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E-commerce is booming in the modern business world. E-commerce is electronic commerce. Electronic commerce (ecommerce) involves the buying and selling of goods and services, or the transfer of funds and data over electronic networks, primarily the Internet. E-commerce (electronic commerce) is a paradigm shift affecting both marketers and customers. In fact, e-commerce is more than just another way to promote existing business practices. This completely changes the traditional way of doing business. This major change in business model has resulted in tremendous growth worldwide. India is no exception. Massive internet penetration has contributed to the growth of e-commerce, and startups in particular are increasingly using this option as a differentiating business model. In addition, e-commerce has a significant impact on the environment. While this model is widely used in current business scenarios, this option has not yet been fully explored. Current research is being conducted to illustrate e-commerce scenarios and analyze e-commerce trends. The study also examines key variables critical to the success of e-commerce business models.

ObjectiveCurrently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22+0to 31+6weeks gestational age across the perinatal care pathway by gestational age and birth weight.DesignRetrospective analysis of routinely collected data.SettingA national cohort from the UK and British Crown Dependencies.PatientsBabies born at 22+0to 31+6weeks gestational age from 1 January 2016 to 31 December 2020.InterventionsNone.Main outcome measuresSurvival to 28 days.ResultsEstimates of neonatal survival are provided for babies: (1) alive at the onset of care during the birthing process (n=43 763); (2) babies where survival-focused care was initiated (n=42 004); and (3) babies admitted for neonatal care (n=41 158). We have produced easy-to-use survival charts for singleton and multiple births. Generally, survival increased with increasing gestational age at birth and with increasing birth weight. For all births with a birthweight over 1000 g, survival was 90% or higher at all three stages of care.ConclusionsSurvival estimates are a vital tool to support and supplement clinical judgement within perinatal care. These up-to-date, national estimates of survival to 28 days are provided based on three stages of the perinatal care pathway to support ongoing clinical care. These novel results are a key resource for policy and practice including counselling parents and informing care provision.

Aims We assessed the performance of modelsf (risk scores) for predicting recurrence of atrial fibrillation (AF) in patients who have undergone catheter ablation. Methods and results Systematic searches of bibliographic databases were conducted (November 2018). Studies were eligible for inclusion if they reported the development, validation, or impact assessment of a model for predicting AF recurrence after ablation. Model performance (discrimination and calibration) measures were extracted. The Prediction Study Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias. Meta-analysis was not feasible due to clinical and methodological differences between studies, but c-statistics were presented in forest plots. Thirty-three studies developing or validating 13 models were included; eight studies compared two or more models. Common model variables were left atrial parameters, type of AF, and age. Model discriminatory ability was highly variable and no model had consistently poor or good performance. Most studies did not assess model calibration. The main risk of bias concern was the lack of internal validation which may have resulted in overly optimistic and/or biased model performance estimates. No model impact studies were identified. Conclusion Our systematic review suggests that clinical risk prediction of AF after ablation has potential, but there remains a need for robust evaluation of risk factors and development of risk scores.

IntroductionProstate MRI is a well-established tool for the diagnostic work-up for men with suspected prostate cancer (PCa). Current recommendations advocate the use of multiparametric MRI (mpMRI), which is composed of three sequences: T2-weighted sequence (T2W), diffusion-weighted sequence (DWI) and dynamic contrast-enhanced sequence (DCE). Prior studies suggest that a biparametric MRI (bpMRI) approach, omitting the DCE sequences, may not compromise clinically significant cancer detection, though there are limitations to these studies, and it is not known how this may affect treatment eligibility. A bpMRI approach will reduce scanning time, may be more cost-effective and, at a population level, will allow more men to gain access to an MRI than an mpMRI approach.MethodsProstate Imaging Using MRI±Contrast Enhancement (PRIME) is a prospective, international, multicentre, within-patient diagnostic yield trial assessing whether bpMRI is non-inferior to mpMRI in the diagnosis of clinically significant PCa. Patients will undergo the full mpMRI scan. Radiologists will be blinded to the DCE and will initially report the MRI using only the bpMRI (T2W and DWI) sequences. They will then be unblinded to the DCE sequence and will then re-report the MRI using the mpMRI sequences (T2W, DWI and DCE). Men with suspicious lesions on either bpMRI or mpMRI will undergo prostate biopsy. The main inclusion criteria are men with suspected PCa, with a serum PSA of ≤20 ng/mL and without prior prostate biopsy. The primary outcome is the proportion of men with clinically significant PCa detected (Gleason score ≥3+4 or Gleason grade group ≥2). A sample size of at least 500 patients is required. Key secondary outcomes include the proportion of clinically insignificant PCa detected and treatment decision.Ethics and disseminationEthical approval was obtained from the National Research Ethics Committee West Midlands, Nottingham (21/WM/0091). Results of this trial will be disseminated through peer-reviewed publications. Participants and relevant patient support groups will be informed about the results of the trial.Trial registration numberNCT04571840.

Polypharmacy and smoking are associated with higher symptom severity in men with lower urinary tract symptoms presenting to primary care. These are potentially modifiable risk factors that can be targeted when managing these patients.

To (a) identify methodological and application papers reporting a model developed specifically for diagnostic test accuracy network meta-analysis (DTA-NMA) or a hierarchical meta-regression method for comparing at least three index tests; (b) review and summarize the characteristics of the methods and the application papers; and (c) compare DTA-NMA and hierarchical meta-regression methods empirically.We performed a scoping review and searched major databases until March 3rd, 2021. We assessed the characteristics of the identified methods, conducted a descriptive analysis of characteristics of the application articles, and applied the DTA-NMA and meta-regression methods to the available data.We included 49 articles (plus one companion report), of which nine were methodological (describing 11 DTA-NMA methods) and 40 were application papers (data available for 32 DTA-NMAs). Our results showed a steep increase in recent years in DTA-NMA publications. DTA-NMA models may lead to different results. Although sensitivity estimates were comparable between meta-regression and DTA-NMA models, specificity estimates were higher in meta-regression.The choice of a DTA-NMA model will depend on the available data, including the use of different thresholds for test positivity, different study designs, and software familiarity. Selection between the methods may impact on the NMA results, especially for specificity.

Objectives: This is a protocol for a Cochrane Review (prognosis). The objectives are as follows:. Primary objectives To assess prognostic factors for predicting the occurrence of PDR in individuals with diabetic retinopathy. Table 1. PICOTS of the primary objective (Table presented.). Secondary objectives To assess prognostic risk factors for predicting the progression of PDR from less than HRC-PDR to HRC-PDR. Table 2. PICOTS of the secondary objective (Table presented.). Investigation of sources of heterogeneity between studies We anticipate between-study heterogeneity relating to two key areas. Clinical heterogeneity including the effect of different comorbidities, medications, and interventions in study cohorts. Differences in how outcomes are measured, such as diagnoses of PDR (clinical examination versus supported by imaging/imaging technologies used) and how progression is defined. Methodological heterogeneity generated from different study designs, and how robustly studies are conducted with regard to risk of bias and approach to analysis. We will explore the effects of these aspects of heterogeneity if a meta-analysis is conducted.

IntroductionLower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. GP access to simple, accurate tests and clinician decision tools are needed to facilitate accurate and effective patient management of LUTS in primary care.Methods and analysisPRImary care Management of lower Urinary tract Symptoms (PriMUS) is a prospective diagnostic accuracy study based in primary care. The study will determine which of a number of index tests used in combination best predict three urodynamic observations in men who present to their GP with LUTS. These are detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity. Two cohorts of participants, one for development of the prototype diagnostic tool and other for validation, will undergo a series of simple index tests and the invasive reference standard (invasive urodynamics). We will develop and validate three diagnostic prediction models based on each condition and then combine them with management recommendations to form a clinical decision support tool.Ethics and disseminationEthics approval is from the Wales Research Ethics Committee 6. Findings will be disseminated through peer-reviewed journals and conferences, and results will be of interest to professional and patient stakeholders.Trial registration numberISRCTN10327305.

Electronic word of mouth or e-WOM has gained a lot of salience in marketing literature. However, the conceptualisation of e-WOM in the literature has often relied on past practices in e-WOM generation and use. For example, in the previous few decades, several studies that have used e-WOM to predict future sales/revenue of products and services have conceptualised e-WOM with similar factors such as volume, valence and dispersion of e-WOM, while only adapting it to their research context. In this article, we critique extant conceptualisations of e-WOM, and make a case of moving beyond a uni-dimensional perspective of conceptualising e-WOM and argue for the inclusion of the quality of individual posts/comments in measuring e-WOM. We argue that new conceptualisation of e-WOM must also consider the language, emotions and content of the e-WOM messages. Keeping this in mind, an alternative conceptualisation of e-WOM is offered.

Extended perinatal mortality (stillbirths and neonatal deaths) in the UK and Crown Dependencies is monitored by MBRRACE-UK, a national surveillance programme. Extended perinatal death of babies delivered within individual maternity and neonatal care providers in a previous year are analysed and presented in the form of extended perinatal mortality rates in the MBRRACE-UK Perinatal Mortality Surveillance Report. Aggregate analysis such as this masks unexpected fluctuations in the incidence of mortality, thus concealing high or low rates of the adverse outcome in the organisations. Furthermore, uncovering the reasons for a high or low rate of mortality from past data results in delayed opportunities for learning and implementing appropriate initiatives, consequently delaying the reduction of avoidable extended perinatal deaths.This PhD is in collaboration with MBRRACE-UK to improve the surveillance of extended perinatal mortality in healthcare. Statistical process control methodology is investigated for prospective and continuous monitoring of extended perinatal mortality. The methodology is studied for individual Neonatal Networks, Trusts and Health Boards across the UK and Crown Dependencies as part of national surveillance, with the view of implementation by MBRRACE-UK. Statistical process control methods have been endorsed in healthcare to monitor poor patient outcomes; however, their utility in perinatal medicine to reliably detect a high or low rate of a rare adverse outcome such as extended perinatal mortality in a timely manner is unclear when:1. The sociodemographic information on births is not available to MBRRACE-UK in a timely manner from multiple statutory sources.2. The organisations have different number of annual births and extended perinatal deaths.3. The probability of extended perinatal mortality varies for each birth due to their individual risk profile.These issues are explored in detail in the thesis.

Background Plasmodium vivax (P vivax) is a focus of malaria elimination. It is important because P vivax and Plasmodium falciparum infection are co‐endemic in some areas. There are asymptomatic carriers of P vivax, and the treatment for P vivax and Plasmodium ovale malaria differs from that used in other types of malaria. Rapid diagnostic tests (RDTs) will help distinguish P vivax from other malaria species to help treatment and elimination. There are RDTs available that detect P vivax parasitaemia through the detection of P vivax‐specific lactate dehydrogenase (LDH) antigens. Objectives To assess the diagnostic accuracy of RDTs for detecting P vivax malaria infection in people living in malaria‐endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria; and to identify which types and brands of commercial tests best detect P vivax malaria. Search methods We undertook a comprehensive search of the following databases up to 30 July 2019: Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Science Citation Index Expanded (SCI‐EXPANDED) and Conference Proceedings Citation Index‐Science (CPCI‐S), both in the Web of Science. Selection criteria Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction (PCR)) in blood samples from patients attending ambulatory health facilities with symptoms suggestive of malaria in P vivax‐endemic areas. Data collection and analysis For each included study, two review authors independently extracted data using a pre‐piloted data extraction form. The methodological quality of the studies were assessed using a tailored Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool. We grouped studies according to commercial brand of the RDT and performed meta‐analysis when appropriate. The results given by the index tests were based on the antibody affinity (referred to as the strength of the bond between an antibody and an antigen) and avidity (referred to as the strength of the overall bond between a multivalent antibody and multiple antigens). All analyses were stratified by the type of reference standard. The bivariate model was used to estimate the pooled sensitivity and specificity with 95% confidence intervals (CIs), this model was simplified when studies were few. We assessed the certainty of the evidence using the GRADE approach. Main results We included 10 studies that assessed the accuracy of six different RDT brands (CareStart Malaria Pf/Pv Combo test, Falcivax Device Rapid test, Immuno‐Rapid Malaria Pf/Pv test, SD Bioline Malaria Ag Pf/Pv test, OnSite Pf/Pv test and Test Malaria Pf/Pv rapid test) for detecting P vivax malaria. One study directly compared the accuracy of two RDT brands. Of the 10 studies, six used microscopy, one used PCR, two used both microscopy and PCR separately and one used microscopy corrected by PCR as the reference standard. Four of the studies were conducted in Ethiopia, two in India, and one each in Bangladesh, Brazil, Colombia and Sudan. The studies often did not report how patients were selected. In the patient selection domain, we judged the risk of bias as unclear for nine studies. We judged all studies to be of unclear applicability concern. In the index test domain, we judged most studies to be at low risk of bias, but we judged nine studies to be of unclear applicability concern. There was poor reporting on lot testing, how the RDTs were stored, and background parasitaemia density (a key variable determining diagnostic accuracy of RDTs). Only half of the included studies were judged to be at low risk of bias in the reference standard domain, Studies often did not report whether the results of the reference standard could classify the target condition or whether investigators knew the results of the RDT when interpreting the results of the reference standard. All 10 studies were judged to be at low risk of bias in the flow and timing domain. Only two brands were evaluated by more than one study. Four studies evaluated the CareStart Malaria Pf/Pv Combo test against microscopy and two studies evaluated the Falcivax Device Rapid test against microscopy. The pooled sensitivity and specificity were 99% (95% CI 94% to 100%; 251 patients, moderate‐certainty evidence) and 99% (95% CI 99% to 100%; 2147 patients, moderate‐certainty evidence) for CareStart Malaria Pf/Pv Combo test. For a prevalence of 20%, about 206 people will have a positive CareStart Malaria Pf/Pv Combo test result and the remaining 794 people will have a negative result. Of the 206 people with positive results, eight will be incorrect (false positives), and of the 794 people with a negative result, two would be incorrect (false negative). For the Falcivax Device Rapid test, the pooled sensitivity was 77% (95% CI: 53% to 91%, 89 patients, low‐certainty evidence) and the pooled specificity was 99% (95% CI: 98% to 100%, 621 patients, moderate‐certainty evidence), respectively. For a prevalence of 20%, about 162 people will have a positive Falcivax Device Rapid test result and the remaining 838 people will have a negative result. Of the 162 people with positive results, eight will be incorrect (false positives), and of the 838 people with a negative result, 46 would be incorrect (false negative). Authors' conclusions The CareStart Malaria Pf/Pv Combo test was found to be highly sensitive and specific in comparison to microscopy for detecting P vivax in ambulatory healthcare in endemic settings, with moderate‐certainty evidence. The number of studies included in this review was limited to 10 studies and we were able to estimate the accuracy of 2 out of 6 RDT brands included, the CareStart Malaria Pf/Pv Combo test and the Falcivax Device Rapid test. Thus, the differences in sensitivity and specificity between all the RDT brands could not be assessed. More high‐quality studies in endemic field settings are needed to assess and compare the accuracy of RDTs designed to detect P vivax., Plain language summary Rapid tests for diagnosing malaria caused by Plasmodium vivax in people living in areas where malaria is very common What is the aim of the review? Malaria infection is caused mainly by two species of malaria parasite: Plasmodium falciparum and Plasmodium vivax. The aim of this review was to evaluate rapid diagnostic tests (RDTs) to diagnose P vivax infection. Why are rapid tests for P vivax malaria important? For clinical management, knowing which parasite species is causing the malaria is important as the drug treatments differ. For P vivax infection, an additional drug is required to eliminate the infection from the liver. For public health control of malaria, we know that P falciparum is declining over the previous 15 years, and infections from P vivax have therefore increased in importance. What was studied in this review? RDTs provide results quickly and are often as a dipstick. We studied RDTs that specifically test for P vivax malaria. RDTs are simple to use, point‐of‐care tests. They are suitable for use in rural settings by primary healthcare workers, using drop of blood on the dipstick that causes colour change and a distinct line that indicates a positive test result. Healthcare workers in rural areas can perform RDTs for P vivax without needing a laboratory or special equipment. We wanted to find out which brands of RDTs were the most accurate for diagnosing P vivax malaria. We compared the new tests against the standard form of diagnosis with microscopy, and also more recent methods polymerase chain reaction (PCR): a molecular method to identify P vivax DNA in blood samples. What are the main results of the review? We included 10 studies that looked at the accuracy of six diagnostic test brands for detecting P vivax malaria in people with suspected malaria symptoms. The studies were conducted in Ethiopia (four studies), India (two studies) and Bangladesh, Brazil, Colombia, and Sudan (one study each). Compared with microscopy, the Care Start Malaria Pf/Pv Combo test performed well with 99% sensitivity and specificity (four studies). This means that: • for every 100 people tested who have P vivax malaria, one person will have a negative test result, and might not receive the right treatment soon enough; • for every 100 people tested who do not have P vivax malaria, one will have a positive result, and might receive unnecessary treatment. Compared with microscopy, the Falcivax Device Rapid test had a sensitivity of 77% and a specificity of 99% (two studies). This means that: • For every 100 people tested who have P vivax malaria, 23 people will have a negative test result; and, • for every 100 people tested who do not have P vivax malaria, one person will have a positive result. We are moderately confident (certain) in the accuracy results for the Care Start Malaria Pf/Pv Combo test. The results are from a small number of studies (four), so our findings may change when results from further studies become available. We are less confident in the accuracy results for the Falcivax Device Rapid test, because these came from only two studies. Our findings for this test will probably change when results from further studies become available. Our results are based on a small number of studies, so we could not reliably assess all six brands of antibody test or compare their accuracy. Most studies included in this review had limitations: it was not clear how people were selected for testing, or how the study results were assessed and checked, which could have affected the results. Some rapid antibody tests were investigated by only one study. Some studies did not report clearly how common P malaria was in the area where the study was done. How up‐to‐date is this review? The review authors searched for studies published up to 30 July 2019.