Missed Opportunities for TB Investigation in Primary Care Clinics in South Africa: Experience from the XTEND Trial.

SETTING: 40 primary health clinics (PHCs) in four provinces in South Africa, June 2012 -February 2013. OBJECTIVE: To determine whether health care worker (HCW) practice in investigating people with TB symptoms was altered when the initial test for TB was changed from smear microscopy to Xpert MTB/RIF. DESIGN: Cross-sectional substudy at clinics participating in a pragmatic cluster randomised trial, Xpert for TB: Evaluating a New Diagnostic "XTEND", which evaluated the effect of Xpert MTB/RIF implementation in South Africa. METHODS: Consecutive adults exiting PHCs reporting at least one TB symptom (defined as any of cough, weight loss, night sweats and fever) were enrolled. The main outcome was the proportion who self-reported having sputum requested by HCW during the clinic encounter just completed. RESULTS: 3604 adults exiting PHCs (1676 in Xpert arm, 1928 in microscopy arm) were enrolled (median age 38 years, 71.4% female, 38.8% reported being HIV-positive, 70% reported cough). For 1267 participants (35.2%) the main reason for attending the clinic was TB symptom(s). Overall 2130/3604 (59.1%) said they reported their symptom(s) to HCW. 22.7% (818/3604) reported having been asked to give sputum for TB investigation. Though participants in the Xpert vs. microscopy arm were more likely to have sputum requested by HCW, this was not significantly different: overall (26.0% [436/1676] vs 19.8% [382/1928]; adjusted prevalence ratio [aPR] 1.31, [95% CI 0.78-2.20]) and when restricted to those presenting at clinics due to symptoms (49.1% [260/530] vs 29.9% [220/737]; aPR 1.38 [0.89-2.13]) and those reporting being HIV-positive (29.4% [190/647] vs 20.8% [156/749]; aPR 1.38[0.88-2.16]). Those attending clinic due to TB symptoms, were more likely to have sputum requested if they had increasing number of symptoms; longer duration of cough, unintentional weight loss and night sweats and if they reported symptoms to HCW. CONCLUSIONS: A large proportion of people exiting PHCs reporting TB symptoms did not get tested. Implementation of Xpert MTB/RIF did not substantially change the probability of testing for TB. Better systems are needed to ensure that opportunities to identify active TB among PHC attendees are not missed

Small contribution of gold mines to the ongoing tuberculosis epidemic in South Africa: a modeling-based study.

BACKGROUND: Gold mines represent a potential hotspot for Mycobacterium tuberculosis (Mtb) transmission and may be exacerbating the tuberculosis (TB) epidemic in South Africa. However, the presence of multiple factors complicates estimation of the mining contribution to the TB burden in South Africa. METHODS: We developed two models of TB in South Africa, a static risk model and an individual-based model that accounts for longer-term trends. Both models account for four populations - mine workers, peri-mining residents, labor-sending residents, and other residents of South Africa - including the size and prevalence of latent TB infection, active TB, and HIV of each population and mixing between populations. We calibrated to mine- and country-level data and used the static model to estimate force of infection (FOI) and new infections attributable to local residents in each community compared to other residents. Using the individual-based model, we simulated a counterfactual scenario to estimate the fraction of overall TB incidence in South Africa attributable to recent transmission in mines. RESULTS: We estimated that the majority of FOI in each community is attributable to local residents: 93.9% (95% confidence interval 92.4-95.1%), 91.5% (91.4-91.5%), and 94.7% (94.7-94.7%) in gold mining, peri-mining, and labor-sending communities, respectively. Assuming a higher rate of Mtb transmission in mines, 4.1% (2.6-5.8%), 5.0% (4.5-5.5%), and 9.0% (8.8-9.1%) of new infections in South Africa are attributable to gold mine workers, peri-mining residents, and labor-sending residents, respectively. Therefore, mine workers with TB disease, who constitute ~ 2.5% of the prevalent TB cases in South Africa, contribute 1.62 (1.04-2.30) times as many new infections as TB cases in South Africa on average. By modeling TB on a longer time scale, we estimate 63.0% (58.5-67.7%) of incident TB disease in gold mining communities to be attributable to recent transmission, of which 92.5% (92.1-92.9%) is attributable to local transmission. CONCLUSIONS: Gold mine workers are estimated to contribute a disproportionately large number of Mtb infections in South Africa on a per-capita basis. However, mine workers contribute only a small fraction of overall Mtb infections in South Africa. Our results suggest that curtailing transmission in mines may have limited impact at the country level, despite potentially significant impact at the mining level

The Passion Bug: How and When Do Leaders Inspire Work Passion?

Drawing from signaling theory, we propose a work passion transfer model where leaders\u27 passion is transmitted to employees through the former\u27s leadership style and is contingent on employees\u27 perceived importance of performance to self-esteem (IPSE). Data from 201 supervisor–employee dyads from the health-care industry show that leaders\u27 harmonious passion led to employees\u27 harmonious passion through charismatic leadership, whereas contingent reward leadership accounted for the transfer of obsessive passion; IPSE did not play a moderating role for either form of passion. Results from a supplementary study further reveal that the link between leadership and employee passion operated through employees\u27 perception of leader passion and that employees\u27 IPSE accentuated for the relationship between perceived leader obsessive passion and employees\u27 obsessive passion. This study advances research in work passion, leadership, and signaling theory and provides important implications for managerial practice

Disentangling Passion and Engagement: An Examination of How and When Passionate Employees Become Engaged Ones

While anecdotal industry evidence indicates that passionate workers are engaged workers, research has yet to understand how and when job passion and engagement are related. To answer the how question, we draw from person-environment fit theory to test, and find support for, the mediating roles of perceived demands-abilities (D-A) fit and person-organization (P-O) fit in the relationships between passion and job engagement, and between passion and organizational engagement, respectively. Also, because the obsessive form of passion is contingency-driven, we answer the when question by adopting a target-similarity approach to test the contingent role of multi-foci trust in the obsessive passion-to-engagement relationships. We found that when obsessively passionate workers trust their organization, they report greater levels of organizational engagement (because of increased P-O fit). In contrast, when these workers trust both their co-workers and supervisor simultaneously, they report greater levels of job engagement (because of increased D-A fit)

Chameleonic Obsessive Job Passion: Demystifying the Relationships between Obsessive Job Passion and In-Role and Extra-Role Performance

In seeking to address the theoretical ambiguity regarding how and when obsessive job passion (OJP) leads to work performance, we integrate both self-verification and person–environment (P-E) fit perspectives to propose and test a moderated mediation model linking OJP to performance. We argue that OJP is indirectly related to co-worker-rated in-role and extra-role performance through self-verification, and these indirect links are conditioned by perceived demands–abilities (D-A) fit and needs–supplies (N-S) fit. Results from 190 healthcare professionals and their co-workers collected at three different time periods revealed the contrasting roles played by these two moderators. Individuals with higher OJP self-verify more when they perceive low D-A fit, but self-verify less when they perceive high N-S fit, whereas the opposite holds true for high D-A fit and low N-S fit. Contrary to predictions, negative relationships were found between self-verification and both types of performance. Specifically, OJP is associated with greater in- and extra-role performance (because of reduced self-verification) under high perceived D-A but low N-S fit, whereas the opposite results are observed under low perceived D-A and high N-S fit. The findings underscore the contingent nature of OJP and contribute to job passion, self-concept, and person–environment fit research

Assessing Group Fairness with Social Welfare Optimization

Statistical parity metrics have been widely studied and endorsed in the AI community as a means of achieving fairness, but they suffer from at least two weaknesses. They disregard the actual welfare consequences of decisions and may therefore fail to achieve the kind of fairness that is desired for disadvantaged groups. In addition, they are often incompatible with each other, and there is no convincing justification for selecting one rather than another. This paper explores whether a broader conception of social justice, based on optimizing a social welfare function (SWF), can be useful for assessing various definitions of parity. We focus on the well-known alpha fairness SWF, which has been defended by axiomatic and bargaining arguments over a period of 70 years. We analyze the optimal solution and show that it can justify demographic parity or equalized odds under certain conditions, but frequently requires a departure from these types of parity. In addition, we find that predictive rate parity is of limited usefulness. These results suggest that optimization theory can shed light on the intensely discussed question of how to achieve group fairness in AI

Anishinaabemowin: Teachers' Practices in Manitoba

The purpose of this study is to develop a deeper understanding of the relationships among Anishinaabe language and literacies, Indigenous knowledge systems (IKS), and bimaadiziwin (“a way of life” in the Anishinaabe language) by exploring current Aboriginal language teaching and learning practices. The study is based on the perceptions and experiences of four Anishinaabe language teachers in Manitoba, Canada. It is informed by the author’s experiences as an Anishinaabe speaker, a former language teacher, a consultant, an instructor, and a school administrator. The research is based on a theoretical and conceptual framework reflective of an Indigenous perspective to address the research questions: (1) How are Anishinaabe language teachers incorporating IKS and bimaadiziwin into their Indigenous language and literacies programs? (2) What experiences and resources can these teachers identify that would enhance their ability to incorporate IKS and bimaadiziwin into their teaching of the Anishinaabe language and literacies in the classroom?In this study, the language-teacher participants identified Anishinaabe traditional teachings, land-based learning, and a variety of other language teaching and learning practices, such as discussing and utilizing humour, promoting healthy lifestyles with students, and using technology, as the main teaching and learning practices within their current Anishinaabe language and literacies programs. The enhanced resources and experiences they identified included the importance of knowing and living one’s Indigenous knowledge (IK) and bimaadiziwin, and knowledge of the traditional teachings, such as minwaadiziwin (kindness), maanaji’iwin (respect), zaagi’idiwin (love), debwemowin (truth), and dabasenimowin (humility). When one can practice these traditional teachings on a daily basis, according to the Elders, one is living a mino-bimaadiziwin (a good life). Other teaching and learning practices identified by the language teachers included, but were not limited to, involvement of Elders and Indigenous Knowledge Keepers as the most knowledgeable and experienced people, access to print and non-print language materials, ongoing face-to-face interaction with students, and language immersion programming. The study results revealed that the Anishinaabe language teachers were providing amazingly deep cultural and linguistic foundations within their individual classrooms by utilizing their own IK and bimaadiziwin as the foundation of their teaching and learning practices. The cultural and spiritual nuances embedded in these Anishinaabe language and literacies programs provided deeper cultural and linguistic understandings of teaching and learning practices and insights not previously researched