11 research outputs found
A contribution to the linguistic analysis of business conversations within the language/action perspective
No full textElectrical Engineering, Mathematics and Computer Scienc
Growth, distribution, and poverty in Africa : messages from the 1990s
No full textreview recent evidence on the trends in household well-being in Africa during the 1990s. They draw on the findings of a series of studies on poverty dynamics that use the better data sets now available. The authors begin by taking a broad view of poverty, tracing changes in both income poverty and in other more direct measures of individual welfare. Experiences have been varied: several countries have seen a sharp decline in poverty, while some have witnessed a marked increase. Yet, in the aggregate, economic growth has been pro-poor. Nonetheless, the aggregate numbers also hide significant and systematic distributional effects which have caused some groups to be left behind. The authors draw four key conclusions: Economic policy reforms (improving macroeconomic balances and liberalizing markets) have been conducive to reducing poverty. Market connectedness is key for the poor to benefit from new opportunities generated by economic growth. Some population groups and regions, by virtue of their sheer remoteness, have been left behind when growth picks up. Education and access to land further condition the extent to which households can benefit from economic opportunities and escape poverty. Finally, rainfall variations and ill health are found to have profound effects on poverty outcomes in Africa underscoring the significance of social protection in a poverty reduction strategy.Health Economics&Finance,Health Monitoring&Evaluation,Environmental Economics&Policies,Public Health Promotion,Services&Transfers to Poor,Governance Indicators,Achieving Shared Growth,Poverty Assessment,Environmental Economics&Policies,Health Economics&Finance
Review of \u3ci\u3eBhutan: A Physical and Cultural Geography\u3c/i\u3e by Pradyumna P. Karan.
No full textThis “preliminary geographical appraisal” of Bhutan is an important contribution to knowledge about an unfamiliar country. Part of the contribution results from information collected by Dr. Karan during recent expeditions. Some field data are presented in the form of new maps, including those of population distribution and important valleys. (An accompanying map with settlement features on a shaded-relief base appeared earlier as Map Supplement No. 5, A.A.G. Annals.) Also, the author\u27s bibliography and assemblage of previously scattered materials will aid future studies of the Himalayan state. Unfortunately the book will have limited value for many geographers. The numerous pictures, especially the full-page colored ones, should appeal more to “armchair travelers” than to professional geographers, and the book\u27s cost will discourage its use as a textbook. Furthermore, the contents lack a spatial emphasis. Many paragraphs describe political history or current events rather than their spatial relationships. For ex-ample, geographers may skip the discussion about the political demands by exiled Bhutanese (p. 17) but will search for comments about locational factors favoring food industries at Samchi (p. 47). The book possesses the merits of a “first” geographic survey, but it contains limited “geographic” information
Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist
No full textAcknowledgements R. Munro and R. Black of NHS National Services Scotland, UK, provided data intelligence. B. Robson helped review this paper; A. Longmate was involved in the preliminary design of this study; J. Ingram, J. Ferbrache and SPSP managers from health boards in Scotland provided some of the information on surgical checklist implementation practices at hospitals across NHS Scotland. Data, analytical methods and study materials used may be made available to other researchers on request. The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported. No important aspects of the study have been omitted. Any discrepancies from the study as planned (and, if relevant, registered) have been explained. This study was not funded by any individual or group. The Research Governance Department of the University of Aberdeen sponsored this project and supported the application through ethical review and data management. Disclosure: A.A.G. has received royalties from multiple publishers for writing on improving healthcare, including through use of checklists: Objetiva, Sextante (Brazil); Profile Books Ltd (British Commonwealth); Cheers Publishing Company, Commonwealth Publishing Co (People's Republic of China); Jesenski & Turk, Mizaik Knjiga, Mozaik Knjiga (Croatia); Dokoran (Czech Republic); Lindhart og Rinhoft Forlag (Denmark); Pilgrim Group (Estonia); Editions Moyen‐Courrier, Fayard, Libraire Arthème Fayard, Moyen‐Courrier (France); Radarami (Georgia), S Fischer, Verlagsgruppe Random House (Germany); Crete University Press (Greece); Tericam Kindo (Hungary); Mehta Publishing House, Penguin Random House Books (India); Gramedia Pustaka Utama, Serambi Ilmu Semesta (Indonesia); Arjmand Press (Iran); Am Oved, Modan (Israel); Einaudi Editore (Italy); Misuzu Shobo, Shinyusha Co Ltd (Japan); Janis Roze Publishers (Latvia); Vaga (Lithuania); Mime Forlag (Norway); Magnum, Znak (Poland); Lua de Papel (Portugal); Codecs, Grup Media Litera, Litera, Streamland Ltd (Romania); Slovant Publishers (Slovakia); Mladinska Knjiga (Slovenia); Antoni Bosch Editor, Editorial Empuries, Galaxia Gutenberg (Spain); Asa Editore, Bookie Publishing House, Book21, Sosoh Publishing (South Korea); Volante (Sweden); Alpina, AST (Russia); Matichon, Openworlds (Thailand); Arbeiderspers, Nieuwezijds, Uitgeverij De Arbeiderspers, Uitgeverij Nieuwezijds (the Netherlands); Domingo, Koton Kitap (Turkey); Verlagsgruppe Vivat (Ukraine); CBS Television, Henry Holt, Houghton Mifflin, Harvard Business School Press, McGraw Hill, Pearson Publishing, Public Broadcasting Service, Picador USA (USA), First News‐Tn Viet Publishing Co, Suc Manh Ngoi But Co (Vietnam); and Harper Collins (World). The authors declare no other conflict of interest.Peer reviewe
Experience and everyday environment: a group reflective strategy
No full textThe distinctiveness of this thesis lies in its use of Group and Researcher Reflection. It is a responsive and experiential study, which has two main aims: to explore the phenomenon, experience in the everyday environment, and to develop an appropriate method. The study centres round Group Reflection, which consists of a small group of local residents (in Ushaw Moor, Co Durham), who met regularly over a year, to reflect together. They met to explicate and explore their experience, particularly heightened experience, of their everyday environment, and together to recognise themes, and so reveal, develop and share their understanding. The group collected their themes under three general headings: nature, buildings and people. A report summarising this Group Reflection was produced with the group. The whole of the Group Reflection forms the basis for subsequent Researcher Reflection. This seeks alternative orderings and interpretation of the material explicated, themes and experiences, and considers their relationship to the wider literature on environmental experience. A number of alternative themes, or gatherings, are suggested: looking language, social concept, ordering regimes, person-environment engagement. Then, the concepts experience, place and dwelling are explored in the context of everyday environment, and a number of speculations are made about the possible changing nature of dwelling. The study is inspired by Phenomenology, and therefore seeks to allow the phenomenon to speak of itself: through those who have direct experience of it, and it hopes to take into account the essential entanglement of what is studied with those who study. Finally, it seeks to encourage readers to continue the reflective journey into their own exploration of experience in the everyday environment
Rapid, point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection
No full textBackgroundAccurate rapid diagnostic tests for SARS‐CoV‐2 infection could contribute to clinical and public health strategies to manage the COVID‐19 pandemic. Point‐of‐care antigen and molecular tests to detect current infection could increase access to testing and early confirmation of cases, and expediate clinical and public health management decisions that may reduce transmission.ObjectivesTo assess the diagnostic accuracy of point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection. We consider accuracy separately in symptomatic and asymptomatic population groups.Search methodsElectronic searches of the Cochrane COVID‐19 Study Register and the COVID‐19 Living Evidence Database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) were undertaken on 30 Sept 2020. We checked repositories of COVID‐19 publications and included independent evaluations from national reference laboratories, the Foundation for Innovative New Diagnostics and the Diagnostics Global Health website to 16 Nov 2020. We did not apply language restrictions.Selection criteriaWe included studies of people with either suspected SARS‐CoV‐2 infection, known SARS‐CoV‐2 infection or known absence of infection, or those who were being screened for infection. We included test accuracy studies of any design that evaluated commercially produced, rapid antigen or molecular tests suitable for a point‐of‐care setting (minimal equipment, sample preparation, and biosafety requirements, with results within two hours of sample collection). We included all reference standards that define the presence or absence of SARS‐CoV‐2 (including reverse transcription polymerase chain reaction (RT‐PCR) tests and established diagnostic criteria).Data collection and analysisStudies were screened independently in duplicate with disagreements resolved by discussion with a third author. Study characteristics were extracted by one author and checked by a second; extraction of study results and assessments of risk of bias and applicability (made using the QUADAS‐2 tool) were undertaken independently in duplicate. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and pooled data using the bivariate model separately for antigen and molecular‐based tests. We tabulated results by test manufacturer and compliance with manufacturer instructions for use and according to symptom status.Main resultsSeventy‐eight study cohorts were included (described in 64 study reports, including 20 pre‐prints), reporting results for 24,087 samples (7,415 with confirmed SARS‐CoV‐2). Studies were mainly from Europe (n = 39) or North America (n = 20), and evaluated 16 antigen and five molecular assays.We considered risk of bias to be high in 29 (37%) studies because of participant selection; in 66 (85%) because of weaknesses in the reference standard for absence of infection; and in 29 (37%) for participant flow and timing. Studies of antigen tests were of a higher methodological quality compared to studies of molecular tests, particularly regarding the risk of bias for participant selection and the index test. Characteristics of participants in 35 (45%) studies differed from those in whom the test was intended to be used and the delivery of the index test in 39 (50%) studies differed from the way in which the test was intended to be used. Nearly all studies (97%) defined the presence or absence of SARS‐CoV‐2 based on a single RT‐PCR result, and none included participants meeting case definitions for probable COVID‐19.Antigen testsForty‐eight studies reported 58 evaluations of antigen tests. Estimates of sensitivity varied considerably between studies. There were differences between symptomatic (72.0%, 95% CI 63.7% to 79.0%; 37 evaluations; 15530 samples, 4410 cases) and asymptomatic participants (58.1%, 95% CI 40.2% to 74.1%; 12 evaluations; 1581 samples, 295 cases). Average sensitivity was higher in the first week after symptom onset (78.3%, 95% CI 71.1% to 84.1%; 26 evaluations; 5769 samples, 2320 cases) than in the second week of symptoms (51.0%, 95% CI 40.8% to 61.0%; 22 evaluations; 935 samples, 692 cases). Sensitivity was high in those with cycle threshold (Ct) values on PCR ≤25 (94.5%, 95% CI 91.0% to 96.7%; 36 evaluations; 2613 cases) compared to those with Ct values >25 (40.7%, 95% CI 31.8% to 50.3%; 36 evaluations; 2632 cases). Sensitivity varied between brands. Using data from instructions for use (IFU) compliant evaluations in symptomatic participants, summary sensitivities ranged from 34.1% (95% CI 29.7% to 38.8%; Coris Bioconcept) to 88.1% (95% CI 84.2% to 91.1%; SD Biosensor STANDARD Q). Average specificities were high in symptomatic and asymptomatic participants, and for most brands (overall summary specificity 99.6%, 95% CI 99.0% to 99.8%).At 5% prevalence using data for the most sensitive assays in symptomatic people (SD Biosensor STANDARD Q and Abbott Panbio), positive predictive values (PPVs) of 84% to 90% mean that between 1 in 10 and 1 in 6 positive results will be a false positive, and between 1 in 4 and 1 in 8 cases will be missed. At 0.5% prevalence applying the same tests in asymptomatic people would result in PPVs of 11% to 28% meaning that between 7 in 10 and 9 in 10 positive results will be false positives, and between 1 in 2 and 1 in 3 cases will be missed.No studies assessed the accuracy of repeated lateral flow testing or self‐testing.Rapid molecular assaysThirty studies reported 33 evaluations of five different rapid molecular tests. Sensitivities varied according to test brand. Most of the data relate to the ID NOW and Xpert Xpress assays. Using data from evaluations following the manufacturer’s instructions for use, the average sensitivity of ID NOW was 73.0% (95% CI 66.8% to 78.4%) and average specificity 99.7% (95% CI 98.7% to 99.9%; 4 evaluations; 812 samples, 222 cases). For Xpert Xpress, the average sensitivity was 100% (95% CI 88.1% to 100%) and average specificity 97.2% (95% CI 89.4% to 99.3%; 2 evaluations; 100 samples, 29 cases). Insufficient data were available to investigate the effect of symptom status or time after symptom onset.Authors' conclusionsAntigen tests vary in sensitivity. In people with signs and symptoms of COVID‐19, sensitivities are highest in the first week of illness when viral loads are higher. The assays shown to meet appropriate criteria, such as WHO's priority target product profiles for COVID‐19 diagnostics (‘acceptable’ sensitivity ≥ 80% and specificity ≥ 97%), can be considered as a replacement for laboratory‐based RT‐PCR when immediate decisions about patient care must be made, or where RT‐PCR cannot be delivered in a timely manner. Positive predictive values suggest that confirmatory testing of those with positive results may be considered in low prevalence settings. Due to the variable sensitivity of antigen tests, people who test negative may still be infected.Evidence for testing in asymptomatic cohorts was limited. Test accuracy studies cannot adequately assess the ability of antigen tests to differentiate those who are infectious and require isolation from those who pose no risk, as there is no reference standard for infectiousness. A small number of molecular tests showed high accuracy and may be suitable alternatives to RT‐PCR. However, further evaluations of the tests in settings as they are intended to be used are required to fully establish performance in practice.Several important studies in asymptomatic individuals have been reported since the close of our search and will be incorporated at the next update of this review. Comparative studies of antigen tests in their intended use settings and according to test operator (including self‐testing) are required.</p
Explorations in historiographies of geographical knowledges
No full textDoctor of PhilosophyDepartment of GeographyJohn A. Harrington JrGeographers, as part of their work as scholars and academics, continually “do” geography. Geography is practiced as research when tools, perspectives, and techniques are applied to problems or areas of study, exploring, understanding, and building geographical information. Geography is practiced as a social discipline when geographers interact with those around them, sharing geographical knowledge through writing, publishing, presenting, teaching, and discussion so others can read, listen, and engage.
In doing geography – continuously practicing research and engaging in the documentation and communication of geographical knowledge – geographers also actively continuously construct the history of geography. These incidences, slides, and pages of knowledges are the foundation and structure of geography as a practiced discipline.
Research explored the historiographies of geographical knowledges in presidential addresses of the Association of American Geographers, thematic conceptualizations of the subfield of cultural geography, and representation of women across editions of introductory human geography textbooks through content analysis and spatial. Conclusions strongly support the contention that geographic knowledges and the nature of geographic thought actively evolve as contemporary scholars practice their profession. By paying attention to these constructive processes and understanding their interactive role in it, geographers are better informed of the history of their specialty and their direct and vested role in the enterprise
Effect of alirocumab on lipoprotein(a) and cardiovascular risk after acute coronary syndrome
No full textBACKGROUND Lipoprotein(a) concentration is associated with cardiovascular events. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C).OBJECTIVES A pre-specified analysis of the placebo-controlled ODYSSEY Outcomes trial in patients with recent acute coronary syndrome (ACS) determined whether alirocumab-induced changes in lipoprotein(a) and LDL-C independently predicted major adverse cardiovascular events (MACE).METHODS One to 12 months after ACS, 18,924 patients on high-intensity statin therapy were randomized to alirocumab or placebo and followed for 2.8 years (median). Lipoprotein(a) was measured at randomization and 4 and 12 months thereafter. The primary MACE outcome was coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina.RESULTS Baseline lipoprotein(a) levels (median: 21.2 mg/dl; interquartile range [IQR]: 6.7 to 59.6 mg/dl) and LDL-C [corrected for cholesterol content in lipoprotein(a)] predicted MACE. Alirocumab reduced lipoprotein(a) by 5.0 mg/dl (IQR: 0 to 13.5 mg/dl), corrected LDL-C by 51.1 mg/dl (IQR: 33.7 to 67.2 mg/dl), and reduced the risk of MACE (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.78 to 0.93). Alirocumab-induced reductions of lipoprotein(a) and corrected LDL-C independently predicted lower risk of MACE, after adjustment for baseline concentrations of both lipoproteins and demographic and clinical characteristics. A 1-mg/dl reduction in lipoprotein(a) with alirocumab was associated with a HR of 0.994 (95% CI: 0.990 to 0.999; p = 0.0081).CONCLUSIONS Baseline lipoprotein(a) and corrected LDL-C levels and their reductions by alirocumab predicted the risk of MACE after recent ACS. Lipoprotein(a) lowering by alirocumab is an independent contributor to MACE reduction, which suggests that lipoprotein(a) should be an independent treatment target after ACS. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402) (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Cardiolog
Effects of Alirocumab on Cardiovascular Events After Coronary Bypass Surgery
No full textBACKGROUND Patients with acute coronary syndrome (ACS) and history of coronary artery bypass grafting (CABG) are at high risk for recurrent cardiovascular events and death.OBJECTIVES This study sought to determine the clinical benefit of adding alirocumab to statins in ACS patients with prior CABG in a pre-specified analysis of ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab).METHODS Patients (n = 18,924) 1 to 12 months post-ACS with elevated atherogenic lipoprotein levels despite high-intensity statin therapy were randomized to alirocumab or placebo subcutaneously every 2 weeks. Median follow-up was 2.8 years. The primary composite endpoint of major adverse cardiovascular events (MACE) comprised coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization. All-cause death was a secondary endpoint. Patients were categorized by CABG status: no CABG (n = 16,896); index CABG after qualifying ACS, but before randomization (n = 1,025); or CABG before the qualifying ACS (n = 1,003).RESULTS In each CABG category, hazard ratios (95% confidence intervals) for MACE (no CABG 0.86 [0.78 to 0.95], index CABG 0.85 [0.54 to 1.35], prior CABG 0.77 [0.61 to 0.98]) and death (0.88 [ 0.75 to 1.03], 0.85 [0.46 to 1.59], 0.67 [0.44 to 1.01], respectively) were consistent with the overall trial results (0.85 [ 0.78 to 0.93] and 0.85 [0.73 to 0.98], respectively). Absolute risk reductions (95% confidence intervals) differed across CABG categories for MACE (no CABG 1.3% [0.5% to 2.2%], index CABG 0.9% [-2.3% to 4.0%], prior CABG 6.4% [0.9% to 12.0%]) and for death (0.4% [-0.1% to 1.0%], 0.5% [-1.9% to 2.9%], and 3.6% [0.0% to 7.2%]).CONCLUSIONS Among patients with recent ACS and elevated atherogenic lipoproteins despite intensive statin therapy, alirocumab was associated with large absolute reductions in MACE and death in those with CABG preceding the ACS event. (ODYSSEY OUTCOMES: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402) (C) 2019 by the American College of Cardiology Foundation.Cardiolog
