Got Milk? The Impact of Heifer International\u27s Livestock Donation Programs in Rwanda on Nutritional Outcomes

International animal donation programs have become an increasingly popular way for people living in developed countries to transfer resources to families living in developing countries. We evaluate the impact of Heifer International’s dairy cow and meat goat donation programs in Rwanda. We find that the program substantially increases dairy and meat consumption among Rwandan households who were given a dairy cow or a meat goat, respectively. We also find marginally statistically significant reductions in weight-for-height z-scores and weight-for-age z-scores of about 0.4 standard deviations among children aged 0-5 years in households that were recipients of meat goats, and reductions in heightfor- age z-scores of about 0.5 standard deviations among children in households that received dairy cows. Our results suggest that increasing livestock ownership in developing countries may significantly increase consumption of nutrient dense animal-source foods and improve nutrition outcomes

Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults, irrespective of signs or symptoms

Background Tuberculosis is a leading cause of infectious disease‐related death and is one of the top 10 causes of death worldwide. The World Health Organization (WHO) recommends the use of specific rapid molecular tests, including Xpert MTB/RIF or Xpert Ultra, as initial diagnostic tests for the detection of tuberculosis and rifampicin resistance in people with signs and symptoms of tuberculosis. However, the WHO estimates that nearly one‐third of all active tuberculosis cases go undiagnosed and unreported. We were interested in whether a single test, Xpert MTB/RIF or Xpert Ultra, could be useful as a screening test to close this diagnostic gap and improve tuberculosis case detection. Objectives To estimate the accuracy of Xpert MTB/RIF and Xpert Ultra for screening for pulmonary tuberculosis in adults, irrespective of signs or symptoms of pulmonary tuberculosis in high‐risk groups and in the general population. Screening "irrespective of signs or symptoms" refers to screening of people who have not been assessed for the presence of tuberculosis symptoms (e.g. cough). To estimate the accuracy of Xpert MTB/RIF and Xpert Ultra for detecting rifampicin resistance in adults screened for tuberculosis, irrespective of signs and symptoms of pulmonary tuberculosis in high‐risk groups and in the general population. Search methods We searched 12 databases including the Cochrane Infectious Diseases Group Specialized Register, MEDLINE and Embase, on 19 March 2020 without language restrictions. We also reviewed reference lists of included articles and related Cochrane Reviews, and contacted researchers in the field to identify additional studies. Selection criteria Cross‐sectional and cohort studies in which adults (15 years and older) in high‐risk groups (e.g. people living with HIV, household contacts of people with tuberculosis) or in the general population were screened for pulmonary tuberculosis using Xpert MTB/RIF or Xpert Ultra. For tuberculosis detection, the reference standard was culture. For rifampicin resistance detection, the reference standards were culture‐based drug susceptibility testing and line probe assays. Data collection and analysis Two review authors independently extracted data using a standardized form and assessed risk of bias and applicability using QUADAS‐2. We used a bivariate random‐effects model to estimate pooled sensitivity and specificity with 95% credible intervals (CrIs) separately for tuberculosis detection and rifampicin resistance detection. We estimated all models using a Bayesian approach. For tuberculosis detection, we first estimated screening accuracy in distinct high‐risk groups, including people living with HIV, household contacts, people residing in prisons, and miners, and then in several high‐risk groups combined. Main results We included a total of 21 studies: 18 studies (13,114 participants) evaluated Xpert MTB/RIF as a screening test for pulmonary tuberculosis and one study (571 participants) evaluated both Xpert MTB/RIF and Xpert Ultra. Three studies (159 participants) evaluated Xpert MTB/RIF for rifampicin resistance. Fifteen studies (75%) were conducted in high tuberculosis burden and 16 (80%) in high TB/HIV‐burden countries. We judged most studies to have low risk of bias in all four QUADAS‐2 domains and low concern for applicability. Xpert MTB/RIF and Xpert Ultra as screening tests for pulmonary tuberculosis In people living with HIV (12 studies), Xpert MTB/RIF pooled sensitivity and specificity (95% CrI) were 61.8% (53.6 to 69.9) (602 participants; moderate‐certainty evidence) and 98.8% (98.0 to 99.4) (4173 participants; high‐certainty evidence). Of 1000 people where 50 have tuberculosis on culture, 40 would be Xpert MTB/RIF‐positive; of these, 9 (22%) would not have tuberculosis (false‐positives); and 960 would be Xpert MTB/RIF‐negative; of these, 19 (2%) would have tuberculosis (false‐negatives). In people living with HIV (1 study), Xpert Ultra sensitivity and specificity (95% CI) were 69% (57 to 80) (68 participants; very low‐certainty evidence) and 98% (97 to 99) (503 participants; moderate‐certainty evidence). Of 1000 people where 50 have tuberculosis on culture, 53 would be Xpert Ultra‐positive; of these, 19 (36%) would not have tuberculosis (false‐positives); and 947 would be Xpert Ultra‐negative; of these, 16 (2%) would have tuberculosis (false‐negatives). In non‐hospitalized people in high‐risk groups (5 studies), Xpert MTB/RIF pooled sensitivity and specificity were 69.4% (47.7 to 86.2) (337 participants, low‐certainty evidence) and 98.8% (97.2 to 99.5) (8619 participants, moderate‐certainty evidence). Of 1000 people where 10 have tuberculosis on culture, 19 would be Xpert MTB/RIF‐positive; of these, 12 (63%) would not have tuberculosis (false‐positives); and 981 would be Xpert MTB/RIF‐negative; of these, 3 (0%) would have tuberculosis (false‐negatives). We did not identify any studies using Xpert MTB/RIF or Xpert Ultra for screening in the general population. Xpert MTB/RIF as a screening test for rifampicin resistance Xpert MTB/RIF sensitivity was 81% and 100% (2 studies, 20 participants; very low‐certainty evidence), and specificity was 94% to 100%, (3 studies, 139 participants; moderate‐certainty evidence). Authors' conclusions Of the high‐risks groups evaluated, Xpert MTB/RIF applied as a screening test was accurate for tuberculosis in high tuberculosis burden settings. Sensitivity and specificity were similar in people living with HIV and non‐hospitalized people in high‐risk groups. In people living with HIV, Xpert Ultra sensitivity was slightly higher than that of Xpert MTB/RIF and specificity similar. As there was only one study of Xpert Ultra in this analysis, results should be interpreted with caution. There were no studies that evaluated the tests in people with diabetes mellitus and other groups considered at high‐risk for tuberculosis, or in the general population

The Use of Social Media as a Marketing Tool in Business Activities

V moderním světě se sociální sítě staly klíčovým nástrojem prodeje a marketingu, přičemž mají obrovský vliv na rozvoj podnikání jakékoli velikosti. Ať už jde o malý startup nebo velkou korporaci, sociální platformy nabízejí jedinečné možnosti pro získávání zákazníků, budování značky a zvyšování zisků. Tato bakalářská práce se zaměřuje na zkoumání dvou klíčových platforem sociálních sítí, jako jsou Instagram a TikTok, které hrají významnou roli v moderním digitálním marketingu a komunikaci. Hlavním cílem této práce je prozkoumání klíčových principů fungování těchto platforem a různých možností propagace. Dalším cílem je také vytvoření strategie, která pomůže firmám efektivně propagovat jejich produkty a služby prostřednictvím populární sociální platformy Instagram. Autor se bude zabývat různými typy propagace na Instagram, například vlivem videoobsahu na zapojení publika, vlivem frekvence příspěvků na růst počtu sledujících a mnoha dalšími faktory. V praktické části práce bude proveden sběr a analýza dat s cílem zjistit, jak uživatelé využívají Instagram k vyhledávání produktů a služeb. Hlavní pozornost bude věnována identifikaci faktorů, které přitahují pozornost publika k profilům značek, a analýze jejich preferencí a chování. Kromě toho budou uspořádány otevřené rozhovory s odborníky v oblasti internetového marketingu, kteří se specializují na propagaci na Instagram. Všechna získaná data budou systematizována a shrnuta, což umožní vytvořit a navrhnout nejefektivnější strategii propagace pro podnikání na této platformě.In the modern world, social media has become a key tool for sales and marketing, exerting a significant influence on the development of businesses of all sizes. Whether it is a small startup or a large corporation, social platforms offer unique opportunities for customer acquisition, brand building, and profit growth.This bachelor's thesis focuses on examining two key social media platforms, Instagram and TikTok, which play a significant role in modern digital marketing and communication. The primary objective of this work is to explore the core principles of how these platforms function and the various promotional opportunities they offer.Another goal is to develop a strategy that will help businesses effectively promote their products and services through the popular social platform Instagram. The author will investigate various types of promotions on Instagram, such as the impact of video content on audience engagement, the effect of posting frequency on follower growth, and many other factors. In the practical part of the thesis, data collection and analysis will be conducted to determine how users utilize Instagram to search for products and services. The main focus will be on identifying the factors that draw audience attention to brand profiles and analyzing their preferences and behavior. Additionally, open interviews with internet marketing experts specializing in Instagram promotion will be organized. All collected data will be systematized and summarized, enabling the creation and design of the most effective promotional strategy for businesses on this platform

Nurse's Cooperation with a Patient in the Resuscitation and Intensive Care Units

Relevance of the topic: Resuscitation and Intensive Care Unit always provides care and nursing services to patients with higher needs. In this study we try to find out what problems nurses face and how to solve them when dealing with patients of different conditions. Aim of the study: To evaluate the communication between nurses working at the Resuscitation and Intensive Care Unit. Research objectives: To define the concept and types of the communication. Describe the aspects of nurse’s communication with conscious and unconscious patients in the Resuscitation and Intensive Care Unit. Identify the most important verbal and non-verbal expressions of nurses working in a Resuscitation and Intensive Care Unit. Identify the peculiarities of communicating with conscious and unconscious patients in the Resuscitation and Intensive Care Unit. Research methods: Quantitative research using an anonymous questionnaire was selected. The survey included 25 nurses working at Vilnius university hospital Santaros klinikos Resuscitation and Intensive Care Unit. During the survey, the reversibility of questionnaires was 100%. The MS Office Excel 2013 computer program was used to analyze the research data. Results: For most nurses are important communication skills, however almost one third of nurses responded that their special skills are important as well. The most common factors that make communication difficult is the patient's lack of consciousness. Most nurses face difficulties in communication with aggressive, psychomotor-agitated patients. A quarter of the nurses' has a communication problem when it is not creating conditions for the patient to ask the question, more than a tenth of the nurses have identified such a communication gap – the ability to respond properly and the patient's language interruption. For communication with speech impaired – conscious intubated and tracheostomy patients, in many cases nurses used supportive measures. For communication with the visually impaired, all nurses' information is provided orally and by touch. When dealing with patients with hearing impairments, almost all nurses often use articulation, less often communicate with sign language / body language. When communicating with a dying patient, most nurses are psychologically supportive, endeavor to listen, calm down, and remain in silence. When communicating with unconscious patients, most nurses use non-verbal communication – name and conversation. Conclusions: In order to communicate effectively in the nursing process, it is important to establish a proper relationship between the nurse and the patient; communication is determined by the choice of verbal and non-verbal communication.Literatūriškai aprašoma bendravimo samprata ir rūšys, bendravimas su sąmoningais ir nesąmoningais pacientais. Tyrimo metu siekiama nustatyti su kokiomis problemomis ir jų sprendimo būdais susiduria slaugytojos bendraudamos su įvairių būklių pacientais

Mycobacterium tuberculosis Pyrazinamide Resistance Determinants: a Multicenter Study

Pyrazinamide (PZA) is a prodrug that is converted to pyrazinoic acid by the enzyme pyrazinamidase, encoded by the pncA gene in Mycobacterium tuberculosis. Molecular identification of mutations in pncA offers the potential for rapid detection of pyrazinamide resistance (PZA(r)). However, the genetic variants are highly variable and scattered over the full length of pncA, complicating the development of a molecular test. We performed a large multicenter study assessing pncA sequence variations in 1,950 clinical isolates, including 1,142 multidrug-resistant (MDR) strains and 483 fully susceptible strains. The results of pncA sequencing were correlated with phenotype, enzymatic activity, and structural and phylogenetic data. We identified 280 genetic variants which were divided into four classes: (i) very high confidence resistance mutations that were found only in PZA(r) strains (85%), (ii) high-confidence resistance mutations found in more than 70% of PZA(r) strains, (iii) mutations with an unclear role found in less than 70% of PZA(r) strains, and (iv) mutations not associated with phenotypic resistance (10%). Any future molecular diagnostic assay should be able to target and identify at least the very high and high-confidence genetic variant markers of PZA(r); the diagnostic accuracy of such an assay would be in the range of 89.5 to 98.8%

The Value of Action Planning

Job search is a largely self-regulated process, subject to behavioralbiases that lead to sub-optimal search and employment outcomes.Within this context, we designed, implemented and tested anaction-planning tool to promote greater job search intensity.We find that action planning helps unemployed youths to follow through on their job search intentions, and adopt a more efficient and effective search strategy. Greater search efficiency and effectiveness translates to sizeable improvements in employment outcomes. Given that a rising number of young people globally are not enrolled in education, employed, or searching for work it is particularly important to understand how to optimize the job search process. There is suggestive evidence that in the presence of high and persistent unemployment, South African youth are becoming increasingly discouraged in their job search

The Power of a Reference Letter

The labor market is characterized by information gaps between work seekers and prospective employers, particularly when it comes to hiring low-skill entry level workers. Information asymmetries about workers’ skills can result in poorer matches, lower productivity for employers, and increased inequity for the unemployed. One approach to resolving the asymmetry is introducing a formal referral system: reference letters from former employers. The authors finds that reference letters improve firms’ screening ability and employment outcomes, especially for women. Despite their high value, the use of reference letters in job applications is low, partly due to work seekers underestimating their value

Harnessing the Carniolan honey bee breed in maximizing productivity

Climate warming has been observed everywhere in recent years, including the Kaluga region. This makes it possible to use more heat-loving, intensively developing bee breeds for the production of beekeeping products. The aim of the research is to evaluate the possibility of using Carniolan bees in apiaries for the production of commercial honey. The material of the research were 4-frame honeycomb packages of bees purchased in the Republic of Uzbekistan. Bee families were placed in 12-frame hives designed for a standard nest frame of 300 mm high and 435 mm wide. Bee family development was monitored weekly by counting the number of frames fully occupied by insects. Honey production was estimated by weighing the honey produced by each family. During the development, the bee families were divided into three groups according to the age of the mothers or their turnover. At the beginning of the main honey collection, the average number of bee families in the three groups was 11.8±1.41 frames, and at the end of the season it was 9.8±1.86 frames. From I group of bee families, which did not show tendency to swarming, 25.1±8.63 kg of honey was obtained; from II group of bee families, which replaced mothers by spontaneous change, without swarming – 15.7±7.13 kg, from III group, into which bee families were divided, taking into account productivity of formed broods - 4,4±6,16 kg. Honey collection per each family of bees at the beginning of the period averaged 15.4±12.44 kg. The increase in the number of bee families during the season, taking into account the formation of brood and culling, amounted to 10%. The results of the research allow to recommend the use of the Carniolan breed of bees in the apiaries of Kaluga region