Defining Research to Improve Health Systems

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems

ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Most current guidelines recommend two serological tests to diagnose chronic Chagas disease. When serological tests are persistently inconclusive, some guidelines recommend molecular tests. The aim of this investigation was to review chronic Chagas disease diagnosis literature and to summarize results of ELISA and PCR performance.</p> <p>Methods</p> <p>A systematic review was conducted searching remote databases (MEDLINE, LILACS, EMBASE, SCOPUS and ISIWeb) and full texts bibliography for relevant abstracts. In addition, manufacturers of commercial tests were contacted. Original investigations were eligible if they estimated sensitivity and specificity, or reliability -or if their calculation was possible - of ELISA or PCR tests, for chronic Chagas disease.</p> <p>Results</p> <p>Heterogeneity was high within each test (ELISA and PCR) and threshold effect was detected only in a particular subgroup. Reference standard blinding partially explained heterogeneity in ELISA studies, and pooled sensitivity and specificity were 97.7% [96.7%-98.5%] and 96.3% [94.6%-97.6%] respectively. Commercial ELISA with recombinant antigens studied in phase three investigations partially explained heterogeneity, and pooled sensitivity and specificity were 99.3% [97.9%-99.9%] and 97.5% [88.5%-99.5%] respectively. ELISA's reliability was seldom studied but was considered acceptable. PCR heterogeneity was not explained, but a threshold effect was detected in three groups created by using guanidine and boiling the sample before DNA extraction. PCR sensitivity is likely to be between 50% and 90%, while its specificity is close to 100%. PCR reliability was never studied.</p> <p>Conclusions</p> <p>Both conventional and recombinant based ELISA give useful information, however there are commercial tests without technical reports and therefore were not included in this review. Physicians need to have access to technical reports to understand if these serological tests are similar to those included in this review and therefore correctly order and interpret test results. Currently, PCR should not be used in clinical practice for chronic Chagas disease diagnosis and there is no PCR test commercially available for this purpose. Tests limitations and directions for future research are discussed.</p

An epidemiological approach to study congenital Chagas' disease

Transplacental transmission of Trypanosoma cruzi has been the focus of much attention in highly endemic areas in South America. Frequency of congenital transmission and factors associated with risk of it are still not well understood. Parasite strains may account for part of the geographical variation observed. Methodological differences between the studies do not permit a combined interpretation of results. This paper examines the epidemiological data available from Brazil, Bolivia, and Argentina and discusses possible epidemiological study design to investigate risk factors for transmission

Impact of the legume catch crop serradella on subsequent growth and P mobilization under barley in different fertilization treatments.

Legume catch crops can enhance soil fertility and promote the N and P supply of the subsequent main crop, especially with low mineral fertilizer use. However, the specific impact of catch crops on arbuscular mycorrhiza formation of the following main crop is unknown. Therefore, the impact of serradella (Ornithopus sativus) vs. bare fallow was tested on mycorrhiza formation, potential soil enzyme activities and plant-available P under subsequently grown barley (Hordeum vulgare) and different fertilization treatments (P-unfertilized-P0; triple superphosphate-TSP; compost-COM; combined-COM + TSP) in a long-term field experiment in northeastern Germany. Catch cropping significantly increased mycorrhiza formation of barley up to 14% compared to bare fallow. The impact of serradella on mycorrhiza formation exceeded that of the fertilization treatment. Serradella led to increased phosphodiesterase activities and decreased ss-glucosidase activities in soil. Plant availability of P was not significantly affected by serradella. These findings provide initial evidence that even serradella as a non-host crop of mycorrhizal fungi can promote the mycorrhiza formation of the subsequent crop and P mobilization in soil. We conclude that the prolonged vegetation cover of arable soils by the use of catch crops can promote P mobilization and transfer from P pools to the following main crops

Effect of triple superphosphate and biowaste compost on mycorrhizal colonization and enzymatic P mobilization under maize in a long-term field experiment.

Phosphorus (P) fertilizers and mycorrhiza formation can both significantly improve the P supply of plants, but P fertilizers might inhibit mycorrhiza formation and change the microbial P cycling. To test the dimension and consequences of P fertilizer impacts under maize (Zea mays L.), three fertilizer treatments (1) triple superphosphate (TSP, 21-30 kg P ha(-1) annually), biowaste compost (ORG, 30 Mg ha(-1) wet weight every third year) and a combination of both (OMI) were compared to a non-P-fertilized control (C) in 2015 and 2016. The test site was a long-term field experiment on a Stagnic Cambisol in Rostock (NE Germany). Soil microbial biomass P (P-mic) and soil enzyme activities involved in P mobilization (phosphatases and ss-glucosidase), plant-available P content (double lactate-extract; P-DL), mycorrhizal colonization, shoot biomass, and shoot P concentrations were determined. P deficiency led to decreased P immobilization in microbial biomass, but the maize growth was not affected. TSP application alone promoted the P uptake by the microbial biomass but reduced the mycorrhizal colonization of maize compared to the control by more than one third. Biowaste compost increased soil enzyme activities in the P cycling, increased P-mic and slightly decreased the mycorrhizal colonization of maize. Addition of TSP to biowaste compost increased the content of P-DL in soil to the level of optimal plant supply. Single TSP supply decreased the ratio of P-DL:P-mic to 1:1 from about 4:1 in the control. Decreased plant-benefits from mycorrhizal symbiosis were assumed from decreased mycorrhizal colonization of maize with TSP supply. The undesirable side effects of TSP supply on the microbial P cycling can be alleviated by the use of compost. Thus, it can be concluded that the plant-availability of P from soil amendments is controlled by the amendment-specific microbial P cycling and, likely, P transfer to plants

Fast Energy Spectrum and Transverse Beam Profile Monitoring and Feedback Systems for the SLC Linac

Fast energy spectrum and transverse beam profile monitoring systems have been tested at the SLC. The signals for each system are derived from digitizations of images on phosphor screens. Individual beam bunch images are digitized in the case of the transverse profile system and synchrotron radiation images produced by wiggler magnets for the energy spectrum. Measurements are taken at two-second intervals. Feedback elements have been installed for future use and consist of rf phase shifters to control energy spectrum and dipole correctors to control the beam launch into the linac affecting the transverse beam profile. Details of these systems, including hardware, timing, data acquisition, data reduction, measurement accuracy, and operational experience will be presented. 9 refs