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.

Management of irrigation frequency and nitrogen fertilization to mitigate GHG and NO emissions from drip-fertigated crops

Drip irrigation combined with split application of fertilizer nitrogen (N) dissolved in the irrigation water (i.e. drip fertigation) is commonly considered best management practice for water and nutrient efficiency. As a consequence, its use is becoming widespread. Some of the main factors (water-filled pore space, NH4+ and NO3−) regulating the emissions of greenhouse gases (i.e. N2O, CO2 and CH4) and NO from agroecosystems can easily be manipulated by drip fertigation without yield penalties. In this study, we tested management options to reduce these emissions in a field experiment with a melon (Cucumis melo L.) crop. Treatments included drip irrigation frequency (weekly/daily) and type of N fertilizer (urea/calcium nitrate) applied by fertigation. Crop yield, environmental parameters, soil mineral N concentrations and fluxes of N2O, NO, CH4 and CO2 were measured during 85 days. Fertigation with urea instead of calcium nitrate increased N2O and NO emissions by a factor of 2.4 and 2.9, respectively (P < 0.005). Daily irrigation reduced NO emissions by 42% (P < 0.005) but increased CO2 emissions by 21% (P < 0.05) compared with weekly irrigation. We found no relation between irrigation frequency and N2O emissions. Based on yield-scaled Global Warming Potential as well as NO cumulative emissions, we conclude that weekly fertigation with a NO3−-based fertilizer is the best option to combine agronomic productivity with environmental sustainability. Our study shows that adequate management of drip fertigation, while contributing to the attainment of water and food security, may provide an opportunity for climate change mitigation.

Policy Changes to the Federal and State Management of Subsistence Hunting and Fishing in Alaska

Subsistence in Alaska is currently being impacted by naturally occurring factors such as global warming, species migration shifts, and the declination of fishery and wildlife populations. Not only are external factors pressuring the debate, management strategies from the dual management operation appear to have failed. The current national focus has been centered on federal policy changes regarding subsistence. This project extends the federal subsistence review process into the state management of subsistence and provides practical solutions for enhancing both policy programs.

Agency for International Development needs to strengthen its management of study, research, and evaluation activities : report /

"B-133220."

Vegetables and their cultivation; the history, cultivation, and forcing of culinary vegetables, saladings, and herbs, for home use and exhibitions; also the formation of the vegetable garden; the management of soils; manures and their uses; and the eradication of injurious insect and fungoid pests, etc. ...

Mode of access: Internet.

Advice to a mother on the management of her children : and on the treatment on the moment of some of [sic] their more pressing illnesses and accidents /

Includes index.

Cost and management of nuclear safety and cleanup and compliance at Department of Energy defense sites [microform] : hearing before the Committee on Governmental Affairs, United States Senate, One Hundredth Congress, second session, Wednesday, July 13, 1988.

CIS Microfiche Accession Numbers: CIS 89 S401-10

Audel's Gas engine manual : a practical treatise relating to the theory and management of gas, gasoline and oil engines, including chapters on producer gas plants, marine motors and automobile engines.

Mode of access: Internet.

The Sportsman's dictionary; containing instructions for various methods to be observed in riding, hunting, fowling, setting, fishing ... the management of dogs, game ... and the manner of curing their various diseases and accidents.

Mode of access: Internet.

Report of Her Majesty's commissioners appointed to inquire into the revenues and management of certain colleges and schools, and the studies pursued and instruction given therein : with an appendix and evidence.

Treats of the public schools of Eton, Winchester, Westminster, Charterhouse, St. Paul's Merchant taylors', Harrow, Rugby, Shrewsbury.

The farmer's and stock breeder's guide to breeding, rearing and dealing in horses, cattle, sheep, and swine : and giving plain directions, from experience as to everything relating to the profitable management of the barn and the farm yard including the proper veterinary treatment of domestic animals /

Mode of access: Internet.

An essay on the history and management of literary, scientific, and mechanics' institutions and especially how far they may be developed and combined, so as to promote the moral well-being and industry of the country /

Half-title (p. [i-ii]) : Society of Arts. Prize essay on literary, scientific, and mechanics' institutions.