Objective: This paper summarizes findings of a comprehensive, systematic review of the peer-reviewed and grey literature on performance measurement according to each stage of the performance measurement process -conceptualization, selection and development, data collection, and reporting and use. It also outlines implications for practice. Methods: Six hundred sixty-four articles about organizational performance measurement from the health and business literature were reviewed after systematic searches of the literature, multi-rater relevancy ratings, citation checks and expert author nominations. Key themes were extracted and summarized from the most highly rated papers for each performance measurement stage. Results: Despite a virtually universal consensus on the potential benefits of performance measurement, little evidence currently exists to guide practice in healthcare. Issues in conceptualizing systems include strategic alignment and scope. There are debates on the criteria for selecting measures and on the types and quality of measures. Implementation of data collection and analysis systems is complex and costly, and challenges persist in reporting results, preventing unintended effects and putting findings for improvement into action. Conclusion: There is a need for further development and refinement of performance measures and measurement systems, with a particular focus on strategies to ensure that performance measurement leads to healthcare improvement. Résumé Objectif : Ce document résume les résultats d'un examen détaillé et systématique de la littérature grise et des publications évaluées par les pairs sur la mesure du rendement pour chaque étape du processus -conceptualisation, sélection et développe-ment, collecte de données, présentation des résultats et utilisation. Il présente aussi des répercussions sur la pratique. Méthodes : Après avoir effectué des recherches systématiques dans la littérature, demandé à des évaluateurs multiples de déterminer la pertinence des documents repérés, vérifié les citations et désigné les auteurs experts, 664 articles sur la mesure du rendement organisationnel provenant de publications des domaines de la santé et des affaires ont été examinés. On a dégagé puis résumé des thèmes clés à partir des documents ayant reçu la plus haute cote pour chaque étape de la mesure du rendement. Résultats : Malgré un consensus quasi universel sur les avantages potentiels de la mesure du rendement, il existe actuellement peu de preuves pour guider la pratique dans les soins de santé. Les problèmes de conceptualisation des systèmes comprennent, entre autres, l' alignement stratégique et la portée. On ne s' entend pas sur les critères à utiliser pour sélectionner les mesures et sur les types et la qualité de ces dernières. La mise en place des systèmes de collecte et d' analyse de données est complexe et coû-teuse, et il y a encore des défis à relever dans la présentation des résultats, la prévention des effets non prévus et la transformation des résultats en des mesures co...

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Several protozoan parasites have been shown to undergo a form of programmed cell death that exhibits morphological features associated with metazoan apoptosis. These include the rodent malaria parasite, Plasmodium berghei. Malaria zygotes develop in the mosquito midgut lumen, forming motile ookinetes. Up to 50% of these exhibit phenotypic markers of apoptosis; as do those grown in culture. We hypothesised that naturally occurring signals induce many ookinetes to undergo apoptosis before midgut traversal. To determine whether nitric oxide and reactive oxygen species act as such triggers, ookinetes were cultured with donors of these molecules. Exposure to the nitric oxide donor SNP induced a significant increase in ookinetes with condensed nuclear chromatin, activated caspase-like molecules and translocation of phosphatidylserine that was dose and time related. Results from an assay that detects the potential-dependent accumulation of aggregates of JC-1 in mitochondria suggested that nitric oxide does not operate via loss of mitochondrial membrane potential. L-DOPA (reactive oxygen species donor) also caused apoptosis in a dose and time dependent manner. Removal of white blood cells significantly decreased ookinetes exhibiting a marker of apoptosis in vitro. Inhibition of the activity of nitric oxide synthase in the mosquito midgut epithelium using L-NAME significantly decreased the proportion of apoptotic ookinetes and increased the number of oocysts that developed. Introduction of a nitric oxide donor into the blood meal had no effect on mosquito longevity but did reduce prevalence and intensity of infection. Thus, nitric oxide and reactive oxygen species are triggers of apoptosis in Plasmodium ookinetes. They occur naturally in the mosquito midgut lumen, sourced from infected blood and mosquito tissue. Up regulation of mosquito nitric oxide synthase activity has potential as a transmission blocking strategy.