried out on both academic and trade publications. As of the end of May 2016, this identified 128 relevant articles containing 201 future scenarios. Coding these against aspects of existing manufacturing and supply chain theory has led to the development of a framework for identify “white space” in existing thinking. Findings: The coding shows that existing future scenarios are particularly concentrated on job shop applications and pull based supply chain processes, although there are fewer constraints on geographical scope. Five distinct areas of “white space” are proposed, reflecting various opportunities for future 3DP supply chain development. Research limitations: Being a structured literature review, there are potentially articles not identified through the search criteria used. The nature of the findings is also dependent upon the coding criteria selected. However, these are theoretically derived and reflect important aspect of strategic supply chain management. Practical implications: Practitioners may wish to explore the development of business models within the “white space” areas. Originality/value: Currently, existing future 3DP scenarios are scattered over a wide, multi-disciplinary literature base. By providing a consolidated view of these scenarios, it is possible to identify gaps in current thinking. These gaps are multidisciplinary in nature and represent opportunities for both academics and practitioners to exploit

Properties of High-Latitude CME-Driven Disturbances During Ulysses Second Northern Polar Passage

Ulysses observed five coronal mass ejections (CMEs) and their associated disturbances while the spacecraft was immersed in the polar coronal hole (CH) flow above 70° N in late 2001. Of these CMEs, two were very fast (\u3e850 km s−1) driving strong shocks in the wind ahead, and two others were over-expanding. The two fast CMEs were observed leaving the Sun by LASCO/SOHO, and were observed in the ecliptic by Genesis and ACE. These were large events, spanning at least from the northern heliospheric pole to the ecliptic. One-dimensional hydrodynamic simulations indicate that these could be described as overpressured CMEs launched from the Sun at speeds initially faster than ambient, but then decelerating to the ambient solar wind speed as they propagated outward. The two over-expanding CMEs mark their first occurrence since Ulysses’ first orbit when such CMEs were only observed in polar CH flow

Is Housing Quality Associated with Malaria Incidence among Young Children and Mosquito Vector Numbers? Evidence from Korogwe, Tanzania

Background Several studies conducted in Northeast Tanzania have documented declines in malaria transmission even before interventions were scaled up. One explanation for these reductions may be the changes in socio-environmental conditions associated with economic development, and in particular improvements in housing construction. Objective This analysis seeks to identify (1) risk factors for malaria incidence among young children and (2) household and environmental factors associated with mosquito vector numbers collected in the child’s sleeping area. Both analyses focus on housing construction quality as a key determinant. Methodology For 435 children enrolled in a larger trial of intermittent preventive treatment for malaria in infants in the Korogwe District in Tanga, Northeastern Tanzania, detailed information on their dwelling characteristics were collected in the last year of the trial. Principal components analysis was used to construct an index of housing structure quality and converted to quintile units for regression analysis. Univariate and multivariate random effects negative binomial regressions were used to predict risk factors for child malaria incidence and the mean total number of indoor female Anopheles gambiae and funestus mosquitoes collected per household across three occasions. Findings Building materials have substantially improved in Korogwe over time. Multivariate regressions showed that residing in rural areas (versus urban) increased malaria incidence rates by over three-fold and mean indoor female A. gambiae and funestus numbers by nearly two-fold. Compared to those residing in the lowest quality houses, children residing in the highest quality houses had one-third lower malaria incidence rates, even when wealth and rural residence were controlled for. Living in the highest quality houses reduced vector numbers while having cattle near the house significantly increased them. Conclusions Results corroborate findings from other studies that show associations between malaria incidence and housing quality; associations were concentrated amongst the highest quality houses

The independent effect of living in malaria hotspots on future malaria infection: an observational study from Misungwi, Tanzania.

BACKGROUND: As malaria transmission declines, continued improvements of prevention and control interventions will increasingly rely on accurate knowledge of risk factors and an ability to define high-risk areas and populations at risk for focal targeting of interventions. This paper explores the independent association between living in a hotspot and prospective risk of malaria infection. METHODS: Malaria infection status defined by nPCR and AMA-1 status in year 1 were used to define geographic hotspots using two geospatial statistical methods (SaTScan and Kernel density smoothing). Other malaria risk factors for malaria infection were explored by fitting a multivariable model. RESULTS: This study demonstrated that residing in infection hotspot of malaria transmission is an independent predictor of malaria infection in the future. CONCLUSION: It is likely that targeting such hotspots with better coverage and improved malaria control strategies will result in more cost-efficient uses of resources to move towards malaria elimination

Cost Implications of Improving Malaria Diagnosis: Findings from North-Eastern Tanzania

BACKGROUND: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a or=5 year age group in the lower transmission site (RR 14.0 95%CI 8.2-24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001). A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001). Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system. IMPLICATIONS: The introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start