| 1. |
- Burchett, Helen E D, et al.
(author)
-
Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.
- 2017
-
In: BMJ open. - : BMJ. - 2044-6055. ; 7:3
-
Journal article (peer-reviewed)abstract
- The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts.A comparative case study approach, analysing variation in outcomes across different settings.Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case.28 cases from 10 studies were included, representing 148461 patients seeking care for suspected malaria.The interventions included different mRDT training packages, supervision, supplies and community sensitisation.Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial).Outcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs.Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.
|
|
| 2. |
- Chandler, Benjamin M. P., et al.
(author)
-
Glacial geomorphological mapping : A review of approaches and frameworks for best practice
- 2018
-
In: Earth-Science Reviews. - : Elsevier BV. - 0012-8252 .- 1872-6828. ; 185, s. 806-846
-
Research review (peer-reviewed)abstract
- Geomorphological mapping is a well-established method for examining earth surface processes and landscape evolution in a range of environmental contexts. In glacial research, it provides crucial data for a wide range of process-oriented studies and palaeoglaciological reconstructions; in the latter case providing an essential geomorphological framework for establishing glacial chronologies. In recent decades, there have been significant developments in remote sensing and Geographical Information Systems (GIS), with a plethora of high quality remotely-sensed datasets now (often freely) available. Most recently, the emergence of unmanned aerial vehicle (UAV) technology has allowed sub-decimetre scale aerial images and Digital Elevation Models (DEMs) to be obtained. Traditional field mapping methods still have an important role in glacial geomorphology, particularly in cirque glacier, valley glacier and icefield/ice-cap outlet settings. Field mapping is also used in ice sheet settings, but often takes the form of necessarily highly-selective ground-truthing of remote mapping. Given the increasing abundance of datasets and methods available for mapping, effective approaches are necessary to enable assimilation of data and ensure robustness. This paper provides a review and assessment of the various glacial geomorphological methods and datasets currently available, with a focus on their applicability in particular glacial settings. We distinguish two overarching 'work streams' that recognise the different approaches typically used in mapping landforms produced by ice masses of different sizes: (i) mapping of ice sheet geomorphological imprints using a combined remote sensing approach, with some field checking (where feasible); and (ii) mapping of alpine and plateau-style ice mass (cirque glacier, valley glacier, icefield and ice-cap) geomorphological imprints using remote sensing and considerable field mapping. Key challenges to accurate and robust geomorphological mapping are highlighted, often necessitating compromises and pragmatic solutions. The importance of combining multiple datasets and/or mapping approaches is emphasised, akin to multi-proxy approaches used in many Earth Science disciplines. Based on our review, we provide idealised frameworks and general recommendations to ensure best practice in future studies and aid in accuracy assessment, comparison, and integration of geomorphological data. These will be of particular value where geomorphological data are incorporated in large compilations and subsequently used for palaeoglaciological reconstructions. Finally, we stress that robust interpretations of glacial landforms and landscapes invariably requires additional chronological and/or sedimentological evidence, and that such data should ideally be collected as part of a holistic assessment of the overall glacier system.
|
|
