Motivators for enrollment and completion of pregnancy outcomes research: A comparison of African-American and Caucasian women's perspectives

Women and minority populations, specifically African-Americans, continue to be under represented in medical research. The exclusion of women and minorities from clinical trials raises questions about whether treatment outcomes are generalizable to these populations and about equity in the provision of health care. Despite the recognition of the need to include women and minorities in medical research, many factors limit their participation. This study explored the motivators for participation, retention and satisfaction of reproductive-aged women who participated in the Right from the Start Study (RFTS), an ongoing, prospective study of early pregnancy risk factors for spontaneous abortion and preterm birth. The goal was to improve our understanding of factors important to participation in pregnancy-outcomes research, and to determine if these factors varied between African-American and white women. Three focus groups, two with African-American women and one with white women, were conducted to learn about the women's opinions on participation in pregnancy outcomes research. The majority of the women in all focus groups indicated that facilitative aspects of the study, such as free ultrasounds and pregnancy tests were the most important reason for participating in the RFTS study. However, factors influencing retention and satisfaction with research differed between the racial groups. Interest in the research topic, familial altruism and personal relevance were the major themes expressed by the African-American women; whereas, Caucasian women were motivated by commitment, convenience and reimbursement. By using the themes that emerged from these focus groups in combination with the literature on participation and retention in medical research, the design of future research trials involving reproductive-aged women can be improved to reflect better understanding of the factors affecting enrollment, retention and satisfaction with research. We speculate that all studies involving reproductive-aged women, and especially African-American women, should focus on improving and emphasizing individual benefits of participation. Research designed to study reproductive-aged women should include components that are purposeful to the participant, such as tests that the participant values, and should employ staff who are friendly and compassionate. If the barriers known to impede participation are lessened while factors that improve satisfaction and enrollment are enhanced, the participation and retention of women in future trials can be ensured.Master of Public Healt

Corporate Social Responsibility/Sustainability Reporting Among the Fortune Global 250: Greenwashing or Green Supply Chain?

The sustainability reporting efforts of MNCs who are members of the Fortune Global 250 (FG250) was investigated. The focus was on sustainability reporting by MNCs of supply chain impacts. The reporting of FG250 MNCs was examined to determine if greenwashing was occurring or whether MNCs had committed to operating a green supply chain. A mixed methodology was used consisting of quantitative analysis of twenty-five MNC CSR/sustainability reports which were randomly selected from the FG250 listing. Qualitative analysis using content analysis was also conducted on the reports. Both methodologies concentrated on the sustainability reporting of the selected MNCs in regard to their supply chain. Findings were mixed as there were great variations among the MNCs in their level of sustainability reporting about their supply chains. Some MNCs did not report on the activities of their supply chain at all (20%), the majority of the MNCs reported on their supply chain impacts at the value and goal level (48%), while the rest reported at the management approach level (32%). A majority of the sampled MNCs could be accused of greenwashing due to the lack of detailed quantitative information provided by the MNCs on the environmental impacts of their supply chai

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A physarum-inspired approach to supply chain network design

A supply chain is a system which moves products from a supplier to customers, which plays a very important role in all economic activities. This paper proposes a novel algorithm for a supply chain network design inspired by biological principles of nutrients’ distribution in protoplasmic networks of slime mould Physarum polycephalum. The algorithm handles supply networks where capacity investments and product flows are decision variables, and the networks are required to satisfy product demands. Two features of the slime mould are adopted in our algorithm. The first is the continuity of flux during the iterative process, which is used in real-time updating of the costs associated with the supply links. The second feature is adaptivity. The supply chain can converge to an equilibrium state when costs are changed. Numerical examples are provided to illustrate the practicality and flexibility of the proposed method algorithm

Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries?

BACKGROUND: The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country METHODS: The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence RESULTS: Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics CONCLUSIONS: Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleadin

The impact of supply chain agility on business performance in a high level customization environment

To improve business performance in rapidly changing environments, supply chain agility can be a crucial requisite to address responsiveness issues, especially in environments with high levels of customization. This paper examines the effect of supply chain agility on customer service, differentiation, and business performance. A survey research methodology was employed using a sample of 156 manufacturing firms that provide high levels of customization. In particular, structural equation modeling (SEM) was employed to evaluate the proposed model. The results suggest that supply chain agility influences customer service and differentiation positively. However, it does not affect business performance directly; instead, better business performance can be achieved and mediated through improved customer service and differentiation. In particular, differentiation through customer service is the most effective way to improve business performance, and supply chain agility can help to achieve high-level customer service. The paper advises managers on details of how to fulfil their business performance ambitions better through suggested key agile supply chain management activities

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe