Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections

BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. OBJECTIVES To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. MAIN RESULTS Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). AUTHORS' CONCLUSIONS Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

Aligning Library Strategy and Structure With the Campus Academic Plan: A Case Study

Colleges and universities’ missions are typically comprised of educating students, training professionals, engaging in scholarship and research, promoting creative activity, improving healthcare, and providing public service. Academic libraries exist to support these core functions, yet most academic libraries are organized based on library functions rather than the primary missions of their college or university. This paper describes one academic library’s attempt to align library strategy and structure with its university’s academic plan.

HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

Development and evaluation of a video-based modeling strategy for the dissemination phase of a school health tobacco -use prevention program

Even the best school health education programs will be unsuccessful if they are not disseminated effectively in a manner that encourages classroom adoption and implementation. This study involved two components: (1) the development of a videotape intervention to be used in the dissemination phase of a 4-year, NCI-funded diffusion study and (2) the evaluation of that videotape intervention strategy in comparison with a print (information transfer) strategy. Conceptualization has been guided by Social Learning Theory, Diffusion Theory, and communication theory. Additionally, the PRECEDE Framework has been used. Seventh and 8th grade classroom teachers from Spring Branch Independent School District in west Houston participated in the evaluation of the videotape and print interventions using a 57-item preadoption survey instrument developed by the UT Center for Health Promotion Research and Development. Two-way ANOVA was used to study individual score differences for five outcome variables: Total Scale Score (comprised of 57 predisposing, enabling, and reinforcing items), Adoption Characteristics Subscale, Attitude Toward Innovation Subscale, Receptivity Toward Innovation, and Reinforcement Subscale. The aim of the study is to compare the effect upon score differences of video and print interventions alone and in combination. Seventy-three 7th and 8th grade classroom teachers completed the study providing baseline and post-intervention measures on factors related to the adoption and implementation of tobacco-use prevention programs. Two-way ANOVA, in relation to the study questions, found significant scoring differences for those exposed to the videotape intervention alone for both the Attitude Toward Innovation Subscale and the Receptivity to Adopt Subscale. No significant results were found to suggest that print alone influences favorable scoring differences between baseline and post-intervention testing. One interaction effect was found suggesting video and print combined are more effective for influencing favorable scoring differences for the Reinforcement for the Adoption Subscale.^ This research is unique in that it represents a newly emerging field in health promotion communications research with implications for Social Learning Theory, Diffusion Theory, and communication science that are applicable to the development of improved school health interventions. ^

Automatic Bandwidth Estimation Strategy for High-Quality Non-Parametric Modeling based Moving Object Detection

Here, a novel and efficient moving object detection strategy by non-parametric modeling is presented. Whereas the foreground is modeled by combining color and spatial information, the background model is constructed exclusively with color information, thus resulting in a great reduction of the computational and memory requirements. The estimation of the background and foreground covariance matrices, allows us to obtain compact moving regions while the number of false detections is reduced. Additionally, the application of a tracking strategy provides a priori knowledge about the spatial position of the moving objects, which improves the performance of the Bayesian classifier

Issues in implementing ACE: A stack copying based and-or parallel system

We discuss several issues involved in the implementation of ACE, a model capable of exploiting both And-parallelism and Or-parallelism in Prolog in a unified framework. The Orparallel model that ACE employs is based on the idea of stack-copying developed for Muse, while the model of independent And-parallelism is based on the distributed stack approach of &-Prolog. We discuss the organization of the workers, a number of sharing assumtions, techniques for work load detection, and issues relaed to which parts need to be copied when a flexible and-scheduling strategy is used.

SMS-based optimization strategy for ultra-compact SWIR telephoto lens design: erratum

We report and correct an error in [Opt. Express 20, 9726–9735 (2012)]. The author list has been modified. All other contents are unchanged.

An attitude-based reasoning strategy to enhance interaction with augmented objects

This paper describes a mobile-based system to interact with objects in smart spaces, where the offer of resources may be extensive. The underlying idea is to use the augmentation capabilities of the mobile device to enable it as user-object mediator. In particular, the paper details how to build an attitude-based reasoning strategy that facilitates user-object interaction and resource filtering. The strategy prioritizes the available resources depending on the spatial history of the user, his real-time location and orientation and, finally, his active touch and focus interactions with the virtual overlay. The proposed reasoning method has been partially validated through a prototype that handles 2D and 3D visualization interfaces. This framework makes possible to develop in practice the IoT paradigm, augmenting the objects without physically modifying them.

SMS-based optimization strategy for ultra-compact SWIR telephoto lens design

A new optical design strategy for rotational aspheres using very few parameters is presented. It consists of using the SMS method to design the aspheres embedded in a system with additional simpler surfaces (such as spheres, parabolas or other conics) and optimizing the free-parameters. Although the SMS surfaces are designed using only meridian rays, skew rays have proven to be well controlled within the optimization. In the end, the SMS surfaces are expanded using Forbes series and then a second optimization process is carried out with these SMS surfaces as a starting point. The method has been applied to a telephoto lens design in the SWIR band, achieving ultra-compact designs with an excellent performance.

A vision-based strategy for autonomous aerial refueling tasks

Autonomous aerial refueling is a key enabling technology for both manned and unmanned aircraft where extended flight duration or range are required. The results presented within this paper offer one potential vision-based sensing solution, together with a unique test environment. A hierarchical visual tracking algorithm based on direct methods is proposed and developed for the purposes of tracking a drogue during the capture stage of autonomous aerial refueling, and of estimating its 3D position. Intended to be applied in real time to a video stream from a single monocular camera mounted on the receiver aircraft, the algorithm is shown to be highly robust, and capable of tracking large, rapid drogue motions within the frame of reference. The proposed strategy has been tested using a complex robotic testbed and with actual flight hardware consisting of a full size probe and drogue. Results show that the vision tracking algorithm can detect and track the drogue at real-time frame rates of more than thirty frames per second, obtaining a robust position estimation even with strong motions and multiple occlusions of the drogue.

A Hierarchical Tracking Strategy for Vision-Based Applications On-Board UAVs

In this paper, we apply a hierarchical tracking strategy of planar objects (or that can be assumed to be planar) that is based on direct methods for vision-based applications on-board UAVs. The use of this tracking strategy allows to achieve the tasks at real-time frame rates and to overcome problems posed by the challenging conditions of the tasks: e.g. constant vibrations, fast 3D changes, or limited capacity on-board. The vast majority of approaches make use of feature-based methods to track objects. Nonetheless, in this paper we show that although some of these feature-based solutions are faster, direct methods can be more robust under fast 3D motions (fast changes in position), some changes in appearance, constant vibrations (without requiring any specific hardware or software for video stabilization), and situations in which part of the object to track is outside of the field of view of the camera. The performance of the proposed tracking strategy on-board UAVs is evaluated with images from realflight tests using manually-generated ground truth information, accurate position estimation using a Vicon system, and also with simulated data from a simulation environment. Results show that the hierarchical tracking strategy performs better than wellknown feature-based algorithms and well-known configurations of direct methods, and that its performance is robust enough for vision-in-the-loop tasks, e.g. for vision-based landing tasks.

Toward a planning model for the peruvian university system as a competitive strategy.

University education in Peru is based on models of teacher-centered teaching and a conception of knowledge which is closed and static and under the dominance of an information model now overwhelmed by multiple factors hastened by international change. The worlds most prestigious universities have chosen cultural diversity as a sign of quality and are hence interested in the mobility of teachers and students through exchange and cooperation with foreign educational institutions. These universities respond more effectively to pressure from the international business sector, better satisfy training demands, introduce new information and communication technologies into education and research and have improved administration and management structures. While there is progress, the university system in Peru is a planning model defined "as a discipline that seeks to respond to the needs of an organization defined by new cultural and social models" (A. Cazorla, et al 2007).This paper studies the non-Euclidean thinking of planning and development of John Friedmann (2001). Based on the four domains of social practice, it proposes a planning model for Peruvian universities that meets international requirements.