Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.

Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Bodily Ontology of the Soul and Health Reform: Adventist Turn In Christian Anthropology

Prodorom platonske antropologije, kršćanstvom još od 2. stoljeća počinje dominirati dualizam, nepomućen ponešto holističkijim tomizmom, a dodatno osnažen kartezijanizmom koji je kršćansku teologiju i dušu odgurnuo još dalje od tijela. Tek se šezdesetih godina 20. stoljeća teolozi počinju osvješćivati o daleko pozitivnijem i inkluzivnijem stavu Biblije prema tijelu. No, stoljeće prije toga, adventistički se pokret rađa u kondicionalizmu kakvog je iznio Hobbes u Levijatanu (XLIV). Čovjek nema dušu, on jest »živa duša« – tijelo oživljeno »dahom života« (Post 2,7). Bez tijela nema života, pa tako ni vječnog pakla. Ovome adventisti pridružuju i filozofiju zdravstvene reforme u kojoj njega tijela ima ključnu ulogu i o čemu ovisi intelektualni i duhovni napredak čovjeka, te na tom temelju grade obilnu zdravstvenu i obrazovnu praksu. Ova fizikalistička inačica kršćanske antropologije jedinstven je svjetonazorski doprinos filozofiji tijela i tema vrijedna akademske pažnje.Following the spread of Platonic anthropology, Christianity has started, already since the 2nd century A.D., to be dominated by dualism – a trend undisturbed by somewhat more holistic Thomism, and further strengthened by Cartesianism, which distanced Christian theology and soul even further away from the body. During the 1960s, theologians have become aware of the far more positive and inclusive attitude that the Bible has towards the body. Yet, a century before, the Adventist movement was born in conditionalism such as presented by Hobbes in Leviathan (XLIV). Man does not have a soul; he is a “living soul” – a body vivified by the “breath of life” (Gen 2:7). Without the body, there is no life, nor, consequentially, eternal hell. To this Adventists have also conjoined a philosophy of health reform in which the care of the body has a key role, and upon which depends man’s intellectual and spiritual wellbeing. On this foundation, they have built a rich healthcare and educational practice. This physicalist version of Christian anthropology is a unique worldview contribution to philosophy of the body and a subject worthy of academic attention

Religious revelation, secrecy and the limits of visual representation

This article seeks to contribute to a more adequate understanding of the adoption of modern audiovisual mass media by contemporary religious groups. It does so by examining Pentecostal-charismatic churches as well as the Christian mass culture instigated by its popularity, and so-called traditional religion in Ghana, which develop markedly different attitudes towards audiovisual mass media and assume different positions in the public sphere. Taking into account the complicated entanglement of traditional religion and Pentecostalism, approaching both religions from a perspective of mediation which regards media as intrinsic to religion, and seeking to avoid the pitfall of overestimating the power of modern mass media to determine the world, this article seeks to move beyond an unproductive recurrence to oppositions such as tradition and modernity, or religion and technology. It is argued that instead of taking as a point of departure more or less set ideas about the nexus of vision and modernity, the adoption of new mass media by religious groups needs to be analyzed by a detailed ethnographic investigation of how these new media transform existing practices of religious mediation. Special emphasis is placed on the tension between the possibilities of gaining public presence through new media, and the difficulty in authorizing these media, and the experiences they induce, as authentic. Copyright © 2006 SAGE Publications

Does type of hospital ownership influence physicians' daily work schedules? An observational real-time study in German hospital departments

Background: During the last two decades the German hospital sector has been engaged in a constant process of transformation. One obvious sign of this is the growing amount of hospital privatization. To date, most research studies have focused on the effects of privatization regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Yet little attention has been devoted to the effects of privatization on physicians' working routines. The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. By analysing working hours, further impacts of hospital privatization can be assessed and areas of improvement identified. Methods: Observations were made by shadowing 100 physicians working in private, for-profit or non-profit as well as public hospital departments individually during whole weekday shifts in urban German settings. A total of 300 days of observations were conducted. All working activities were recorded, accurate to the second, by using a mobile personal computer. Results: Results have shown significant differences in physicians' working activities, depending on hospital ownership, concerning working hours and time spent on direct and indirect patient care. Conclusion: This is the first real-time analysis on differences in work activities depending on hospital ownership. The study provides an objective insight into physicians' daily work routines at hospitals of different ownership, with additional information on effects of hospital privatization

The Role of Human Movement in the Transmission of Vector-Borne Pathogens

Vector-borne diseases constitute a largely neglected and enormous burden on public health in many resource-challenged environments, demanding efficient control strategies that could be developed through improved understanding of pathogen transmission. Human movement—which determines exposure to vectors—is a key behavioral component of vector-borne disease epidemiology that is poorly understood. We develop a conceptual framework to organize past studies by the scale of movement and then examine movements at fine-scale—i.e., people going through their regular, daily routine—that determine exposure to insect vectors for their role in the dynamics of pathogen transmission. We develop a model to quantify risk of vector contact across locations people visit, with emphasis on mosquito-borne dengue virus in the Amazonian city of Iquitos, Peru. An example scenario illustrates how movement generates variation in exposure risk across individuals, how transmission rates within sites can be increased, and that risk within sites is not solely determined by vector density, as is commonly assumed. Our analysis illustrates the importance of human movement for pathogen transmission, yet little is known—especially for populations most at risk to vector-borne diseases (e.g., dengue, leishmaniasis, etc.). We outline several important considerations for designing epidemiological studies to encourage investigation of individual human movement, based on experience studying dengue

The spotted gar genome illuminates vertebrate evolution and facilitates human-teleost comparisons

To connect human biology to fish biomedical models, we sequenced the genome of spotted gar (Lepisosteus oculatus), whose lineage diverged from teleosts before teleost genome duplication (TGD). The slowly evolving gar genome has conserved in content and size many entire chromosomes from bony vertebrate ancestors. Gar bridges teleosts to tetrapods by illuminating the evolution of immunity, mineralization and development (mediated, for example, by Hox, ParaHox and microRNA genes). Numerous conserved noncoding elements (CNEs; often cis regulatory) undetectable in direct human-teleost comparisons become apparent using gar: functional studies uncovered conserved roles for such cryptic CNEs, facilitating annotation of sequences identified in human genome-wide association studies. Transcriptomic analyses showed that the sums of expression domains and expression levels for duplicated teleost genes often approximate the patterns and levels of expression for gar genes, consistent with subfunctionalization. The gar genome provides a resource for understanding evolution after genome duplication, the origin of vertebrate genomes and the function of human regulatory sequences

Data-analysis strategies for image-based cell profiling

Image-based cell profiling is a high-throughput strategy for the quantification of phenotypic differences among a variety of cell populations. It paves the way to studying biological systems on a large scale by using chemical and genetic perturbations. The general workflow for this technology involves image acquisition with high-throughput microscopy systems and subsequent image processing and analysis. Here, we introduce the steps required to create high-quality image-based (i.e., morphological) profiles from a collection of microscopy images. We recommend techniques that have proven useful in each stage of the data analysis process, on the basis of the experience of 20 laboratories worldwide that are refining their image-based cell-profiling methodologies in pursuit of biological discovery. The recommended techniques cover alternatives that may suit various biological goals, experimental designs, and laboratories' preferences.Peer reviewe