Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Background: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. Methods: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. Results: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. Conclusion: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation

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

Real Option Identification Framework for Mine Operational Decision-Making

Identification of opportunities for applying real options (RO) in mining operations is a major challenge to decision-makers. In order to make optimal decisions in uncertain times, managers require a full understanding of the relationships between risk, uncertainty and flexibility. RO analysis, which captures the value of any managerial flexibility that may exist in a project, provides a proactive management of uncertainty. Thus, it enhances optimal decision-making. However, it is important that a structured framework is created to identify project uncertainties and areas available to cultivate flexibility. In this paper, uncertainty identification framework in a mining operation is proposed, and areas for managerial flexibility and their application domains within the mining cycle are mapped as well. To avoid complex mathematical models, which hinder the adoption of RO analysis in mining operations, a relationship between risk measure (beta) and flexibility (flexibility index) is derived and applied. This implies that if a project beta is known, then the expected option values and volatility of future cash flows can be precisely estimated. Once the option value is calculated using the derived equation, a modified smooth pasting condition with the mean value theorem is subsequently applied to estimate the optimal value. This combination of beta, flexibility index and mean value theorem can be used as a decision criterion for screening various options within a mining project

Jet Structure of Baryon Excess in Au+Au Collisions at sqrt(S_NN) = 200 GeV

396 authors, 6 pages text, 4 figures, RevTeX 4. To be submitted to PRL. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.html - EITwo particle correlations between identified meson and baryon trigger particles with 2.5 < p_T < 4.0 GeV/c and lower p_T charged hadrons have been measured at midrapidity by the PHENIX experiment at RHIC in p+p, d+Au and Au+Au collisions at sqrt(s_NN) = 200 GeV. The probability of finding a hadron near in azimuthal angle to the trigger particle is almost identical for leading mesons and baryons for non-central Au+Au. The yield for both trigger baryons and mesons is significantly higher in Au+Au than in p+p and d+Au, except for trigger baryons in central collisions. The baryon excess is likely to arise predominantly from hard scattering processes