Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana.

OBJECTIVE: To test in West Africa the impact of rapid diagnostic tests on the prescription of antimalarials and antibiotics both where microscopy is used for the diagnosis of malaria and in clinical (peripheral) settings that rely on clinical diagnosis. DESIGN: Randomised, controlled, open label clinical trial. SETTING: Four clinics in the rural Dangme West district of southern Ghana, one in which microscopy is used for diagnosis of malaria ("microscopy setting") and three where microscopy is not available and diagnosis of malaria is made on the basis of clinical symptoms ("clinical setting"). PARTICIPANTS: Patients with suspected malaria. Interventions Patients were randomly assigned to either a rapid diagnostic test or the current diagnostic method at the clinic (microscopy or clinical diagnosis). A blood sample for a research microscopy slide was taken for all patients. MAIN OUTCOME MEASURES: The primary outcome was the prescription of antimalarials to patients of any age whose double read research slide was negative for malaria. The major secondary outcomes were the correct prescription of antimalarials, the impact of test results on antibiotic prescription, and the correct prescription of antimalarials in children under 5 years. RESULTS: Of the 9236 patients screened, 3452 were randomised in the clinical setting and 3811 in the microscopy setting. Follow-up to 28 days was 97.6% (7088/7263). In the microscopy setting, 722 (51.6%) of the 1400 patients with negative research slides in the rapid diagnostic test arm were treated for malaria compared with 764 (55.0%) of the 1389 patients in the microscopy arm (adjusted odds ratio 0.87, 95% CI 0.71 to 1.1; P=0.16). In the clinical setting, 578 (53.9%) of the 1072 patients in the rapid diagnostic test arm with negative research slides were treated for malaria compared with 982 (90.1%) of the 1090 patients with negative slides in the clinical diagnosis arm (odds ratio 0.12, 95% CI 0.04 to 0.38; P=0.001). The use of rapid diagnostic tests led to better targeting of antimalarials and antibiotics in the clinical but not the microscopy setting, in both children and adults. There were no deaths in children under 5 years at 28 days follow-up in either arm. CONCLUSION: Where microscopy already exists, introducing rapid diagnostic tests had limited impact on prescriber behaviour. In settings where microscopy was not available, however, using rapid diagnostic tests led to a significant reduction in the overprescription of antimalarials, without any evidence of clinical harm, and to better targeting of antibiotics. Trial registration ClinicalTrials.gov NCT00493922

Geographical and temporal trends in imported infections from the tropics requiring inpatient care at the Hospital for Tropical Diseases, London - a 15 year study.

BACKGROUND: Understanding geographic and temporal trends in imported infections is key to the management of unwell travellers. Many tropical infections can be managed as outpatients, with admission reserved for severe cases. METHODS: We prospectively recorded the diagnosis and travel history of patients admitted between 2000 and 2015. We describe the common tropical and non-tropical infectious diseases and how these varied based on region, reason for travel and over time. RESULTS: A total of 4362 admissions followed an episode of travel. Falciparum malaria was the most common diagnosis (n=1089). Among individuals who travelled to Africa 1206/1724 (70.0%) had a tropical diagnosis. The risk of a tropical infection was higher among travellers visiting friends and relatives than holidaymakers (OR 2.8, p<0.001). Among travellers to Asia non-tropical infections were more common than tropical infections (349/782, 44.6%), but enteric fever (117, 33.5%) of the tropical infections and dengue (70, 20.1%) remained important. The number of patients admitted with falciparum malaria declined over the study but those of enteric fever and dengue did not. CONCLUSIONS: Most of those arriving from sub-Saharan Africa with an illness requiring admission have a classical tropical infection, and malaria still predominates. In contrast, fewer patients who travelled to Asia have a tropical diagnosis but enteric fever and dengue remain relatively common. Those visiting friends and relatives are most likely to have a tropical infection

Ethical and Social Challenges with developing Automated Methods to Detect and Warn potential victims of Mass-marketing Fraud (MMF)

Mass-marketing frauds (MMFs) are on the increase. Given the amount of monies lost and the psychological impact of MMFs there is an urgent need to develop new and effective methods to prevent more of these crimes. This paper reports the early planning of automated methods our interdisciplinary team are developing to prevent and detect MMF. Importantly, the paper presents the ethical and social constraints involved in such a model and suggests concerns others might also consider when developing automated systems

Critical Spirituality, Moral Philosophy, and Business Ethics

Critical ethics, according to David Boje, require a restoration of moral philosophy as a core value to the theory and practice of business ethics. Managerial business ethics often lack an answerability that challenges systemicity, which produces inhumane unethics. This essay supports answerability for the administered world of organization, power and politics. We join critical post-modern theorists in rejecting managerialism and the cultural industry. We advocate an ethics of responsibility that is drawn from moral philosophy and a free spirituality (by which we mean a trust in human potential, consciousness and human evolution). Just as ethics is often a grey area constantly being rethought, so too moral philosophy is being questioned and revised in post- modern theorizing. Disciplines relating to ethics are deconstructing the philosophical and ideological theories in order to move into the future. Critical theory is a work always and already partial in its progress. (Boje 2007) The assumptions of critical theory, as well as ethics and moral philosophy, therefore remain in a flow state. Each area of theory must function in a dialectical fashion - allowing for the unknown, the unseen and the unimaginable. Only in this state of mind can a truly creative co-mingling of unfinished ethics and evolving critical theory occur

A system for measuring bubble voidage and frequency around tubes immersed in a fluidized bed of particles

Journal ArticleGas-solid fluidized beds are common in chemical processing and energy production industries. These types of reactors frequently have banks of tubes immersed within the bed to provide heating or cooling, and it is important that the fluid dynamics within these bundles is efficient and uniform. This paper presents a simple, low-cost method for quantitatively analyzing the behavior of gas bubbles within banks of tubes in a fluidized bed cold flow model. Two probes, one containing an infrared emitter and one containing an infrared (IR) detector, are placed into adjacent glass tubes such that the emitter and detector face each other. As bubbles pass through the IR beam, the detector signal increases due to less solid material blocking the path between the emitter and detector. By calibrating the signal response to known voidage of the material, one can measure the bubble voidage at various locations within the tube bundle. The rate and size of bubbles passing through the beam can also be determined by high frequency data collection and subsequent analysis. This technique allows one to develop a map of bubble voidage within a fluidized bed, which can be useful for model validation and system optimization

Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana.

Cost-effectiveness information on where malaria rapid diagnostic tests (RDTs) should be introduced is limited. We developed incremental cost-effectiveness analyses with data from rural health facilities in Ghana with and without microscopy. In the latter, where diagnosis had been presumptive, the introduction of RDTs increased the proportion of patients who were correctly treated in relation to treatment with antimalarials, from 42% to 65% at an incremental societal cost of Ghana cedis (GHS)12.2 (US$8.3) per additional correctly treated patients. In the "microscopy setting" there was no advantage to replacing microscopy by RDT as the cost and proportion of correctly treated patients were similar. Results were sensitive to a decrease in the cost of RDTs, which cost GHS1.72 (US$1.17) per test at the time of the study and to improvements in adherence to negative tests that was just above 50% for both RDTs and microscopy

Accountability principles for policy oriented research organisations : a guide to the framework and online database

After years of empirical research and collaborative engagement with a wide variety of organisations, the accountability framework supports research organisations’ ability to respond, in a structured way, to the challenges of increasing attention and demands for accountability. The Accountability Principles for Research Organisations (APRO) explores the meaning and use of concepts of accountability among organisations that conduct research which are influential in the formation of public policy. The accountability framework identifies core principles, work processes and types of stakeholders that are relevant to all policy-oriented research organisations

Indicators of injury recovery identified by patients, family members and clinicians

Introduction A focus on what is important to patients has been recognized as an essential pillar in care to ensure safe patient care that focuses on outcomes identified as important by patients. Despite this, asking trauma patients and their families what they consider should be the priorities of care and recovery has been neglected. Methods Adult trauma patients admitted to two centers in Australia for ≥24 h for the treatment of physical injury, and family members of injured patients and clinicians caring for injured patients were invited to participate. Individual interviews were conducted with the patient and family members prior to hospital discharge, and again one and three months post discharge. Individual interviews or focus groups were conducted with clinicians at one point in time. Content analysis of all transcripts was undertaken to determine the indicators of successful recovery over time. Results Participants in the three stakeholder groups were enrolled (patients − 33; family members—22; clinicians—40). Indicators of recovery focused on five main categories including returning to work, resuming family roles, achieving independence, recapturing normality and achieving comfort. Other categories that were less frequently identified included maintaining one’s household, restoring emotional stability, cosmetic considerations and appearance, realignment of life goals, psychological recovery and development of self. Indicators of recovery after physical injury were similar across the three stakeholder groups, although with greater detail identified by patients. In addition, indicators evolved over time with increasing recognition of the importance of the overall impact of the injury in general and on activities of daily living and an unfolding appreciation that life could not be taken for granted. Conclusions Description of the indicators of recovery after traumatic injury that matter to patients, family members and clinicians enable an understanding of similarities and differences. Further testing in a broader cohort of participants is essential to identify patient reported outcome measures that might be used in trauma care and associated research

Would you use it with a seal of approval? Important attributes of 2,4-dinitrophenol (2,4-DNP) as a hypothetical pharmaceutical product

Background2,4-Dinitrophenol (2,4-DNP) is an effective but highly dangerous fat burner, not licensed for human consumption. Death cases reported for 2,4-DNP overdose, particularly among young adults, have raised concerns about the ineffective regulatory control, lack of education and risks associated with impurity, and the unknown concentration of 2,4-DNP purchased on the Internet.MethodsUsing a sequential mixed method design and based on a hypothetical scenario as if 2,4-DNP was a licensed pharmaceutical drug, first we conducted a qualitative study to explore what product attributes people consider when buying a weight-loss aid. Focus group interviews with six females and three males (mean age = 21.6 ± 1.8 years) were audiorecorded, transcribed verbatim, and subjected to thematic analysis. Sixteen attributes were identified for the Best–Worst Scale (BWS) in the quantitative survey with 106 participants (64% female, mean age = 27.1 ± 11.9 years), focusing on 2,4-DNP. Demographics, weight satisfaction, and risk for eating disorder data were collected.ResultsIn contrast to experienced users such as bodybuilders, our study participants approached 2,4-DNP cautiously. Attributes of 2,4-DNP as a hypothetical weight-loss drug comprised a range of desirable and avoidable features. Of the 16 selected attributes, BWS suggested that long-term side effects were the most and branding was the least important attribute. Effectiveness and short-term side effects were also essential. Those in the &gt;25 year group showed least concerns for legality. Neutral BWS scores for cost, treatment, degree of lifestyle changes required, and specificity required for the hypothetical weight-loss drug to be effective were likely caused by disagreement about their importance among the participants, not indifference.ConclusionWith advances in research, 2,4-DNP as a pharmaceutical drug in the future for treating neurodegenerative diseases and potentially for weight loss is not inconceivable. Caution is warranted for interpreting the BWS scores. Owing to the difference in what data represent at individual vs. population levels, with pooled data, the method correctly identifies attributes by which most people are satisfied but misrepresents attributes that are individually very important but not universally agreed. Whilst this may be an advantage in marketing applications, it limits the utility of BWS as a research tool