Objective To evaluate an immunoreactive trypsinogen (IRT) IRT/IRT1 up arrow/DNA algorithm, aimed at improving sensitivity while decreasing cystic fibrosis (CF) carrier identification.Study design New technologies allow the measurement of the second IRT level solely in infants with an elevated first IRT level. Specimens with an elevated second IRT level undergo mutation analysis. We tested the projected efficacy with retrospective data from Colorado.Results All known infants with CF would have been identified with our proposed IRT cutoff points, and 3 would have been missed with our mutation panel. Two of 3 missed cases would have been identified by using a failsafe method ( IRT >99.9th percentile), yielding a sensitivity rate of 99.7% (95% CI, 98.4-99.9). Estimated reduction in carrier detection was 80% compared with IRT/ DNA.Conclusion IRT/IRT1 up arrow/DNA appears to improve cystic fibrosis newborn screen sensitivity while decreasing carrier identification, providing an alternative to IRT/ IRT in states that obtain 2 blood spots. (J Pediatr 2009; 155: 61822).

g0005 bogus empowerment Letting people think they have control over outcomes and the power to act on their own judgments when they actually do not have this control or power; can be the unintended consequence of hyperbole about the democratic nature of a situation. g0010 ethnography A descriptive study of an intact cultural or social group or an individual or individuals within the group, based primarily on participant observation and open-ended interviews; based on learning from people as opposed to studying people. g0015 iterative process A process in which replications of a cycle produce results that approximate the desired result more and more closely. For rapid assessment, the process describes the cycle of data analysis and data collection, designed to produce a preliminary understanding of a situation from an insider’s perspective. g0020 participants Persons interviewed as part of the rapid assessment process. The term can be used interchangeably with ‘‘informants’’ or ‘‘respondents’’ when these terms are not modified with the words ‘‘individual’’ or ‘‘key.’’ The term ‘‘subjects’’ is generally avoided. g0025 rapid appraisal, rapid rural assessment, rapid rural appraisal (RRA), participatory rural appraisal (PRA) Different types of rapid qualitative research based on small multidisciplinary teams using semistructured interviews and direct observations to collect information in processes that can be completed in less than 6 weeks. As usually implemented, these approaches lack the methodological rigor of rapid assessment. g0030 rapid assessment process (RAP), rapid assessment Intensive, team-based qualitative inquiry using triangulation, iterative data analysis, and additional data collection to quickly develop a preliminary understanding of a situation from the insider’s perspective. g0035 triangulation A term from navigation and physical surveying that describes an operation for determining a position by use of bearings from two known fixed points. Triangulation is used as a metaphor by social scientists for the use of data from different sources, the use of several different researchers, the use of multiple perspectives to interpret a single set of data, and the use of multiple methods to study a single problem.

McKeganey concludes his Commentary on Rapid Assessment and Response (RAR) with what I believe is a valid call for rigorous and independent evaluations of the results of rapid assessment (McKeganey, 2000). Evaluation, however, is also needed for other types of action research. He joins the ranks of a small group of critical observers of rapid assessment who note the enthusiasm of its proponents, their general lack of perspective, and their unrealistic expectations as to what it can achieve. McKeganey’s commentary on RAR, however, is not consistent with RAR as discussed by Stimson and colleagues (Rhodes et al., 1999; Stimson et al., 1999) and in the RAR Guides produced by the World Health Organization (WHO, 1998; WHO/UNAIDS, 1998; WHO/UNICEF, 1998). His commentary on rapid assessment is also not consistent with my experience with rapid assessment or rapid appraisal during the last two decades (Beebe, 1995, 2000). Therefore, I do not believe many of his specific issues with RAR are appropriate. McKeganey appears to have concluded that there is no significant difference in the methods employed by RAR and traditional social research. According to him the only real difference is RAR’s reliance on less information collected more quickly. When he refers to a singular ‘‘assessor’’ implementing RAR he misses what may be the most significant difference — teams and not individuals implement RARs and these teams should include ‘‘insiders’’. The WHO Guides (1998) consistently refer to RAR teams and include explicit reference to building the RAR team. Rapid assessment substitutes intensive team interaction during the collection and analysis of data for the prolonged fieldwork normally associated with social research. Intensive teamwork is especially critical for data collection based on triangulation and during the iterative process of data analysis and additional data collection. Team interaction among team members, including ‘‘insiders’’ from the group under investigation, can increase the power of triangulation exponentially. The process benefits from the different

Rapid appraisal is an approach for developing a preliminary, qualitative understanding of a situation. This paper identifies three basic concepts-(1) a system perspective, (2) triangulation of data collection, and (3) iterative data collection and analysis-and suggests that they provide a conceptual foundation for rapid appraisal and a rationale for the selection of specific research techniques. The basic concepts and their related research techniques provide a flexible but rigorous approach for data collection and analysis by a team of two or more individuals, usually with different academic discipline backgrounds. The paper reviews the history of rapid appraisal, provides a definition, discusses the three basic concepts and the illustrative research techniques associated with them, argues for flexibility, and suggests the use of a ''Data Collection Checklist'' to remind the team of important concepts and as a means by which the reader of a report can estimate the degree of confidence that can be placed in the results.