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Background: Outsourcing health care services has become popular globally, provided by both profit and non-for-profit organisations with varying degrees of quality. To date, few published studies have evaluated the quality of care in health services using outsourcing. The purpose of this study was to determine if there were differences in quality of care (effectiveness, safety and patient experience) for a Transition Care Program designed to improve older people's independence and confidence after a hospital stay, when provided within a public health network compared to being outsourced to private facilities.Methods: An audit of medical records was completed of clients discharged to a residential Transition Care Program operating across three sites from a large health service network (n=1,546). Site one remained within the public health service (internally managed), whereas sites 2 and 3 involved outsourcing to residential aged care facilities. The main outcome measures were discharge destination, the length of stay and number of falls. Client demographics were analysed descriptively, and inferential statistics for continuous data and negative binomial regression for event data were used to examine differences between the sites.Results: There were differences in quality of care between the internally and outsourced managed sites. One outsourced site discharged a smaller proportion to rehabilitation (p=0.003) compared to the other two sites. There were differences in length of stay between the three sites. The length of stay was a mean of 4.8 days less at site 1 (internally managed) (95% CI 0.5 to 9.1) than site 2 and 4.6 days less (95%CI 1.2 to 8.1) than site 3. For those discharged to permanent residential care, length of stay was 9.4 days less at the internal site than site 2 (95% CI 3.5 to 15.2) and 7.0 days less than site 3 (95% CI 1.9 to 12). Additionally, a lower rate of falls was recorded at site 1 (internally managed) compared to site 2 (outsourced) (IRR =0.44 (95%CI 0.32 to 0.60), p <.001).Conclusion: An internally-managed Transition Care Program in a public health network was associated with better quality of care outcomes compared to outsourced services. [ABSTRACT FROM AUTHOR]

Multiple regression is a widely used technique for data analysis in social and behavioral research. The complexity of interpreting such results increases when correlated predictor variables are involved. Commonality analysis provides a method of determining the variance accounted for by respective predictor variables and is especially useful in the presence of correlated predictors. However, computing commonality coefficients is laborious. To make commonality analysis accessible to more researchers, a program was developed to automate the calculation of unique and common elements in commonality analysis, using the statistical package R. The program is described, and a heuristic example using data from the Holzinger and Swineford (1939) study, readily available in the MBESS R package, is presented. [ABSTRACT FROM AUTHOR]

Highlights: ▶ A combined map of urogenital schistosomiasis across all primary schools on Mafia is presented. ▶ Risk-factor analysis reveals lack of endemic transmission by local water contact. ▶ A detailed snail distribution map and species list is shown for all encountered freshwater molluscs. ▶ Parasitological challenge experiments reveal refractory nature of local Bulinus with S. haematobium. ▶ Snails and schistosomes were characterised by DNA barcoding methods. [Copyright &y& Elsevier]

Highlights: [•] Schistosoma haematobium can be detected in infected snails before shedding. [•] Snail prepatent infection rates are higher than patent infection rates. [•] Refractory snails can be used to indicate the presence of S. haematobium miracidia. [•] Infection can be detected in refractory snails for up to 72h post penetration. [Copyright &y& Elsevier]

Abstract: Biomphalaria glabrata is the major intermediate snail host for Schistosoma mansoni, one of the important schistosomes infecting man. Much remains to be discovered concerning specific molecules mediating the defence events in these intermediate hosts, triggered by invading schistosomes. An expressed sequence tag (EST) gene discovery strategy known as ORESTES has been employed to identify transcripts that might be involved in snail–schistosome interactions in order to examine gene expression patterns in infected B. glabrata. Over 3930 ESTs were sequenced from cDNA libraries made from both schistosome-exposed and unexposed snails using different tissue types, producing a database of 1843 non-redundant clones. The non-redundant set has been assessed for gene ontology and KEGG pathway assignments. This approach has revealed a number of signalling, antioxidant and immune-related gene homologues that, based on current understanding of molluscan and other comparative systems, might play an important role in the molluscan defence response towards infection. [Copyright &y& Elsevier]

Several DNA probes were designed for use in real-time polymerase chain reaction (PCR) assays to target sequence variation within the ribosomal intergenic spacer (IGS) of schistosomes. A sub-section of the IGS (∼300bp) was amplified, with cross-specific primers, after which group-specific fluorescent, locked nucleic acid probes were assessed for their ability to differentiate and quantify DNA from Schistosoma haematobium and Schistosoma mansoni group parasites. A number of fluorescent probe candidates were screened and validated against genomic DNA from adult schistosome worms and laboratory infected freshwater snails. Two fluorescent, locked nucleic acid probes ShaemLNA5 and SmanLNA2, of 20-26bp in length, were identified and found to be effective in providing evidence of infection in field-collected snails. To adapt these real-time PCR assays for more resource-poor laboratory settings, a PCR-restriction fragment length polymorphism (RFLP) assay was developed and primer/probe combinations were modified for use in oligochromatography, a DNA 'dipstick' technology. An appropriate dipstick was developed, inclusive of internal amplification and amplicon migration controls that could be of particular importance for assessing schistosome transmission dynamics. These assays and tools also have future potential for use in detection of schistosome infections in humans and livestock., (Copyright © 2013. Published by Elsevier B.V.)

Background: Intestinal schistosomiasis, caused by Schistosoma mansoni, is endemic to Lake Victoria, with high prevalence of the disease observed in human lakeshore communities. However, nonhuman primates have recently been overlooked as potential hosts of the disease, despite known susceptibility., Methods: Using a variety of stool, urine, and serological diagnostic methods, 39 semi-captive wild-born chimpanzees and 37 staff members at Ngamba Island Chimpanzee Sanctuary, Lake Victoria, Uganda, were examined for S. mansoni infection. Miracidia recovered from stool were DNA barcoded to investigate cross-over between humans and chimpanzees. The island was also surveyed for Biomphalaria intermediate host snails, which were examined for infection with S. mansoni., Results: Chimpanzees were unequivocally shown to be infected with intestinal schistosomiasis with a seroprevalence in excess of 90%. Three egg-positive cases were detected, although the sensitivity of the diagnostic tests varied due to earlier prophylactic praziquantel treatment. Miracidia hatched from chimpanzee stool revealed three DNA haplotypes commonly found in humans living throughout Lake Victoria, including staff on Ngamba Island, as well as two novel haplotypes. At one site, a snail was observed shedding schistosome cercariae., Conclusions: The anthropozoonotic potential of intestinal schistosomiasis on Ngamba Island is greater than previously thought. Moreover, the ability of chimpanzees to void schistosome eggs capable of hatching into viable miracidia further suggests that these nonhuman primates may be capable of maintaining a local zoonotic transmission of schistosomiasis independently of humans. The implications for management of captive and wild primate populations at risk of exposure are discussed.