Both educational and health care organizations are in a constant state of change, whether triggered by national, regional, local, or organization-level policy. The speech-language pathologist/audiologist-administrator who aids in the planning and implementation of these changes, however, may not be familiar with the expansive literature on change in organizations. Further, how organizational change is planned and implemented is likely affected by leaders' and administrators' personal conceptualizations of social power, which may affect how front line clinicians experience organizational change processes. The purpose of this article, therefore, is to introduce the speech-language pathologist/audiologist-administrator to a research-based classification system for theories of change and to review the concept of power in social systems. Two prominent approaches to change in organizations are reviewed and then discussed as they relate to one another as well as to social conceptualizations of power.
This work presents a review of the Coleophoridae of Central and Eastern Africa. A lectotype is designated for Coleophora psychropa Meyrick, 1920, and the male genitalia of C. crossanthes Meyrick, 1938, are illustrated for the first time. Coleophora sabaea Baldizzone, 2007, previously known only from Yemen, is added to the African fauna. Nine new species of Coleophora Hübner, 1822 are described: C. schouteni sp. nov., C. giustii, sp. nov., C. centrafricana sp. nov., C. riftella sp. nov., C. camerunensis sp. nov., C. ensifera sp. nov., C. gilgilensis sp. nov., C. nyanzaensis sp. nov., C. silvestris sp. nov.
Abstract
Background
Chronic hepatitis C virus (HCV) infection affects 71 million individuals, mostly residing in low- and middle-income countries (LMICs). Direct-acting antivirals (DAAs) give high rates of sustained virological response (SVR) in high-income countries where a restricted range of HCV genotypes/subtypes circulate.
Methods
We studied United Kingdom–resident patients born in Africa to examine DAA effectiveness in LMICs where there is far greater breadth of HCV genotypes/subtypes. Viral genome sequences were determined from 233 patients.
Results
Full-length viral genomic sequences for 26 known subtypes and 5 previously unidentified isolates covering 5 HCV genotypes were determined. From 149 patients who received DAA treatment/retreatment, the overall SVR was 93%. Treatment failure was associated primarily with 2 subtypes, gt1l and gt4r, using sofosbuvir/ledipasvir. These subtypes contain natural resistance-associated variants that likely contribute to poor efficacy with this drug combination. Treatment failure was also significantly associated with hepatocellular carcinoma.
Conclusions
DAA combinations give high SVR rates despite the high HCV diversity across the African continent except for subtypes gt1l and gt4r, which respond poorly to sofosbuvir/ledipasvir. These subtypes are widely distributed across Western, Central, and Eastern Africa. Thus, in circumstances where accurate genotyping is absent, ledipasvir and its generic compounds should not be considered as a recommended treatment option.
Real-World Outcomes of Direct-Acting Antiviral Treatment and Retreatment in United Kingdom–Based Patients Infected With Hepatitis C Virus Genotypes/Subtypes Endemic in Africa
