A systematic review and meta-analysis of diagnostic delay in pulmonary embolism

BACKGROUND: Diagnostic delay in patients with pulmonary embolism (PE) is typical, yet the proportion of patients with PE that experienced delay and for how many days is less well described, nor are determinants for such delay. OBJECTIVES: This study aimed to assess the prevalence and extent of delay in diagnosing PE. METHODS: A systematic literature search was performed to identify articles reporting delays in diagnosing PE. The primary outcome was mean delay (in days) or a percentage of patients with diagnostic delay (defined as PE diagnosis more than seven days after symptom onset). The secondary outcome was determinants of delay. Random-effect meta-analyses were applied to calculate a pooled estimate for mean delay and to explore heterogeneity in subgroups. RESULTS: The literature search yielded 10,933 studies, of which 24 were included in the final analysis. The pooled estimate of the mean diagnostic delay based on 12 studies was 6.3 days (95% prediction interval 2.5 to 15.8). The percentage of patients having more than seven days of delay varied between 18% and 38%. All studies assessing the determinants of coughing ( n  = 3), chronic lung disease ( n  = 6) and heart failure ( n  = 8) found a positive association with diagnostic delay. Similarly, all studies assessing recent surgery ( n  = 7) and hypotension ( n  = 6), as well as most studies assessing chest pain ( n  = 8), found a negative association with diagnostic delay of PE. CONCLUSION: Patients may have symptoms for almost one week before PE is diagnosed and in about a quarter of patients, the diagnostic delay is even longer

Organizational sensegiving: Indicators and nonprofit signaling

Resource acquisition depends upon the agreement between an organization's sense of identity and the perceptions of organizational identity held by resource providers. To smooth the flow of resources and buffer against potential issues, organizations seek to manage external perceptions and, to the extent possible, control their organizational identity. Using exploratory factor analysis, we examine the data from 300 GuideStar profiles to develop a sense of how nonprofit organizations “give sense” to resource providers and attempt to manage their organizational identity. We find evidence of three sensegiving strategies. We then use a seemingly unrelated regression model to examine the relationship between these strategies and revenue outcomes, finding evidence that (a) nonprofit organizations demonstrate intentional sensegiving, and (b) different sensegiving approaches are related to different income streams

Confidentiality and public protection: ethical dilemmas in qualitative research with adult male sex offenders

This paper considers the ethical tensions present when engaging in in-depth interviews with convicted sex offenders. Many of the issues described below are similar to those found in other sensitive areas of research. However, confidentiality and public protection are matters that require detailed consideration when the desire to know more about men who have committed serious and harmful offences is set against the possibility of a researcher not disclosing previously unknown sensitive information that relates to the risk of someone being harmed.</p

Applied utility and the auto-ethnographic short story: persuasions for, and illustrations of, writing critical social science

In some quarters it is argued that, narrative researchers might be classified as being either storyanalysts or storytellers. They go on to suggest that one feature of storytellers is that they undertake a form of analysis as the process of writing unfolds. With these sentiments in mind, in the present paper, we consider how auto-ethnographical accounts of traumatic and challenging life events might, through the analysis contained within, demonstrate value within the realm of applied pedagogy. In making our case we embrace and adapt the literary genre of storytelling, more specifically, the short story. The story presented here, ‘Travel Writer’, offers an opaque, multicontextualised and lifelong view of career transition. The present paper, in more general terms, considers the capacity of auto-ethnography and, more specifically, the short storied version of it, to engender critical reader engagement, to encourage personal reflection in others, and to act as a point of stimulus for the enactment of applied debate through the lens of critical social science. With regards to the assumptions of critical social science, the final discussion also considers how the auto-ethnographic text, as a pedagogic tool, might help others to contest and challenge the meta-narratives that, we argue, risk stagnating established thinking

Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water?

In recent years, several studies have addressed a possible relationship between nitrate exposure and childhood type 1 insulin-dependent diabetes mellitus. The present ecologic study describes a possible relation between the incidence of type 1 diabetes and nitrate levels in drinking water in The Netherlands, and evaluates whether the World Health Organization and the European Commission standard for nitrate in drinking water (50 mg/L) is adequate to prevent risk of this disease. During 1993-1995 in The Netherlands, 1,104 cases of type 1 diabetes were diagnosed in children 0-14 years of age. We were able to use 1,064 of these cases in a total of 2,829,020 children in this analysis. We classified mean nitrate levels in drinking water in 3,932 postal code areas in The Netherlands in 1991-1995 into two exposure categories. One category was based on equal numbers of children exposed to different nitrate levels (0.25-2.08, 2.10-6.42, and 6.44-41.19 mg/L nitrate); the other was based on cut-off values of 10 and 25 mg/L nitrate. We determined standardized incidence ratios (SIRs) for type 1 diabetes in subgroups of the 2,829,020 children with respect to both nitrate exposure categories, sex, and age and as compared in univariate analysis using the chi-square test for trend. We compared the incidence rate ratios (IRRs) by multivariate analysis in a Poisson regression model. We found an effect of increasing age of the children on incidence of type 1 diabetes, but we did not find an effect of sex or of nitrate concentration in drinking water using the two exposure categories. For nitrate levels > 25 mg/L, an increased SIR and an increased IRR of 1.46 were observed; however, this increase was not statistically significant, probably because of the small number of cases (15 of 1,064). We concluded that there is no convincing evidence that nitrate in drinking water at current exposure levels is a risk factor for childhood type 1 diabetes mellitus in The Netherlands, although a threshold value > 25 mg/L for the occurrence of this disease can not be excluded

Human behaviour and economic growth: a psychocultural perspective on local and regional development

A renewed emphasis on behavioural traits has emerged as a means of explaining regional and local differences in economic performance and development. Given this, the aim of this study is to identify distinct local psychocultural behavioural profiles and to examine the extent to which these are associated with economic growth. Combining theories of community culture and personality psychology into a holistic spatially-oriented perspective, the paper argues that the types of human behaviour found across local places emerges from the co-evolution of cultural and personality factors. An empirical analysis of localities in Great Britain identifies and explores three underlying psychocultural profiles: Diverse Extraversion; Inclusive Amenability and Individual Commitment. It is found that inclusive amenable and individually committed psychocultural behaviour generally appear to hold back local economic growth, with the exception of recessionary periods. The reverse relationship is somewhat the case for diverse extravert behaviour. It is concluded that a better understanding of the holistic relationship and co-evolution of the cultural and psychological behavioural make-up of localities and regions has the potential to provide new insights into expected development outcomes as well as the forms of policy intervention that are required within regions and localities, each of which has its own individual psychocultural character

The politics of access in fieldwork: Immersion, backstage dramas and deception

YesGaining access in fieldwork is crucial to the success of research, and may often be problematic because it involves working in complex social situations. This paper examines the intricacies of access, conceptualizing it as a fluid, temporal and political process that requires sensitivity to social issues and to potential ethical choices faced by both researchers and organization members. Our contribution lies in offering ways in which researchers can reflexively negotiate the challenges of access by: 1. Underscoring the complex and relational nature of access by conceptualizing three relational perspectives – instrumental, transactional and relational – proposing the latter as a strategy for developing a diplomatic sensitivity to the politics of access; 2. Explicating the political, ethical and emergent nature of access by framing it as an ongoing process of immersion, backstage dramas, and deception; and 3. Offering a number of relational micropractices to help researchers negotiate the complexities of access. We illustrate the challenges of gaining and maintaining access through examples from the literature and from Rafael’s attempts to gain access to carry out fieldwork in a Police Force

Shifting perspectives on coastal impacts and adaptation

The Intergovernmental Panel on Climate Change reports reflect evolving attitudes in adapting to sea-level rise by taking a systems approach and recognizing that multiple responses exist to achieve a less hazardous coast.info:eu-repo/semantics/publishedVersio